WCNR 24/Abstracts

OP-001

Exploring neural correlates of motor function and fitness in people living with multiple sclerosis

Z. Moslemi¹, E. A. Toledo-Aldana¹, N. D. Bye¹, H. C. M. Foy¹, A. Y. Rajaei¹, J. Buttigieg², J. O. Totosy de Zepetnek¹, J. Eng^3,4, S. J. Donkers⁵, C. S. Mang¹

¹University of Regina, Kinesiology, Regina, Canada

²University of Regina, Biology, Regina, Canada

³University of British Columbia, Physical Therapy, Vancouver, Canada

⁴University of British Columbia, Centre for Aging SMART, Vancouver, Canada

⁵University of Saskatchewan, Medicine, Saskatoon, Canada

Introduction: Multiple sclerosis (MS) is a chronic, autoimmune, and inflammatory disease of the central nervous system that affects walking and balance and contributes to physical deconditioning.

Objective: To explore relationships between walking and balance motor function, fitness, corticospinal excitability, and blood markers of neuropathology in people with MS.

Materials & methods: Functional assessments included the Timed 25-foot Walk Test (T25-FW) and Mini-Balance Evaluation Systems Test (Mini-BESTest). Aerobic fitness (V̇O2-peak) was determined using a maximal exercise test. Transcranial magnetic stimulation (TMS) was used to determine an active motor threshold for the tibialis anterior (TA) in the stronger leg. A panel of biomarkers of neuronal inflammation and damage were measured from peripheral blood serum. Unpaired t-tests compared participants with (TA+) and without (TA−) a response to TMS. Spearman"s correlations evaluated relationships among measures. As preliminary work, medium-to-large effect sizes (Cohen"s d ≥ 0.5, rho ≥ |0.3|) were noted.

Results: Data was collected from 17 participants (age: 56±9 years; 11 female; 9 primary progressive, 7 secondary progressive, 1 relapsing-remitting). TA− participants (n=7) tended to have slower T25-FW times (d=-0.89, p=0.29), lower V̇O2-peaks (d=1.35, p=0.01), and higher concentration of neuroinflammatory blood biomarkers (IP-10, fractalkine, IL-12p40, IL-6, CTACK; d-range=-0.62 to -2.50, p-range=0.01 to 0.40) than TA+ participants (n=10). Lower V̇O2-peaks correlated with higher IP-10 (rho=-0.61, p<0.05) and IL-12p40 (rho=-0.62, p<0.05) concentrations. Slower T25-FW performance and worse Mini-BESTest scores correlated with higher concentration of NF-L, a marker of neuronal damage (rho=0.55, p=0.03; rho=-0.65, p<0.01).

Conclusion: Combining assessments of corticospinal excitability and blood markers of neuroinflammation could provide insight into pathophysiology underpinning specific clinical characteristics in MS.

OP-002

The training effect of tinkering activities on cognitive flexibility in community-dwelling older adults: an event-related potential studies

H. T. Pang¹, Y. T. Chen¹, C. K. Fu¹, H. F. Mao¹, C. T. Wu²

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

²University of Tokyo, International Research Center for Neurointelligence (WPI-IRCN), UTIAS, Tokyo, Japan

Introduction: In Taiwan, the growing elderly population brings an increased need for effective cognitive interventions. Traditional cognitive training methods often result in limited, unidimensional improvements, which may not substantially benefit their daily functional abilities. Tinkering Activities, however, may address this issue by emphasizing Cognitive Flexibility (CF), a vital executive function for daily tasks. The method challenges CF and encourages active problem-solving, filling a notable gap in traditional cognitive training.

Purpose: This study assesses the effects of Tinkering Activities, an active-inference cognitive training approach, on CF in older adults. It contrasts this method with traditional cognitive training, using an Event-Related Potential (ERP) integrative assessment approach.

Method: A randomized controlled trial with 23 healthy older females (average age 68.26) compared Tinkering to traditional board games over 12 weeks, with weekly 2-hour sessions. CF was measured behaviorally (switching costs) and neurologically (P3b ERP component, indicating cognitive resource allocation) using a task-switching paradigm, an assessment requiring responses based on alternating rule sets.

Results: Initial behavioral findings show that Tinkering significantly reduced switching costs compared to the Traditional Board Game approach. Analysis of P3b components is ongoing to further substantiate these results. An increase in P3b amplitude during switching trials is expected in individuals post-Tinkering intervention compared to those who participated in the board game group.

Conclusion: Initial behavioral data suggest Tinkering may enhance CF in older adults more effectively than conventional methods. This highlights Tinkering’s potential as a superior and accessible cognitive intervention approach to enhance CF in healthy elderly population. Further ERP analysis is needed to confirm its neural efficacy in CF over traditional methods.

OP-003

Sociodemographic, epidemiological, clinical and functional profile of individuals with parkinson’s disease attended in a brazilian rehabilitation center: multicentric study

F. Lopes¹, A. P. Vargas², P. Scalzo³

¹Sarah Rehabiliation Hospital, Neurorehabilitation, Belo Horizonte, Brazil

²Sarah Rehabiliation Hospital, Neurology, Belo Horizonte, Brazil

³FEDERAL UNIVERSITY OF MINAS GERAIS, Biology, Belo Horizonte, Brazil

Parkinson’s disease is the second most prevalent neurodegenerative disease in the world. In Brazil studies that characterize this population are scarce. This study investigated and described the sociodemographic, epidemiological, clinical and functional characterization of people with PD admitted for rehabilitation at the SARAH NETWORK of Rehabilitation Hospitals. A sample of 742 participants was selected. The mean age of patients at the time of admission was 64.1 (±65),mean age of diagnosis at 58.9 years (±11.2), mean PD duration of 5.3 (±) years. The sample consisted predominantly of men (n=447, 60.2%), retired (n=363, 48.9%), married or in a stable union (n=459, 61.9%), and 314 (42 .4%) and had between 5 and 11 years of education. Tremor was the most frequent first symptom, reported by 383 (51.6%) patients. Regarding the presence of comorbidities, a higher frequency of Systemic Arterial Hypertension (n = 385, 51.9%) and low back pain was diagnosed in (n=266, 35.8%). The majority of patients (n=396, 53.4%) were in HY stage 2.0 and were completely independent (SE > 80 points, n=561, 81.8%) According to the TUG classification, 175 (61.9%) were not at risk of falling. For T10m, 201 (65.5%) were community walkers. Most patients, n=331 (63.7%), did not present balance deficits according to BSE. For the MBT, 214 (78.1%) were non-fallers. Regarding treatment, the vast majority of individuals (79.7%) used Levodopa + Benserazide. Cognitive changes were present in the majority investigated, n= 330 (53.7%) according to the MMSE. The presence of depressive symptoms was found in 486 (75.1%) of patients in the six units surveyed and the main complaint of sleep disturbance reported was daytime drowsiness in 318 (42.9%) people. Through observation of the data found, it is possible to develop treatment strategies and health policies aimed at the needs of the Brazilian population with PD, as well as the strengthening and importance of rehabilitation as a treatment strategy.

OP-004

Exploring clinical progress in Guillain-Barré syndrome: a study of AMAN and AMSAN variants in an indian tertiary care hospital with emphasis on speech and swallowing

T. Motiwala¹, S. Karnik¹, G. Hattiangadi¹

¹NMC & BYL Nair Charitable Hospital, Audiology and Speech Therapy, Mumbai, India

Introduction: Guillain-Barré Syndrome (GBS) is a rare neurological disorder characterized by the immune system’s attack on peripheral nerves, often triggered by an antecedent infection. GBS primarily presents with symptoms like muscle weakness and paralysis, and can affect functions such as speech and swallowing.

Objectives: This study aims to assess speech and swallowing impairments in individuals with different GBS variants and evaluate their impact on the quality of life.

Methods: We conducted a case study with five GBS patients, including three with AMSAN and two with AMAN variants. All patients received intravenous immunoglobulin (IVIG) treatment for five days based on CSF and nerve conduction studies. Respiratory functions were managed with Inspiratory Muscle Training (IMT). Speech and swallowing were assessed through perceptual observations and quality of life scales.

Results: Patients showed significant improvement through oromotor exercises, proprioceptive neuromuscular facilitation, traditional swallowing maneuvers, and safe swallow strategies. Four out of five patients improved from grade 5 to grade 2 on the GBS disability scale after speech and swallowing management. The Swallowing Quality of Life questionnaire (SWAL-QOL) score also increased in all the patients post-therapy. AMSAN variant patients showed faster and better progress than AMAN variant patients. These interventions enhanced their oral nutrition intake and speech capabilities.

Conclusion: This study highlights the multifaceted impact of GBS on speech and swallowing. Proactive assessment and intervention in these areas are essential for comprehensive GBS care. Additionally, the research underscores the connection between improved speech and swallowing and enhanced quality of life in GBS patients.

OP-005

Benefits of MS Ballroom Fitness^TM on balance, walking capacity, and well-being in multiple sclerosis – a randomized controlled trial

L. Hvid^1,2, J. L. Steenberg³, A. Ng⁴, L. Skovgaard³

¹The Danish MS Hospitals, Research, Ry City, Denmark

²Aarhus University, Public Health, Aarhus, Denmark

³The Danish MS Society, Copenhagen, Denmark

⁴Marquette University, Exercise Science Program, Milwaukee, WI, United States

Introduction: Multiple sclerosis (MS) is accompanied by balance and walking dysfunction alongside deterioration of mental well-being and health-related quality of life (QoL). MS Ballroom FitnessTM (MS_B-Fit) is a personalized dance/fitness based concept targeting exactly these challenges. However, few studies involving persons with MS (pwMS) have investigated the effectiveness of MS_B-Fit.

Objectives: By using a cluster randomized controlled study design, our aim was to investigate the potential benefits of a 7-week MS_B-Fit intervention on balance, walking capacity, mental well-being, and QOL in pwMS.

Materials & methods: A total of n=91 ambulatory pwMS were enrolled (93% females, 54±9 years, patient determined disease steps 2.6±1.5 [range 0-7]) and evenly randomized into walking exercise therapy (MS_B-Fit: n=44, group-based, 2 sessions/week, mix of dance and fitness, moderate-to-high intensity or complexity, 50-60 minutes) or control (Ctrl; n=47, continuation of habitual living). Assessments were carried out before and after, with outcomes including spot step test (SSST; walking coordination- and balance; primary outcome), four square step test (FSST; dynamic balance and coordination), 6-minute walk test (6MWT; walking endurance), WHO-5 mental well-being index (WHO5), and VAS 0-100 health-related quality of life (QoL).

Results: Between-group improvements (mean [95%CI]) in favor of MS_B-Fit were observed for SSST (0.008 [0.003;0.013] testruns/s, p<0.01; corresponds to a reduction of -0.77 seconds), FSST (0.018 [0.010;0.027] testruns/s, p<0.01; corresponds to a reduction of -1.04 seconds), 6MWT (36 [19;52] m, p<0.01), WHO5 (7.4 [1.4;13.4] points, p<0.05), and QoL (7.7 [2.7;12.8] points, p<0.05). This was achieved due to improvements in MS_B-Fit, whereas CTRL remained unchanged.

Conclusion: In pwMS, 7 weeks of MS Ballroom Fitness^TM (MS_B-Fit) was very effective in improving balance and walking capacity alongside mental well-being and QoL.

OP-007

The effects of a 12-week training program on cognition and sleep quality in individuals with PD: preliminary findings of an ongoing RCT

J. Cristini¹, F. Seo¹, A. Potvin-Desrochers², H. Lajeunesse², A. Dagher³, R. B. Postuma³, P. Rosa-Neto^3,4, J. Carrier⁵, A. W. Amara⁶, S. Steib⁷, C. Paquette², M. Roig¹

¹McGill University, Physical and Occupational Therapy, Montreal, Canada

²McGill University, Department of Kinesiology & Physical Education, Montreal, Canada

³McGill University, The Neuro (Montreal Neurological Institute-Hospital), Montreal, Canada

⁴McGill University, Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada

⁵University of Montreal, Psychology, Montreal, Canada

⁶University of Colorado, Neurology, Aurora, CO, United States

⁷University of Heidelberg, Department of Exercise, Training and Active Aging, Institute of Sport and Sport Science, Heidelberg, Germany

Introduction: Individuals with Parkinson’s Disease (PD) suffer from disabling non-motor symptoms such as sleep problems and cognitive impairment, with 24-31% of those individuals eventually developing dementia. Critically, sleep problems may accelerate cognitive deterioration in this clinical condition. Hence, safe interventions such as physical exercise that may improve sleep quality and cognition hold significant potential in PD¹.

Objectives: To investigate whether a 12-week training program performed at moderate-to-vigorous intensity can improve cognition and sleep quality in individuals with PD.

Materials & methods: Twenty-four individuals with PD (Female = 11; Age = 64.8 ± 10.3; PD duration = 7.9 ± 5.6) performed a 12-week supervised training program. Assessments were performed at baseline and after the interventions. Cognition was assessed with the SCales for Outcomes of PD–Cognition. Objective and subjective sleep quality was assessed with the PD Sleep Scale 2 and actigraphy, respectively. Linear mixed models were used to assess changes in sleep and cognition.

Results: Following the intervention, participants showed improved cognitive scores (B = 0.472; 95%CI = 0.039, 0.905; p = 0.034) and subjective sleep quality (B = -1.222; 95%CI = -2.215, -0.229; p = 0.018); whereas, no significant changes in objective sleep quality were observed.

Conclusion: These preliminary findings indicate that a 12-week training program can effectively enhance cognition and subjective sleep quality in individuals with PD. Our ongoing RCT will determine whether exercise induces similar improvements in objective sleep measures (ie, sleep architecture) and whether the observed cognitive ameliorations are linked to better sleep¹.

Reference

1. Cristini, J., et al. Phys Ther (2023).

OP-008

A head-to-head comparison of the effects of aerobic vs. resistance training on the six-minute walk test in people with multiple sclerosis – preliminary results from the MSBOOST trial

L. Taul-Madsen¹, L. Hvid^1,2, U. Dalgas^1,2

¹Aarhus University, Public Health, Aarhus, Denmark

²The Danish MS Hospitals, Ry and Haslev, Denmark

Introduction: Impaired physical function is a highly debilitating symptom in persons with multiple sclerosis (pwms), often measured by the six-minute walk test (6MWT). Performance on this test relies predominantly on aerobic capacity and lower extremity muscle strength. Aerobic training (AT) and resistance training (RT) are among the two most applied exercise modalities in MS rehabilitation, targeting the underlying physiological factors. While both AT and RT have been shown to elicit improvements in 6MWT, it remains unclear which modality is the most effective.

Objective: To perform a head-to-head comparison on the effectiveness of AT and RT on physiological factors and physical function (6MWT) in pwms.

Materials & methods: A total of n=150 pwMS (45 ± 8 years, 74 % women) were enrolled and randomized into either 12 weeks of AT (n=60, 30 sessions), RT (n=60, 30 sessions), or control ("usual care", n=30). Evaluation of isometric knee extensor muscle strength (MVC; isokinetic dynamometry), aerobic capacity (VO2peak; incremental exercise test), and six-minute walk test (6MWT) were evaluated before and after the intervention.

Results: Aerobic capacity increased in AT vs. control by 4.3 [1.5;7.1] mL o2/min/kg (mean [95CI]) and in AT vs. RT by 3.2 [0.9;5.5], but not in RT vs. control (1.1 [-1.6;3.9]). Knee extensor muscle strength increased in RT vs. control by 0.87 [0.04;1.7] Nm/Kg and in RT vs. AT 0.75 [0.27;1.21], but not in AT vs. control (0.14 [-0.18;0.47]). 6MWT increased in RT vs. control by 26 [2; 50] m and in RT vs. AT 18 [-2;38] (trend), but not in AT vs. control (8 [-15; 32] m).

Conclusion: While both RT and AT elicited improvements in physiological factors (muscle strength and aerobic capacity, respectively), the 6MWT increased in RT only. Based on these findings, RT appears superior to AT in translating physiological improvements into enhancement in physical function.

OP-009

Exploring implementation preferences for building online mindfulness-based interventions for people with multiple sclerosis across Ontario

A. Sureshkumar¹, D. Luong², J. Scandiffio³, G. Feng¹, S. Munce^1,2, N. Lai⁴, M. Bayley^1,2, M. Kastner^1,5, A. Furlan^1,2, J. Oh^1,3, M. Nelson¹, A. Sud¹, A. Feinstein^1,6, R. Simpson^1,2

¹University of Toronto, Toronto, Canada

²University Health Network, Toronto, Canada

³Unity Health, Toronto, Canada

⁴University of Guelph, Guelph, Canada

⁵North York General Hospital, Toronto, Canada

⁶Sunnybrook Research Institute, Toronto, Canada

Introduction: Multiple sclerosis (MS) affects over 30,000 people in Ontario. MS can be a stressful condition, which can exacerbate anxiety and depression in people with MS (PwMS) and diminish quality of life. Mindfulness-based interventions (MBIs) effectively reduce stress in PwMS. Online MBIs offer distinct advantages and overcome common access barriers in PwMS, but their implementation has not been studied at scale. Identifying the needs and preferences for MBI implementors is necessary before full-scale implementation.

Objective: To identify implementation priorities amongst PwMS and other key knowledge users to inform the development of an online MBI program for PwMS across Ontario.

Materials & methods: A qualitative descriptive design was employed with an integrated knowledge translation (iKT) approach. Virtual semi-structured interviews explored experiences and perspectives of five knowledge user groups (n=41): 1) PwMS, 2) care partners 3) MS clinicians, 4) MBI instructors, and 5) health service leaders. Interviews were digitally recorded and transcribed verbatim. An inductive thematic analysis approach was used.

Results: Four themes were identified:1) creating mindfulness experiences for PwMS; 2) accessibility through clinical guidance; 3) cultivating collective mindfulness sessions and 4) resource-driven pathways to progress. PwMS value agency in attuning generic MBIs to their capabilities. MS clinicians and MBI instructors described a preference for programs focused on MS. Interactions between PwMS and MBI instructors create a sense of accountability to adhere to practices.

Future Directions: This study provides valuable insights to inform implementation of online MBIs for PwMS. Findings from this first phase will be used to build an online survey. Findings from both phases will be merged to inform the development of an implementation toolkit. This research has the potential to significantly improve the quality of life of PwMS.

OP-010

High intensity group exercise incorporating behaviour change to target physical activity in people with Parkinson’s disease: a randomised controlled trial

S. Brauer¹, R. Lamont¹, J. O’Sullivan²

¹University of Queensland, School of Health & Rehabilitation Sciences, Brisbane, Australia

²University of Queensland, UQ Centre for Clinical Research, Herston, Australia

Background: Exercise-based interventions can lead to short-term improvements in physical activity in people with Parkinson"s disease (PD), however sustained changes are difficult to achieve. Approaches that address both the capacity to engage in physical activity and self-management strategies to change and maintain exercise behaviours are required.

Objectives: To determine if a program of personalized high intensity group exercise incorporated with a self-management approach to behaviour change results in a greater and more sustained improvement in physical activity and secondary outcomes than usual care in people with mild-moderate PD.

Materials & methods: A prospective, parallel-group, randomised trial with concealed allocation, blinded assessors and intention-to-treat analysis involving 92 people with PD was undertaken. The experimental group undertook twelve, 80-minute sessions of a physiotherapy-led high intensity group exercise program combined with a self-management approach to change activity behaviours, with a control group of usual care. Outcomes were measured at baseline (Wk0), immediately post intervention (Wk5) and at follow-up (Wk26). The primary outcome was physical activity (steps/day) measured with an activity monitor. Secondary outcomes included detailed measures of patterns of physical activity.

Results: The experimental group took significantly more steps after intervention (Wk5-0) than the control group (mean diff 2089 steps, 95%CI 469 to 2627), but this was not sustained at follow up (Wk26-5, mean diff 1103 steps, 95%CI -659 to 1784). The experimental group spent a longer time and took more steps in bouts of higher intensity activity (>100steps/min) at Wk5 (p<0.020) than the control group, which was sustained at follow up (p< 0.022).

Conclusion: Sustaining gains in physical activity following intervention in PD is a challenge, with it critical to be clear on the specific behaviour to target.

OP-011

Are we providing older persons after brain injury the same care as younger persons? A retrospective population-based study

N. Timilshina¹, A. Ali¹, L. Langer¹, J. Gargaro¹, M. Bayley¹

¹University Health Netwrok, KITE | Toronto Rehab, Toronto, Canada

Introduction: Traumatic brain injury (TBI) is a major public health problem resulting in hospitalizations, morbidity and mortality globally. Despite the large proportion of elderly persons experiencing TBI, limited data exist at the population level.

Objective: To apply quality indicators (QI) to examine TBI care quality for older persons (65 years and older).

Methods: Provincial administrative health services data from publicly funded healthcare were used. We co-developed 12 QIs with healthcare partners and persons with lived experience, and measured care quality for patients 65+ years with TBI between 2016 and 2021. Age and gender adjusted incidence and QIs with 95% confidence limits were calculated. Variations in QI performance was explored according to age group, sex, geographic region, and income quintile.

Results: A total of n=15,194 complex-mild and n=19,237 moderate/severe brain injury cases were identified between 2016-2021. The age and gender adjusted incidence rate for all severities of TBI increased with age. Older persons were more likely to get admitted to general rehab than specialized TBI rehab after discharged from acute care (8.35% vs 3.04% for persons with moderate to severe TBI). Higher ED visits rates in years 1 and 2 increased with age (156.8 per 100 PY in 80+ age group vs. 114.9 per 100 PY in 65-79 years age) group). The rate of falls in the first two years after moderate-severe TBI was higher among elderly patients (43.7 per 100 PY in 80+ age group vs. 30.6 per 100 PY in 65-79 year group).

Conclusion: This study establishes a foundation for quality-of-care assessments and monitoring disparity in care for older adults with TBI at a population level. Gaps were identified in receiving rehabilitation services after discharge from acute care, and follow-up with health professionals. Ensuring that older persons receive appropriate rehabilitation and community support to reduce falls is necessary to maintain independence in the community.

OP-012

Are older adults with SCI receiving the right care at the right time? A care quality evaluation study

N. Timilshina¹, J. Gargaro¹, A. Ali¹, M. Bayley¹

¹University Health Netwrok, KITE | Toronto Rehab, Toronto, Canada

Introduction: Older adults are disproportionately affected by traumatic spinal cord injury (tSCI). However, there are few studies using population-level data to evaluate care quality for older adults, particularly in the rehabilitation and community care stages.

Objectives: To examine the incidence of tSCI and measure quality of care received by older adults (65+) at the population level, using a set of evaluative Quality Indicators (QI).

Methods: Provincial-level administrative health services data were used to identify incident cases of tSCI between 2016 and 2021. We achieved consensus on 12 QIs with a diverse group of key partners, including clinicians, researchers, and people with lived experience. QI data was stratified by several socio-economic factors, including age group, sex, geographic regions, and income quintile.

Results: 1787 patients with tSCI were identified between 2016 to 2021. The incidence rate of tSCI increased with age (43 per million for 65–79-year-olds and 59 per million for people over 80). Older adults with tSCI were less likely to be admitted to specialized inpatient rehabilitation than their younger counterparts, with 38% of 65–79-year-olds and 16% of people over 80 admitted to specialized inpatient care, compared to 43% of those aged 16-64. Among older adults who did not receive inpatient rehabilitation, the proportion followed-up by a specialist in the community within a year of acute discharge was low, particularly for those in the 80+ age group (52%) compared to that for all ages (65%).

Conclusion: Despite having the highest risk of sustaining tSCIs, older adults are less likely to be admitted to specialized inpatient rehabilitation and receive specialist follow-up in the community. These findings highlight the need for better prevention, and evidence-based policymaking to improve access to specialized rehab and community care to optimize recovery, maintain functional independence, and facilitate aging in place with a tSCI.

OP-013

Self-reported body function and daily life activities 18 months after COVID-19: a nationwide cohort study

J. Seljelid¹, A. Palstam^1,2, K. Stibrant Sunnerhagen¹, H. C. Persson³

¹University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden²Dalarna University, School of Health and Welfare, Falun, Sweden³Swedish National Transport Research Institute, Gothenburg, Sweden

Introduction & objectives: The aim was to investigate body functions and daily life activities 18 months after Covid-19 infection, depending on the initial severity of disease and sex.

Patients & methods: All 11,955 individuals on sick leave due to Covid-19 during the first wave of the pandemic in Sweden were invited to answer a questionnaire regarding experienced negative changes in body function and daily life activities, approximately 18 months after start of sick leave. The analysis of data included descriptive statistics, group comparisons and multivariate binary logistic regressions (4 groups).

Results: Of 5,464 responders (45.7%), 4,676 (85.6%) reported experiencing at least one problem in body functions and the reported prevalence of problems in daily life activities was 46%. The most frequently reported problems were fatigue (66.3%), cognition, sleep, and movement. In general, women and initially hospitalised individuals reported more problems. In the regression analysis, problems in body functions could partly explain whether individuals experienced problems in daily life activities. However, only fatigue and movement significantly contributed throughout all groups (p <0.001). Furthermore, the odds ratios for fatigue were larger in both regressions for women, compared to both for men.

Conclusion: In this nationwide study, more than 8 out of 10 individuals experienced problems in body functions 18 months after being on sick leave due to Covid-19, with women and initially hospitalised individuals reporting more problems. Problems in body functions, such as fatigue, could partly explain problems in daily life activities. However, the mechanisms behind the consequences are not yet clear and needs to be further investigated.

OP-014

Cost efficiency of specialist inpatient rehabilitation following major trauma: a cohort from analysis from the UK national clinical database comparing different levels of dependency

B. Karahacioglu¹, L. Hung Tze^2,1, L. Turner-Stokes^3,1

¹Northwick Park Hospital, UK Rehabilitation Outcomes Collaborative, London, United Kingdom

²Woodlands Health, Post-acute and Rehabilitative Care, Singapore, Singapore

³King’s College London, Dept of Palliative Care Policy & Rehabilitation, London, United Kingdom

Introduction: Previous analyses from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database have demonstrated that specialist inpatient neurorehabilitation is both effective and highly cost-efficient (BMJ Open 2016;6:e010238). Despite their higher initial costs of rehabilitation, cost-efficiency was greatest in the most dependent patients. As yet, no equivalent data exist for rehabilitation following major trauma.

Objectives: To examine cost-efficiency across different groups of dependency in a national cohort of patients undergoing specialist inpatient rehabilitation following trauma.

Patients & methods: The Northwick Park Dependency and Care Needs Assessment (NPDS/NPCNA) measures dependency and uses a computerised algorithm to estimate ongoing care costs in the community. Cost-efficiency: Time taken to offset (TTO) rehabilitation costs by savings in NPCNA-estimated costs of on-going care. Patients with complete NPCNA data on admission and discharge were included (n=8752) and divided into 3 groups of dependency on admission (Low NPDS=0-9 (n=1574), Medium NPDS=10-24 (n=2429) and High NPDS=25+ (n=4749)). Between-groups analysis: ANOVA with Bonferroni correction.

Results: Demographics: Mean age 53.1 years, Males:females 77:23%. Aetiology: Brain injury (TBI) 77.5%, Spinal cord injury (SCI) 12.6%, Amputation 8.4%, Other 1.4%. Mean episode costs were £26,639 (SD 33,174), £30,831 (SD 34,507) and £59,447 (SD 49,742) for the Low, Medium and High groups respectively. Annual savings in care costs were respectively £32,653, £78,196 and £102,109; and TTOs were 24.4, 17.0 and 19.7. Group differences were significant between all three groups for episode costs (p<0.01) and annual cost savings (p<0.001), but there were no significant between group differences in cost-efficiency.

Conclusions: In this cohort, annual cost savings were again greatest in the high dependency group - but, despite this, cost-efficiency was similar across all 3 groups.

OP-015

Cost efficiency of specialist inpatient rehabilitation following major trauma: a comparison by different types of injury from the UK national clinical database

L. Hung Tze^1,2, B. Karahacioglu^2,3, L. Turner-Stokes^4,2

¹Woodlands Health, Post-acute and Rehabilitative Care, Singapore, Singapore

²Northwick Park Hospital, UK Rehabilitation Outcomes Collaborative, London, United Kingdom

³North West London Hospitals University Healthcare NHS Trust, Regional Hyperacute Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom

⁴King’s College London, Dept of Palliative Care Policy & Rehabilitation, London, United Kingdom

Introduction: Previous analyses from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database have demonstrated that rehabilitation is not only effective but highly cost-efficient across a range of neurological conditions (BMJ Open 2016;6:e010238). As yet no equivalent data exist for different types of injury following major trauma.

Objectives: To examine the cost-efficiency across different types of injury in a national cohort of patients undergoing specialist inpatient rehabilitation following major trauma.

Patients & methods: An observational cohort study of prospectively collected clinical data from the UKROC database. The Northwick Park Dependency and Care Needs Assessment (NPDS/NPCNA) estimates ongoing care costs in the community using a computerised algorithm. Cost-efficiency: Time taken to offset (TTO) rehabilitation costs by savings in NPCNA-estimated costs of on-going care. Patients with complete NPCNA data on admission and discharge were included (n=8752) and compared by type of injury using between-groups ANOVA with Bonferroni correction.

Results: Mean age 53.1 years, Males:females 77:23%. Aetiology: Brain injury (TBI) 77.5%, Spinal cord injury (SCI) 12.6%, Amputation 8.4%, Other 1.4%. Overall mean length of stay: 75.6 (SD63.5) days, mean episode costs £45,609 (45,826). The mean reduction in weekly care costs of £1594 (SD2,150) p<0.001, offset the cost of rehabilitation within 19.6 months (SD87.8). Mean episode costs were highest for TBI (£48,847) and lowest for Amputation (£13,737). TTOs for the 3 main groups (TBI, SCI, Amputation) were 19.6, 16.8 and 7.5 months respectively. Group differences in episode cost were significant between all 3 groups (p<0.001) but only reached significance for TTO between TBI and Amputation (p=0.002).

Conclusions: Despite a wide range in length of stay and consequently in episode costs, specialist inpatient rehabilitation was highly cost efficient for all types of injury following major trauma.

OP-016

Overcoming medication-related barriers in specialised inpatient neurorehabilitation

F. Broadbridge-Kirbitson¹, L. Graham¹

¹Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom

Introduction: Specialised inpatient neurorehabilitation is resource-intensive and expensive, catering to patients with complex medical and rehabilitation needs. Improving communication on handover between acute care and rehabilitation services can help optimise patients’ medications earlier, leading to efficient resource use and improved patient outcomes.

Objectives: To identify and address medication-related barriers to early rehabilitation and improve the quality of medical handovers among referring clinicians to a UK tertiary neurorehabilitation centre.

Patients & methods: A retrospective review was performed on all patient admission records from January to September 2023 at Walkergate Park Neurorehabilitation Centre. Medication history details, identified as barriers to early rehabilitation by the neurorehabilitation medical team, were evaluated and rated as either "absent", "limited" or "comprehensive". These included details on seizure history, antiepileptic medications and spasticity treatments.

Results: 30 patient admission records were identified (70% male, mean age 52 years). Medication indications were absent in 73% of admissions. Of 18 patients on antiepileptics information on seizure nature and antiepileptic titration was absent in 78% of cases. Of 14 patients prescribed oral spasticity agents, only 14% had comprehensive information on initiation, titration, and treatment response. Of 11 patients on botulinum toxin injections, only 18% had comprehensive information including brand, date, muscles treated and dose of previous injections. Subsequently a detailed medical handover proforma was developed with multidisciplinary team input and incorporated into the admissions process.

Conclusion: Lack of adequate information on admission can delay early rehabilitation and adversely affect patient outcomes. Proactively addressing medication-related barriers through improved communication and handover facilitates medical optimisation and early rehabilitation.

OP-017

Long-term outcomes of community-based intensive care treatment following early neurological rehabilitation – results of a multicentric German study

D. Götze¹, B. Einhäupl¹, L. Willacker¹, S. Reichl², R. Pletz², T. Kohlmann³, E. Henning³, L. Schmeyers⁴, A. Straube¹, R. Süss⁴, S. Fleßa⁴, F. Müller⁵, A. Bartsch-de Jong⁵, S. Blömeke⁵, J. Hartl⁵, N. Vallejo Rancol⁶, D. Liedert⁶, T. Olander⁶, V. Ziegler⁷, R. Weinhardt⁷, S. Schmidt⁸, J. Rollnik⁸, L. Kleinlein⁹, T. Platz^2,10, A. Bender^1,6

¹Ludwigs-Maximilians University Munich, Neurology, Munich, Germany

²University Medicine Greifswald, Greifswald, Germany

³University Medicine Greifswald, Greifswald, Germany

⁴University of Greifswald, Greifswald, Germany

⁵Schoen Clinik Bad Aibling, Bad Aibling, Germany

⁶Hospital for Neurological Rehabilitation, Burgau, Germany

⁷Hospital for Neurological Rehabilitation, Rhön-Clinic, Bad Neustadt a. d. Saale, Germany

⁸BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany

⁹Statistical Consulting StaBLab, Department of Statistics, LMU Munich,, Munich, Germany

¹⁰University of Greifswald, Institute for Neurorehabilitation and Evidence-Based Practice, “An-Institut”, Greifswald, Germany

Introduction: Weaning patients from mechanical ventilation (MV) and tracheal cannula (TC) in neurological early rehabilitation (NER) is mostly successful. However, some patients leave NER with TC (20%) or MV (6%), requiring costly home-based specialized intensive care nursing (HSICN). Limited data exist on medical and demographic characteristics and long-term outcomes of these patients.

Objectives: The study aimed to assess patients’ health status at NER discharge and during HSICN, identifying predictors of post-discharge survival. Follow-up data were collected to analyze health changes post-discharge, enhancing understanding of care challenges for these severely affected patients.

Patients & methods: A multicentric study across five German NER hospitals collected data from neurological patients with TC/MV at discharge. Survival rates were calculated using Kaplan-Meier estimates, and inferential statistical tests compared deceased and surviving patients. Cox regression was used to analyze predictors of post-discharge survival.

Results: Among the 312 patients, the 1-year survival rate was 61.9%, decreasing to 41.5% after 3 years. Older age, higher number of diagnoses at discharge, longer MV duration and male gender were associated with an increased likelihood of death, while longer prior NER duration with a lower likelihood. Follow-up data revealed no significant health improvements during HSICN, but showed a 20% weaning rate for TC patients.

Conclusion: Identifying survival predictors can aid in determining at-risk groups, and thus could be integrated into decision-making process for NER discharge. The findings contribute to understanding the healthcare situation of individuals with serve neuro-disabilities requiring HSICN, allowing the development of an optimized post-hospital care model as currently investigated in an ongoing German study (OptiNIV, Platz et al. 2022).

OP-018

Defining and conceptualising financial capability in adults with acquired cognitive impairment

S. Swan¹, F. Patterson¹, T. Bredy¹, J. Fleming¹

¹University of Queensland, School of Health and Rehabilitation Science, Brisbane, Australia

Introduction: Variable and inconsistent terminology use has typified the literature regarding financial capability in adults with acquired cognitive impairment. Financial capacity, financial competence and financial management have been utilised somewhat interchangeably in both research and clinical practice.

Objectives: To explore definitions and conceptual frameworks of financial capability in relation to adults with acquired cognitive impairment due to acquired brain injury (ABI) or other neurological disability, including dementia.

Methods & materials: A qualitative evidence synthesis approach was utilised. Seven health related electronic databases were searched, with two qualified occupational therapists screening all papers. Included papers reported on conceptual frameworks related to financial capability in adults with acquired cognitive impairment. Data were then extracted for tabulation and thematic synthesis.

Results: Title and abstract screening was completed for 5180 papers, full-text review for 148 papers, with 19 papers included in the final analysis. Results confirmed inconsistency in terminology use and meaning, with conceptual frameworks more commonly originating in the psychology literature in relation to people with dementia. Themes found in the literature include the multi-dimensionality of financial capability, financial decision-making ability and exploitation risk for legal capacity/competence and the underlying neuropathological cause of declining financial capability. One framework, the "Financial Management Activity Process" informed by qualitative occupational therapy research with ABI participants may provide useful guidance for rehabilitation.

Conclusion: Further research with the inclusion of consumer lived experience is recommended to inform models of care for this complex area of practice.

OP-019

An implementation evaluation of the driving and dementia roadmap in alzheimer society organizations

C. Hawley¹, G. Naglie², E. Stasiulis², H. Sandhu², C. Galucci², M. Rapoport²

¹University of Warwick, Medicine, Coventry, United Kingdom

²University of Toronto, Toronto, Canada

Background: In response to the immense challenges that people with dementia (PWD) and family/friend carers (FCs) face in the driving cessation process, we developed the Driving and Dementia Roadmap (DDR) (www.drivinganddementia.ca). The DDR is a web-based resource comprised of information and tools to support PWD, FCs and healthcare providers in the decision-making and transition to non-driving.

Objective: To understand the factors (i.e. barriers and facilitators) that influenced the DDR’s implementation in Alzheimer Society (AS) settings, we conducted an implementation evaluation.

Participants & methods: The DDR was implemented by AS staff in 6 organizations in 4 Canadian provinces. Nineteen AS staff were interviewed after a 3 to 6-month period of delivering the DDR to their clients. Data were examined using a thematic analysis approach guided by the Consolidated Framework for Implementation Research (CFIR).

Results: Main factors facilitating the DDR’s implementation were related to the DDR’s characteristics: its perceived evidence strength (research based), quality (e.g. variety of tools, association with reputable organizations), superiority to other resources (more comprehensive and user-friendly) and ease of delivery. AS staff characteristics that facilitated implementation included their enthusiastic and favorable views about the DRR’s potential to be an empowering resource to instigate conversations and early planning for driving cessation. Barriers to implementation included clients’ lack of computer skills as well as competing priorities for AS staff such as other projects and tasks, and attending to COVID-19 related issues (e.g. isolation, caregiver burnout).

Conclusion: This study highlights how the perceived strengths of the DDR resource itself and AS staff’s favorable beliefs about the DDR facilitated its successful implementation in AS settings. Strategies to address implementation barriers include offering a print-based version of the DDR.

OP-020

Prevalence of hyponatremia in spinal cord injury patients

H. M. Knight¹, S. Swarna², S. Hirani³, D. Ramdin¹, A. A. Khine¹, S. Al-Mitwally², S. Wong²

¹Oxford University Hospitals, Oxford Centre of Enablement, Oxford, United Kingdom²Stoke Mandeville Hospital, National Spinal Injuries Centre, Aylesbury, United Kingdom³University of London, Health Service Research, London, United Kingdom

Introduction: Hyponatremia is reported to be more common in SCI patients.1,2 Little is known about the prevalence and predictors of hyponatremia in patient with spinal cord injury (SCI).

Objectives: The study aim was to (1) establish the prevalence of hyponatremia on admission and (2) assess if there is any association on hyponatremia.

Patients & methods: A retrospective study was conducted in a SCI centres during January 2019 to December 2022. We defined hyponatremia as (≤135 mmol/L) and severe hyponatremia as (<125 mmol/L).

Results: 570 adults (median age: 60 years, 32.1% female, 36.3% ≥65 years) with SCI (47.4% tetraplegia, 23.9% AIS:A) were included. Of 570 patients had their serum sodium checked within 48 hours of admission, 94 (16.5%) patients had hyponatremia and 1 (0.17%) had severe hyponatremia. No statistical difference was observed on gender, tetraplegia, high cervical (C4 or above) injury, ethnicity, duration- and level- of SCI, cause of SCI, American Spinal Injury Association impairment scale, smoking status, presence of pressure ulcer, tracheostomy tube, use of antibiotics and use of proton pump inhibitor and hypoalbuminemia (serum albumin <25g/L) in both groups. Hyponatremia was associated with older adult (>65 years: 24.5% v 11.8%, p<0.001); lower haemoglobin (g/L: 115 v 126, p<0.001); lower haematocrit (L/L: 0.345 v 0.375, p<0.001); lower serum magnesium (mmol/L: 0.76 v 0.79, p=0.003); use of anabolic steroid (57.1% v 15.9%, p=0.011) and use of diuretics (27.5%v 14.8%, p=0.009).

Conclusion: The present study shows hyponatremia is common in SCI patients and maybe a risk factor for poorer outcomes. Routine monitoring, management and treatment of hyponatremia should be considered. A follow up study is underway to establish whether hyponatremia is associated with adverse clinical outcomes and it"s risk factors.

OP-021

Clinical and health outcomes after severe acquired brain injury: a prospective cohort study

N. A. Lannin^1,2, L. Turner-Stokes³, L. Jolliffe^1,4, R. Nicks⁵, J. Ratcliffe⁶, I. D. Cameron⁷, M. Crotty⁶, A. Holland^1,2, P. Hunter², J. Morarty²

¹Monash University, Neuroscience, Melbourne, Australia

²Alfred Health, Melbourne, Australia

³King’s College London, Cicely Saunders Institute, London, United Kingdom

⁴Peninsula Health, Melbourne, Australia

⁵Eastern Health, Melbourne, Australia

⁶Flinders University, Adelaide, Australia

⁷University of Sydney, Sydney, Australia

Introduction: Survivors of more severe acquired brain injuries (ABI) are perceived to benefit less from rehabilitation interventions, and thus, are frequently denied access to inpatient rehabilitation services. There is limited information on the course of recovery and long-term outcome of adults with severe ABI who receive slow-stream rehabilitation from specialised brain injury services.

Objectives: To characterize the outcomes achieved by adults with severe ABI who received slow-stream rehabilitation, and determine the potential benefit of inpatient rehabilitation.

Materials & methods: Observational cohort study of prospectively collected clinical data from admission to discharge. Consecutive inpatients with a non-progressive ABI admitted to the programme during its first two years" operation were included (January-2016 to December-2017) provided they had complete UKFIM+FAM outcomes recorded on admission and discharge; n=196 were included.

Results: Mean age of the cohort was 44.6 years (range 17-78), 72% male and predominant cause of ABI was trauma (63%). The patient cohort had high levels of dependency (mean Northwick Park Dependency Scale Score 30.6 (SD17.9) which necessitated a mean of 118 days of rehabilitation (95%CI103,136). Despite severity, significant improvements in FIM™ motor scores were demonstrated from admission to discharge (mean improvement 34.2 points (95%CI30.1,38.2), FIM™ cognitive scores (mean improvement 10.1 points (95%CI8.8, 11.5), and UKFIM+FAM total score (mean improvement 72 points (95%CI64.9, 78.9, p<.001).

Conclusion: Adults with severe ABI achieved significantly important functional gains and psychosocial improvement following inpatient rehabilitation. The long length of stay in this cohort along with the slow-stream nature of the program, suggests that recovery after ABI is a gradual and ongoing process but is enabled

OP-022

Understanding the barriers and facilitators of brain injury healthcare services: a qualitative study

J. Grewal¹, C. J Kennedy², R. Mamman¹, J. Breese Biagioni³, M. A. Garcia-Barrera², J. Schmidt¹

¹University of British Columbia, Vancouver, Canada

²University of Victoria, Victoria, Canada

³CGB Centre for Traumatic Life Losses, Victoria, Canada

Introduction: Individuals with acquired brain injury (ABI) can experience concurrent diagnoses such as mental health and addiction concerns and hence, require specialized care. There are services and programs to support people with concurrent diagnoses of brain injury, mental health, and addictions. However, the barriers and facilitators of these services from the perspectives of individuals with ABI and stakeholder groups is unknown.

Objective: To explore stakeholder perspectives on the barriers and facilitators of brain injury healthcare services for individuals with concurrent mental health and addiction concerns.

Materials & methods: We conducted semi-structured focus group interviews during a one-day event in British Columbia (BC), Canada with individuals with ABI and caregivers, clinicians, policy makers, and researchers. Questions focused on the barriers and facilitators of providing and receiving brain injury healthcare services. Using a constructivist approach, manifest content analysis was used to analyze data.

Results: 90 participants were interviewed during 15 simultaneous focus groups and 34 participants were people with lived experiences of ABI. Participants emphasized perceived barriers such as, lack of awareness of brain injury, disconnected brain injury healthcare services, and inadequate funding. Participants described facilitators such as, receiving peer support, working with committed professionals, and involvement of community organizations (i.e., brain injury societies) to promote awareness and recognition of brain injury.

Conclusion: This study emphasized the barriers and facilitators of brain injury healthcare services for individuals who are experiencing concurrent mental health and addiction concerns in BC. Policy makers and healthcare administrators may use these findings to curate accessible, individualized, and equitable programs for individuals living with brain injury, mental health, and addictions in BC.

OP-023

Association between global outcomes and presence of depression in the first 6 months after a traumatic brain injury

S. Subramanian^1,2, K. Canlas¹, A. Cantu¹, B. Castro¹, K. Segner¹, S. Rolin², J. Davis³

¹University of Texas, Physical Therapy, San Antonio, TX, United States

²University of Texas, Rehabilitation, San Antonio, TX, United States

³University of Texas, Neurology, San Antonio, TX, United States

Introduction: Traumatic brain injury (TBI) is a major cause of mortality and morbidity. Motor and mood impairments tend to persist in this population. Post-TBI functional outcomes are commonly assessed using measures like the Glasgow Outcome Scale Extended (GOSE). Depression is a mood disorder that can influence post-TBI outcomes. The association between functional outcomes and depression has received less attention, particularly in the six months post-TBI.

Objectives: To identify whether and to what extent post-TBI depression is associated with functional outcomes in the first six months.

Materials & methods: We conducted a retrospective analysis of data submitted to the Federal Interagency TBI Research informatics center. We used global outcomes and depression (assessed using GOSE and Patient Health Questionnaire; PHQ-9 respectively) scores data assessed at 2wks, 3 and 6mos from TRACK-TBI study. We dichotomized GOSE (≤5:poor, ≥6:good) and PHQ-9 (≤9:no depression, ≥10:depression) scores, based upon guidelines. Chi-Squared tests compared the proportion of individuals with and without depression between the two GOSE groups. Logistic Regression analyses estimated the odds of being depressed in the presence of poor outcomes. Significance was set at p<0.05.

Results: Data were available from 556 participants (N=2wks:313, 3mos:194, 6mos:49).The proportion of individuals with poor recovery was 60.4% at 2wks, 41.8% at 3mos and 34.7% at 6mos. A greater proportion of those with poor outcomes had higher PHQ-9 scores (p<0.05) at all three assessments: 2wks (80.9%,n=93,χ=31.9); 3mos (68.1%,n=32; χ=17.7) and 6mos (58.3%,n=7;χ=3.9). Logistic regression analyses revealed that those with poor outcomes were 4.5, 4.3 and 3.8 times more likely (all p<0.01) to be depressed at the 3 assessment periods respectively.

Conclusion: Individuals with poor global outcomes post-TBI are more likely to be depressed. Concomitant presence of depression should be assessed along with global outcomes.

OP-024

Digital participation in traumatic brain injury: the results of a scoping review about assessment tools for computer mediated communication

J. Buettner-Kunert¹, N. Heider¹, J. Royko¹, K. Resch¹, Z. Falkowska¹

¹Ludwigs-Maximilians University Munich, Deutsche Philologie, Munich, Germany

Background: Individuals with chronic traumatic brain injury (IwTBI) are often affected by communication disorders which might have an impact on their social participation. This applies to both in-person as well as computer-mediated communication (CMC), which is considered an integral part of everyday life. Guidelines from professional societies recommend questionnaires and checklists for assessing restrictions of communicative participation. However, there is no overview of whether the available instruments can capture digital aspects of participation or social media use in TBI.

Aim: In this scoping review, following the PRISMA criteria, we aimed to provide an overview over currently available instruments that help assess CMC use as a measure of digital participation in the TBI population.

Method: Relevant databases were screened for publications between the years 2013 and 2023 with search terms referring to social participation, assessment tools, CMC and the target group, in order to find suitable tools to assess digital participation in IwTBI. In a multistage selection process (PRISMA), the instruments found were examined in terms of items that assess digital participation.Results: Following a screening on title/ abstract and full-text level, a total of 10 studies could be identified that present assessment tools that evaluate CMC use as a measure of digital participation in the TBI population. Said studies were analyzed and compared in terms of content according to the selected parameters.

Conclusion: Digital participation is an important aspect of everyday lives for IwTBI. Therefore, CMC should be an integral part of rehabilitation. The existing appropriate questionnaires uncovered in the current study should therefore be applied routinely to detect impairments in CMC and digital participation. Overall, however, there is still a great need for research in the field of CMC, both regarding methods for measuring digital participation disorders as well as resources.

OP-025

Exercise-induced symptom exacerbation in moderate-to-extremely severe traumatic brain injury

S. Gallow^1,2, J. McGinley², J. Olver³, G. Williams^1,2

¹Epworth HealthCare, Physiotherapy, Richmond, Australia

²University of Melbourne, Physiotherapy, Parkville, Australia

³Epworth HealthCare, Rehabilitation, Richmond, Australia

Introduction: In contrast to concussion and mild traumatic brain injury (TBI), there are no explicit guidelines for the safe resumption of cardiorespiratory fitness (CRF) or high-level mobility (HLM) in moderate-to-extremely severe TBI. The incidence of exercise-induced symptom exacerbation and adverse events (AEs) in the early sub-acute phase of recovery (≤ 3 months post injury) remains unclear in this population with a lack of monitoring and reporting demonstrated in the current literature.

Objectives: To determine the incidence of exercise-induced symptom exacerbation and AEs during CRF and HLM in the early sub-acute phase of recovery following moderate-to-extremely severe TBI.

Patients & methods: Consecutive admissions to a TBI inpatient unit were screened for recruitment. One hundred fifty eligible and consenting participants undertook CRF assessment on a cycle ergometer, HLM assessment on the High-level Mobility Assessment Tool, or both, for a total of 206 testing sessions. Symptom ratings were recorded pre and post assessment on a 22-item, seven-point Likert scale. A summed symptom severity score (SSS) was calculated, with an increase of ≥ 10 points classified as symptom exacerbation.

Results: Two participants experienced exercise-induced symptom exacerbation, one during HLM testing and one during CRF testing. One AE, a fall, occurred during a HLM testing session. Sixteen of 139 CRF sessions resulted in a SSS reduction ≥ 10 points. Nine of 67 HLM sessions resulted in a SSS reduction ≥ 10 points.

Conclusion: Cardiorespiratory fitness and HLM assessment in the early sub-acute phase of recovery following moderate-to-extremely severe TBI appears to be safe, with low rates of symptom exacerbation and AEs identified in this study. Participants were more likely to show a significant improvement in SSS post CRF and HLM assessment than an exacerbation of symptoms.

OP-026

Long-term follow-up of older adults with traumatic brain injury: preliminary results from the uppsala long-term outcome in older adults with traumatic brain injury study (U-LOTS)

C. von Seth¹, A. Lewén¹, M. Lannsjö¹, P. Enblad¹, J. Lexell²

¹Uppsala University, Medicine, Uppsala, Sweden

²Lund University, Health Science, Lund, Sweden

Introduction: The Uppsala Long-term outcome in Older adults with Traumatic brain injury Study (U-LOTS) aims to describe functioning, disability, health, well-being, lifestyle, personal and environmental factors three years or more after TBI among people 60 years or older.

Objectives: To present the initial results of the U-LOTS regarding associations between injury severity and function.

Patients & methods: Patients with TBI between 2008 to 2019 were recruited from the Uppsala Traumatic Brain Injury (UTBI) register, which includes all adults that are admitted to the Neurointensive care unit at Uppsala University Hospital following a TBI. Follow up was conducted as a home visit with a structured interview. Injury severity was stratified by initial level of consciousness as mild (Glasgow Coma Scale (GCS) 13-15), moderate (GCS 9-12) or severe (GCS 3-8). A set of validated outcome measures, including Glasgow Outcome Scale – Extended (GOS-E) and the Functional Independence Measure (FIM) were used. FIM motor- and cognitive function were analysed separately. Data are presented as median [interquartile range]. Correlation was assessed with Kendall’s tau.

Results: 79 persons, 28 female and 51 males, aged 68 [64-72] years at the time of TBI were included in the study and were assessed 3 to 14 years post injury. Injury severity was mild (N=24), moderate (N=40) and severe (N=15). At follow-up, the median GOS-E was 6 [4-7], median FIM-motor was 86 [71-90] and median FIM-cognition was 33 [27-35]. The correlation between injury severity and GOS-E, FIM-motor and FIM-cognition was -0.27, -0.24 and -0.35, respectively (p <0.01).

Conclusions: Outcome after a TBI among people 60 years or older is not substantially different from younger people and confirm the relationship between injury severity and outcome. Future studies in the U-LOTS will further investigate factors for outcome after TBI among elderly people.

OP-027

Evidence-based review of randomized controlled trials of interventions for the management of behavioural issues in individuals with moderate to severe traumatic brain injury

R. Teasell¹, H. MacKenzie¹, E. A. Bateman¹, S. Mehta¹, A. McIntyre², U. Barua¹, C. Flores-Sandoval¹, M. Bayley³

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

²Western University, Nursing, London, Ontario, Canada

³University of Toronto, Toronto, Canada

Introduction: Behavioural disorders are common among individuals with Traumatic Brain Injury (TBI), regardless of severity.

Objectives: To examine randomized controlled trials (RCTs) of interventions addressing mental health in individuals with moderate to severe TBI. The studies presented in this review are part of a larger database of randomized TBI RCTs.

Materials & methods: Systematic searches up to December 2022 were conducted for articles published in the English language in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO. Studies were included if they met the following criteria: (1) mean age of ≥18yrs; (2) ≥50% of the sample had moderate to severe TBI; and, (3) the study design was a RCT.

Results: 47 RCTs, published from 1992 to 2022, that examined interventions and outcome measures that addressed behavioural issues following moderate to severe TBI were included. Behavioural disorders addressed included disinhibition, aggression, irritability, impulsiveness, inappropriate sexual behaviour and social behaviour. These studies collectively enrolled 3,362 participants, with sample sizes ranging from 9 to 366. The majority of RCTs were conducted in the United States (57.4%) and 59.6% were conducted after 2010. Of these, 28 RCTs examined non-pharmacological interventions, and 19 RCTs examined pharmacological interventions.

Conclusion: Overall, amantadine was found to reduce aggressive behaviour and dexmedetomidine was effective for the reduction of postoperative agitation in acute care. Social skills programs and peer mentorship were reported to improve behaviour. Psychotherapy interventions ad behavioural management programs showed conflicting evidence for the reduction of anger and challenging behaviours, while emotion recognition programs and cognitive rehabilitation showed limited effectiveness.

OP-028

Exploring social support dynamics after traumatic brain injury: a mixed methods approach

J. Witten¹, J. Griffioen¹, J. Grewal¹, J. Schmidt²

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²University of British Columbia, Occupational Therapy, Vancouver, Canada

Introduction: Moderate to severe traumatic brain injury (TBI) is a common injury that can have life-long impacts. Social support is known to facilitate improved health, well-being, and quality of life. However, there is limited investigation of the types of social supports after TBI using a theoretical framework, and how these may influence health and participation after TBI.

Objectives: This study will (1) explore the types of social support after TBI using the conceptual analysis of social support framework, and (2) identify barriers and facilitators of social support using inductive analysis.

Methods: A mixed methods approach was used. Thirty participants with TBI completed an online quantitative survey on type, level, and amount of social support provided in different stages after TBI. Of those, 12 participants participated in a focus group. Quantitative data were analysed descriptively, qualitative data were analysed inductively using thematic analysis.

Results: Findings from quantitative data align with the conceptual model of social support indicating that people experienced a lack of instrumental, informational, and environmental supports after sustaining their injury. Initial analysis from qualitative data indicated three themes including (1) "finding belonging in a community", discussing the value of a community who share similar experiences, (2) "disconnecting from previous life", highlighting the loss of supports and productive roles after injury, and (3) "participating with different needs and abilities", which notes change in community engagement and social interaction.

Significance: Using an individualized approach, health care service delivery may focus on distinct needs of addressing social supports from friends, family, and community that can facilitate a greater sense of belonging post-injury. By characterizing and identifying barriers and facilitators, supports in neurorehabilitation can be effectively assessed.

OP-029

Identifying appropriate patients in acute care for a brain injury rehabilitation unit using a referral toolkit

V. Ng^1,2, S. Brolin², A. Dawson², P. Cabral²

¹Fraser Health Authority, Rehab Network, Surrey, Canada

²Health Authority, Rehabilitation, Vancouver, Canada

Introduction: In 2018, Fraser Health Authority opened a Brain Injury Rehabilitation Unit to deliver specialized care for acquired brain injury patients from across a network of 11 hospitals.

However, the majority – 54% – of referrals for this rehabilitation unit were unsuitable, resulting in inappropriate utilization of these limited numbers of beds. Subsequently, the Fraser Health Rehabilitation Network created and implemented a Brain Injury Rehabilitation Unit Referral Toolkit.

Objectives: The purpose of the Brain Injury Rehabilitation Unit Referral Toolkit was to support clinicians across the network of 11 hospitals to identify appropriate acquired brain injury patients for the rehab unit to ensure better utilization of beds and patient outcomes.

Methods: The referral toolkit included the following, which were incorporated into a newly developed electronic referral form: 1) Clear candidacy criteria; 2) Mandatory patient assessments including the Montreal Cognitive Assessment, Agitated Behavior Scale, Galveston Orientation and Amnesia Test, etc.); 3) Patient Consent; and 4) Repatriation agreement.

Results: Following implementation of the referral toolkit, the rate of appropriate referrals to the Brain Injury Rehabilitation Unit increased by 20%. Consequently, the unit achieved the following: i) Increased proportion of patients discharged home from 73% to 84%; ii) Increased median change in the Functional Independence Measure® (FIM®) from 17 to 26; and iii) Increased average FIM® efficiency (i.e., change in FIM® divided by the length of stay) from 0.42 to 0.95.

Conclusion: Creation and implementation of the Brain Injury Rehabilitation Unit Referral Toolkit successfully increased the rate of appropriate referrals to the rehab unit; and subsequently resulted in better utilization of the limited number of beds and improved patient outcomes.

OP-030

Post-concussive headache: a retrospective review of 50 consecutive patient headache histories and physical exams supporting specific post-traumatic headache subtypes

N. Zasler¹, S. Etheredge²

¹Concussion Care Centre of Virginia, Brain Injury Medicine, Henrico, VA, United States

²Concussion Care Centre of Virginia, Physical Therapy, Henrico, VA, United States

Introduction: postconcussive headache diagnosis remains controversial with no formal guidelines for assessment (history and/or physical exam) nor any agreement on diagnostic classificaiton. Many clinciians have debated the utility of using a symptom based classification system such as ICHD-3 which may overdiagnose certain types of headaches in this patient population in partiuclar migraine. Most studies examing post traumatic headache including post concussive headache have relied on ICHD-3 classification to drive the prevailing opinion that most of these headaches are of migrainous etiollogy. Surprising, no study to date has systematically examined headache history concommitant with the heache examination findings of a consecutive group of patients.

Objectives: To retrospectively assess a group of 50 patients following concussions / claimed concussions with a history of post-traumatic headachhe who presented to a specialized brain injury medicine practice for care via comprehensive review of the headache history taken and physical examination (neurlogical and musculoskeletal) performed.

Patients: 50 consectuive patients (both pediatric and adult)

Methods: A standardized internally developed headache survey was used for all patients assessed. The headache exam includied central and peripheral neurological as well as a detailed musculoskeletal examation icnluding postual asymmetries that might promulgate headache pain generators.

Results: Resutls will be reviewed relative to key historical and physical exam findings and the implicaitons for headache subtype diagnosis including the incidence of multiple pain generators to the subjective report of headache.

Conclusions: The findings will be couched in a discussion of the importance of "taking blinders off" when assessing a complex condition such as post-concussive headache that has multiple potential traumatically induced pain generators.

OP-031

A systematic review of exoskeleton use in human spinal cord injury (SCI) rehabilitation and their impact on non-motor complications

K. I. A. Chiu¹, M. J. Gallagher², S. Abbott², B. Ajayi², J. Bernard², T. Bishop², D. Lui²

¹St George’s University of London, London, United Kingdom

²St George’s Hospital, London, United Kingdom

Introduction: SCI affects more than mobility, impacting continence, pain, and reducing quality of life (QoL). Active exoskeletons enhance neural signals which can promote neuroplasticity to help address secondary SCI complications; contrasting passive exoskeletons that rehabilitate patients by repetition of movement.

Objectives: To examine different types of exoskeleton robots and their effectiveness for rehabilitation of secondary SCI complications.

Materials & methods: A literature search between January 2011 to June 2023 on Pubmed Central, Pubmed, Web of Science and Embase.

Studies including active powered exoskeleton (HAL), passive powered exoskeletons (ReWalk, Ekso, H-MEX, Atlante, Indego, SuitX Phoenix and Rex Bionics) and a passive stationary exoskeleton (Lokomat). Functional outcomes examined were measurements of continence, pain and QoL.

Results: 14 studies reviewed and 235 patients were tested. 35 HAL users showed significant improvements in Wexner scores from 8.89 to 6.51. 21 ReWalk users had bladder control assessed using parts of the neurogenic bladder symptom score and neurogenic bowel dysfunction score, improving from 3 to 4 (satisfied). For pain, only 2 HAL patients and 1 ReWalk patient showed significant reductions. For QoL, 2 HAL and 21 ReWalk patients improved based on the SF36. 21 Ekso patients improved in the SF12.

Conclusion: Active and passive powered exoskeletons improved patients’ post-SCI secondary complications after rehabilitation. These improvements were only seen in 3 exoskeletons and were not seen in the stationary exoskeleton Lokomat. HAL showed consistent improvements in all 3 functional outcomes demonstrating a consistent increase in neuroplasticity compared to the passive and stationary/powered exoskeletons.

OP-032

Quantifying unilateral central facial palsy

J. Fabricius¹, A. Møgelmose², R. Gade²

¹Aarhus University, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus, Denmark

²Aalborg University, Department of Architecture, Design and Media Technology, Aalborg, Denmark

Introduction: In a newly published systematic review (1) we have concluded that assessment tools for quantifying degree of central facial palsy (CFP) are developed and validated for peripheral facial palsy (PFP) only. Based on differences in how CFP and PFP manifest, there is a need for assessment tools which are developed and/or validated for CFP.

Objectives: The objective of this study was to develop an app-based objective measure of unilateral CFP for use in clinical trials and practice.

Materials & methods: The developed software builds on the MediaPipe FaceMesh v2 facial surface landmark model, developed by Google for smartphone cameras. FaceMesh have been validated in 1,700 subjects from different ethnicities around the world. Data on subjects with CFP due to acquired brain injury have been included in refining output from the facial landmark system, in order to capture facial asymmetries from CFP. A horizontal line through the zygomatic frontal sutures, and a perpendicular vertical line through the root of the nose acts as reference lines for the various facial landmarks used as outcome.

Results: In development of the software, we screened 163 consecutively admitted patients with acquired brain injury for CFP. Among the patients, 62 screened positive for CFP. Video recordings on a total of 41 subjects who could participate in facial mimicry exercises, and had their CFP confirmed by a clinical expert panel, were included in development of the software. Each participant underwent seven mimicry exercises in the first week following admission for specialized rehabilitation, which was recorded on a tablet.

Conclusion: The software and data on the 41 subjects with CFP will be ready for presentation at the conference in May 2024.

Reference

(1) Jesper Fabricius et al. (2021) Assessment and rehabilitation interventions for central facial palsy in patients with acquired brain injury: a systematic review, Brain Injury, 35:5, 511-519.

OP-033

Outcomes from virtual and in-person interdisciplinary mTBI rehabilitation: a pilot study

L. Graham¹, M. Morrissey¹, J. Dickey², S. McGuire³, B. Moran³

¹Western University, Physical Therapy, London, Ontario, Canada

²Western University, Kinesiology, London, Ontario, Canada

³St. Joseph’s Health Care London, Rehabilitation, London, Ontario, Canada

Introduction: The pandemic spurred development of a virtual or telerehabilitation version of an interdisciplinary group intervention for adults with persistent symptoms post-concussion/mild traumatic brain injury (mTBI): BrainEx90.

Objectives: To compare patient outcomes after completing virtual BrainEx90 to in-person BrainEx90. To investigate differences in outcomes between groups based on sex.

Materials & methods: Adults with persisting symptoms post-mTBI completed a 16-session combined physiotherapy and occupational therapy intervention as part of usual care. Participants enrolled prior to the COVID-19 pandemic completed an in-person version of the intervention, whereas participants enrolled during the pandemic completed a virtual version. The Rivermead Post-Concussion Symptoms Questionnaire, the Generalized-Anxiety Seven-Item Questionnaire, Brain Injury Vision Symptom Survey, and the Canadian Occupational Performance Measure were completed approximately 1 week prior to their first session, and within 6 weeks of their last session. Changes in outcomes were evaluated using t-tests, Welch"s t-tests, or Mann Whitney U tests as appropriate. Stratified analyses were also performed to evaluate outcomes between the virtual and in-person interventions for each sex.

Results: The preliminary analysis included 8 people in the virtual group (all female, 51.8 ± 8.7 years) and 35 in the in-person group (45 ± 11.7 years, including eight males). The secondary analysis included eight females in virtual group (51.8 ± 8.7 years), and 27 females in in-person group (44 ± 11.5 years). No male comparison was completed, as none consented from virtual group. No significant differences were detected among any outcomes between the virtual and in-person interventions among all participants, or between females.

Conclusion: There may be no difference in subjective outcomes following virtual or in-person rehabilitation. Additional data collection required to compare groups based on sex.

OP-034

Long-lasting efficacy of radial extracorporeal shock wave intervention and conventional rehabilitation through tele-rehabilitation strategies for stroke survivors

E. E. Mihai¹, G. Luca², A. Mîniceanu³, A. M. Anghel³, M. Berteanu^1,2

¹Carol Davila University of Medicine and Pharmacy Bucharest, Physical Therapy and Rehabilitation, Bucharest, Romania

²Elias Emergency University Hospital, Physical Therapy and Rehabilitation, Bucharest, Romania

³Polytechnic University, Automatic Control and Industrial Informatics Department, Bucharest, Romania

Introduction: Stroke is a major factor for disability and death in adults, leading to an increasing need for long-term rehabilitation programs. To ensure an accessible way for stroke survivors to access healthcare and rehabilitation programs, tele-rehabilitation and tele-assessment strategies became an integrated part in every day practice.

Objectives: The aim of the case report is to highlight the efficacy of a TR program after patient discharge in maintaining the beneficial effects after a conventional physical therapy (CPT) program and radial extracorporeal shock wave therapy (rESWT) intervention in a stroke survivor.

Materials & methods: A male diagnosed with stroke and right spastic hemiplegia, received rehabilitative care which was delivered during his hospital stay and consisted of CPT protocol and two rESWT sessions, as well as a tele-rehabilitation strategy program after discharge from the rehabilitation department. The assessments were performed remotely using an instrumented treadmill and stabilometric hardware, both connected to the Internet.

Results: Discharge evaluation and the 20 weeks follow-up showed that the stroke survivor faced decreased spasticity grade and pain intensity, improvement in sensorimotor function, balance, and ambulation distance.

Conclusion: This case highlights the usefulness of implementing and integrating tele-rehabilitation (TR) strategies in maintaining and enhancing the effects of rESWT intervention delivery and CPT protocol for decreasing lower limb spasticity of stroke origin and improving gait parameters. To need to continue having these beneficial effects translates into the development and implementation of a platform whose design aims to retrieve parameters such as range of motion, spatiotemporal and kinematic variables of stroke survivors undergoing rESWT delivery within a CPT program. The platform displays data according to the patient’s movement and performs a real-time transfer to the assessor

OP-035

Combining a multidimensional dance-based rehabilitation program with a digital experience-based motivational support: the Dancerex Rehabilitation Experience Digital Therapeutics (DT-x)

O. Realdon¹, F. Borgnis², V. Blasi², S. Isernia², F. Mantovani¹, M. Cotelli³, R. Manenti³, S. Marino⁴, V. Lo Buono⁴, P. A. Mavrodiev², M. Saresella², M. P. Amato², F. Baglio²

¹University of Milano-Bicocca, Department of Human Sciences for Education, Milan, Italy

²IRCCS Carlo Gnocchi Foundation, Milan, Italy

³IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy

⁴IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy

Digital therapeutics (DTx) is a new class of therapy based on by high-quality software programs to prevent, manage, or treat a medical disease. Although rehabilitation is an important player in Chronic Neurological Diseases (CNDs), only a few people in need have currently access to rehabilitation care. Moreover, the issue of treatment adherence remains an open issue.

The aim is to design and develop a new DTx (DANCE REhabilitation Experience-DTx) which combines a multidimensional dance-based program with a holistic experience-based motivational support delivered through an applied game.

A randomized, double-blind, controlled trial enrolling 192 patients with CNDs (including Multiple Sclerosis and MCI at risk of Alzheimer’s Disease) from three rehabilitation Institutes (IRCCS) in Italy will be conducted. Participants will be randomly assigned to DANCEREX-DTx treatment, or Multidimensional dance-based program (active comparator) or Educational program (no treatment). Groups will be assessed at the baseline, after intervention, and one year from enrolment.

Treatment adherence, a measure of patient-relevant structural and procedural effect, will be the primary outcome. Quality of life and cognitive and motor performance outcomes will be collected in addition to surrogate measures (neuroimaging and neurobiological) and user experience data.

We expect that DANCEREX-DTx, combining sensory-motor stimulation, music and cognitive engagement, will be a feasible and effective approach for CNDs since the early stages of the disease. Moreover, this DTx will be able to reduce motor, cognitive and psycho-behavioural symptoms and promote changes in the biomolecular substrate and connectivity. The integration of the rehabilitation program into the videogame-based motivational support will be crucial for the transition from rehabilitation as a task to rehabilitation as an experience, enhancing patients’ adherence and engagement when carrying out intensive treatment at home.

OP-036

Newro LOGICS^© – Probably world’s first rehab management software - is a customized ERP application software with sets of productivity programs for enhancing & optimizing functional recovery based on learnings from Artificial Neural Networks (ANN) to treat damaged Biological Neural Networks (BNN)

S. Sharan¹, S. Prathiba¹, C. Nikhil¹, A. Ganapathy¹, V. Siddharth¹, H. Sneha¹, R. Jothipriya¹

¹PRS Neurosciences & Mechatronics Research Institute (PNMRI), Functional Neurosciences - neuromodulation & neuro rehabilitation, Bengaluru, India

Introduction: The human brain operates through a complex network of neurons referred to as a Natural Neural Network (NNN) or Biological Neural Network (BNN). In parallel, technological advancements have given rise to Artificial Neural Networks (ANN) – a computational model inspired by the functioning of normal human brain. The human brain comprises approximately 100 billion neurons & over 100 trillion synaptic connections. These neurons form the fundamental building blocks, connected by synapses, allowing electrical & chemical signals to traverse. In the brain, the input is processed through sensory registration cortex, representing the sensory inputs. The output, akin to the motor response, involves the motor premotor & supplementary motor regions. The hidden layers in this natural network correspond to the association areas of the brain.

Objective: The objective of this study is to understand the similarities between the NNN and ANN to create software which helps in recovering lost functions in damaged brain and spinal cord’s functional circuits.

Method and Methodology: We conducted a detailed descriptive discussion amongst our 9-member multi-disciplinary neuro team whereby each one explained their perspective about functional neurological circuits involved in the processing of information. We called these elements "processors". We discussed the need for a processor based on clinical, clini-tech and research backgrounds.

Results: A robust end-to-end patient management system software with our patent-pending algorithms is needed to drive recovery of the damaged functional neurological circuits to reduce the duration of recovery without compromising the best possible outcome & make intelligent decisions with limited human assistance. We constructed newro LOGICS which stands as our guiding tool in clinical, clini-tech & research applications.

Conclusion: newro LOGICS translates research to functional recovery & is future ready with AI, ML & XR for big data analytics.

OP-038

Eye tracking of older people with executive and visuospatial function problems during balance training using non-immersive virtual reality

M. Maldonado^1,2, P. Alegríoa^1,2, P. Salas^1,2

¹Clinica Alemana, Physical Therapy and Rehabilitation, Santiago, Chile

²Universidad del Desarrollo, Physical Therapy, Santiago, Chile

Background and aims: In older people with mild to moderate cognitive impairment, an association is found between multiple falls and a reduction in executive functions (EF), more so than deficits in other cognitive domains, including global cognitive performance. However, to date, no experimental studies have examined the effects of oculomotor function and visual attention on visuo-cognitive reaction time performance, using eye tracking in older populations. A therapeutic intervention that promotes balance training is virtual reality systems. Eye trackers are arguably the most widely used eye tracker in micro-saccade research today. This study will seek to analyze the eye tracking of older adults with alterations in executive function and visuospatial ability when performing balance and gait training, using non-immersive virtual reality, to identify the visual strategies used, in order to evaluate or propose strategies that improve their physical dexterity.

Methods: Prospective, observational and descriptive cohort study of older adult patients over 60 years of age with mild to moderate cognitive impairment, balance disorders, due to neurological injuries and diseases: stroke, Parkinson’s disease, and vestibular disorders attending outpatient rehabilitation. and with the use of Virtual Reality and Tobii Pro Glasses 2. Convenience sampling (non-probability)

Results: The patient recruitment process has recently begun. Each one will carry out 10 training sessions with virtual reality using eye trackers. It is expected to have the preliminary analysis by March 2024.

References

1. Nagy B, Czigler I, PLoS One. 2020;15(5).

2. Taylor ME, Lord SR, Close JCT. 2017;25(4):397-406.

3. Ebaid D, Crewther SG. Sci Rep. 2020;10(1):020-66773.

OP-039

Efficacy of a new virtual reality-based serious game for the rehabilitation of unilateral neglect in patients with acquired brain injury

F. B. Berenice^1,2,3, D. Zeugin^2,3, S. Crottaz-Herbette^4,3, D. Perez-Marcos⁴

¹University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland

²MySpace Lab, Neuroscience, Lausanne, Switzerland

³Lausanne University Hospital (CHUV), Service of Neuropsychology and Neurorehabilitation, Lausanne, Switzerland

⁴MindMaze, Lausanne, Switzerland

Introduction: Acquired brain injury (ABI), primarily caused by stroke or trauma, presents substantial challenges to cognitive functions, especially attention. Attention deficits following ABI, such as neglect, can impair an individual’s capacity to engage with their surroundings and function independently. Emerging neurorehabilitation approaches aim to address these cognitive impairments. Among these, virtual reality (VR) stands out as an innovative tool complementing established methods such as prism adaptation.

Objectives: This study has two main objectives: firstly, to identify predictors for success in VR rehabilitation, and secondly, to explore how patients with neglect respond to prism adaptation in VR settings. The goal is to enhance our understanding of personalized VR games based on individual impairments and clinical conditions, contributing to more effective rehabilitation strategies.

Patients & methods: 30 ABI patients from the Service of Neuropsychology and Neurorehabilitation, Lausanne University Hospital, Switzerland, were included. Our focus is a tennis VR game, targeting neglect through prism adaptation. Hand positions, sessions and target accuracy were correlated with clinical data via statistical analysis. Hand trajectories were also visually interpretated.

Results: Various parameters significantly influence game success. We observed significant trajectory-specific differences in scores between neglect types, and a significant global improvement in hand trajectories and target accuracy.

Conclusion: Using VR for neurorehabilitation is a groundbreaking and ecologically valid approach. This study validates the effectiveness of VR in addressing neglect and highlights its potential as a complementary therapeutic method. Through deficit-oriented predictions, it contributes to individualized rehabilitation planning, emphasizing the importance of integrating emerging technologies into traditional programs for more effective, patient-centered treatment.

OP-040

Telerehabilitation after stroke: pyramid review findings

K. Stangenberg-Gliss¹, B. Borgetto¹, C. Kopkow²

¹HAWK University of Applied Sciences and Art, Hildesheim, Germany

²Brandenburg University of Technology, Therapy Science, Cottbus-Senftenberg, Germany

Introduction: Among cardiovascular diseases, stroke is one of the most serious life-threatening conditions. However, due to demographic and epidemiological changes in our society, as well as the increasing shortage of healthcare professionals, the imbalance between demand and supply of therapy is growing. Remote therapy of stroke patients in their own homes can help to solve this problem.

Objective: To provide an overview of the efficacy and effectiveness of digital health interventions (DHIs)¹ in physiotherapy, occupational therapy and speech therapy for the treatment of stroke patients at home.

Patients & methods: A pyramid review² was conducted to comprehensively map the complexity and diversity of digital therapeutic services for stroke patients in their homes. The pyramid review allows the presentation and integration of external evidence on telerehabilitation after stroke.

Results: By reviewing the qualitative and quantitative research in this field, the efficacy and effectiveness of the individual therapy approaches are compared and evaluated in relation to age, gender, lesion location and severity of deficits.

Conclusion: The therapeutic treatment of motor deficits after stroke in the home environment reveals the heterogeneity of the underlying technological concepts (image-, sensor- and VR-based). A programme theory for telerehabilitative services for stroke patients with motor deficits in the home environment is still lacking in order to be able to offer the appropriate digital form of therapy for each patient and their individual goals in everyday therapeutic practice.

References

1. Classification of digital interventions, services and applications in health: a shared language to describe the uses of digital technology for health, 2nd edition. Geneva: WHO; 2023

2. Borgetto, B., Tomlin, G.S., et al. (2019). Evidenz in der Gesundheitsversorgung: Die Forschungspyramide. In: Haring, R. (eds) Gesundheitswissenschaften. Springer

OP-041

Dynamic changes in corticospinal tract morphology and motor recovery following stroke: a longitudinal diffusion tensor tractography study

J. Park¹, S. Lee¹, Y. Na², M. Cho^3,2, S. B. Pyun^1,3,2

¹Korea University Anam Hospital, Physical Therapy and Rehabilitation, Seoul, South Korea

²Korea University College of Medicine, Brain Convergence Research Center, Seoul, South Korea

³Korea University College of Medicine, Biomedical Sciences, Seoul, South Korea

Introduction: The corticospinal tract (CST) is the crucial neural tract of which the integrity is associated with the long-term motor recovery. However, few researches were reported that the change of an injured CST reflects motor function recovery using diffusion tensor tractography (DTT).

Objectives: This study aimed to investigate the morphological type changes of CST between early subacute phase and 6 months after stroke and its relationship with recovery of motor function over time.

Patients & methods: Among a total of 181 stroke patients from the STroke Outcome Prediction (STOP) database, 80 with hemiplegic stroke who performed functional assessment and diffusion tensor imaging at <1month (initial) and 6 months post-stroke were included. We evaluated Fugl-Meyer assessment (FMA), muscle strength test of upper and lower limbs, Manual Function Test (MFT), Berg Balance Scale (BBS), Functional Ambulation Category (FAC) and Modified Barthel Index (MBI). The morphological type of CST on DTT were classified as 3 types based on fiber number; type A1 (good), A2 (poor) or B (no integrity). And patients were grouped into 3 groups according to the CST type changes between initial and 6-month postonset: Better, Worse and No-change groups.

Results: Initial CST types were A1 (40.0%), A2 (37.5%), and B (22.5%). The distribution of CST types between initial and follow-up assessments differed significantly (p < 0.001). At 6 months post-stroke, CST type changed in 35.0% of patients: Better (20.0%), Worse (15.0%), and No-change (65.0%). Significant differences in improvement in both MBI and MBI self-care scores were observed depending on the groups. (p = 0.044, p = 0.039).

Conclusion: Changes in CST type were frequent during the transition from the early to the chronic phase after a stroke. While CST type change was not directly associated with motor outcome measures, it did significantly relate to activities of daily living (ADL) recovery.

OP-042

Impact of blood flow restriction on neuromotor control and proprioception using a robotic technology: insights from healthy adults and implications for Parkinson’s disease

L. Lippi^1,2, A. Turco¹, A. Folli¹, E. Cavallo¹, G. Massocco¹, A. Ammendolia^3,4, A. de Sire^3,4, M. Invernizzi^1,2

¹University of Eastern Piedmont "A. Avogadro", Health Science, Novara, Italy

²Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Alessandria, Italy

³University of Catanzaro "Magna Graecia", Department of Medical and Surgical Sciences, Catanzaro, Italy

⁴University of Catanzaro "Magna Graecia", Research Center on Musculoskeletal Health, Catanzaro, Italy

Introduction: In recent years, an increasing literature has emphasized the role of blood flow restriction (BFR) in several rehabilitation settings. While its advantages for muscle function have been deeply studied, its impact on neuromuscular control remains still unknown.

Objectives: This study aimed to evaluate the effects of BFR on stabilometric and balance performance

Materials & methods: In this pilot randomized cross-over study, we enrolled healthy adults without risk factors for thrombosis. Study participants were randomly divided into 2 groups, Group A and Group B. Both groups underwent postural evaluations with and without wearing the BFR device. Moreover, after this randomized cross-over part of the study we enrolled a small sample of Parkinson’s disease (PD) patients to assess the safety and feasibility of BFR and its impact on posture.

Results: A total of 14 healthy subjects (aged 18 to 40 years) were included and randomly assigned to Group A (n=7) and Group B (n=7). Statistically significant differences were shown in balance tests under static conditions conducted on the Hunova® robotic platform, including average root-mean-square distance with open eyes and total excursion AP range with closed eyes (p<0.05). Furthermore, elastic balance testing revealed differences in terms of the Romberg index (BFR: 0.16 ± 0.16; without BFR: 0.09 ± 0.07; p = 0.047). Moreover, 4 patients with PD were enrolled (mean age 67.08 ± 12.04 years) showing a modification induced by BFR in the Romberg index (BFR: 1.04 ± 0.86; without BFR: 0.87 ± 0.21). BFR was well tolerated and no adverse events were reported.

Conclusion: The findings of this study suggested that BFR may be both safe and effective in influencing postural outcomes. This research provided further insights about the effects of BFR, with potential implications in patients with Parkinson"s disease. Further investigations are warranted to elucidate the role of BFR on balance and postural function.

OP-045

Effect of tDCS concurrent with VR-based robot on hemiplegic upper limb function after ischemic stroke: a randomized controlled study

C. Guo¹, Y. Shen¹, T. Wang¹

¹Nanjing Medical University, Rehabilitation, Nanjing City, China

Objective: To investigate the effect of transcranial direct current stimulation (tDCS)combined with virtual reality(VR)-based upper limb robot synchronous intervention on improving upper limb function recovery and the change of cortical excitability in subacute stroke patients.

Patients & methods: 40 patients were randomized according to the block randomized method, including the experimental group(tDCS combined with VR-based upper limb robot synchronous intervention) and the control group(sham tDCS combined with VR-based upper limb robot synchronous intervention).

Interventions: Fifteen sessions of treatment(20 min/day and 5 sessions/week for 3 weeks).

Main Outcome Measure(s): The Fugl-Meyer assessment upper limb scale(FMA-UL) and action research arm test(ARAT)were used to assess upper limb function. Activities of daily life(ADL)were evaluated by the modified Barthel index(MBI). Cortical excitability was monitored by functional near-infrared spectroscopy(fNIRS). All outcomes were measured before and after treatment.

Results: After treatment, two groups showed significant improvements in FMA-UL, ARAT, and MBI scores. The differences between FMA-UL and ARAT in the experimental group were significantly better than in the control group. There was no statistically significant difference in MBI scores between the two groups. According to fNIRS results, there were significant differences in the contralesional prefrontal cortex (PFC) and ipsilesional primary motor cortex (M1) based on HbO2 concentration differences (HbO2) between the two groups. The activation of ipsilesional M1 and contralesional PFC in the experimental group was increased after treatment, whereas it was decreased in the control group.

Conclusions: Compared with VR-based upper limb robots,tDCS combined with VR-based upper limb rehabilitation robot synchronous intervention can effectively improve the upper limb function and promote the activation of ipsilesional M1 and contralesional PFC in subacute stroke patients. However, there was no obvious advantage in improving ADL.

OP-046

Effects of tDCS on neural markers of hierarchical auditory prediction in individuals with moderate to severe traumatic brain injury

G. Rivera¹, P. Moya¹, I. Góngora¹

¹University of Chile, Physical Therapy, Santiago, Chile

Introduction: Psychomotor slowness, attention-related disorders, and memory failure are among the most common complaints reported by people suffering chronically from moderate to severe traumatic brain injury (CMS-TBI). Under the predictive coding framework, deficits in the ability to anticipate events could contribute to psychomotor slowness due to impairments in the capacity to generate predictions at successive hierarchical levels, which can be explored through event-related potentials (ERPs) as neurophysiological correlates of prediction error signals.

Objective: Determine if CMS-TBI subjects exhibit disturbances in generating high-level top-down predictions and explore whether a single session of transcranial direct current stimulation (tDCS) modulates these disturbances.

Methods: EEG recordings were collected from 30 CMS-TBI subjects and 20 controls. Neuropsychological and behavioural measures were obtained. ERPs were recorded under the global-local paradigm. tDCS targeted right frontal areas, with sham tDCS as a control. Differences in the ERP were estimated through non-parametric statistical testing and multivariate pattern analysis.

Results: CMS-TBI subjects have a preserved capacity to generate top-down prediction at low and intermediate hierarchical levels, indexed by the MMN and P3a response. Top-down predictions at high-hierarchical levels, indexed by the P3b were hard to detect in non-parametric analysis, but through MVPA was possible to differentiate between conditions leading to P3b. The tDCS over right PFC did not affect electrophysiological markers.

Conclusion: These results suggest an impairment in the generation of high-order expectations, which could explain the psychomotor slowness reported by CMS-TBI subjects. The tDCS over frontal areas do not affect the electrophysiological measures.

OP-047

Efficacy of two-sites sequential ripetitie transcanial magnetic stimulation to reduce neuropsychiatric symptomatology after cerebral lesions, a case report

G. C. Riccitelli^1,2, R. Borgonovo¹, M. Villa¹, S. Rossi¹, A. Kaelin-Lang^1,2

¹Civic Hospital, Istituite of Clinical Neuroscience of Southern of Switzerland, Lugano, Switzerland

²University of Lugano, Biomedical Sciences, Lugano, Switzerland

Background: Neuropsychiatric disorders with impulse control issues affect up to 90% of traumatic brain injury (TBI) patients. Behavioral disorders are highly disabling and often psychopharmacological therapy is not enough to limit its detrimental effects.

Objective: To apply a novel repetitive transcranial magnetic stimulation (rTMS) protocol to reduce neuropsychiatric disorders in a TBI patient.

Patient & method: A 34-year-old woman with a past severe head injury trauma, with hemosiderin deposits in the fronto-temporal regions in brain MRI; stable over time. Behavioural disturbances (impulsivity, disinhibition, cognitive dyscontrol, emotional instability) and extrapyramidal side effects persist despite treatment with maximum doses of antipsychotics and mood stabilisers. The patient underwent 20 daily sessions of sequential inhibitory (1Hz) and excitatory (20Hz) rTMS stimulation on the right and left dorsolateral prefrontal cortex. Neuronavigation and stimulation intensity was monitored during the treatment. Neuropsychiatric scales and cognitive tests were administrated at baseline, after 2, 4, and 8 weeks (wks). Daily emotions were also recorded.

Results: Following 2 wks of rTMS, there was a slight decrease in impulsivity (-7%), a substantial decrease in obsessive-compulsive symptoms (-54.4%), and a boost in attentive-executive performances with a notable increase in accuracy of answers (+71%) and processing speed (+34.6%). After 4 wks, impulsivity was reduced (-26.3%), while remaining psychiatric and cognitive abilities were unchanged. A lasting effect was found after 8 wks including increased positive emotions.

Conclusions: The findings provide initial evidence for the persistent beneficial effects of rTMS on impulsivity, obsessive-compulsive disorders and executive dyscontrol in TBI patients. Sequential alternate frequency rTMS in conjunction with psychopharmacological therapy may represent a novel approach to the treatment of behavioural disorders in TBI patients.

OP-048

Boot camp: upper limb recovery for people with chronic stroke

B. Hordacre¹, J. Uy¹, I. Serrada¹, S. Chamberlain¹, S. Hillier¹

¹University of South Australia, Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Adelaide, Australia

Introduction: Stroke recovery occurs rapidly within the first months. However, recovery is often incomplete with limited rehabilitation available for chronic stroke survivors. This raises the question, can people with chronic stroke recover if provided sufficient therapy?

Objectives: We aimed to establish a cost-effective, student supported, community chronic stroke rehabilitation boot camp for upper limb recovery. Objectives were to evaluate clinical efficacy and participant experiences in participating in the boot camp.

Patients & methods: Thirty-nine people with chronic stroke and upper limb impairment were invited to participate in a randomised cross-over controlled trial to evaluate a 5 week boot camp program. Boot camp was co-designed with people who had experienced stroke. Therapy was tailored to the individual"s impairments and goals and delivered in groups of up to 4 participants (90h therapy over 5 weeks). Rehabilitation was delivered by an experienced physiotherapist and supported by allied health students. The control phase was 5 weeks of usual care. Primary outcome measure was the Fugl-Meyer. Secondary measures assessed upper limb activity, quality of life, and self-efficacy. An interview was conducted by a stroke survivor to understand participant experiences.

Results: An intensive upper limb boot camp led to an 11-point (SD 5.7) improvement on the Fugl-Meyer, exceeding usual care (~1 point improvement; t(37)=10.85, p<0.001) and the minimal clinically significant difference (5.25 points). Improvements in upper limb activity (p<0.001) and self-efficacy (p=0.004) were also observed, but not quality of life (p=0.134). Participants reported positive outcomes regarding mental health and increased motivation. There was a common theme of enjoying the peer support and social engagement during the program.

Conclusion: Boot camp promotes significant arm recovery in people with chronic stroke. Benefits of the program include psychological and social support.

OP-050

Simulating therapy-induced recovery in bilingual aphasia via computational modeling and machine learning approaches

E. Carpenter¹, U. Grasemann², M. Scimeca¹, M. J. Marte¹, M. Russell¹, C. Peñaloza^3,4,5, R. Miikkulainen², S. Kiran¹

¹Boston University, Speech, Language, and Hearing Sciences, Boston, MA, United States

²University of Texas, Computer Science, Austin, TX, United States

³University of Barcelona, Cognition, Development and Educational Psychology, Barcelona, Spain

⁴University of Barcelona, Neuroscience, Barcelona, Spain

⁵Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Cognition and Brain Plasticity Unit, Barcelona, Spain

A current challenge of bilingual aphasia rehabilitation is selecting which language promotes better direct gains and cross-language generalization (CLG). Computational models can be used to address this issue by simulating therapy outcomes in both languages and recommending the optimal language for therapy. In this study, we compare model simulated data and patient data from 48 Spanish-English bilingual persons with aphasia (BPWA) as part of a RCT (Peñaloza et al., 2020). Half received therapy in the model recommended language and half received therapy in the language opposite of the model recommendation. A community detection analysis (CDA) clustered BPWA into 5 clusters with similar pre-stroke proficiency and post-stroke impairments (Carpenter et al., in prep.). We then compared therapy outcomes for the patient data and model simulated data across these 5 clusters. For direct therapy gains, we found that results from both the patient and simulated data revealed that mild (Clusters 3 and 5) and mild-moderate (Cluster 2) BPWA significantly improved over time regardless of whether the language was recommended or not, while very severe BPWA (Cluster 1) displayed negligible gains over time irrespective of the model recommendation. Critically, for both datasets we found that BPWA with moderate deficits (Cluster 4) who received therapy in the recommended language made significantly larger gains over time compared to those who received therapy in the model opposite language. For CLG, we found that for both the patient data and model simulated data very mild BPWA (Clusters 3 and 5) showed significant gains over time. The model simulated data also predicted CLG from Cluster 2, but this was not observed in the patient data. These findings highlight that (i) BPWA recover differently depending on their clinical profile, (ii) the model accurately simulated treatment outcomes across clusters of BPWA, and (iii) the model was most effective for BPWA with moderate deficits.

OP-051

Aerobic exercise interventions for promoting cardiovascular health and mobility after stroke: a systematic review & Bayesian network meta-analysis

K. Moncion¹, L. Rodrigues^2,3, E. Wiley¹, K. S. Noguchi¹, A. Negm⁴, J. Richardson^1,5, M. J. MacDonald⁶, M. Roig^2,3, A. Tang²

¹McMaster University, Rehabilitation, Hamilton, Canada²McGill University, Physical and Occupational Therapy, Montreal, Canada³Jewish Rehabilitation Hospital, Montreal Center for Interdisciplinary Research in Rehabilitation, Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Feil and Oberfeld Research Centre, Laval, Canada⁴University of Calgary, Medicine, Calgary, Canada⁵McMaster University, Deptarment of Health Research Methods Evidence and Impact, Hamilton, Canada⁶McMaster University, Kinesiology, Hamilton, Canada

Introduction: There is ongoing debate regarding the most effective aerobic exercise (AE) intervention for promoting stroke recovery.

Objective: To determine the superiority of AE interventions on key outcomes of stroke recovery, including cardiorespiratory fitness (V̇O₂peak, primary outcome), systolic blood pressure (SBP) and mobility (e.g., 6-Minute Walk Test (6MWT) distance and 10-meter usual gait speed) after stroke.

Methods: Eight databases, including MEDLINE, EMBASE, Web of Science, CINAHL, CENTRAL, SPORTDiscus, PsycINFO, and AMED Allied and Complementary Medicine, were searched from inception to February 2023.

Eligibility criteria: Randomized controlled trials were included that compared the effects of any AE interventions [low-, moderate-, high-intensity continuous training (HICT), high-intensity interval training (HIIT)] to no exercise, usual care or other AE interventions in individuals post-stroke.

Analysis: Systematic review and Bayesian network meta-analysis (NMA) methodology were employed. Surface under the cumulative ranking curve (SUCRA) values were used to rank interventions. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) minimally contextualized framework for NMA was followed.

Results: There were 28 studies (n=1298) included in the NMA for V̇O₂peak, 11 (n=648) for SBP, 28 (n=1494) for 6MWT, and 18 (n=775) for 10-meter usual gait speed. The greatest effect on V̇O₂peak, 6MWT, and 10-meter usual gait speed was observed after HIIT and HICT. No differences between interventions were found for SBP. SUCRA values identified HIIT as the superior AE intervention for all outcomes of interest. HIIT was the most effective intervention for improving V̇O₂peak [3.2 mL/kg/min (95% CrI 0.7 to 5.6) moderate certainty] compared to usual care.

Conclusion: This NMA suggests that higher-intensity AE is superior to traditional low to moderate-intensity AE for improving outcomes after stroke.

OP-052

Stroke rehabilitation in India: assessment based on WHO STARS guidelines

G. Handa Thukral¹, S. Hazra², P. H Chalageri³

¹All India Institute of Medical Sciences, Physical Therapy and Rehabilitation, New Delhi, India

²NRS Medical College, Physical Therapy and Rehabilitation, Kolkata, India

³CMC, Physical Therapy and Rehabilitation, Vellore, India

Introduction: WHO STARS as a part of Rehabilitation 2030 initiative was adopted to understand Stroke Rehabilitation sitution in India based on available data.

Objectives: To do a desk review with available information based on systematic review, Health policy and governmental initiatives with regard to stroke in India

Materials & methods: Indirect observations based on acute care data, registries, national sample surveys and national guidelines are analysed. In this study, A total of 10 data items were collected based on the WHO STARS questionnaire regarding stroke rehabilitation.

Results: Globally comparable estimates of disability are limited and there is a need to update data collection sources with rehabilitation-related data in India. The burden of disability, other stroke-related consequences and care givers burden are used to estimate rehabilitation needs in this study. Cross sectional disability measurement assesses primary stroke-related disability as well as secondary disability caused by a lack of awareness and the absence of adequate rehabilitation services in LMICs where rehabilitation referral is not a standard practice, so its better to consider disability as an input for rehabilitation logic model rather than an output. The other components in the areas of Leadership and governance, Financing, Human Resources, Service Delivery, Rehabilitation Quality, Rehabilitation Infrastructure and Information and assistive technology were also evaluated.

Conclution: The current study gives an overview of the situation based on available literature. India is toiling towards integrating accessible and affordable rehabilitation services to all strata of persons with disabilities (including stroke).

Reference

Handa, G., Hazra, S. & Chalageri, P.H. WHO Systematic Assessment of Rehabilitation Situation (STARS): A systematic review on the status of stroke rehabilitation in India. Curr Phys Med Rehabil Rep (2023). https://doi.org/10.1007/s40141-023-00418-2

OP-053

The taxonomy of “digital health interventions” and their sub-groups in the synchronous digital therapeutic rehabilitation of stroke patients – a scoping review

K. Stangenberg-Gliss¹, A. Elser¹, B. Borgetto¹

¹HAWK University of Applied Sciences and Art, Hildesheim, Germany

Introduction: Stroke is a leading cause of impairment and death. Many survivors suffer from motor, sensory and speech impairments and require ongoing rehabilitation. Digital health interventions have the potential to overcome barriers such as distance between patient and therapist. However, there is a lack of clarity in terms and definitions used in therapeutic research and practice.

Objectives: Therefore, the aim of this scoping review is to provide a comprehensive overview of the definitions and terms used in publications by healthcare professionals (occupational therapy, physiotherapy, speech and language therapy) related to synchronous digital stroke rehabilitation.

Patients & methods: A Scoping review was conducted of all publications related to stroke survivors who received synchronous technology-based distance therapeutic (PT, OT, SLT) rehabilitation services (image-based, sensor-based, virtual environment and virtual reality-based) published worldwide in English, French or German as of year 2000 up to December 2022. A concept map of the terms and definitions used was elaborated.

Results: There is a lack of consistency in the use of terminology in the field of digital stroke rehabilitation in terms and definitions in relation to countries, languages or professional groups. A preference and a definition for the term “telerehabilitation” was found.

Conclusion: Although the WHO taxonomy¹ aims to provide a ‘bridging language’ to ensure understanding between the different actors, an exchange and networking of the therapeutic professions among each other would be necessary in order to reach a common terminology for ‘consultations between remote clients and healthcare providers’ in stroke rehabilitation.

¹ Classification of digital health interventions. Geneva: World Health Organization; 2018(WHO/RHR/18.06). Licence: CC BY-NC-SA 3.0 IGO.

OP-054

Effect of a virtually-delivered behaviour change program that includes grasp feedback from a wearable device on upper limb activity after stroke: an RCT

L. A. Simpson¹, R. Barclay², M. Bayley³, S. P. Dukelow⁴, B. J. MacIntosh⁵, M. MacKay-Lyons⁶, C. Menon⁷, B. Mortenson¹, T. H. Peng¹, C. L. Pollock¹, S. Pooyania⁸, N. Silverberg¹, R. Teasell⁹, J. Yao¹, J. Eng¹

¹University of British Columbia, Vancouver, Canada

²University of Manitob, Winnipeg, Canada

³University of Toronto, Toronto, Canada

⁴University of Calgary, Calgary, Canada

⁵Sunnybrook Health Sciences Centre, Toronto, Canada

⁶Dalhousie University, Halifax, Canada

⁷ETH Zurich, Zurich, Switzerland

⁸University of Manitoba, Winnipeg, Canada

⁹Western University, London, Ontario, Canada

Introduction: Upper limb activity following stroke is low and may not be sufficient to promote optimal recovery. Incorporating the use of the arm and hand in daily life is the ultimate goal of upper extremity rehabilitation. We investigated whether a behaviour change program coupled with a wrist-worn device to provide grasp feedback could increase daily reach and grasp movements.

Methods: This study was a two-group, assessor-blinded, randomized control trial, conducted at 6 sites from the CanStroke Recovery Trials Platform between 2020 to 2022. Participants (n=69) were community-living and less than 1 year post stroke with residual arm movement and upper limb use limitations. They were randomized to receive a 3-week virtually-delivered program (Virtual Arm Boot Camp V-ABC, n=33) or 3 weeks usual care (Control group, n=36). V-ABC consisted of a home exercise program, feedback from a wrist-worn device to monitor grasps (hand counts) and 6 virtual sessions with a trained therapist over 3 weeks. The primary outcome was between group differences in average daily hand counts at post-evaluation using a linear mixed effects model. Secondary outcomes included upper limb self-reported use, functional capacity and quality of life measures. Longitudinal outcomes examining changes between pre, post and 2 month follow up were also examined.

Results: Participants were a mean 63 years of age and 231 days post-stroke with 38% women. The V-ABC group demonstrated greater average daily hand counts at post-evaluation compared to usual care (mean difference=368.15, 95% CI: 6.25 to 730.05, p=0.046). Significant between group differences were also found in self-reported upper limb use and functional capacity in favour of the V-ABC group.

Conclusions: This study is the first to provide evidence that a virtually-delivered behaviour change program that consists of exercise, feedback from a wearable device and therapist support can increase upper limb activity following stroke.

OP-055

Cognitive deficits in stroke rehabilitation – insights from indian physiotherapists

J. V. A. Dsouza¹, B. G S¹

¹St. John’s Medical College Hospital, Bangalore, India, Physiotherapy, Bengaluru, India

Introduction: Cognitive deficits post-stroke profoundly impede rehabilitation goals. Despite their pivotal role, limited insights exist into Indian physiotherapist’s strategies for addressing these challenges.

Objectives: To Investigate Indian physiotherapists’ perspectives on post-stroke cognitive deficits and assess the need for additional training in India’s resource-constrained settings.

Methodology: Cross-sectional survey utilized Google Forms. Eligible physiotherapists held BPT/MPT/MSc/PhD degrees, had ≥2 years’ experience in stroke patient rehabilitation, encountered cognitive deficit patients. Neurorehabilitation professionals designed survey questions.

Results: 490 physiotherapists participated. 92% (n=451) believed they were qualified for cognitive screening tests. 90% (n=441) routinely assessed cognition, typically within the first 7 days post-stroke. Mini-Mental State Examination (MMSE) was commonly used (58%, n=283). Challenges surfaced when working with patients with cognitive deficits, especially language barriers. Physiotherapists noted cognition’s substantial impact on physical recovery (95%, n=421), with 93% (n=408) recognizing extended recovery periods and only 5% (n=24) meeting rehabilitation goals on schedule. 98% (n=433) acknowledged exercise’s role in enhancing cognition for functional recovery. 70% (n=344) faced patients unable to achieve full physical recovery potential due to cognitive deficits. 39% (n=170) had access to cognitive dysfunction specialists, and 98% (n=482) made referrals when needed, with 93% (n=457) engaging in collaborative planning.

Conclusion: Survey highlights Indian physiotherapists’ cognizance of cognitive deficits’ significance in stroke rehabilitation. It exposes a training and resource gap, with only 39% having access to cognitive specialists, necessitating urgent attention. It emphasizes the need to incorporate cognitive training into rehabilitation programs for comprehensive recovery.

OP-056

Life after a severe stroke – outcomes at hospital discharge and after 3 months

K. Stibrant Sunnerhagen¹, M. Reinholdsson¹

¹University of Gothenburg, Neuroscience, Gothenburg, Sweden

Introduction: People who suffer a severe stroke have a higher incidence of acute complications associated with poorer recovery and higher mortality. Studies on people with severe stroke are important but scarce.

Objective: The aim of the study was to investigate functional status, discharge destination, length of hospital stay and mortality at hospital discharge and at a three-month follow-up in patients with severe stroke.

Patents & methods: This study is a retrospective, register-based cross-sectional study. We included adult patients with intracerebral hemorrhage or ischemic stroke who were admitted to three stroke units in Gothenburg, between 2014-2019. Stroke severity was assessed on admission using the NIH Stroke Scale and was dichotomized into severe stroke (NIHSS ≥15) and mild to moderate stroke. For comparison between groups, tests such as Mann-Whitney U, Kruskal Wallis, Chi-squared and Fisher’s exact were used. Mortality was analyzed with survival analysis, Kaplan-Meier.

Results: The study included 5,945 patients of whom 902 had severe stroke. Of these, 73% needed support with personal care at discharge, and 56% were independent at a three-month follow-up. At discharge, 45% returned to their own home while 55% were discharged to a nursing home. At the follow-up, 37% were still living in a nursing home. The median length of hospital stay was 25 days. Overall mortality at a three-month follow-up was 41%, while mortality among patients who lived in a nursing home prior stroke was 73%.

Conclusions: Severe stroke in the elderly (≥75 years) was associated with increased dependence in activity of daily living, living in a nursing home, higher mortality and shorter length of hospital stay compared to the younger patients. The results of this study provide information on important aspects of life after severe stroke that can be used to meet the needs of patients in this vulnerable group.

OP-057

Stroke disrupts structural connectivity of oculomotor cortical network

C. Rubino^1,2, A. Gammelgaard Damsbo^3,4, L. A. Boyd^1,2

¹University of British Columbia, Physical Therapy, Vancouver, Canada

²University of British Columbia, Graduate Program in Rehabilitation Sciences, Vancouver, Canada

³Aarhus University, Neurology, Aarhus, Denmark

⁴Aarhus University, Medicine, Aarhus, Denmark

Introduction: It is not known how oculomotor function (saccades and fixations) is disrupted after stroke. This is partly due to a lack of 1) specificity in clinical assessments to detect oculomotor impairments, and 2) research that explicitly examines oculomotor control together with motor function and recovery after stroke.

Objectives: We aimed to examine structural connectivity of oculomotor cortical regions, in individuals with 1) left vs. right hemisphere, and 2) cortical vs. subcortical stroke.

Patients & methods: Cerebral MRIs of 44 individuals with chronic stroke were included: 15 were female; mean age=65.8 +/-10 years; all had unilateral, middle cerebral artery stroke (23 right hemisphere; 18 cortical). Stroke lesion masks were manually drawn. Oculomotor cortical regions were derived from task-based functional MRI in a healthy cohort (n=20); clusters of functional activation were parcellated into left/right frontal and parietal eye fields (FEF, PEF). Lesion masks and cortical atlas were overlaid onto diffusion tensor imaging derived tractograms from the Human Connectome Project. A regional disconnectivity score for each cortical atlas region was extracted and represented the estimated fraction of streamlines between cortical regions disrupted by the lesion.

Results: Structural connectivity of oculomotor cortical network regions was disrupted in 82% of individuals. Regional oculomotor disconnectivity did not differ by side of stroke, but did differ in individuals with cortical vs. subcortical stroke; cortical stroke had greater structural disconnectivity (median difference for lFEF = 0.1, rFEF = 0.08, lPEF = 0.04, rPEF = 0.03; all p<0.006).

Conclusions: Structural connectivity in the oculomotor cortical network is disputed after stroke; cortical stroke had the greatest impact on oculomotor connectivity. These findings may have important clinical implications for diagnosis of oculomotor deficits and rehabilitation.

OP-058

Bridging the gap: an updated review of translational stroke rehabilitation research

M. L. Bird^1,2, T. Miller^3,4, M. P. Herath¹, S. Hung^2,5, L. K. Kwah⁶, S. Thilarajah^6,7, L. A. Connell⁸, J. Eng^2,5

¹University of Tasmania, Physiotherapy, Launceston, Australia

²University of British Columbia, Vancouver, Canada

³University of British Columbia, Vancouver, Canada

⁴University of British Columbia, Vancouver, Canada

⁵Rehabiliation Research Program, GF Strong Rehabilitation Centre and The Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada

⁶Singapore Institute of Technology, Health and Social Sciences Cluster, Singapore, Singapore

⁷Department of Physiotherapy, Singapore General Hospita, Singapore, Singapore

⁸Lancaster University, Lancaster, United Kingdom

Introduction: Previous reviews have identified a limited range of implementation interventions designed to bridge the evidence-to-practice gap in stroke rehabilitation. Diverse intervention types have produced limited actionable recommendations, which has driven a growth of recent publications in this area.

Objective: To summarize the range of recently published implementation intervention strategies and evaluate their effectiveness in changing stroke rehabilitation practice or patient outcomes.

Methods: In this update of our previous review, we searched EMBASE, CINAHL, Cochrane and MEDLINE databases from April 2019 to July 2023. We included controlled trials involving clinicians working in stroke rehabilitation and reporting changes in clinician practice behaviour, patient outcomes, or both. Data describing intervention strategies, and patient outcomes were extracted and tabulated.

Results: Of 779 unique studies screened, 26 were reviewed in full text, with 10 included in the data synthesis. Most implementation strategies aimed at clinicians were multifaceted, with educational material or opportunities (8), multi-professional collaborations (5) and audit and feedback (4) commonly reported. Two interventions included patient mediated interventions. This updated evidence synthesis identified several positive client level outcomes for secondary stroke prevention, reduced stroke recurrence and yielded economic benefits.

Conclusion: Recent studies which highlight a variety of implementation strategies that apply best practice evidence, focus on patient outcomes and show potential for improving patient outcomes after stroke. Multifaceted approaches are needed to facilitate clinical behaviour change and underscore the need for intervention flexibility and customisation in order to support clinicians in delivering evidence-based care to meet diverse patient needs.

OP-059

White matter hyperintensities modify relationships between corticospinal tract damage and motor outcomes after stroke

J. Ferris¹, B. Lo², G. Barisano³, A. Brodtmann^4,5, C. Buetefisch⁶, A. Conforto⁷, M. Donnelly², N. Egorova-Brumley⁵, K. Hayward⁵, M. S. Khlif⁴, K. Revill⁶, A. Zavaliangos-Petropulu⁸, L. A. Boyd⁹, S. L. Liew²

¹Simon Fraser University, Gerontology, Vancouver, Canada

²University of Southern California, Los Angeles, CA, United States

³Stanford University, Stanford, CA, United States

⁴Monash University, Melbourne, Australia

⁵University of Melbourne, Melbourne, Australia

⁶Emory University, Atlanta, GA, United States

⁷São Paulo State University, São Paulo, Brazil

⁸University of California, Los Angeles, CA, United States

⁹University of British Columbia, Vancouver, Canada

Introduction & objectives: Motor outcomes after stroke relate to corticospinal tract (CST) damage. Recovery from stroke is mediated by surviving neural pathways that compensate for the stroke injury. These compensatory pathways may be affected by concurrent age-related structural damage from white matter hyperintensities (WMHs). Here, we evaluated if WMHs modulate the relationship between CST damage and post-stroke motor impairment outcome.

Materials & methods: We included 223 individuals from the ENIGMA Stroke Recovery Working Group. CST damage was indexed with weighted CST lesion load (CST-LL). Mixed effects beta-regression models were fit to test the impact of CST-LL, WMH volume, and their interaction on motor impairment, controlling for age, time post-stroke and stroke lesion volume.

Results: WMH volume related to motor impairment above and beyond CST-LL (β = 0.178, p = 0.022). We tested if relationships varied by WMH severity (mild vs. moderate-severe). In individuals with mild WMHs, motor impairment related to CST-LL (β = 0.888, p < 0.001) with a CST-LL x WMH interaction (β = -0.211, 0.026). In individuals with moderate-severe WMHs, motor impairment related to WMH volume (β = 0.299, p = 0.044), but did not significantly relate to CST-LL or a CST-LL x WMH interaction.

Conclusions: WMH-related damage may be under-recognized in stroke research as a factor contributing to variability in motor outcomes. Furthermore, WMH severity might define neurologic subtypes, wherein structural brain reserve relates to motor outcome for individuals with extensive pre-existing damage to cerebral white matter. Our findings emphasize the importance of brain structural reserve in motor outcomes after brain injury.

OP-060

Functional profiles of 103,969 persons admitted for in-patient rehabilitation after a stroke over 14 years in Canada

A. Venturini^1,2, N. Dendukuri^3,2, N. Mayo^1,2

¹McGill University, Physical and Occupational Therapy, Montreal, Canada

²McGill University, Centre for Outcomes Research and Evaluation, Montreal, Canada

³McGill University, Medicine, Montreal, Canada

Introduction: One third of persons surviving a stroke do so with severe impairments. Organized inpatient rehabilitation minimizes dependence in daily activities but it is not readily available in Canada. About 37% of persons surviving stroke need inpatient rehabilitation but less than half are admitted. Identifying functional profiles of people with stroke admitted to inpatient rehabilitation, may help identify new pathways for improved utilization of services.

Objective: Identify the most common functional profiles (from scores on the Functional Independence Measure-FIM) for people admitted to inpatient rehabilitation.

Patients & methods: Observational study of multiple admission-to-discharge cohorts from April 2008 to March 2022 using data from the National Rehabilitation Reporting System at CIHI (Canadian Institute for Health Information). Polytomous latent class analysis was used to identify groups who at admission to inpatient rehabilitation have similar patterns of function across the domains of self-care, transfers, locomotion, bowel and bladder control, communication, social interaction, and cognition.

Results: The cohort includes 103,969 episodes of care for 98,337 different people admitted to 133 facilities across 9 provinces. Median LOS is 31 days, 42 days in 2008, 32 days in 2021. Six latent classes were observed: I dependent in all areas of functioning (24%); II dependent in all except continence (14%); III dependent in all except communication (27%); IV dependent for self-care, transfers, and locomotion (18%); V dependent for communication, social interaction, and cognition (7%); and VI independent (8%). The effect of admission year on functional profiles was negligible.

Conclusion: Despite changes to prevention and management of acute stroke, little has changed in the functional profile of persons admitted to inpatient rehabilitation across 14 years in Canada.

OP-061

Evaluating neural mechanisms of Prism-based visuomotor adaptation

O. Aloba^1,2, J. Hope², M. Muthukumar², T. Leone², T. Kesar^1,2

¹Emory University, Neuroscience, Atlanta, GA, United States

²Emory University, Rehabilitation, Atlanta, GA, United States

Background: Prism adaptation therapy (PAT) is an effective treatment to reduce Spatial Neglect (SN) and improve function post-stroke. However, neural mechanisms underlying PAT and its effects on cortical plasticity are not well-known. Non-invasive sensorimotor electrical stimulation enhances corticomotor excitability and is used as an adjunct to motor training. However, feasibility and interactive effects of electrical stimulation applied in conjunction with PAT on SN are not known.

Purpose: To evaluate the feasibility of novel spatial-motor treatment strategies that combine PAT with somatosensory stimulation, and their effects on corticospinal and intracortical excitability.

Methods: This study evaluated the effects of a single session of PAT training with somatosensory versus sham stimulation on corticomotor and intracortical excitability, and associations of these neurophysiologic effects with the magnitude of PAT-induced visuomotor behavioral adaptation in able-bodied individuals. Before and after PAT, visuospatial behavior was evaluated using pointing tasks with eyes open and closed; corticomotor and intracortical excitability were evaluated using motor-evoked potential(MEP) amplitudes from single and paired-pulse transcranial magnetic stimulation (TMS) delivered to M1.

Results: Preliminary results (N=10) show that PAT with stimulation induced a greater leftward shift in visuo-proprioceptive pointing behavior at Post versus Pre compared to PAT with sham stimulation (p= 0.0004); an increase in TMS-MEP of First Doral Interossei (FDI) (p= 0.003) and Tibialis Anterior (TA) muscles (p= 0.058). We will then evaluate paired-pulse TMS data and test hypothesis that PAT behavioral after-effects correlates with training-induced change in MEPs. Our study generates data supporting novel motor spatial retraining and combinatorial approaches to enhance the rehabilitation of SN and motor function post-stroke.

Support:NIHT32NS096050, NIHNINDS1F31NS131020 & NIHNICHD1R01HD095975

OP-062

Stroke inpatient rehabilitation environments: aligning building construction and clinical practice guidelines through care process mapping

J. P. Saa¹, R. Lipson-Smith^2,3, M. White⁴, A. Davis^5,3, T. Yang⁴, J. Wilde⁵, M. Blackburn⁶, L. Churilov⁷, J. Bernhardt³, N. Redesign³

¹Florey Institute of Neuroscience, Melbourne, Australia

²University of Western Sydney, New South Wales, Australia

³Florey Institute of Neuroscience, Melbourne, Australia

⁴Swinburne University of Technology, Melbourne, Australia

⁵University of South Australia, Adelaide, Australia

⁶Australasian Health Facility Guidelines, Australasian Health Infrastructure Alliance, New South Wales, Australia

⁷University of Melbourne, Melbourne, Australia

Background: Stroke inpatient rehabilitation is complex and important, yet the process of care is rarely fully described. Care processes interact with and depend on patient needs, staffing and equipment availability, and other resources such as the built environment. While clinical practice guidelines are developed to optimize recovery, aligning building design with care needs remains unclear.

Objective: To articulate stroke inpatient rehabilitation processes via process maps and evaluate to what extent current stroke clinical and building construction (i.e., design) guidelines align to support inpatient stroke rehabilitation.

Methods: Using the Value-Focused Process Engineering (VFPE) methodology, stroke survivors, architects, policymakers, and clinical experts collaborated to create detailed process maps describing the places and activities that typically occur in current stroke inpatient rehabilitation. Alignment between Australian Stroke Rehabilitation Guidelines and Australasian Health Facility Design Guidelines was assessed against these maps.

Results: We present a comprehensive process map for stroke inpatient rehabilitation and detailed phase-specific maps (admission, typical weekday, weekend, discharge). Integration of clinical and design guidelines revealed gaps where guidelines lack detail to be readily linked to current stroke inpatient care practice, highlighting areas for improved future stroke rehabilitation unit planning.

Conclusions: Our study describes the care process for inpatient stroke rehabilitation, highlighting areas where efficiencies and effectiveness could be optimized, and emphasizes the need for collaborative efforts between clinical and design experts to maximize guideline potential, enhancing the planning and design of future stroke rehabilitation spaces.

OP-063

Enhancing stroke inpatient rehabilitation environments: exploring design options and their impact on the stroke care process

J. P. Saa¹, R. Lipson-Smith^2,3, M. White⁴, A. Davis^5,3, T. Yang⁴, J. Wilde⁵, M. Blackburn⁶, L. Churilov⁷, J. Bernhardt³, N. R. Collaboration³

¹Florey Institute of Neuroscience, Melbourne, Australia

²University of Western Sydney, New South Wales, Australia

³Florey Institute of Neuroscience, Melbourne, Australia

⁴Swinburne University of Technology, Melbourne, Australia

⁵University of South Australia, Adelaide, Australia

⁶Australasian Health Facility Guidelines, Australasian Health Infrastructure Alliance, New South Wales, Australia

⁷University of Melbourne, Melbourne, Australia

Background: Hospital design and the built environment significantly influence the experience and outcomes of healthcare. Aligning clinical practice and building design guidelines is crucial for optimizing stroke recovery outcomes. Understanding the potential impact of various design options is essential for creating effective rehabilitation facilities.

Objective: Our study aimed to evaluate the impact of four distinct stroke inpatient facility design options, integrating clinical and building design guidelines, as well as input from individuals with lived experience of stroke.

Methods: Using Value-Focused Process Engineering (VFPE), we identified areas within the existing stroke inpatient rehabilitation care process that clinicians and stroke survivors identified for improvement. Four inpatient ward options were created in virtual reality, based on suggested improvements. These options were evaluated against seven fundamental objectives crucial for rehabilitation spaces.

Results: Our study presents four virtual reality-based stroke inpatient ward options, depicting active areas within stroke rehabilitation units, including outdoor spaces, spaces for gym activities, unit mobility, and leisure time.

Conclusion: Our findings underscore potential changes essential for optimizing stroke inpatient rehabilitation units to better fulfill fundamental objectives. These insights serve as a guide for clinical and design experts to enhance stroke recovery based on evidence-based practices.

OP-064

International recommendations for early mobility training after mild-moderate intracerebral haemorrhage – outcomes from the Protocols for Early Mobility Training team (PEMTeam)

E. Ramage^1,2, R. Lipson-Smith^1,3, J. Baggio⁴, A. E. Dahl⁵, L. Churilov⁶, C. Delcourt^7,8,9, S. Dorsch^10,11, G. Edmonds¹², D. Gandhi¹³, M. Hiddleson¹⁴, M. Hindson¹⁵, L. N. Inche Mat¹⁶, H. Kavanagh^17,18, C. Lin^19,20, T. Lio²¹, I. Maso²², L. Miranda²³, A. Mullens²⁴, B. Parsons¹, B. Silver²⁵, L. Suttie²⁶, S. Thilarajah^27,28, T. Ullberg^29,30, W. Z. Wan Asyraf³¹, M. Weir McDonnell³², J. Bernhardt¹

¹Florey Institute of Neuroscience, Heidelberg, Australia

²Western Health, Melbourne, Australia

³University of Western Sydney, The MARCS Institute for Brain, Behaviour and Development, Sydeny, Australia

⁴Federal University of Alagoas, Medicine, Arapiraca, Alagoas, Brazil

⁵Trondheim University Hospital, Trondheim, Norway

⁶University of Melbourne, Parkville, Australia

⁷The George Institute for Global Health, Sydney, Australia

⁸University of New South Wales, Sydney, Australia

⁹Macquarie University, Macquarie Park, Australia

¹⁰ACU, Sydney, Australia

¹¹StrokeEd Collaboration, Sydney, Australia

¹²Fiona Stanley Hospital, Murdoch, Australia

¹³Christian Medical College & Hospital, Ludhiana, India

¹⁴Barwon Health, Geelong, Australia

¹⁵Austin Health, Heidelberg, Australia

¹⁶Putra University, Putra, Malaysia

¹⁷St James’ Hospital, Dublin, Ireland

¹⁸Clinical Design & Innovation Heal Service Executive, Dublin, Ireland

¹⁹University of Alabama, Birmingham, AL, United States

²⁰Birmingham VA Medical Center, Birmingham, AL, United States

²¹St John of God Midland Public and Private Hospitals, Midland, Australia

²²Roberto Santos General Hospital, Stroke Unit, Salvador, Brazil

²³São Paulo State University, Botucatu, Brazil

²⁴Consumer Partner, Sydney, Australia

²⁵UMass Chan Medical School, Worcester, MA, United States

²⁶Consumer Partner, Melbourne, Australia

²⁷Singapore Institute of Technology, Singapore, Singapore

²⁸Singapore General Hospital, Singapore, Singapore

²⁹Lund University, Malmö, Sweden

³⁰Skane University Hospital Lund, Malmö, Sweden

³¹Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan, Kuala Lumpur, Malaysia

³²Saolta University Health Care Group, Mayo University Hospital, Castlebar, Ireland

Background: There are currently no early mobility trials for ICH investigating early mobility training after intracerebral haemorrhage (ICH). AVERT (III), the largest international rehabilitation trial in stroke identified that too much training, too early can worsen clinical outcomes in this population. There is a need for safe and effective early mobility training protocols specifically for clinicians managing patients with acute intracerebral haemorrhage (ICH).

Aim: Combining best evidence and expert judgment, we aimed to develop a "living" ICH early mobility training protocol for subsequent implementation and testing.

Method: A collaboration of stroke experts from 9 countries (low-middle- and high-income settings) developed the protocol using a Value Focused Thinking methodology over a series of iterative workshops. Stage 1: identify the fundamental objectives and key requirements of an optimal protocol for early mobility training after stroke. Stage 2: identify key factors for early mobility decision-making.

Results: Three survivors of stroke, three researchers, six neurologists, 12 physiotherapists and two nurses collaborated through the workshops. Maximising recovery, patient, and family engagement, and the ability to deliver appropriate care were identified as fundamentally important for early mobility training (stage 1). Blood pressure, oxygen saturation, cerebral perfusion pressure, consciousness, agitation, stroke severity, acute interventions, imaging, palliative status, patient appearance and time post-event were identified for incorporation into a decision matrix for initiation and suspension of early mobility training after ICH (stage 2).

Conclusion: Our living protocol built with clinical and patient expertise and best evidence aims to meet current demand. The next steps will be to implement, monitor and refine the protocol in real-world settings.

OP-065

Discrepancy between upper limb capacity and performance after stroke: what is the impact of cognition?

J. Veerbeek¹, A. Van de Winckel², B. Ottiger¹, D. Cazzoli^1,3, T. Nyffeler^1,3,4, T. Vanbellingen^1,3

¹Luzerner Kantonsspital, Neurocenter, Lucerne, Switzerland

²University of Minnesota, Physical Therapy, Minneapolis, MN, United States

³University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Switzerland

⁴University of Bern, Neurology, Bern, Switzerland

Background: The newly developed and Rasch-validated Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale (UL-LIMOS) is a performance-based measure in which the multidisciplinary team rates the stroke patient"s upper limb use in a daily clinical setting (i.e., "upper limb performance"). It allows investigating whether patients use their upper limb motor capacity in daily life, and which factors impact (not fully) exploited capacity in daily life.

Objectives: To determine how many stroke patients have poor daily life upper limb performance despite having a mild upper limb motor impairment. To investigate the impact of global cognitive impairment, apraxia, and spatial neglect on this discrepancy.

Patients & methods: We analyzed prospective data from subacute stroke patients at admission to an inpatient neurorehabilitation. We assessed upper limb performance with the UL-LIMOS; upper limb motor impairment (i.e., capacity) with the Fugl-Meyer Assessment subscale; global cognitive impairment with the Montreal Cognitive Assessment; apraxia with the Apraxia Screen of TULIA, and neglect with the Catherine Bergego Scale. We used a Mann-Whitney U test to evaluate differences between groups with and without capacity and performance discrepancy.

Results: Of the 211 patients, 131 had mild upper limb motor impairments, and 88 of them showed a discrepancy reflected by poor daily life upper limb performance. Patients exhibiting a discrepancy had a lower global cognitive function (p=0.007), more impaired praxis (p=0.002), and more impaired visual-spatial function (p=0.005) than those without a discrepancy.

Conclusion: Cognitive impairments (i.e., global cognitive function, apraxia, neglect) seem to play a role in exhibiting poor upper limb performance in daily life with the affected limb, even when having only a mild upper limb paresis after stroke. We recommend future studies on investigating the impact of cognitive factors on daily life functioning in adults with stroke.

OP-066

Lateropulsion resolution and outcomes up to one year post-stroke: a prospective, longitudinal cohort study

J. Nolan¹, E. Godecke^1,2, A. Jacques¹, B. Singer²

¹University of Notre Dame Australia, Fremantle, Australia

²Edith Cowan University, Joondalup, Australia

Introduction: Post-stroke lateropulsion is prevalent and characterised by an active push of the body toward the more affected side and/or active resistance to weight acceptance onto the less affected side. Data are lacking regarding long-term persistence of post-stroke lateropulsion and long-term functional outcomes of affected people.

Objectives: This study aimed to explore lateropulsion resolution and associations between lateropulsion, functional outcomes and falls occurrence up to one year post-stroke.

Methods: Participants for this prospective, longitudinal cohort study were recruited from a Stroke Rehabilitation Unit (SRU). Assessments were conducted at SRU admission and discharge and at three, six, nine, and twelve months post-stroke. Outcomes included the Four-Point Pusher Score (4PPS), Functional Independence Measure (FIM), mobility status (ordinal scale) and fall occurrence.

Results: The final analyses included data from 144 participants. Eighty-two participants (56.9%) had lateropulsion (4PPS≥1) on admission. Odds of resolved lateropulsion (4PPS=0) increased longitudinally from discharge for people who participated in rehabilitation physiotherapy (OR: 9.7, 28.1, 43.1, 81.3 - p<0.001 at three, six, nine and 12 months respectively). The greatest FIM improvement across all 4PPS categories occurred during the SRU inpatient phase. The probability of falls post-discharge was greatest among participants with 4PPS=1 at three months, when compared with 4PPS=0 (p=0.022).

Conclusion: This study showed that lateropulsion can continue to resolve up to one year post-stroke. Earlier lateropulsion resolution was associated with ongoing rehabilitation physiotherapy participation. Findings have implications for long-term resource allocation to meet the rehabilitation needs of people with lateropulsion. Future large prospective trials investigating long-term lateropulsion resolution associated with defined rehabilitation strategies, doses and durations, are recommended.

OP-067

Cost-effiectiveness analysis of the use of wearable robotic exoskeletons for rehabilitation post-stroke and spinal cord injury in Singapore

E. Chew^1,2, R. Shankar², E. Wong¹, H. S. Lai¹, N. Tang¹

¹National University Hospital, Singapore, Singapore

²Alexandra Hospital, Singapore, Singapore

Background: Wearable robotic exoskeletons (WRE) have been shown to be effective to improve odds of independent after stroke and spinal cord injury (SCI), particularly in the early stages of rehabilitation. However, the cost-effectiveness of this intervention compared to conventional physiotherapy is unclear. We evaluated the effectiveness of adopting WRE across multiple rehabilitation settings across Singapore - from tertiary rehabilitation centres, to community hospitals and community day rehabilitation centres, and the cost-effectiveness of such a programme.

Method: This was a prospective non-randomised controlled study comparing participants with neurological conditions including stroke and SCI, who underwent 12 sessions of therapy which included use of WRE vs those who underwent conventional gait rehabilitation. A Markov decision-analytic modelling was conducted to estimate costs and outcomes from the perspective of the healthcare system. Participants were stratified according to acute (<1 month), subacute (1-9 months) and chronic (>9 months) phases post- stroke and SCI. The quality-adjusted life years (QALY) and incremental cost-effectiveness ratio (ICER) for each group were calculated.

Results: We recruited a total of 252 stroke and 72 spinal cord injured participants and 27 with other neurological conditions; 111 in the acute phase, 110 in the subacute phase and 130 in the chronic phase. The cost-effectiveness analysis revealed ICER of SGD16,671 and and SGD22,708 for the acute and subacute phase post-stroke respectively and SGD 24,650 and SGD 57,653 in the acute and subacute phases post-SCI respectively.

Conclusion: Incorporating WRE into rehabilitation of stroke and SCI rehabilitation programmes is cost-effective in the acute/ subacute stages, leads to higher QALY gains and improved patient-perceived health. Future research should explore longer term outcomes and broader societal implications to inform policy decisions.

OP-069

Constraint induced therapy: lessons learned from 35 years of research development and future implications

D. Morris¹, S. Dos Anjos¹, M. Bowman¹

¹University of Alabama, Physical Therapy, Birmingham, AL, United States

Introduction: Constraint Induced (CI) Therapy is an efficacious form of rehabilitation that targets both capacity and performance by overcoming learned nonuse and producing beneficial neuroplastic change. It was derived from basic research with monkeys and clinical research with humans. CI Therapy has 3 main components: 1) intensive training of an impaired function, 2) a "transfer package" of techniques to promote transfer from the clinic to life situation, and 3) constraining use of an impaired function. Since introduced 35 years ago, the approach has continued to be refined and has been tailored to a variety of functions and has been applied with a wide range of patient groups. Hundreds of publications have detailed scientific investigations of the approach. This body of work has led to important lessons that extend beyond the use of the specific CI therapy protocol including the importance of: 1) using concentrated, massed delivery of structured practice, 2) using structured behavioral management strategies in rehabilitation, and 3) emphasizing performance skills during activities in patients" home and community environment as part of interventions and outcome assessment. This presentation will address the origin and progression of CI therapy research and clinical application, critical lessons learned from this work, future research aims and implications for all forms of neurorehabilitation.

Objectives: Describe the theoretical basis and signature elements of CI therapy protocols. Discuss important lessons, coming from CI therapy research, that have shaped contemporary neurorehabilitation practice. Propose future research needs.

Conclusion: CI therapy research has had a tremendous impact on neurorehabilitation for multiple functional skills and patient populations. Further research will enhance our understanding of CI therapy principles and promote refinement of the protocol for improved application of the approach.

OP-070

Intermittent theta burst stimulation modulates mirror visual feedback for hemiplegic upper limb recovery after stroke

K. Fong¹, J. J. Zhang¹, G. Kranz¹, C. Y. Wu¹, G. K. Lau¹

¹Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

Introduction: Theta burst stimulation (TBS) and mirror visual feedback (MVF) reduce interhemispheric asymmetry in both hemispheres, which leads to motor recovery after stroke.

Objective: To investigate the modulatory effects of intermittent TBS (iTBS) with MVF in mirror therapy (MT) on hemiplegic upper extremity motor recovery and neurophysiological outcomes in patients with stroke.

Patients & methods: In this randomized controlled trial, 36 patients with chronic stroke were enrolled and randomly assigned to one of three groups: iTBS with MT, sham iTBS with MT, and iTBS with bilateral arm training (BAT). Outcomes included Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT), and sensorimotor beta event-related desynchronization (ERD) induced by MVF.

Results: There was a significant time-by-group interaction effect in the FMA-UE hand sub-scores (F = 2.49, P = 0.042). Post hoc analyses showed that patients who received iTBS with MT or BAT demonstrated greater improvements in the FMA-UE hand sub-scores at the one-month follow-up, in contrast to those who received sham iTBS with MT (P = 0.043 and 0.012, respectively). Among patients with lower upper limb functioning, iTBS with MT yielded a greater improvement in the FMA-UE total scores than the sham iTBS with MT after the first session (P = 0.014), the 10th session (P = 0.025), and at one-month follow-up (P = 0.005). EEG findings showed that iTBS with MT, but not the other two protocols, enhanced the beta ERD over the ipsilesional sensorimotor area.

Conclusion: iTBS combined with MT or BAT is superior to sham iTBS combined with MT in regard to improving the distal functions of hemiplegic upper extremity in patients with chronic stroke. The effects were still superior at the one-month follow-up. Moreover, iTBS combined with MT appears to prime the ipsilesional motor cortex to be more receptive to MVF, achieving interhemispheric symmetry for motor recovery.

OP-071

Increasing lateral weight shift may not improve biomechanics of walking after complex brain injury

S. Mills ¹

¹South Australia Health, SA Brain Injury Rehabilitation Service, Adelaide, Australia

Introduction: Recovering walking is the highest priority for people with impaired mobility after brain injury. Increasing lateral weight shift is often considered a priority during walking training after brain injury. However, the biomechanical changes during weight shift have not been clearly described.

Objective: To compare frontal plane weight shift between left stance and right stance during walking, in healthy adults and adults after brain injury.

Materials & methods: Three-dimensional kinematic data were recorded during walking in 30 healthy adults and 10 adults who recovered walking using rails after three months post-brain injury, with 9 able to walk unaided. Upper body segment and foot positions were defined at left and right mid-stance. Lateral weight shift was quantified as displacements of head, trunk and pelvis between left and right mid-stance in the frontal plane. Mann-Whitney U tests evaluated differences between the two groups. Body segment positions were graphed for visual analysis.

Results: Lateral displacements of head, thorax and pelvis between left and right mid-stance, and step width, were significantly greater in adults after brain injury (p= <0.001 – 0.005), except for pelvis when walking with rails (p=0.105). Graphs of body segment positions demonstrated marked differences in mid-stance alignment between the two groups. While healthy adults maintained consistent alignment of head, thorax and pelvis between the feet during walking, alignment varied markedly after brain injury.

Conclusion: Lateral displacement of upper body segments was greater in adults with brain injury, suggesting that biomechanics may not improve by increasing lateral weight shift. Alignment of body segments differed markedly after brain injury, suggesting that changes in alignment may be affecting biomechanics of weight shift. Greater step width appears to be one factor influencing increased lateral displacement of upper body segments after brain injury.

OP-072

Rehabilitation needs in patients with neuroinvasive West Nile Virus infection: a retrospective evaluation

M. C. Maccarone¹, F. Piccione¹, N. Faccin¹, L. Barzon^2,3, S. Masiero¹

¹University of Padua, Neurorehabilitation, Padua, Italy

²University of Padua, Microbiology and Virology Unit, Padua, Italy

³University of Padua, Department of Molecular Medicine, Padua, Italy

Introduction: West Nile Virus (WNV), an arthropod-transmitted virus, caused 588 reported cases in Italy in 2022, inducing varying degrees of acute illness with neuroinvasive manifestations such as meningitis, encephalitis, and acute flaccid paralysis. These infections often lead to lasting cognitive and motor sequelae, impairing autonomy. However, existing literature lacks a comprehensive exploration of patient characteristics and rehabilitation needs.

Objectives: This study aims to identify the rehabilitation needs of WNV-affected individuals and to explore post-discharge rehabilitation settings.

Materials & methods: Our retrospective analysis includes 29 patients diagnosed with WNV in 2022, who underwent a physiatrist evaluation during hospitalization. We examined demographic characteristics, comorbidities, discharge diagnosis, and the presence of sensory, muscle, swallowing, or respiratory deficits, along with Barthel Index scores and discharge destinations.

Results: In our study, most patients were diagnosed with WNV meningitis or encephalitis at discharge, with four cases associated with acute flaccid paralysis. Common comorbidities included hypertension, vascular disease, type 2 diabetes, cancer, and ischemic cardiopathy. Approximately half of the patients exhibited muscular tone alterations, while dysphagia and respiratory issues were observed in a subset. Barthel Index scores declined from 30 at admission to 20 at discharge, and discharge destinations varied, with 58% returning home, 25% to other hospital facilities, and 17% to rehabilitation facilities.

Conclusion: The study highlights prevalent neuromuscular and motor deficits in WNV patients, with some individuals experiencing swallowing and respiratory issues, emphasizing the need for comprehensive rehabilitation interventions extending beyond the hospital stay into the post-acute phase. Further research is needed to delineate specific intervention approaches tailored to these patients.

OP-073

Enhancing stroke recovery through transcutaneous auricular vagus nerve stimulation: a novel approach to improving walking and balance

A. Gerges¹, B. Hordacre¹, S. Hillier¹, J. Uy¹, T. Hamilton², S. Chamberlain¹

¹University of South Australia, Adelaide, Australia

²University of Western Australia, Perth, Australia

Introduction: Stroke is a major contributor to long-term disability globally, necessitating innovative interventions for improved functional recovery. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a promising approach for promoting neural plasticity and facilitating motor rehabilitation.

Objective: This study explores the feasibility and safety of taVNS as a novel therapeutic strategy to enhance walking and balance post-stroke.

Methods: A randomised double-blind sham-control trial was conducted with individuals aged ≥ 18 years who have chronic stroke. Participants were randomly assigned to either active or sham taVNS groups, receiving standard rehabilitation interventions concurrently with taVNS. The primary outcome was feasibility and safety, while secondary outcomes included walking speed, balance assessments, and functional mobility tests. Assessments were performed at baseline, post-intervention, and follow-up.

Results: We are reporting preliminary data analysis, with the study expected to conclude in April 2024. Fourteen of the 15 eligible volunteers consented to participate, and 13 (9 active and 5 sham taVNS) completed the study. Ninety-three percent of participants found the intervention helpful, and all considered it acceptable. Blinding was effective in 61% of participants. Mild adverse events were reported in 23% of participants including headaches, and pain/irritation at electrode site. Both sham and active groups showed improvements in gait speed, endurance, and balance post intervention. Interestingly, at follow-up (≥ 30 days) these improvements were more preserved in the active group.

Conclusion: Preliminary findings indicate that taVNS is a feasible and safe adjunctive therapy for enhancing balance and gait in chronic stroke. If proven effective, this non-invasive and well-tolerated intervention could offer a cost-effective and easily applicable method to enhance walking and balance recovery after stroke.

OP-074

Bilateral proximal arm transplantation: functional results at three years

L. Huchon^1,2, A. Gazarian³, L. Badet⁴, E. Morelon⁵, K. T. Reilly², S. Mateo^1,2, S. Lahlali³, P. Petruzzo⁴, G. Rode^1,2

¹Lyon Civil Hospitals, Physical Therapy and Rehabilitation, Saint-Genis-Laval, France

²Neuroscience Research Center, Team Trajectoires, Lyon, France

³Lyon Civil Hospitals, Upper limb orthopedic surgery, Hôpital Edouart Herriot, Lyon, France

⁴Lyon Civil Hospitals, Urology and transplantation surgery, Hôpital Edouart Herriot, Lyon, France

⁵Lyon Civil Hospitals, Transplantation, nephrology and clinical immunology, Hôpital Edouart Herriot, Lyon, France

Introduction: 21 years after the world"s first bilateral hand transplantation, the first very proximal bilateral arm transplantation, was performed on January 2021 in Lyon (France).

Objective: To report the functional results of this transplantation at 3 years.

Patient & methods: The recipient was a 48-year-old man with bilateral proximal upper-limb amputation 23 years earlier. The surgical procedure consisted of a total arms transplantation, including reconstruction of the gleno-humeral joint on the left side. Nerve repair on the right occurred at the proximal nerve level and on the left at the secondary trunk of the axillary plexus. Rehabilitation included lymphatic drainage, passive and active motion of joints, muscular electrostimulation, hand therapy, physiotherapy, occupational therapy, psychomotricity, physical activities, visuomotor training approaches (motor imagery, virtual mirror therapy, virtual reality).

Results: Patient experienced several episodes of acute rejection and infectious complications due to immunosuppression. 36 months after the procedure, he is in good general condition. The passive range of motion of both upper limbs is subnormal. Muscles strength range from 3 to 4/5 according to the MRC scale on the right , and from 1 to 4/5 on the left, except the intrinsic hand muscles which are 0/5. The patient feels the 4.56 Semmes-Weinstein monofilament on his right hand and the 6.65 on his left hand. 15 mm two-point static discrimination is present on some distal phalanges. The patient can perform manual prehension for small and light objects, with both hands, and uses mono or bi-manual prehensions in daily life activities. His capacities are better for all his main functional objectives, he is satisfied with his arms, and his quality of life and body image are greatly improved.

Conclusion: Bilateral proximal arm transplantation is feasible and valuable for restoring body image, quality of life and some arm function in bilateral arm amputees.

OP-075

Development of a multi-sensor approach to examine heart rate response to free-living walking: a launch point to clinical application

F. E. Godkin¹, B. F. Cornish¹, K. S. Weber¹, K. B. Beyer¹, S. Thomson¹, C. L. Pollock², K. Van Ooteghem¹, W. E. McIlroy¹

¹University of Waterloo, Kinesiology, Waterloo, Canada

²University of British Columbia, Physical Therapy, Vancouver, Canada

Introduction: Walking is commonly prescribed during rehabilitation. Accurate remote measurement of daily life walking intensity can guide therapeutic decisions. Our previous work revealed that conventional activity estimation via wrist-worn accelerometry is prone to misclassifying real-world walking intensity. A multi-sensor approach, including ECG and activity monitoring, has potential to measure free-living resting heart rate (RHR) and walking-related HR change as an index of cardiovascular demand, which may improve the utility of wearables for clinical prescription.

Objectives: To 1) develop a standardized multi-sensor approach to enable quantification of context-specific cardiovascular demand, and 2) utilize this approach to specifically examine walking-related changes in HR across a week-long period.

Participants & methods: Ten healthy adults (9 female, 61±12y) wore a wrist and ankle IMU and chest-mounted ECG for 7-10 days as part of a study that also included individuals post-stroke and with Parkinson"s disease. Walking was detected from ankle data (periods ≥ 60s included). ECG-derived beat-to-beat HR was analyzed using a 15s rolling average. RHR was estimated from 5th percentile of HR values during wrist-detected sleep. Walking-related HR change was based on median HR during walking periods minus RHR, and intensity estimated based on percentage of heart rate reserve (%HRR).

Results: Data are presented as mean±SD (range). Participants had 69±54 (17-169) walking periods, at a cadence of 110±6 (99-119) steps/min. The per-participant median HR across walking periods was 100±12 (75-116) bpm and was 44±12 (21-65) bpm higher than RHR (55±7 (44-64) bpm), representing an intensity of 43±11 (21-56) %HRR.

Conclusion: The use of a multi-sensor approach to measure cardiovascular demand has revealed considerable variability in activity-specific HR responses. Understanding this variability is critical to use of wearable sensors for remote monitoring in clinical cohorts.

OP-076

Investigating the user experiences of stroke survivors and physiotherapists with an omnidirectional treadmill-based virtual reality rehabilitation game: protocol for a mixed-methods feasibility study

A. Quigley^1,2, M. Barrera Machuca³, C. L. Pollock⁴, A. Lamontagne⁵, H. Neyedli⁶, A. McDonald², M. Dunlop², J. Eng⁴

¹Dalhousie University, Physiotherapy, Halifax, Canada

²Nova Scotia Health Authority, Halifax, Canada

³Dalhousie University, Computer Science, Halifax, Canada

⁴University of British Columbia, Physical Therapy, Vancouver, Canada

⁵McGill University, Montreal, Canada

⁶Dalhousie University, Health and Human Performance, Halifax, Canada

Introduction: Regaining the ability to walk is a key priority for stroke survivors, but to be able to walk safely in the community, one needs to manage dual tasks, irregular terrain, inclines, and obstacles, and distractions. Virtual reality (VR) is a promising rehabilitation modality that could promote improvements in walking and balance. Recently, omnidirectional treadmills that allow for movement in all directions and are compatible with virtual reality (omni-VR) technology have become available. Omni-VR provides a real-world walking experience while safely challenging task-oriented exercises. However, user experiences and preferences of stroke survivors and physiotherapists (PTs) are missing from the literature.

Objectives: Our primary aim is to develop and estimate the feasibility and usability of a rehabilitation omni-VR game from the perspective of chronic stroke survivors and PTs. Secondary objectives: 1. Generate preliminary walking ability and balance data among stroke survivors using the omni-VR system. 2. Determine the exercise dose (step counts, intensity, duration) of the VR game.

Patients & methods: We will recruit 12 stroke survivors and 4 PTs from rehabilitation facilities, clinics, and stroke recovery clubs in Halifax, Nova Scotia. Participants will test the rehabilitation game consisting of dynamic balance and walking activities, followed by a qualitative interview.

Results: We will capture feasibility outcomes (recruitment rate, participant burden, technology issues, adverse events) and user experiences (System Usability Scale and Virtual Reality Neurosciences Questionnaire). Interview questions will include experiences using the omni-VR system, barriers and facilitators, and recommendations for a future randomized controlled trial. We will obtain preliminary walking ability, balance, and exercise dose data.

Conclusion: If successful, we will test the use of omni-VR technology for improving walking and balance using a randomized controlled trial.

OP-077

iAssessments: a user-friendly digital ecosystem of clinical assessments for neurorehabilitation

C. Easthope Awai ¹

¹Lake Lucerne Institute, DARTLab, Vitznau, Switzerland

Introduction: Clinical assessments are deeply engrained in the fabric of neurorehabilitation. They inform on recovery prediction, structural, functional, and participatory health status, and provide anchors for therapy decisions. However, assessment data frequently remains siloed in spreadsheets and is highly dependent on training of the assessment teams.

Objectives: We address this gap by proposing the iAssessments, an ecosystem of digital assessments that exchange data and provide centralized analysis and visualization while reducing time of administration.

Patients & methods: iAssessments are digitally enhanced versions of standard clinical assessments, such as the ARAT, Box and Block, 6MWT, etc. They capture clinical outcomes as well as sensor outcomes, such as kinematics, or voice patterns. Each individual iAssessment is developed according to user centered design principles, incorporating stakeholder feedback from the beginning of the design process. We have extensively tested the core iAssessments (ARAT, Activity monitoring) across >50 patients with stroke and Parkinson"s disease within our test center.

Results: Compared to a traditional assessment regime with analog data collection, we demonstrate reduced time for assessment and documentation, increased assessment team productivity, reduced test variability, and integration of data visualization into clinical decision making.

Conclusion: A digital ecosystem of clinical assessments is an easily implementable and powerful adjuvant to therapy decision making.

OP-078

Telehealth self-management support in early stroke rehabilitation: a feasibility randomized controlled trial

D. Lee¹, H. Fischer², B. Yang¹, J. Tingey¹, C. Bombardier¹

¹University of Washington, Rehabilitation, Seattle, WA, United States

²University of Illinois, Occupational Therapy, Chicago, IL, United States

Introduction: Skills to manage the chronic effect of stroke are often not sufficiently addressed in early stroke rehabilitation.

Objectives: The study evaluated the feasibility of conducting a randomized controlled trial testing the efficacy of telehealth self-management support early in stroke recovery.

Patients & methods: Using convenience sampling, first-time stroke patients with a mild stroke were recruited at a Level 1 Stroke Center inpatient rehabilitation unit and randomized into an intervention or treatment-as-usual group. The intervention group participated in five, 30-minute motivational interviewing sessions delivered in person and over phone by a rehabilitation psychologist and a weekly, 6-session, group-based self-management program, called Improving Participation After Stroke Self-management program (IPASS), delivered by an occupational therapist and stroke survivor via Zoom. Feasibility of the process (recruitment, data collection, intervention), resources (supports provided to participants), and scientific impact (preliminary efficacy on health, perceived recovery, self-efficacy, life participation) was assessed using logs, questionnaires, and focus groups. Data were analyzed using descriptive statistics, effect sizes, and thematic analysis.

Results: Fifteen stroke patients were enrolled, and 10 completed the study (intervention n = 6). 100% attendance was achieved with technical support, reminders, and schedule flexibility. Participants were satisfied with the structure, content, and timing of the intervention and reported emotional benefits and gain of new insights. Perceived recovery showed moderate effect (r = 0.54).

Conclusion: The findings support the feasibility of a larger efficacy trial. While preliminary, participant satisfaction and positive effects indicate the importance of integrating self-management interventions early on in stroke rehabilitation to support patients" transition into poststroke community reintegration.

OP-079

The use of markerless motion capture (MMC) system and machine learning for kinematic assessment in patients with stroke

W. T. Lam¹, K. Fong¹

¹Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

Introduction: The use of markerless motion capture (MMC) system in telerehabilitation for patients with stroke offers a convenient approach to remotely monitor and assess their movements without the need for physical markers, enabling accurate tracking of their motor recovery progress and improve their accessibility to remote rehabilitation services.

Objectives: This study investigated the ability of a customized MMC system that used iPad Pros with a LiDAR scanner to measure the angular waveform of the upper and lower limb joint angles of patients with stroke of different functional levels when performing functional tasks. The kinematic data of the hemiplegic and non-hemiplegic side of the patients were compared and evaluated with the results of the functional assessment. Machine learning models were also used to classify the patients to different functional levels based on the kinematic information.

Patients & methods: 50 patients with stroke (mean age: 60.5, M/F ratio: 40/60) between level 3 to level 7 of The Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK) were included. 12 sets of movement extracted from tasks in four standardize assessments performed by their unaffected side followed by their hemiplegic side were captured by our MMC system.

Results: Correlations were found between the kinematic during the motor tasks and the difference in function levels. The machine learning models can classify the patients" functional levels based on the kinematic information with more than 80% of specificity and sensitivity.

Conclusion: These preliminary findings offer insight into the use of MMC system in mobile tablet for evaluating the motor function of patients with stroke. The machine learning system might further help to identify the functional level of the patients which allow the therapists to better monitor the rehabilitation progress of the motor recovery of the patients remotely.

OP-080

Adaptation of emotional state and standing balance measures after repeated exposure to a virtual postural threat during quiet standing

X. Zhang¹, M. Carpenter¹

¹University of British Columbia, Kinesiology, Vancouver, Canada

This study explores the connection between changes in emotional states and standing balance following repeated exposure to virtual postural threats using Virtual Reality (VR). Certain changes to standing balance are more strongly associated with the emotional response to threat. VR has proven to be useful for studying threat-related postural control changes associated with fear and anxiety. However, the relationship between the changes in emotional states and standing balance after repeated exposure to a virtual postural threat is unknown. Individuals wore a head-mounted display (HMD) to experience standing at low and high heights within a virtual lab environment. Five wearable motion trackers were used to provide a first-person view of their avatar"s real-time movement to improve the sense of presence. Twenty-nine young adults completed seven consecutive 90s standing trials at virtual HIGH height (3.2 m). Three 90s standing trials were performed at virtual LOW height (0.8 m) before and after the HIGH height condition. The emotional state was assessed using self-report and electrodermal activity measures, and balance was assessed using forceplate-derived center of pressure (COP). The emotional response of individuals increased significantly during the first high trial and decreased during subsequent trials. During the first high trial, individuals demonstrated a higher mean power frequency of COP adjustments, which decreased to the baseline at the end of the high trials. The results suggest that some standing balance changes are associated with the attenuation of emotional states in VR. Based on preliminary data, it appears that, on average, individuals required 3 to 4 repeated exposure trials at the virtual HIGH condition before emotional responses adapted to near baseline levels. The study enhances our understanding of how emotions, virtual environments, and postural control interact and provides important insight into the time-course of virtual height adaptation.

OP-081

Examining the validity of wrist-based heart rate monitor across different skin tones

S. Hung^1,2, K. Rey¹, G. Rosenthal¹, A. Ng¹, J. Liu¹, N. Akbarali¹, J. Eng^1,2

¹University of British Columbia, Physical Therapy, Vancouver, Canada

²The Centre for Aging SMART, Rehabilitation, Vancouver, Canada

Introduction: Exercise at higher heart rate (HR) intensities is recommended for people with neurological diagnoses to promote neuroplasticity and reduce cardiovascular disease risk. As such, wrist-based HR monitors are increasingly used in neurorehabilitation settings. However, there is conflicting evidence suggesting lower HR measurement accuracy in people with darker skin tones, posing an equality and equity concern for healthcare delivery.

Objectives: To examine the validity of wrist-based HR monitors across different skin tones.

Materials & methods: Twenty-five healthy participants <50 years old without cardiovascular health conditions were recruited. The Fitbit Charge 5 was tested against the Polar H10 chest strap (gold standard). Three skin tones groups were categorized using the Fitzpatrick Scale (FS) as light (FS 1+2), medium (FS 3+4), and dark (FS 5+6). HR was sampled at rest and 1-minute intervals during the YMCA submaximal exercise test. HRs were categorized as resting, <40%, 40-60%, and >60% HR reserve (HRR). Lin"s Concordance Correlation Coefficient (LCCC) tested the agreement between the Fitbit and Polar H10 at rest. Linear mixed-effects models tested the interaction effects of HR intensity and skin tones on absolute error (AE, bpm) of HR during exercise.

Results: Resting HR had acceptable agreement for all skin tones (LCCC: 0.89 to 0.97; mean AE: 2.11 to 3.00). However, interaction effects were observed in medium skin tone and >60% HRR (AE: 7.6, 95%CI: 1.7 to 13.5, p=0.011), and dark skin tones and 40-60% HRR (AE: 11.8, 95%CI: 5.6 to 17.9, p<0.001) and >60% HRR (AE: 11.7, 95%CI: 5.3 to 18.0, p<0.001).

Conclusion: Darker skin tones were associated with greater error at increasing HR intensities compared with lighter skin tones. Thorough testing of wrist-based monitors across different skin tones is warranted before implementing in clinical neurorehabilitation settings.

OP-082

Therapists and stroke patients’ perspectives on videoconferencing and computer devices for delivery of virtual rehabilitation

I. Rash¹, W. Miller¹, B. Mortenson¹, A. Tang², B. M. Sakakibara¹

¹University of British Columbia, Vancouver, Canada

²McMaster University, Hamilton, Canada

Introduction: The use of virtual rehabilitation for stroke recovery is increasingly being used since the COVID-19 pandemic. Video-conferencing platforms (e.g., Zoom, Teams) used on different existing computer devices (e.g., laptops, mobile devices) may influence the delivery and reception of virtual rehabilitation by therapists and patients, respectively.

Objectives: To explore perspectives on videoconferencing and computers used for virtual rehabilitation among people who have had a stroke and therapists.

Patients & methods: This qualitative study used semi-structured interviews with 15 people who had a stroke and nine physical therapists who previously participated in or delivered virtual rehabilitation. The data were analyzed thematically.

Results: Analysis of data from therapists 54 (12) (mean age (SD)) and people who had a stroke 67 (9) (mean age (SD)), most with moderate disability and a functional comorbidity index of three, revealed three themes: 1) Advancing Virtual Rehabilitation, 2) Empowering Choice for Virtual Rehabilitation, and 3) Navigating Patients" Independence. Theme 1 explored a safety perception gap, potential ways to enhance safety, challenges with current technology setups and possible solutions, and the demand for accessible technology. Theme 2 identified the desire for life-like interactions, personalization, and access to rehabilitation. Theme 3 discovered an appreciation for guidance, struggles, and successes with independent exercising and a need for continued support.

Conclusion: This study provides valuable new insight into addressing safety, the technology setup, and how to target and support the patient more effectively during and after virtual rehabilitation.

OP-083

Factors influencing stroke survivor experiences and adherence to telehealth delivery of constraint induced movement therapy programs: the ReCITE study

L. Christie^1,2, N. Fearn^1,2, A. Kilkenny³, C. Shiner^4,5, A. McCluskey^6,7, N. A. Lannin^8,9, J. Boydell¹⁰, A. Meharg¹¹, S. Faux^4,5, S. Middleton¹²

¹St Vincent’s Health Network Sydney, Allied Health Research Unit, Darlinghurst, Australia

²Australian Catholic University, Health Science, North Sydney, Australia

³Waikato Hospital, Physiotherapy, Hamilton, New Zealand

⁴St Vincent’s Health Network Sydney, Rehabilitation, Darlinghurst, Australia

⁵University of New South Wales, Medicine, Sydney, Australia

⁶The StrokeEd Collaboration, Sydney, Australia

⁷University of Sydney, Medicine, Camperdown, Australia

⁸Monash University, Neuroscience, Melbourne, Australia

⁹Alfred Health, Occupational Therapy, Melbourne, Australia

¹⁰Arm’s Reach Occupational Therapy, Bristol, United Kingdom

¹¹Harrison’s Training, Wiltshire, United Kingdom

¹²St Vincent’s Health Network Sydney, St Vincent’s Hospital Melbourne & Australian Catholic University, Nursing, Sydney, Australia

Introduction: Constraint-induced movement therapy (CIMT) is recommended in the Australian and New Zealand Clinical Guidelines for Stroke Management, however only 11% of eligible stroke survivors receive CIMT. Access to transport and daily program attendance are some of the identified barriers to CIMT for stroke survivors. The remote constraint induced therapy of the upper extremity (ReCITE) study explored the feasibility and acceptability of delivering CIMT via telehealth (TeleCIMT).

Obectives: To explore the experiences of stroke survivors who have completed a TeleCIMT program and factors influencing adherence to remotely delivered CIMT programs.

Patients & methods: Qualitative design using semi-structured interviews. Stroke survivors who had completed a three-week TeleCIMT program were interviewed one month post program completion by a researcher independent of their treating team. Interviews were audio-recorded, transcribed and imported into Nvivo for thematic analysis using inductive coding.

Results: Fifteen participants were interviewed following TeleCIMT. Whilst participants reported seeing improvements in their arm function from TeleCIMT, there were several challenges to program adherence. Challenges to the program included the reduced level of direct therapist input when conducting a program remotely and the high cognitive demands of technology use when completing sessions online. Participants also reported a high time burden for program preparation and recording of practice as well as challenges with tolerating six hours of mitt wear per day within the home. Most participants completed their programs without the assistance of a family member or carer, however reported having a support person would have been beneficial to support program adherence, assist with paperwork and to provide encouragement.

Conclusion: Stroke survivors describe TeleCIMT as an acceptable intervention. Additional support is required for technology use and recording practice.

OP-084

TATheN – Remote physiotherapy, occupational, and speech and language therapy in acute stroke patients

K. Stangenberg-Gliss^1,2, I. Schmehl¹, B. Seidel³

¹Unfallkrankenhaus Berlin gGmbH, Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Berlin, Germany

²HAWK Univercity of Applied Sciences and Art, Hildesheim, Germany

³Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany

Introduction: The shortage of specialist therapists, particularly in rural regions, as well as demographic and epidemiological change, require the further development of existing concepts for the provision of therapeutic care e.g. building up a network of therapists from competence centres with small rural clinics.

TATheN has investigated the technical feasibility of standardised therapeutic assessments in a remote setting and their acceptance by therapists and acute stroke patients to close the gap in the otherwise proven "proof of treatment" of telerehabilitation.

Objectives: To test the feasibility of telemedical standardised test procedures for speech therapy, occupational therapy and physiotherapy. Evaluation of the acceptance and satisfaction of the telemedical assessments among stroke patients and therapists. Utilisation of the telemedical offer of a therapeutic second opinion by the therapists for further therapy planning and implementation.

Patients & methods: This is a 1-year feasibility study in a mixed-methods design with 5 regional clinics in rural north-east Germany. 9 standardised therapeutic outcome measures were remotely performed in 30 patients (adult, diagnosis of stroke <14 days, able to give consent). Satisfaction was assessed using the Telehealth Satisfaction Scale (TeSS) for all participants and 11 interviews were conducted with patients and therapists on acceptance. The technical feasibility and time required was evaluated.

Results: All 9 standardised outcome measures were feasible by telemedicine with a high level of acceptance and satisfaction while overcoming the technical, time and organisational hurdles.

Teletherapeutic services improve patient care in the exchange about and with patients.

Conclusion: Supplementary teletherapy is conceivable in the case of time or staff shortages, e.g. in the case of absence.

A follow-up study is needed to clarify the limitations and opportunities for therapists in the care of acute stroke patients.

OP-085

Optimal resistance exercise training parameters for stroke recovery: a systematic review and meta-analysis

K. S. Noguchi¹, K. Moncion¹, E. Wiley¹, A. Morgan¹, E. Huynh¹, G. M. Balbim², B. Elliott³, C. Harris-Blake³, B. Krysa⁴, B. Koetsier⁵, K. Pinili³, M. Beauchamp¹, S. M. Phillips⁶, L. Thabane^7,1,8,9, A. Tang¹

¹McMaster University, Rehabilitation, Hamilton, Canada

²University of British Columbia, Physical Therapy, Vancouver, Canada

³Community Member, Hamilton, Canada

⁴Community Member, Kitchener, Canada

⁵Community Member, St. Catharines, Canada

⁶McMaster University, Kinesiology, Hamilton, Canada

⁷McMaster University, Health Research Methods, Evidence & Impact, Hamilton, Canada

⁸St Joseph’s Healthcare Hamilton, Hamilton, Canada

⁹University of Johannesburg, Health Science, Johannesburg, South Africa

Introduction: Resistance training (RT) improves muscle strength in people with stroke, but its effects on other aspects of stroke recovery are unclear. Variations in exercise prescription parameters (i.e., frequency, intensity, type, and duration) may also elicit more favourable effects on stroke recovery.

Objectives: To examine the effects of RT compared to no exercise or usual care on stroke recovery and quantify the influence of RT prescription parameters on treatment effects.

Materials & methods: Eight electronic databases and 2 clinical trial registries were searched from inception to May 30, 2023, for randomized trials examining the effects of RT compared to no exercise or usual care. Trials were eligible if they reported ≥1 RT exercise parameter. An advisory group of community members with lived experience informed outcomes relevant to recovery. Data were synthesized using random-effects meta-analyses. Meta-regression was used to examine the association between RT parameters and effect sizes.

Results: Thirty-nine studies (33 trials, n=1,530) were included. Compared to usual care or no exercise, RT interventions improved lower body strength (standardized mean difference [SMD]=1.09, 95% confidence interval [CI]: 0.62-1.55), balance (SMD=1.65, 95%CI: 0.84, 2.47), walking capacity (SMD=1.28, 95%CI: 0.47, 2.09), functional ability and mobility (SMD=0.94, 95%CI: 0.20, 1.68), as well as habitual (mean difference [MD]=0.05 m/s, 95%CI: 0.01, 0.09) and fast paced walking speed (MD=0.09 m/s, 95%CI: 0.01, 0.17). Greater frequency of RT was positively associated with walking capacity (p=0.01). Power-focused RT was superior to moderate (p=0.005) and high-intensity RT (p<0.001) for fast paced walking speed. Functional RT was superior to traditional RT for fast walking speed (p=0.01).

Conclusion: RT may improve lower-body strength and some aspects of physical function. More frequent RT, power-focused intensities, and functional RT may best support stroke recovery.

OP-086

Unlocking the restraint – development of a behaviour change intervention to increase the provision of modified constraint-induced movement therapy in stroke rehabilitation

A. Weerakkody^1,2, R. Emmanuel³, J. White², E. Godecke^1,4, B. Singer¹

¹Edith Cowan University, Health Science, Joondalup, Australia

²South Metropolitan Health Service, Rehabilitation in the Home, Fremantle, Australia

³Neurotherapy OT Services, Perth, Australia

⁴North Metropolitan Health Service, Sir Charles Gaidner Osborne Park Health Group, Nedlands, Australia

Introduction: Strong evidence supports the provision of modified constraint-induced movement therapy (mCIMT) to improve upper limb function after stroke. A service audit identified that very few patients received mCIMT in a large subacute, early-supported discharge (ESD) rehabilitation service. A behaviour change intervention was developed to increase the provision of mCIMT following an unsuccessful "education only" attempt.

Objectives: To systematically document the steps undertaken and provide practical guidance to clinicians and rehabilitation services to implement this complex, yet effective, intervention.

Materials & methods: This clinician behaviour change intervention was developed over five stages and led by a working group of neurological experts (n = 3). Data collection methods included discussions with clinicians and an online survey (n = 35). The staged process included reflection on why the first attempt failed to change mCIMT provision (stage 1), mapping barriers and enablers to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW) to guide behaviour change techniques (stages 2 and 3), developing a suitable mCIMT protocol (stage 4), and delivering the behaviour change intervention (stage 5).

Results: The working group identified the need for upskilling in mCIMT delivery and use of a behaviour change framework to guide the implementation. Key determinants of behaviour change operated within the TDF domains of knowledge, skills, environmental context and resources, social role and identity, and social influences. Following the development of a context-specific mCIMT protocol, the BCW guided the behaviour change intervention, and included education, training, persuasion, environmental restructuring, and modelling.

Conclusion: This paper outlines the suite of behaviour change techniques used to influence clinician behaviour and support mCIMT implementation within a large ESD service. Its success will be explored in future research.

OP-087

Aerobic exercise recommendations to optimize best practices in care after stroke: AEROBICS 2024 update

A. Tang¹, M. MacKay-Lyons², K. Moncion¹, H. Fang¹, S. Billinger³, P. Boyne⁴, B. Elliott¹, J. Eng⁵, S. Marzolini⁶, P. Oh⁶, K. Woods-Pinili¹, M. Roig⁷, D. Taylor⁸, A. Quigley²

¹McMaster University, Rehabilitation, Hamilton, Canada

²Dalhousie University, Halifax, Canada

³University of Kansas Medical Center, Kansas City, KS, United States

⁴University of Cincinnati, Cincinnati, OH, United States

⁵University of British Columbia, Vancouver, Canada

⁶University Health Network, Toronto, Canada

⁷McGill University, Montreal, Canada

⁸St. Joseph’s Care Group, Thunder Bay, Canada

Introduction: Exercise is a core component of stroke rehabilitation and secondary prevention. The Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS) are user-friendly recommendations to guide exercise screening, assessment, and prescription. AEROBICS was developed by an international group of experts in 2013 and updated in 2019. Since the last update, new research has emerged on high-intensity interval training, exercise and cerebrovascular health, sex- and gender-related considerations, and impacts of COVID-19 on exercise.

Objective: To update AEROBICS for best practices in screening, prescription and participation in aerobic exercise after stroke ("AEROBICS 2024").

Materials & methods: We convened an international, interdisciplinary group of researchers, and knowledge user clinician and persons with lived experience (including those servicing remote and rural regions of Canada) for two virtual meetings to review an updated evidence review and revise the recommendations. Recommendations were rated on its strength (strong, conditional) and quality of evidence (high, moderate, low, very low). The recommendations will be finalized by a smaller working group by February 2024, and undergo external and patient review (March-April 2024). The final recommendations will be released in May 2024.

Results: We identified 20 randomized trials related to aerobic exercise published since the last AEROBICS update. Virtual meetings were completed in November 2023. Revisions consider new evidence related to timing post-stroke (early acute phase) and dosing of exercise (frequency, intensity, time, type).

Conclusion: The AEROBICS writing group has always emphasized the importance of periodic review to ensure the recommendations remain current, evidence-based, and clinically relevant. AEROBICS 2024 will reflect the newest evidence related to aerobic exercise after stroke.

OP-089

Predictors of treatment gains in a phase 3 stroke recovery trial of vagus nerve stimulation

A. Schwarz^1,2, M. Feldman², V. Le³, N. Engineer⁴, S. C. Cramer^1,2

¹University of California, Neurology, Los Angeles, CA, United States

²California Rehabilitation Institute, Los Angeles, CA, United States

³UC Irvine, Irvine, CA, United States

⁴MicroTransponder Inc, Austin, TX, United States

Introduction: Impairments of arm movement after stroke are common. A recent phase 3 clinical trial supported the efficacy of vagus nerve stimulation (VNS) for such deficits, but response was variable and characteristics of treatment responders remain to be identified.

Objectives: VNS affects function throughout the cerebrum, and so this study tested the hypothesis that treatment-induced changes in arm motor impairment would be predicted by baseline differences in global brain neuroimaging measures.

Materials & methods: Subjects were from the VNS-REHAB trial (Lancet. 397:1545). Stroke lesions were manually traced on T1-weighted images and used to derive measures of regional injury such as to the primary motor cortex (M1) or corticospinal tract (CST). Global brain measures were degree of white matter disease (WMD; Fazekas scale), thalamic volumes, and volume of cerebrospinal fluid (CSF), grey matter, and white matter. Models used treatment group, age, and gender as covariates and the trial’s primary endpoint (change in arm motor Fugl-Meyer (FM) score from baseline to end of 6-weeks of treatment) as the dependent variable.

Results: MRIs were available from 80 patients (age 59.8 ±9.5 years, 29 females). Infarct volumes ranged from 0.4 to 319.5ml. Lesions affected M1 in 37.5% and CST in 83.8%. Across all patients, the regression model for predicting change in FM score included factors for degree of WMD (p=0.007), CSF volume (p=0.003), ipsilesional thalamus volume (p=0.016), and treatment group (p=0.075); R square=32.6%. Results were similar when analyzing only the VNS-group patients.

Conclusion: Global brain measures predominated prediction of motor gains in this VNS trial, a finding that is concordant with VNS mechanism of action. The model’s prediction strength was modest, suggesting additional, non-anatomic factors may also be important. Such findings may be useful for patient selection, subgroup stratification, and personalized medicine in stroke rehabilitation.

OP-090

A randomized controlled trial comparing HIIT vs. MICT on corticospinal excitability in chronic stroke: does intensity matter?

L. Rodrigues¹, K. Moncion², B. de las Heras¹, J. Cristini¹, F. Seo¹, J. Eng³, J. Fung¹, M. MacKay-Lyons⁴, A. Thiel⁵, A. Tang², M. Roig¹

¹McGill University, Physical and Occupational Therapy, Montreal, Canada

²McMaster University, Rehabilitation, Hamilton, Canada

³University of British Columbia, Physical Therapy, Vancouver, Canada

⁴Dalhousie University, Physiotherapy, Halifax, Canada

⁵McGill University, Neurosurgery, Montreal, Canada

Introduction: High-intensity interval training (HIIT) is a time-efficient alternative to moderate-intensity continuous training (MICT) to improve cardiorespiratory fitness in individuals with stroke. However, whether high intensities attained during chronic HIIT are more effective in promoting neuroplasticity than MICT is not yet known.

Objective: To determine the effect of 12-weeks of HIIT or MICT on measures of corticospinal excitability (CSE): resting motor threshold (MT), resting excitability (RE), and short intracortical inhibition and facilitation, in individuals with chronic stroke (≥ 6 months post-stroke).

Materials & methods: Sixty-nine patients (65.80 ± 0.82 years old; 1.85 ± 0.12 years post first-ever stroke; 34% Females) were randomly assigned to 3x/week progressive HIIT (24 mins, n=35) or MICT (~30 mins, n=34) performed on recumbent steppers. CSE measures were obtained with transcranial magnetic stimulation applied on the ipsi- and contralesional hemispheres before and after the training programs. Linear mixed models analyzed longitudinal changes and differences between groups.

Results: Training increased RE in the affected hemisphere in both groups (time effect, β= 0.07 ± 0.03; p=0.02) but only HIIT elicited significant increases compared to baseline (p=0.04). HIIT was also more effective at rebalancing RE between hemispheres than MICT (group*time effect, β=-0.21 ± 0.09; p=0.03). Training reduced MT in the affected hemisphere in both groups (time effect, β=1.03 ± 0.35; p=0.01) but only MICT elicited significant reductions compared to baseline (p=0.02).

Conclusion: Both HIIT and MICT promote increases in CSE in the affected hemisphere by increasing RE and reducing MT. HIIT appears to have significant effects on RE and in rebalancing this measure of CSE between hemispheres. More studies are needed to explain the differential effects of exercise intensity on different measures of CSE and, more importantly, to determine their functional relevance.

OP-091

Aerobic minutes and step number remain low in inpatient stroke rehabilitation

S. Peters¹, Y. Yan², S. Hung³, M. Bayley⁴, K. Best⁵, L. A. Connell⁶, H. Corriveau⁷, S. J. Donkers⁸, S. P. Dukelow⁹, V. Ezeugwu¹⁰, M. H. Milot⁷, B. M. Sakakibara¹¹, L. Sheehy¹², H. Wong¹³, J. Yao¹³, J. Eng^13,3

¹Western University, Physical Therapy, London, Ontario, Canada

²Western University, Graduate Program in Physical Therapy, London, Ontario, Canada

³University of British Columbia, Centre for Aging SMART, Vancouver, Canada

⁴University of Toronto, KITE Research Institute University Health Network, Toronto, Canada

⁵Université Laval, Québec, Canada

⁶University of Central Lancashire, Preston, United Kingdom

⁷Sherbrooke University, Sherbrooke, Canada

⁸University of Saskatchewan, Saskatoon, Canada

⁹University of Calgary, Calgary, Canada

¹⁰University of Alberta, Edmonton, Canada

¹¹University of British Columbia, Centre for Chronic Disease Prevention and Management, Vancouver, Canada

¹²Bruyère Research Institute, Ottawa, Canada

¹³University of British Columbia, Vancouver, Canada

Introduction: Rehabilitation is important for regaining mobility and independence post stroke. Repetitive stepping activities can positively impact walking recovery and current exercise guidelines recommend 3-5 sessions/week of 20-60 aerobic minutes at 40-70% heart rate reserve. However, it is unclear whether guidelines are followed.

Objectives: To quantify aerobic minutes and step number in a usual care inpatient stroke unit physical therapy session, with a secondary focus of comparing to published reports of aerobic minutes and step number.

Patients & methods: We analyzed data from one physical therapy session two weeks after enrolling in the usual care arm of the Walk "n Watch clinical trial. To be included, participants had a stroke, were medically stable, and able to take a minimum of 5 steps with assistance from one therapist. Aerobic minutes and step number were measured using a wrist-based heart monitor and step counter worn on the ankle. Means (CI) and correlations were calculated. Relevant literature was identified and aerobic minutes and step numbers were extracted.

Results: A total of 166 participants (69 female/96 male, mean age=69) were included which represents data from 12 sites across Canada. Participants had an average of 10 aerobic minutes (95%CI 8, 12, median=8) and 985 (95%CI 897, 1073) steps with no association between aerobic minutes and number of steps. Studies fifteen years ago indicate between 63 and 357 steps/session, increasing to 168 to 1167 in the last 3 years. Twenty years ago, 3 aerobic minutes were reported which increased to 11 in the last 3 years.

Conclusion: Most participants in our study did not meet current guidelines with less than 10 aerobic minutes and 1000 steps in one physical therapy session; yet, the number of steps has increased in the past several years. Given that increasing activity levels are critical for recovery post stroke, further investigation into the potential barriers to achieving targets are recommended.

OP-092

Telehealth assessments for individuals with aphasia: a systematic review

S. Teti¹, L. Murray¹, J. B. Orange¹, A. Roberts¹, K. Kankam¹

¹University of Western Ontario, Health Science, London, Ontario, Canada

Purpose: Although current literature demonstrates the effectiveness and feasibility of telehealth services for people with aphasia, the examination of telehealth assessments is limited. The purpose of this systematic review was to examine the current use of telehealth assessment protocols for people with aphasia. Specifically, the review sought to: a) identify the assessment tests and/or measures utilized in the aphasia literature; b) evaluate critically the psychometric properties of standardized tests/measures; and c) appraise critically the quality of these investigations.

Method: A review of the literature published in English since 2000 was conducted by searching MEDLINE, EMBASE, PsychInfo, CINAHL, and Scopus databases to identify relevant studies. A total of 2429 articles were screened. Two reviewers assessed records independently finding 11 articles eligible for inclusion. Data extraction was conducted once and validated by the second reviewer. Quality appraisal was carried out for the included studies as well as the testing measures they employed.

Results: The results of the included studies illustrated a lack of variation among the assessment protocols and aphasia tests used. Most of these tests and/or measures that were utilized exhibited poor validity and reliability properties. Studies were limited in the investigation of screening tests, discourse analysis, extra-linguistic cognitive difficulties, and the use of patient-reported measures.

Conclusion: Overall, this systematic review yielded continued support for the assessment of aphasia via telehealth practices. However, further research is needed to investigate a wider range of aphasia assessment protocols that can be offered via telehealth, including the examination of a variety of tests and/or procedures that when administered via telehealth are similar to the delivery of in-person services.

OP-094

Availability of dysphagia assessment procedures and/or protocols for 2–6-year-old children with paediatric traumatic brain injury in the acute care setting

B. Mehale ¹

¹Stellenbosch University, Pretoria, South Africa

Background: Traumatic brain injury (TBI) is a non-degenerative injury following blunt-force trauma or penetrating injury to the head, resulting in disrupted brain functions. Globally, more than 3 million children sustain a TBI every year, with those aged 0-4 making up the majority (55.2%). Disruptions in typical brain functioningmanifest in impairments, notably in feeding and swallowing i.e., dysphagia. Dysphagia is present in 10-15% of children with moderate TBI, and 68-76% in children with severe TBI.

Rationale: A scoping review was utilised to explore and describe the available dysphagia assessments materials and procedures, and identify any existing needs regarding assessment in the field of dysphagia in PTBI patients in order to inform quality patient management. Information was retrieved from a total of 26 articles (n=26) that complied with the set criteria, and used for data charting, analysis, and discussion.

Results: No set dysphagia assessment protocols were identified for the PTBI population. Non-instrumental assessment procedures were typically utilised by speech-language therapists (SLT) as screening and diagnostic purposes in patients with PTBI. The majority of articles confirmed the use of instrumental assessment procedures such as the Videofluoroscopic Swallowing Study (VFSS) and Fibre-optic Endoscopic Evaluation of Swallowing (FEES) by a multidisciplinary team (MDT) in acute healthcare contexts. Limited contribution from middle to low-income countries such as South Africa was noted, where a lack of research and standardisation of operational procedures still appear to be prevalent.

Conclusion: The efficacy of dysphagia assessment procedures depends on clinicians" skills and their access to resources,which is not always feasible in middle-to-low countries such as SouthAfrica. As a result, the development of a setdysphagia assessment protocol remains a priority in dysphagia care for patients with PTBI.

OP-095

Should I Stay or Should I Go? A pilot feasibility study on music-based cognitive training for adults with MDD

M. Tan^1,2, S. Friyia¹, S. Rizvi³, M. Thaut¹

¹University of Toronto, Music, Toronto, Canada

²Concordia University, Creative Arts Therapies, Montreal, Canada

³St. Michael’s Hospital, ASR Suicide and Depression Studies Unit, Toronto, Canada

Background: Cognitive challenges in attention and executive function worsen over time in individuals with Major Depressive Disorder (MDD), persisting beyond acute episodes with no targeted treatments. Neurologic Music Therapy (NMT) is proven to be effective for cognitive function for brain injuries and developmental disabilities. The interactive aspects of music-based interventions using rhythm, active listening, and composition exercises suggests that NMT could be effective in addressing cognitive dysfunction faced in adults with MDD.

Objectives: Aims of this pilot study are to obtain preliminary data on the effectiveness of short-term NMT on attention and executive function, depression levels, and suicide risk in adults with MDD. Feasibility and acceptability of music-based cognitive training will be assessed.

Methods: Adults ages 18+ with MDD experiencing suicidal ideations participated in 8 weeks of 45-minute individual in-person NMT sessions. Neurocognitive computerised tasks and questionnaires regarding suicidal ideation, depressive symptoms, and quality of life were completed before and after the intervention. Participants also provided feedback on feasibility and acceptability of the intervention.

Results: Preliminary results show improvements in short term and working memory (Digit Span Forward and Backward Tests), and inhibitory control (Stroop Test). On average, the Beck Suicidal Scale of Ideation scores decreased. Participant feedback indicated that NMT was helpful as they noticed improvements in attention and executive function in their daily activities.

Conclusion: This is the first study using NMT interventions, specifically examining the use for cognitive function for adults with MDD and suicide risk. The results of this study will be vital in advancing our knowledge in effective non-pharmaceutical interventions that address cognitive function in adults with MDD and will provide necessary data to build on for future randomised controlled trials.

OP-096

The development of a multisensory group for the treatment of people in a prolonged disorder of consciousness: a case series

A. Forde¹, R. Keenan¹, S. Ghazzawi¹, J. Sheppy¹

¹STEPS Rehabilitation Ltd, Speech and Language Therapy, Sheffield, United Kingdom

Introduction: There is increasing evidence that multisensory stimulation for people in prolonged disorder of consciousness (PDOC) has beneficial effects. Evidence for structure and implementation in a group setting is limited. Patients first interactions with the environment are often due to familiarity with stimulus and preferred carers. Applying this knowledge, a multisensory group was developed by the Speech and Language and Neurologic Music Therapy teams for patients in PDOC in a residential rehabilitation centre.

Objectives: 1) promote arousal, behavioural responsiveness and cognitive processing, 2) identify and enhance sensory strengths to inform interaction guidelines, 3) measure change in responses over time.

Patients & methods: Three patients in PDOC attended a weekly group which provides an enriched and immersive environment tailored to patients" previous life experiences. It includes arousal facilitation, musical orientation, auditory, visual, tactile, olfactory and gustatory stimulation. Outcomes were measured using an informal Wessex Head Injury Matrix (WHIM), Informal Sensory Rating Scale (ISRS) devised internally, Galvanic Skin Response (GSR).

Results: The total number of behaviours and most advanced behaviour scored on the WHIM improved for two patients. The groups’ theme appeared to impact overall number of responses and most advanced behaviour seen, with the most advanced behaviour correlating to previous interests. ISRS showed all patients have sensory strengths that remained consistent across themes. GSR showed an increase in arousal and emotional responses post stimulation.

Conclusion: This innovative group allowed PDOC patients to experience simultaneous sensory input which enhanced responses and informed interaction guidelines. GSR provided useful objective information that has potential to influence the future group structure. Further evaluation of this group is required alongside research into the use of immersive multisensory stimulation.

OP-097

Understanding the population with severe disorders of consciousness related to work accidents: insights from a neurorehabilitation center in a developing country

C. Castillo¹, G. Rivera², V. Cornejo³

¹Hospital Mutual de Seguridad, Santiago, Chile

²University of Chile, Physical Therapy, Santiago, Chile

³Faculty of Health, University of Santo Tomás, Occupational Therapy, Puerto Montt, Chile

Introduction: accidents at work leading to disorders of consciousness represent a preventable yet prevalent form of brain injury in developing nations.

Objective: This study aims to delineate the survival, demographic, and clinical features of individuals experiencing severe disorders of consciousness resulting from accidents at work in a developing country.

Patients & methods: Data were extracted from a clinical database encompassing 5082 records from 2002 to 2018. Among 169 patients diagnosed with disorders of consciousness, 44 resulted from accidents at work. Survival, demographic, and clinical features were collected, with descriptive statistics applied.

Results: The average age was 39 years (SD=20.75), comprising 7 females and 37 males. Of these patients, 38 were in vegetative state, 6 minimally responsive, 31 deceased, and 13 were alive at the review, with an average survival of 2106 days (SD=1746). Maximum survival reached 7826 days, with a minimum of 19 days. Accidents in the workplace involved 22 patients, 19 during commutes, and 3 with other causes. Mechanisms for accidents in the workplace included falls (n=10), pedestrian accidents (n=5), automobile accidents (n=1), direct skull impact (n=5), and other causes (n=4). Commuting accidents comprised high-impact incidents (n=1), pedestrian accidents (n=11), and automobile accidents (n=7), with a third group having other causes (n=3).

Conclusions: This study contributes to characterizing a population of patients injured at work or during commutes, in a country with limited statistical data. There is limited global information on the severe consequences of accidents at work leading to disorders of consciousness and other conditions that may result in severe disability.

OP-098

Dissociation between proximal and distal body part mental representation before and after bilateral arm transplantation

S. Mateo^1,2, L. Huchon^1,2, P. Revol³, M. Charvin⁴, D. Muret⁵, E. Morelon⁶, A. Gazarian⁷, L. Badet⁸, K. T. Reilly^1,2, A. Farné⁵, G. Rode^4,2

¹Lyon Civil Hospitals, Hôpital Henry Gabrielle, Saint-Genis-Laval, France

²Claude Bernard University, CNRS, INSERM Neuroscience Research Centre, Lyon, France

³Claude Bernard University, CNRS, INSERM Neuroscience Research Centre, Lyon, France

⁴Lyon Civil Hospitals, Hôpital Henry Gabrielle, Saint-Genis-Laval, France

⁵Claude Bernard University, CNRS, INSERM Neuroscience Research Centre, Lyon, France

⁶Lyon Civil Hospitals, Hôpital Édouard Herriot, Service de Transplantation, Néphrologie et Immunologie clinique, Lyon, France

⁷Polyclinique Orthopédique de Lyon, Chirurgie de la main et du membre supérieur, Lyon, France

⁸Lyon Civil Hospitals, Hôpital Édouard Herriot, Service d’Urologie et de Chirurgie de la transplantation, Lyon, France

Background: Mental body representations (MBR) change after amputation yet unknown after transplantation.

Objectives: To document changes in MBR after bilateral arm transplantation.

Method: Single case study before (PRE- 10 years) and after transplantation (M3 M12 M18 M24). We measured proprioception and segments lengths (arms: shoulder – elbow; forearms: elbow – wrist; hands: wrist - medius) using a tape (actual distances of the prothesis, PRE or arms after transplantation) and kinematics device (represented distances); In VICON ®, we used 2 markers, 1 sagittal (reference) and another moved by the examiner up to patient’s estimated length. We computed each segment % (represented – actual / actual *100). We analysed the change in segments % as a function of time and side using linear models.

Results: Before transplantation, represented lengths (vs prosthesis) were statistically underestimated for both arms (-22% 95%CI[-26; -19]) and forearms (-10% [-17; -3]) but overestimated for hands (13% [8; 18]). After transplantation, arm underestimation significantly decreased (M3= -8% [-16; 0], M6-M24 between -3% and -16%); forearms were no longer underestimated (M3=4% [-11; 16], M6-M24 around 0%). Only hands remained overestimated (>10%). Some proprioception was observable at the elbows (M3) and fingers (M12).

Discussion: Body parts representation was dissociated between proximal segments (arm – forearm) and distal (hand fingers) before and after arm transplantation. This may be related to distinct processes/timings involving visual "reafferentation" (immediate) and somatosensory reafferentation (slower). After transplantation, only the size of proximal body parts showed significant changes. Instead, the over-represented hand size remained unchanged even when proprioceptive re-emerged at M12. These findings provide initial evidence for bilateral malleability of MBR after bilateral arm transplantation.

OP-102

Temporal changes in corticospinal tract integrity and motor recovery after stroke

S. Lee¹, H. I. Lee¹, J. S. Noh¹, S. B. Pyun^1,2,3

¹Korea University Anam Hospital, Physical Therapy and Rehabilitation, Seoul, South Korea

²Korea University College of Medicine, Physical Therapy and Rehabilitation, Seoul, South Korea

³Korea University College of Medicine, Brain Convergence Research Center, Seoul, South Korea

Introduction: Recovery of motor function is essential in regaining independence after a stroke. However, the relationship between temporal changes in corticospinal tract (CST) integrity and motor recovery remains unclear.

Objectives: We aimed to assess dynamic changes of bihemispheric CST integrity after stroke and investigate their association with the proportions of motor recovery at six months after stroke.

Patients & methods: We enrolled 56 ischemic and 31 hemorrhagic stroke patients for motor assessments and DTI at one- and six months post-stroke. We evaluated CST integrity with DTI parameters: fiber number (FN), fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). Clinical variables included the Fugl-Meyer Assessment (FMA), Manual Function Test (MFT), Berg Balance Scale, and muscle strength. We calculated the delta (Δ) value for both DTI and the proportion of recovery (Δp) for clinical variables. We assessed temporal DTI parameter changes using a Paired t-test or Wilcoxon signed-ranks test. Spearman correlation analysis explored relationships between Δ values of DTI parameters and Δp values of clinical variables.

Results: In ischemic stroke, CST’s bihemispheric FA value at six months was significantly lower than at one month, and ipsilesional AD, RD, and MD values were significantly higher at one month. Furthermore, Δp for upper extremity FMA negatively correlated with ipsilesional Δ AD. Additionally, MFT scores displayed negative correlations with ipsilesional Δ AD, Δ RD, and Δ MD and positive correlations with ipsilesional Δ FA. In hemorrhagic stroke, ipsilesional AD at six months was significantly higher than at one month, but FA, MD, and RD showed no significant differences. Furthermore, the ipsilesional Δ AD did not correlate significantly with Δp in clinical variables.

Conclusion: Our results highlight a strong link between upper extremity function recovery and changes in CST integrity in ischemic stroke.

OP-103

The effect of motor rehabilitation on brain perfusion in Parkinson’s disease

V. Blasi¹, A. Pirastru¹, F. Borgnis¹, F. Rossetto¹, L. Pelizzari¹, M. Cazzoli¹, S. Isernia¹, F. Baglio¹

¹IRCCS Carlo Gnocchi Foundation, CADiTeR, Milan, Italy

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor and cognitive impairment involving executive functioning. Increasing evidence suggests that physical exercise improves both motor and cognitive performances through neuroplastic mechanisms that are yet to be fully understood.

Objectives: To detect, in a group of patients with PD (pwPD), the effect of motor rehabilitation on brain perfusion.

Patients & methods: Thirty-three pwPD were enrolled and participated in a motor rehabilitation program lasting 4 months based on physical aerobic exercises.

All patients underwent a motor evaluation with the 6-minute walking test (6MWT) and an MRI examination before (T0) and after (T1) rehabilitation. MRI (3T Siemens Prisma) included: 1- a T1 weighted 3D sequence [0.8 mm3 resolution]; 2- an axial multi-delay pseudo-continuous arterial spin labeling (pCASL) sequence for brain perfusion [ 3.5 mm3 resolution]. pCASL raw data were corrected for movement and distortions. Perfusion maps were computed and calibration was performed using a voxel-wise approach, to derive quantitative CBF maps. CBF maps were normalized to MNI standard space, and a functional connectivity atlas (2) was used to extract regional average CBF values from 2 ROIs representing the somatomotor and dorsal attention resting state networks. Statistical analyses were computed with Jamovi 1.8.2 with p < 0.05 as the significance threshold.

Results: PwPD demographics: F/M 13/20, mean age 67.9 (sd 8.12), mean UPDRS total score 27.5 (sd 11.0), mean Y&H 1.98 (sd 0.508). A paired t-test was computed to compare motor performances and brain perfusion at T1 versus T1. Results showed improvement at the 6MWT and brain perfusion in the two networks investigated: the somatomotor and the dorsal attentional.

Conclusion: The data herein support the hypothesis that motor rehabilitation promotes neuroplasticity through mechanisms involving brain perfusion.

OP-104

Enhancing stroke lesion detection and segmentation through nnU-net and multi-modal MRI Analysis

S. Leplaideur^1,2, F. Galassi², E. Bannier², A. Masson², L. Meddahi²

¹University Hospital Rennes, Physical Therapy and Rehabilitation, Rennes, France

²University of Rennes, Empenn Team, Rennes, France

Introduction: Accurate delineation of chronic stroke lesions is crucial for many research and clinical applications. Indeed, all neuroimaging research after stroke requires a segmentation process. Moreover, the segmentation is implemented in algorithms discussing prognostic elements. However, manual segmentation from T1-w MR images is time-consuming and prone to errors.

Objectives: This work aimed to automate chronic stroke lesion detection and segmentation using the nnU-Net framework and a combination of datasets. The nnU-Net framework is widely recognized for its state-of-the-art performance in medical image segmentation. We have previously successfully adapted the nnU-Net framework to multiple sclerosis lesion segmentation within the Longiseg4ms tool.

Materials & methods: We utilized the ATLAS v2.0 dataset and an in-house dataset of T1-w and FLAIR MRI scans from patients with chronic stroke lesions. We leveraged the nnU-Net framework and incorporated both T1-w and FLAIR MRI modalities

Results: The target model achieved a mean Dice score of 0.730 and a mean lesion-wise F1 score of 0.684, demonstrating superior performance compared to the baseline model. The high correlation coefficient (Pearson correlation coefficient = 0.930) between the ground truth and model output volumes indicates a strong agreement between the two segmentation methods. This correlation highlights the accuracy of our volume prediction and highlights the reliability of our automated segmentation approach.

Conclusion: Our nnU-Net-based model, trained on T1-w and FLAIR images, improved the segmentation of chronic stroke lesions, outperforming the baseline model. These findings highlight the potential of automated models for improving chronic stroke lesion segmentation and using FLAIR modality to enhance the results.

OP-105

Trunk importance in the assessment of spontaneous movements development using wearable technology

M. A. Marin Palma¹, I. J. Rojas Sepúlveda¹, J. Becerra Caroca¹, J. Carrasco Plaza¹, R. Zepeda Iriarte¹, P. I. Burgos Concha¹

¹University of Chile, Kinesiology, Santiago, Chile

Introduction: The characteristics of spontaneous movement of infants are used for the early prediction of neurological pathology, mainly under the Prechtl method. However, the Prechtl method has been questioned due to its subjectivity and implementation. The objective of this research is to assess spontaneous movement during the first semester of life as the basis of an objective assessment alternative.

Method: Cross-sectional study with 116 separate subjects participated in 3 groups: 0M Group (1 to 4 weeks old) with 43 subjects, 3M Group (9 to 15 weeks old) with 44 subjects, and 6M Group (23 to 30 weeks old) with 29 participants. Participants" movements were recorded using 6 wireless inertial sensors located in the limbs, thorax, and pelvis. Parameters from the acceleration signal were estimated in relation to velocity, cross-correlation, kurtosis, skewness, area, and periodicity. Then a PCA analysis was performed to determine the variables’ contribution.

Results: The parameters of the trunk (25 parameters) and those of the extremities (36 parameters) were compared in the 3 study groups (0M-3M, 3M-6M, and 0M-6M). It can be highlighted that there are 2 parameters for the trunk that can clearly differentiate the 3 groups in their spontaneous movements, and no parameter for the extremities. there are another trunk and limbs variables that differentiate some of these groups but not all 3. The variables that differentiate the 3 groups are the kurtosis of thorax velocity and the periodicity in trunk velocity (thorax-pelvis).

Conclusions: Wireless accelerometry can detect significant differences in the changes of spontaneous movements during the first semester of life. Only the trunk parameters can differentiate between 0M vs 3M, 3M vs 6M, and 0M vs 6M. The limb variables mainly explain the variation between 0M vs 3M and 0M vs 6M. When we compare the trunk and limb parameters, we conclude that the trunk parameters are equally or more important.

OP-106

A systematic review of exoskeleton use in human spinal cord injury (SCI) rehabilitation and their impact on functional mobility outcomes

K. I. A. Chiu¹, M. J. Gallagher², S. Abbott², B. Ajayi², J. Bernard², T. Bishop², D. Lui²

¹St George’s University of London, London, United Kingdom

²St George’s Hospital, London, United Kingdom

Introduction: Exoskeletons are used in rehabilitation after SCI. Some "improve" function where neuroplasticity is induced whereas some focus on "performance" which rehabilitate by repetitive movement.

Objectives: To examine different types of exoskeleton robots’ impact on functional mobility outcomes in SCI patients.

Material & methods: A literature search between January 2011 to June 2023 on Pubmed Central, Pubmed, Web of Science and Embase.

Active powered exoskeleton (HAL), passive powered exoskeletons (ReWalk, Ekso, H-MEX, Atlante, Indego, AIDER and HANK) and a passive stationary exoskeleton (Lokomat) were examined in acute and chronic SCI. Functional outcomes used were 6 minute walk test (6MWT) distance and 10 metre walk test (10MWT) speed. Some studies examined outcomes with the exoskeleton and some without after a period of exoskeleton rehabilitation.

Results: 23 studies were reviewed and 480 patients were tested. For tests with patients in an exoskeleton H-MEX showed the greatest increase in 6MWT with a mean 138%. In tests without aid of an exoskeleton, only HAL, Ekso and HANK showed an improvement after a period of rehabilitation. In acute SCI, HAL showed the best mean increase in 6MWT with 82% and Lokomat in 10MWT with 192%. In chronic SCI HAL showed the best mean increase in 6MWT with 75% and 10MWT with 92%.

Conclusion: All types of exoskeleton improved patients performance after rehabilitation. Active powered exoskeletons achieved the greatest improvement, interestingly stationary exoskeletons achieved similar levels of improvement when tested in a similar patient population.

OP-107

Therapeutic interaction provided by a humanoid robot acting as therapeutic assistant for arm rehabilitation after stroke

T. Platz¹, A. L. Pedersen², A. N. Umlauft³, S. Bader³

¹University Medicine Greifswald, Neurorehabilitation Research Group & Institute for Neurorehabilitation and Evidence-based Practice, Greifswald, Germany

²University Medicine Greifswald, Neurorehabilitation, Greifswald, Germany

³University of Rostock, Computer Science, Rostock, Germany

Objective: To characterize a socially active humanoid robot’s therapeutic interaction as therapeutic assistant when providing arm rehabilitation (i.e. arm basis training, ABT for moderate to severe arm paresis or arm ability training, AAT for mild arm paresis) to stroke survivors when using the digital therapeutic system E-BRAiN (Evidence-Based Robot-Assistance in Neurorehabilitation).

Participants & therapy: Stroke survivors receiving arm rehabilitation (i.e. ABT [n=9] or AAT [n=8]) using E-BRAiN over a course of 9 sessions in two weeks, and 21 other stroke survivors receiving arm rehabilitation sessions (i.e. ABT [n=6] or AAT [n=15]) in a conventional 1:1 therapist-patient setting.

Analysis of therapeutic interaction: Therapy sessions were videotaped on the 1st and 9th day using E-BRAiN and all therapeutic interactions (information provision, feedback, and bond-related interaction) were documented offline both in terms of their frequency of occurrence and time used for the respective type of interaction using the instrument THER-I-ACT. Comparable recordings and assessment of therapeutic interaction was performed for the conventional therapy sessions.

Main results and interpretation: The overall pattern of therapeutic interaction by the humanoid robot was comprehensive and varied considerably with type of therapy (as clinically indicated and intended), largely comparable to human therapists’ interaction, and adapted according to needs for interaction over time. Even substantially long robot-assisted therapy sessions seemed acceptable to stroke survivors and promoted engaged patients’ training behaviour.

Conclusion: Humanoid robot interaction as implemented in the digital system E-BRAiN matches human therapeutic interaction and its modification across therapies well and promotes engaged training behaviour by patients.

Reference

Platz et al., DOI: 10.3389/frobt.2023.1103017

OP-108

Understanding digital technology usability for neurorehabilitation at home: a realistic review with expert consultation

N. El Hajj¹, D. Kairy¹, C. Auger¹

¹University of Montreal, École de réadaptation, Montreal, Canada

Introduction: The neurorehabilitation process requires high-intensity practice in the clinic and at home. Integrating new technologies into a hybrid (virtual and in person) approach seems promising to enhance service accessibility and treatment adherence. Although past studies highlighted the benefits of home-based digital rehabilitation for stroke patients and children, current technologies face underutilization indicating usability issues (effectiveness, efficiency, and satisfaction). Thus, there is a lack of evidence on how well digital technologies work for adults and seniors with neurological conditions, and about the key factors for successfully using these technologies in home rehabilitation.

Objectives: Understand how rehabilitation technologies work at home for individuals with neurological conditions and validate the factors influencing their usability in that setting.

Methods: A realist review will be conducted with expert panels to analyze literature from 2015-2023 on rehabilitation technology usability at home for adults with neurological conditions across various databases and grey sources. By extracting Context-Mechanism-Outcome configurations (CMOC), stage 1 aims to reveal how home contexts trigger mechanisms that affect technology usability. Stage 1 findings will shape consultation materials through expert input using Delphi method. At stage 2, clinicians, users, and researchers will validate and refine findings on the usability of digital technology, addressing the challenges or facilitators associated with these technologies at home.

Results: We will present a logic model validated by an expert panel and a preliminary list of CMOCs that highlight gaps and offer design and evaluation guidelines for digital technology at home.

Conclusion: Establishing guidelines for digital technology usability in the home that consider the unique demands of neurorehabilitation would allow for better implementation and more inclusive development of new technologies.

OP-110

Balancing act: integrating new technologies and philosophical principles in neurorehabilitation

H. Ardaillon¹, S. Ribault¹, N. Lechopier², G. Rode¹

¹Lyon Civil Hospitals, Physical Therapy and Rehabilitation, Lyon, France

²Claude Bernard University, Lyon, France

Introduction: The 12th WCNR highlighted the evolving field of neurorehabilitation, with a focus on emerging technologies and their potential impact on medical practice and education. Innovations like robotics, brain-computer interfaces (BCI), artificial intelligence (AI), and advanced imaging techniques generated significant interest.

Objectives: These technologies hold promise for improving patient recovery, but they also come with limitations that require scrutiny.

Methods: We offer a pragmatical and philosophical comprehensive critical analysis of this challenges.

Results: Novel technologies (e.g., robotics and AI) offer both models for understanding brain plasticity and practical tools for rehabilitation. They enable personalized rehabilitation programs, aid in communication, and enhance motor and cognitive recovery. They also promote collaboration among professionals, enhancing the quality of care. Reducing the time gap between scientific evidence and clinical implementation is crucial. Yet, rigorous evaluation is necessary to assess safety, efficacy, and cost-effectiveness. Invasive devices must be used judiciously, considering potential adverse effects and financial implications. Non-invasive alternatives may offer safer and more cost-effective options. However, it’s important to manage patients’ expectations and acknowledge the uncertainties in scientific progress. Philosophical reflections on identity and the role of technology in medicine offer valuable insights. Technology should complement the uniqueness of each individual in the rehabilitation process. Traditional methods, like observation, clinical examination, and low-tech assessments, remain invaluable.

Conclusion: One must find a balance between sciences and humanities, between technology and humanism, and between generalization and contextualization approaches. Achieving this balance will lead to meaningful progress in patient care and the advancement of neurorehabilitation.

OP-111

Quality of life and its correlates among parents of children diagnosed with cerebral palsy: an observational cross-sectional study

M. Al-Wardat¹, H. Magableh¹, K. Al Mahdawi¹

¹Jordan University of Science and Technology, Rehabilitation, Irbid, Jordan

Introduction: Cerebral palsy (CP) is a neurological disorder affecting children’s brain function, necessitating long-term intensive care, and significantly impacting parents’ quality of life (QOL). This study investigates parental QOL in the context of children diagnosed with CP and its associations with depression, anxiety, stress, sleep quality, and musculoskeletal issues.

Participants & methods: A cross-sectional study involved 150 parents of CP-diagnosed children. Data collection employed various assessment tools: the Gross Motor Function Scale for CP severity, Nordic Musculoskeletal Questionnaire (NMQ) for parental musculoskeletal pain, International Physical Activity Questionnaire (IPAQ) for physical activity levels, Depression Anxiety Stress Scale (DASS-21) for psychological assessment, Pittsburgh Sleep Quality Index (PSQI), and Beach Center Family QOL Scale (BCFQOL) for assessing parental QOL.

Results: Among 150 eligible parents, 80.7% were female, averaging 34.84 (±8.18) years of age. The statistical model explained approximately 35% of the variance in parents’ quality of life (QOL) with children diagnosed with cerebral palsy (r²= 0.35, F= 5.568, P<0.001). Factors significantly associated with QOL included mental health problems (β= 0.176, [95% CI: 0.611 to 9.340], P=0.026), smoking (β= 0.2, [95% CI: 1.468 to 11.608], P=0.012), and experiencing Nordic elbow pain in the past 12 months (β= 0.184, [95% CI: 1.038 to 12.303], P=0.021).

Conclusion: This study underscores the impact of smoking, elbow pain, and mental health issues on the QOL of parents raising children with CP. These findings highlight the need for comprehensive support and interventions to enhance parental QOL in the context of caring for children with CP.

OP-112

Spasticity management model for low and middle income countries based on current world health organization initiatives

R. De la Cerna-Luna¹, R. Reebye¹

¹World Rehabilitation Alliance, Geneva, Switzerland

Introduction: Spasticity presents challenges in low and middle-income countries (LMICs), where rehabilitation access is limited. Recent studies have identified substantial cases of severe spasticity-causing conditions in these regions. Peru, a Latin American LMIC, is represented in the World Rehabilitation Alliance (WRA) of the World Health Organization (WHO) through Edgardo Rebagliati Martins National Hospital (ERMNH), which operates a WRA-based improvement program. Despite the complexities of spasticity management in LMICs, a consensus-based management model is still lacking.

Objectives: Devise a Spasticity Management Model for LMICs, as a proposal to address the challenges and needs of spasticity rehabilitation within these countries.

Materials & methods: The authors, spasticity experts and WRA members, aligned the protocol with ERMNH’s WRA Program, conceiving a multi-step process that included review assessments (especially WHO publications), semi-structured interviews, an internal consensus survey using the Delphi method, and an external review.

Results: The final model includes five goals. The first encompasses physician workforce organization, promoting collaboration, integration into primary care, emergency planning (advocacy for spasticity management in early phases), research, and external relations. The second integrates non-medical specialists to address specific spasticity-causing conditions. The third emphasizes physiatrists’ competencies and leadership. The fourth engages collaborations with stakeholders and evaluates the workforce. The fifth focuses on research publication to enhance spasticity management.

Conclusion: The Spasticity Management Model for LMICs, based on current WHO initiatives, is pioneering and adaptable, with potential for broader use, addressing workforce organization, collaboration, empowerment, stakeholder engagement, and research. It fills a gap in patient care and will guide strategies for addressing spasticity deficiencies.

OP-113

Delphi analysis: anatomy and BoNT-A injection training for spasticity and dystonia

K. Heckert¹, B. Biering-Sørensen², T. Bäumer³, O. Khan⁴, F. Pagan⁵, M. Paulin⁶, T. Stitik⁷, M. Verduzco-Gutierrez⁸, R. Reebye⁹

¹Thomas Jefferson University, Rehabilitation, Philadelphia, PA, United States

²Rigshospitalet (National Hospital), Neurology, Glostrup, Denmark

³University of Lübeck, Institute of System Motor Science, CBBM, Luebeck, Germany

⁴Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, Canada

⁵Georgetown University, Neurology, Washington, DC, United States

⁶Main Line Health, Rehabilitation Associates of the Main Line, Paoli, PA, United States

⁷Rutgers New Jersey Medical School, Physical Therapy and Rehabilitation, Newark, NJ, United States

⁸University of Texas, Rehabilitation, San Antonio, TX, United States

⁹University of British Columbia, Medicine, Vancouver, Canada

Introduction: Effective treatment with botulinum neurotoxin type A (BoNT-A) injection in spasticity and dystonia requires in-depth knowledge of muscle anatomy and injection-guidance methods, such as ultrasound (US). However, there are no global, standardized best practices to guide training program development in these areas.

Objectives: To provide expert consensus on best practices for anatomy teaching and training on US-guided BoNT-A injection for specialists who treat patients with spasticity and dystonia.

Materials & methods: Nine experts (three neurologists; six physical medicine and rehabilitation physicians) took part in a three-round modified Delphi process.

Results: In Round 1, experts generated 16 statements describing best practices for designing training programs on US-guided BoNT-A injection that incorporate anatomy teaching. By the end of Round 3, consensus had been reached on 15 statements, from among which three core principles for designing effective training programs were identified. First, training should be tailored to the target audience’s needs by considering how existing educational programs and trainees’ current competencies could be improved. Second, instructors must align to ensure consistent approaches, messaging, and nomenclature usage over time and between regions. Third, training programs should be simple, adaptable, and hands-on to aid engagement and learning. Experts also reached consensus on best-practice principles for other elements of training program design, such as objectives, content, eligibility criteria, and assessment.

Conclusion: Using these best-practice principles to develop effective, standardized programs for anatomy and US-guided BoNT-A injection training could enhance global collaboration between experts, enable more physicians to treat spasticity and dystonia, and ultimately improve patient outcomes.

OP-114

Rehabilitation approaches for children with spinal muscular atrophy: a scoping review

P. Mortenson^1,2, N. Cushen³, J. Zwicker^1,4,5

¹University of British Columbia, Occupational Therapy, Vancouver, Canada

²British Columbia Children’s Hospital, Occupational Therapy, Vancouver, Canada

³BC Children’s Hospital, Physiotherapy, Vancouver, Canada

⁴British Columbia Children’s Hospital Research Institute, Brain, Behaviour, & Development Theme, Vancouver, Canada

⁵University of British Columbia, Department of Pediatrics (Div. Developmental Ped), Vancouver, Canada

Introduction: With new medical advances, children living with spinal muscular atrophy (SMA) now survive. Evidence for rehabilitation in this new era of disease-modifying treatments is largely unknown. Past SMA rehabilitation consisted of "accommodation" approaches, but therapy has shifted to active "remediation" with expectations for improvements. Consolidation of evidence is necessary to guide treatment decisions for rehabilitation professionals and families.

Objectives: To assemble SMA rehabilitation literature to identify gaps in knowledge, practice, and research.

Materials & methods: Using the PRISMA-ScR protocol to guide this scoping review, we systematically searched five databases and grey literature for sources with a paediatric (0-18 years) and SMA rehabilitation focus, published between 2000-2022. Two independent reviewers screened titles and abstracts using the Covidence platform; a third reviewer resolved disagreements. Rehabilitation interventions and outcomes were extracted and coded using the International Classification of Function Category Tool and analysed using the related "F-Words in Childhood Disability" as an interpretive framework.

Results: With duplicates removed, 1,917 sources were screened, 219 reviewed, and 40 retained for data extraction. Sources cited interventions directed at impairment (45.5%), functioning (18%), participation (12.5%) and environment (24%) domains. Intervention outcomes were desired for impairment (49%), functioning (38%), participation (7%) and quality of life (6%).

Conclusion: There is a trend in SMA rehabilitation for increased, early, and intense therapy with a bottom-up approach of fixing impairments with reported hopes of translation to functional gains. Practice gaps include consideration of "friendships" and "future", goal-directed multidisciplinary approaches, and child and family voices. In this new SMA era, a new model for rehabilitation is required to guide clinical decisions.

OP-115

Correlation of communication function with gross motor function in children with cerebral palsy

G. Yamin ¹

¹Superior University, Physical Therapy and Rehabilitation, Lahore, Pakistan

Cerebral palsy is defined as a group of disorders of the development of movement and posture. It causes restrictions in different activities that are credited to non-progressive unsettling influences. These disturbances occur in the fetal brain that is developing. It is the commonest disorder that causes disability in children. It is associated with deficits in gross motor abilities, speech and intellectual abilities as well as manual abilities. (1) But there is no documented data on associative relationship between functional communication with gross motor classification system. The objective of the current study is to determine the correlation between communication function with gross motor function in children with cerebral palsy due to shortage of evidence on this topic. Majority were male participants (72%), 28% were female participants Mean age was found 8 years with SD 2.77. 38.1% were Quadriplegic CP children, 26.3% were Diplegic CP and 15.3% were Hemiplegic CP. 62.3% were having Speech impairment along with CP, 17.8% were having Seizure episode, and 16.9% were having Cognitive impairment. Chi square test to find association between Gross Motor Function Classification Framework (GMFCS) Level and Communication function classification system levels P value indicates that there is significant association between Gross Motor Function Classification Framework (GMFCS) Level and Communication function classification system levels. Conclusion The result of the study indicates that there is significant association between Gross Motor Function Classification Framework (GMFCS) Level and Communication Function Classification System (CFCS) levels. CP children who have motor impairment also have communication problems. Their ability to communicate may be related to gross motor functioning either by the location of the lesion in brain or the associated physical limitations.

OP-116

Pain in patients with spasticity: patient characteristics from the adult spasticity international registry (ASPIRE) study

E. Duarte¹, J. Wissel², C. List³, M. Schwartz⁴, M. Nelson⁵, T. Musacchio⁶, W. Feng⁷

¹Hospitals del Mar i l’Esperança, Barcelona, Spain

²Vivantes Klinikum Spanda, Berlin, Germany

³Brooks Rehabilitation, Jacksonville, FL, United States

⁴MS Biostatistics, Clermont, FL, United States

⁵AbbVie, Medical Affairs, Chicago, IL, United States

⁶AbbVie, Global Medical Affairs, Rome, Italy

⁷Duke University, Durham, NC, United States

This sub-analysis describes patient (pt) demographics and clinical characteristics at baseline in pts suffering from spasticity-related pain from any etiology using data from the ASPIRE study.

ASPIRE, an international, multicenter, prospective observational registry study (NCT01930786), examined onabotulinumtoxinA (onabotA) utilization and effectiveness in patients with spasticity over 2 yrs. Limited real-world data is available assessing pain in this pt population.

This sub-analysis includes data from adult pts with spasticity-related pain at baseline (evidenced by NPRS>0) who received≥1 treatment with onabotA for spasticity, regardless of prior treatment with botulinum toxin(s). Assessments at baseline included pain from NPRS measurement and Disability Assessment Scale for upper limb (UL) and lower limb (LL) spasticity.

Of 730 pts enrolled in ASPIRE, 494 reported pain at baseline (NPRS>0) and were included in this analysis. Pts with pain at baseline had a mean (SD) age of 54 (15.4) yrs and were predominantly female (57%) and Caucasian (76%). Most pts were previously treated with onabotA (62%), with a mean (SD) time from prior treatment of 7.7 (14.9) months. Stroke was the most frequently reported etiology in 56% of pts, followed by multiple sclerosis (17%), and cerebral palsy (11%). The most common UL spasticity presentations in pts at baseline included clenched fist (63%) and flexed elbow (62%). The most common LL spasticity presentation was equinovarus foot (72%) 35% of pts were treated for LL, 25% for UL, and 41% for both UL and LL. Mean baseline pain was 5.4, and most pts (65%) had a baseline pain score ≥ 5. Scores on DAS pain subscale at baseline were reported as none or mild by 65% of pts (UL) and 59% (LL); moderate or severe scores were reported by 35% of pts (UL) and 41% (LL).

Baseline characteristics in pts with spasticity-related pain at baseline (with NPRS>0) provide important information about individuals seeking onabotA treatment for spasticity.

OP-117

Effect of oral neuromuscular training on decannulation and swallowing in patients with acquired brain injury: a randomized controlled pilot study

M. Blichfeldt¹, M. Kothari¹, J. Fabricius¹

¹Aarhus University, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus, Denmark

Introduction: Patients with severe acquired brain injury (ABI) may require a tracheostomy tube during rehabilitation due to aspiration risk. Oral neuromuscular training devices are used in clinical practice for improving swallowing function in patients with ABI, and may also be applied for patients with tracheostomy tubes. However, the effect of oral neuromuscular training devices on swallowing function is not yet evidence-based.

Objectives: The objective of this study was to investigate the effect of an oral neuromuscular training device on decannulation and swallowing in patients with tracheostomy tubes.

Materials & methods: Design: A randomized controlled pilot study (ClinicalTrials.gov ID: NCT05235282)

Setting: Sub-acute inpatient neurorehabilitation hospital

Eligibility criteria: ≥18 years, ABI, cuffed tracheostomy tube at admission, Fiberoptic Endoscopic Dysphagia Severity Scale - DK (FEDSS-DK) ≥4 at admission, able to adhere with the intervention

Sample size: A power calculation based on Hägglund et al. (2019) revealed that the study required at least 22 participants. To account for withdrawal from the study, the goal is to enroll 26 participants.

Control: The control group received usual training of swallowing function

Intervention: The intervention group received training with an IQoro® oral screen (MYoroface AB, Sweden) three times of five minutes on weekdays for four weeks, as an add-on to usual training of swallowing function.

Outcomes: The primary outcome is time until decannulation from a cuffed tracheostomy tube. Secondary outcomes are swallowing function assessed with Fiberoptic Endoscopic Evaluation of Swallowing (FEES), and daily amounts of saliva above the cuff.

Results: A total of 17 subjects have been included in the study so far.

Conclusion: Findings from the study will be ready for presentation at the conference in May 2024.

OP-118

Feasibility of a randomized controlled trial of cognitive behavioural therapy for functional cognitive disorder after concussion

M. Rioux¹, R. Mamman², W. J. Panenka³, A. K. Howard³, D. L. Perez⁴, M. T. Byworth³, J. Schmidt⁵, J. Lemoult¹, N. Silverberg¹

¹University of British Columbia, Psychology, Vancouver, Canada

²University of British Columbia, Rehabilitation, Vancouver, Canada

³University of British Columbia, Psychiatry, Vancouver, Canada

⁴Havard Medical School, Neurology and Psychiatry, Cambridge, MA, United States

⁵University of British Columbia, Occupational Therapy, Vancouver, Canada

Background: Although objective memory impairment usually resolves within weeks after a concussion, up to 50% of individuals continue to report memory symptoms a year later. A large subset of those with persistent symptoms can be diagnosed with functional cognitive disorder (FCD). Psychological factors such as catastrophizing and avoidance may contribute to FCD after concussion. The current study evaluated the feasibility of a novel, cognitive-behavioural therapy (CBT) intervention for FCD designed to address these psychological factors.

Methods: Participants (N=24) were randomized (1:1, stratified by memory concern severity) into CBT (n=11) or standard of care, cognitive rehabilitation (n=13) (Clinicaltrials.gov #NCT05581810). Both interventions consisted of 11 x 50-minute manualized sessions delivered over videocalls by clinical psychology graduate students. CBT involved cognitive reappraisal for catastrophizing, and in-vivo exposure and behavioural experiments to target avoidance. Cognitive rehabilitation involved traditional memory compensation strategy training. Prespecified feasibility criteria for a successful pilot were set for (1) recruitment, (2) patient-perceived treatment credibility, (3) patient adherence to treatment, (4) therapists’ compliance with the treatment protocol, and (5) retention.

Results & implications: All feasibility criteria fell within the acceptable range and were similar between groups. Recruitment rate was high (85.7%), with only 4 individuals declining enrollment. Credibility of treatment was above the rating scale midpoint for 23/24 participants. One participant withdrew from treatment but all 24 completed the primary outcome post-intervention. In 95% of audited sessions, therapists effectively covered all essential session content. Findings of this study support the feasibility of CBT tailored to FCD and a phase III randomized controlled trial to evaluate the efficacy of the novel intervention for adults with concussion.

OP-119

Employment outcomes and predictors following spinal cord injury in Australia: a population-based cross-sectional study

T. Geraghty^1,2, B. Samantha¹, M. Aurora^3,4, R. Marshall^5,6, A. Nunn⁷, J. Middleton^3,4

¹Griffith University, Hopkins Centre, Brisbane, Australia

²Princess Alexandra Hospital, Rehabilitation, Brisbane, Australia

³University of Sydney, Sydney, Australia

⁴John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia

⁵South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, Australia

⁶University of Adelaide, Health Science, Adelaide, Australia

⁷Victorian Spinal Cord Service, Austin Health, Melbourne, Australia

Introduction: Sustainable employment outcomes are a priority for many following spinal cord injury (SCI). However, rates of employment following SCI in Australia remain well below those for people without disability.

Objectives: To contextualise post-SCI employment in Australia including work participation rates and time to resuming work. To explore the association between socio-demographic, health, and functioning variables with engagement in paid employment for those of working age.

Materials & methods: Self-reported, cross-sectional data for the Australian cohort (1579 participants) of the International Spinal Cord Injury (InSCI) Community survey. The survey included 16-items dedicated to employment. Employment, time to resuming work and underemployment were explored descriptively. Bayesian penalized regression was used to identify associations between 23 predictor variables and paid employment for 1,189 working aged (18-67 years) people.

Results: The post-SCI employment rate was 50%, with 29% currently working. Those unable to return to work immediately post-rehabilitation took a mean of 28 months (SD, 35.9) to return. Underemployment was evident among 16% of those working and tended to be higher among males. Among working aged participants, those who attained a Master/doctoral degree (OR = 3.01, 95% CrI = 1.63, 5.44) and were married (OR = 1.68, 95% CrI = 1.13, 2.49) were more likely to be working. Females (OR = 0.55, 95% CrI = 0.37, 0.81), people receiving a disability pension (OR = 0.17, 95% CrI = 0.13, 0.24) and older participants (OR = 0.75, 95% CrI = 0.63, 0.90) were less likely to be in paid work.

Conclusions: These findings indicate a need for more comprehensive early intervention focused services targeted towards employers and individuals. Modelling outcomes can assist in directing resources to subgroups within SCI populations who need greater assistance related to employment outcomes, including via vocational rehabilitation services.

OP-120

Long term effect of the Possover laparoscopic implantation of neuroprosthesis (the Possover LION procedure) in individuals with spinal cord injury

K. Figlewski^1,2, V. Hvingelby^3,1,2, U. Schou Løve⁴, J. Vibjerg², A. B. Jønsson^2,5, H. Kasch^1,2, J. Feldbæk Nielsen⁶

¹Central Hospital Unit, Neurology, Viborg, Denmark

²Central Hospital Unit, Spinal Cord Injury Centre of Western Denmark, Department of Neurology, Viborg, Denmark

³Aarhus University, Aarhus, Denmark

⁴Central Hospital Unit, Department of Surgery, Viborg, Denmark

⁵Central Hospital Unit, Department of Surgery, Viborg, Denmark

⁶Aarhus University, Department of Hammel Neurorehabilitation and Research Centre, Department of Clinical Medicine, Aarhus, Denmark

Introduction: Spinal Cord Injury (SCI) presents a devastating and debilitating event in a person"s life. Often, sustained disabilities are lifelong and have a significant impact on quality of life (QoL) and activities of daily living (ADL). Furthermore, as patient"s lifestyle become restricted as they are wheel-chair bound or dependent on other such amenities, many experience associated conditions such as a loss of lean body mass and bone mineral density (BMD). In recent years, several neurorestorative therapies have been proposed based on electrical nervous stimulation. One such, the Possover laparoscopic implantation of neuroprosthesis (LION) procedure is a promising treatment and has been showed to improve walking ability.

Methods: Sixteen AIS grade A SCI patients were enrolled in a randomized one-year trial of the Possover LION procedure, results of which have previously been published. Patients have been systematically followed-up at various intervals at the outpatient SCI-clinic at the SCI Centre of Western Denmark. Data regarding Walking Index for SCI (WISCI-II), QoL, ADL and several other performance and activities measures were obtained.

Results: Fourteen males and 2 females with SCI, AIS grade A, neurological level from Th4–L1 have been followed-up up to 6 years post-procedure. All but one participant opted for keeping the implant, one neuroprosthesis was removed due to infection. Improvements in WISCI-II scores, which have been seen at the end of the randomized trial were sustained at the latest follow-up in most cases. Additionally, most patients indicated treatment satisfaction

Conclusion: Overall, while regaining of functional status in terms of gait and standing were infrequently achieved, in cases where this was possible, effects were sustained long-term. Taken together, long-term results of the SCI-LION cohort indicate neuromodulation may be suitable in order to regain functional status in SCI patients with several avenues of future improvement.

OP-121

Telerehabilitation of post stroke upper limb dysfunction with a brain-computer interface controlled FES system: a proof of concept and feasibility study

K. Nair^1,2, S. Mansour^1,2, J. Giles^1,2, R. Marshall^1,2, A. Ali^1,2, M. Arvaneh^1,2

¹Sheffield Teaching Hospitals NHS foundation trust, Neurology, Sheffield, United Kingdom

²University of Sheffield, Neuroscience, Sheffield, United Kingdom

Introduction: Upper limb dysfunctions is a frequent and disabling consequence of stroke. We devised a telerehabilitation system (Tele BCI-FES) merging brain-computer interface d(BCI) and functional electrical stimulation (FES) technologies for domiciliary rehabilitation of post stroke upper limb dysfunction.

Objectives: To demonstrate proof of concept and evaluate the feasibility and acceptance of our tele BCI -FES system

Patients & method: This is an open labelled feasibility study. We recruited 8 participants who had a stroke resulting in upper limb dysfunction six months or longer. They received 9 home-based Tele BCI-FES sessions (3 per week) with remote support from the research team. Primary outcomes were recruitment and retention rates and participants perception on the adoption of technology. The secondary outcomes measures were Fugl-Meyer Assessment for Upper Extremity (FMA_UE) and the Leeds Arm Spasticity Impact Scale (LASIS) before and after the intervention.

Results: Among 8 participants who were recruited, 7 completed the home-based Tele BCI-FES session (retention rate- 87.5% and recruitment rates (86.7%). During the initial sessions, participants experienced difficulties with set up which became easier during subsequent sessions. Participants suggested modifications to enhance user experience. The mean FMA_UE scores before and after intervention were 19.50 and 23.33 (p = 0.032). Mean LASIS score before and after the intervention were 27.83, and 27.17 respectively (p=0.80)

Conclusion: This study demonstrated a trend towards improvement in upper limb function following a period of tele BCI-FES. The high recruitment, retention and acceptability demonstrate that it is feasible to do a larger trial of Tele BCI-FES system for post stroke upper limb rehabilitation. We are planning for further studies demonstrate the efficacy of Tele BCI-FES for post stroke upper limb rehabilitation

OP-122

Treatments of fatigue after spinal cord injury: a systematic review and meta-analysis

C. L. Cano-Herrera^1,2,3, G. Manhas⁴, M. Querée^1,2, B. Hoogenes^5,6, E. A. Bateman^7,8, E. Loh^7,8,9,10, W. Miller^11,12,13, B. Mortenson^11,12,13, A. Townson^11,14, J. Eng^1,2

¹University of British Columbia, Physical Therapy, Vancouver, Canada

²Vancouver Coastal Health, Centre for Aging SMART, Vancouver, Canada

³Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain

⁴University of British Columbia, Medicine, Vancouver, Canada

⁵GGZ ingest Mental Healthcare Services, Amsterdam, Netherlands

⁶Amsterdam University Medical Center, Department of Psychiatry, Faculty of Medicine, Amsterdam, Netherlands

⁷Parkwood Institute, Parkwood Institute Research, London, Ontario, Canada

⁸Western University, Physical Therapy and Rehabilitation, London, Ontario, Canada

⁹Lawson Health Research Institute, London, Ontario, Canada

¹⁰St. Joseph’s Health Care Pain Management Program, London, Ontario, Canada

¹¹Vancouver Coastal Health, Centre for Aging SMART, Vancouver, Canada

¹²University of British Columbia, Occupational Therapy, Vancouver, Canada

¹³International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada

¹⁴University of British Columbia, Physical Therapy and Rehabilitation, Vancouver, Canada

Background: Fatigue is one of the most common consequences of spinal cord injury (SCI), affecting over 50% of people living with SCI. Fatigue may have negative effects on rehabilitation and it negatively affects participation in life activities. Evidence-based treatment options for fatigue in people with SCI are essential to improve their quality of life. This first systematic review on treating fatigue in people with SCI aimed to evaluate the effectiveness of interventions available in the literature.

Data Sources: MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched up to October 2023.

Methods: Randomized controlled trials (RCTs) that incorporated any intervention and assessed outcomes of fatigue in people living with SCI were included. Quality assessments of studies were done using the Cochrane Risk-of-Bias Tool.

Results: After removing duplicates, we screened 232 articles for inclusion; ultimately 5 RCTs were included in the review (N=181 participants). The most common outcome used was the Fatigue Severity Scale (4 RCTS). One study found that moderate-intensity arm-crank exercise significantly improved fatigue compared to a control group (P=0.036) with a large effect size (SMD=1.05; 95% CI, 0.10,2.00). Two studies assessing behavioral interventions found a moderate effect on fatigue (SMD=0.46; 95% CI, -0.00,0.92). Two studies found a negligible effect and no statistically significant difference for massage therapy (SMD=0.06; 95% CI, -0.38,0.50). Risk of bias was classified as High for all but one of the RCTs.

Conclusions: Despite the prevalence of fatigue in SCI, few controlled trials have evaluated intervention efficacy. Preliminary research is promising that exercise and/or behavioral interventions can have a positive effect on fatigue. More research with larger sample sizes and standardized measurement is needed to provide evidence-based treatment options for reducing fatigue in people with SCI.

Keywords: Spinal cord injury, Fatigue, Treatment.

OP-123

The temporal evolution from “bad-news” to “life-changing” communication to SCI persons

E. Zanin¹, S. Salizzato¹, F. Flaminio¹, M. Spinelli², L. Simoncini³, S. Masiero⁴, H. Cerrel Bazo^1,4

¹Rehabilitation Hospital, Spinal Unit and Severe Acquired Brain Injury, Motta di Livenza, Italy

²Niguarda Hospital-University Milano Bicocca, Spinal Unit-NeuroUrology Center, Milan, Italy

³Montecatone Rehabilitation Institute, Spinal Cord Injury Center, Montecatone, Italy

⁴University of Padua, PM&R Department & Medical School, Padua, Italy

Introduction: One of the most challenging aspects related to Spinal Cord Injury (SCI) is making patients aware of their new, life-changing, condition, leaving behind what has been lost compared to the previous condition (bad news). Indeed, motor-functional outcomes after SCI can vary according to the anatomo-clinical features of SCI, making the prognosis communication very difficult for the professionals. Patients" perspective of different aspects associated with SCI can also change over time, from prognosis communication to the end of inpatient phase.Unfortunately, little is known about the experience of prognosis communication perceived by SCI patients during inpatient rehabilitative care and its possible evolution over time.

Objectives: The aim of this study was to investigate how persons with SCI experienced the prognosis communication along different times in an intensive acute care spinal unit.

Materials & methods: Patients were asked to complete a structured questionnaire investigating different aspects associated to prognosis communication in three times: the same day when prognosis communication was given, after 30 days and at the end of inpatient phase.

Results: The patients" understandings and needs varied along time during the intensive rehabilitation program. Their needs varied along intensive acute care rehabilitation phase, according to personal traits and the clinical complexity and evolution of SCI.

Conclusion: Since a proper understanding of functional outcomes after SCI is fundamental for persons with SCI, all the aspects associated to prognosis communication must be considered carefully. In doing so, rehabilitative teams must take into account that the awareness can rise and change over time, rather than being a simple sender-recipient act. Thus, professionals should first acknowledge where the patients are on their current understanding of diagnosis and helping them to move their view from a "bad-new" to a "life-changing" condition.

OP-124

Effectiveness of robot-assisted training in adults with Parkinson’s disease: a systematic review and meta-analysis

C. Arienti¹, B. Mosconi¹, C. Cordani², S. G. Lazzarini¹

¹IRCCS Carlo Gnocchi Foundation, Cochrane Rehabilitation, Milan, Italy²University “La Statale”^2.Department of Biomedical, Surgical and Dental Sciences, Milan, Italy

Introduction: Parkinson"s disease (PD) is a progressive neurodegenerative condition characterized by motor symptoms of bradykinesia, in combination with tremors, rigidity, or postural instability. Because of its progressive nature and the array of motor and non-motor features, the treatment of PD is complex. In recent years, there was an increase in the use of robotic devices in rehabilitation, known as robot-assisted training (RAT).

Objectives: The aim of this work is to summarize the existing evidence on the effectiveness of RAT in adults with PD.

Materials & methods: This is a systematic review with meta-analysis (PROSPERO CRD42022371124). Only randomized controlled trials (RCTs) addressing the effectiveness of RAT in adults with PD were included. Seven databases and two trial registries have been searched from inception to November 2022. Random-effects meta-analysis was performed. Certainty of the evidence was assessed using the GRADE approach.

Results: 15 RCTs (646 randomized participants) met the inclusion criteria and were included in the systematic review. Based on the available evidence, robot assisted gait training (RAGT) may have little or no effect on motor impairment, balance, mobility and freezing of gait, both at the end of treatment and at the longest follow up, compared to treadmill training (TT), but the evidence is very uncertain. Similarly, RAGT may have little or no effect on motor impairment and freezing of gait at the end of treatment and may improve balance at the end of treatment and at follow up compared to overground gait training (OGT), but the evidence is very uncertain.

Conclusion: Based on the available very low certainty evidence, it is not possible to draw firm conclusions about the effectiveness of RAT in adults with PD. Even if no evidence of a difference seems to exist between RAGT and TT or OGT but on balance, further adequately powered trials are urgently needed so that patients are offered evidence-based interventions.

OP-125

Gaze stabilization in persistent postural-perceptual dizziness measured with a novel VR assessment tool

Y. Liu^1,2, E. Dannenbaum¹, A. Lamontagne^1,2, J. Fung^1,2

¹Jewish Rehabilitation Hospital, Research, Laval, Canada

²McGill University, Physical and Occupational Therapy, Montreal, Canada

Introduction: Persistent postural-perceptual dizziness (3PD) describes prolonged dizziness when exposed to complex visual stimuli in upright posture. Gaze stabilization may be impaired with 3PD. Virtual reality (VR) can be applied to create ecological scenarios with static or moving stimuli. We aim to combine VR with eye tracking to develop a tool for diagnosis and eventually interventions.

Objectives: Evaluate the feasibility of the VR-based tool to assess eye movements and determine whether people with 3PD present altered gaze patterns.

Participants & methods: Participants (7 with 3PD vs. 7 controls) completed the test in sitting while watching a busy subway station scene through a FOVE headset with eye movements captured. Participants were exposed to different conditions presented randomly after watching a static train station (baseline environment). The different dynamic conditions include watching a train moving in either directions with or without a central target presented as a balloon. The balloon can be stationary or moving vertically in front of moving or stationary trains. Each condition lasted 5-15s with eye movements recorded. The total gaze trajectory path distance (GTPD) for each condition was analyzed.

Results: In the baseline condition, the average GTPD was similar between 3PD (22.8±18.5 m) and controls (23.91±16.7 m). In the condition with moving train and no balloon, the average GTPD was significantly larger in 3PD (129.63±53.46 m) than controls (85.59± 46.9 m). In the presence of a stationary balloon, GPTD was reduced in controls (72.5±46.8m) but not 3PD (125.43±99.05m). The average GTPD was similar comparing moving with stationary balloon.

Conclusion: This novel VR-based tool can feasibly assess eye movements in different virtual environments, showing that 3PD patients have deficits maintaining gaze stability in dynamic visual environments. Future studies will determine whether training with a visual anchor can improve gaze stability in 3PD.

P-001

Embedding sexual health practice across the continuum of stroke rehabilitation

C. Giurleo¹, A. Kras-Dupuis¹, D. Lala¹, M. Seliman¹, D. Wolfe^2,1, A. McIntyre^3,4

¹St. Joseph’s Health Care London, London, Ontario, Canada

²Parkwood Institute, Parkwood Institute Research, London, Ontario, Canada

³Western University, Nursing, London, Ontario, Canada

⁴London Health Science Centre, Emergency Medicine, London, Ontario, Canada

Introduction: Sexual health may be disrupted after a stroke and is often not addressed in rehabilitation.

Objective: A quality improvement initiative was undertaken to embed sexual health education and support for patients with stroke into clinicians" clinical practice.

Materials & methods: In 2021-2022 a team of clinicians, researchers and persons with stroke developed and implemented a new sexual health practice in inpatient and outpatient stroke rehabilitation. The implementation team followed a systematic process based on Implementation Science principles. The Permission, Limited Information, Specific Suggestions and Intensive Therapy (PLISSIT) model and Sexual Rehabilitation Framework were foundational to program content. Staff attended a one-day workshop and were provided additional educational resources. To assess the impact of the sexual health practice, the Knowledge, Comfort, Approach, and Attitude toward Sexuality Scale (KCAASS) was completed by staff before and after the workshop, and 6 months after the practice was launched (April 2022).

Results: Clinicians reported that their knowledge increased from 29% pre-workshop to 69% after the workshop, and 47% at 6 months; comfort increased by 20% post workshop and by 18% at 6 months. Readiness to apply the skills clinically increased from 22% pre-workshop to 76% post and 60% at 6 months.

Conclusions: Comprehensive staff education and embedding sexual health into clinical practice facilitated normalizing stroke patients" sexual health concerns. Ongoing education and support for staff may be warranted to ensure a sustainable practice. This holistic rehabilitation approach addresses the reintegration of sexual health into the daily lives of patients with stroke.

P-002

Urodynamic study in patients with urinary incontinence following stroke

A. Gupta ¹

¹National Institute of Mental Health & Neuro Sciences-NIMHANS, Dept. of Neurological Rehabilitation, Bengaluru, India

Objective: Assessment of bladder by urodynamic study (UDS) in patients with urinary incontinence following stroke, and correlation with site of lesion.

Study design & setting: Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute.

Materials & methods: Forty patients (22 males) with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion.

Results: The mean age was 46.80 ± 16.65 years (range: 18-80 years). Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 ± 10.27 days (range: 8-53 days) after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90%) having overactive detrusor (OD) and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5%) had OD without detrusor-sphincter dyssynergy (DSD) and 11 (27.5%) had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation (P > 0.05) was found between type of bladder and age or side and site of lesion.

Conclusions: UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion.

Keywords: Stroke, urinary incontinence, urodynamic study

P-003

Anthropometric factors affecting cardiovascular responses to postural sway and other discrete counterpressure maneuvers

E. Williams¹, J. Lando¹, B. Hockin¹, K. Elabd¹, S. Robinovitch¹, I. Parsons^2,3, V. Claydon¹

¹Simon Fraser University, Biomedical Physiology and Kinesiology, Burnaby, Canada

²Royal Centre for Defence Medicine, Research and Clinical Innovation, Birmingham, United Kingdom

³King’s College London, School of Cardiovascular Medicine and Sciences, London, United Kingdom

Many neurological conditions impact the autonomic nervous system, with impairment to blood pressure control. Accordingly, a common comorbid condition that complicates neurorehabilitation is syncope (fainting), which negatively impacts quality of life and increases injury risk. Physical counterpressure maneuvers (CPM) are a common intervention to terminate impending syncope by enhancing venous return through skeletal muscle pumping. However, approximately one-third of patients report difficulty employing CPM due to practical barriers such as mobility impairment.

We evaluated cardiovascular responses to novel discrete movements that hold promise as accessible CPM.

Following supine rest, participants (N=26, 12 female, age 29±1.4 years) performed a baseline stand (BL) on a force platform, followed by three randomized trials of discrete movement (exaggerated anterior-posterior sway, AP; toe clenching, TC; rhythmic gluteal clenching, GC). Non-invasive beat-to-beat cardiovascular outcomes (systolic arterial pressure, SAP; stroke volume, SV; cerebral blood flow velocity, CBFv) were measured continuously. Sympathetic drive was measured as the low frequency peak in the SAP power spectrum (LF SAP).

Both AP and GC improved SAP (BL:+2±2mmHg, AP:+11±2mmHg, p<0.001; GC:+10±2mmHg, p<0.001) and blunted orthostatic reductions in SV (BL:-25±2%; AP:-15±2%, p<0.001; GC:-18±2%, p<0.001) compared to BL, while TC had no effect. Only AP improved orthostatic reductions in CBFv (BL:-29±3%, AP:-22±3%; p=0.021) and reduced LF SAP (BL:60±4%, AP:43±4%; p=0.007). Those with greater BL orthostatic deficits experienced larger enhancements in SAP (R=-0.4, p<0.001), SV (R=-0.3, p=0.003), and CBFv (R=-0.5, p<0.001) during CPM.

AP produced robust cardiovascular responses and may be a viable CPM to bolster against syncope. Muscle pumping during AP reduced reliance on sympathetically-mediated vascular responses, which may be particularly beneficial for patients with neurological causes for syncope.

P-004

Autonomic dysfunction and it complete correction with use of intrathecal autologous BMC (bone marrow concentrate with about 10% stem cells) + movement therapy + neuromodulation in 9 patients with spinal cord injury (SCI), 1 patients with M. Parkinson (MP) and 2 with cerebellar atrophy typ C (CA)

J. Bodziony ¹

¹AZ SwissClinic AG, Lucerne, Switzerland

Autonomic dysfunction (AD), also known as dysautonomia, refers to a group of conditions that result from damage to the nerves that manage everyday body processes. (Fig.1) These nerves are part of our autonomic nervous system, which controls unconscious or involuntary actions and impaired sensations.

Autonomic dysfunction can have many causes, including degenerative neurological diseases like MP and CA or traumatological like SCI.

Symptoms can be widespread and might include: Anosmia; Salivary gland dysfunction; Vision problems; Temperature control - People cannot sweat, do not differentiate between cold and warm; Impaired sensation: This might include numbness, tingling, weakness, pain, remapping; Dysphagia; Problems with heart rate and blood pressure; Digestive problems; Urinary issues: This might involve frequent urination, urinary incontinence, or difficulty starting to urinate; Anorectal dysfunction, constipation; Sexual problems: erectile dysfunction; vaginal dryness or difficulty achieving orgasm.

AD is a prevalent health problem that remains underdiagnosed, undertreated, underappreciated and underrated across healthcare systems. The reason of this is failing of complete correction of AD. Treatment for AD typically involves only managing symptoms.

It would be presented a new therapy method with use of intrathecal autologous BMC (Bone Marrow Concentrate) with about 10% stem cells) + Movement Therapy + Neuromodulation which can completely correct AD.

Last Reference

Bodziony J, Hassanzadeh H. (2021), Combination of intrathecal autologous BMC (Bone Marrow Concentrate) with 5days robotic movement therapy + Electric Muscle Stimulation (EMS) +intravenous modulation + intensive physiotherapy improve trunk control and completely recover sensibility in patients with chronic SCI. European Congress of Neurorehabilitation, Berlin 8–11.12.2021, eP1-84 Neurologie & Rehabilitation, December | 27 | ISSN 0947-2177

P-006

Feasibility, acceptability, and potential impact of a hybrid telerehabilitation program on cardiovascular dysautonomia in Parkinson’s disease

L. Crépin^1,2, I. Beaulieu-Boire³, É. Riesco^1,2, F. A. Savoie^4,2, P. Boissy^1,2, C. Viscogliosi^1,2, M. Tousignant^1,2, F. Michaud¹, Y. Tousignant-Laflamme¹, G. Léonard^1,2, L. Pinheiro Carvalho^1,2

¹Sherbrooke University, Sherbrooke, Canada

²Centre de Recherche sur la Vieillissement, Sherbrooke, Canada

³Centre Intégré Universitaire de Santé et de Service Sociaux de l’Estrie-CHUS, Médecine, Sherbrooke, Canada

⁴Université du Québec, Rimouski, Canada

Introduction: Parkinson’s disease (PD) though known for its motor symptoms causes a multitude of limiting non-motor symptoms, such as cardiovascular dysautonomia (CD) (≈ 50%). Few studies show that rehabilitation can reduce CD. The increasing number of PD cases requires rethinking of traditional approaches, for example using telerehabilitation (TR).

Objective: To assess feasibility, acceptability, and potential effect of a hybrid (synchronous/asynchronous) TR program on CD for people with PD.

Methods: 3 people (61.0±6.5yo) with mild and moderate PD and CD were recruited. The hybrid TR program (12 weeks; 3x/week) includes exercise and education components and has a synchronous/asynchronous session progression from 3/0 (week 1) to 0/3 (week 12). Feasibility is assessed by recruitment, retention, and adherence rates. Acceptability is defined through semi-structured interviews identifying barriers and facilitators. The impact of the program is measured through performance tests (6-minute walk test-6MWT, heart rate variability-HRV, 24h ambulatory blood pressure monitoring-ABPM) and questionnaires on CD (SCOPA-AUT, score/9; OHQ, score/100). The higher the scores, the more CD symptoms.

Results: 2 persons have completed the intervention (A/B): 1W/1M; 55/61yo; 6/8 years since diagnosis; stage 2/2 according to H&Y; BMI 20.0/25.9 kg/m2. The recruitment, retention and adherence rates are 10, 100 and 89% respectively. Participants who completed the study were satisfied with the program, as measured by acceptability measures. The 6MWT distance increased beyond the minimum clinically important difference (Apre/Apost – Bpre/Bpost): 445/521m – 467/593m. HRV parameters and MAPA indicate a better cardiovascular response in post-intervention. Questionnaires scores decreased for OHQ (39/5 – 36/0) and SCOPA-AUT (1/1 – 1/0).

Conclusion: The designed program appears feasible despite a low recruitment rate, acceptable from the participants" perspective and effective to reduce CD in PD.

P-007

Modulating vascular responses during urodynamic assessment using transcutaneous spinal cord stimulation

T. Miller^1,2, M. Calderón-Juárez^1,2, R. N. Malik^1,2, S. Samejima^1,2, C. Shackleton^1,2, J. Ge², A. Hosseinzadeh², L. Rempel², R. Sachdeva^1,2, S. Balthazaar^2,3,4, A. Krassioukov^1,2,5

¹University of British Columbia, Medicine, Vancouver, Canada

²International Collaboration on Repair Discoveries (ICORD), Medicine, Vancouver, Canada

³University of British Columbia, Division of Cardiology, Vancouver, Canada

⁴University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom

⁵GF Strong Rehabilitation Centre, Spinal Cord Program, Vancouver, Canada

Background: Recent evidence suggests transcutaneous spinal cord stimulation (tSCS) may mitigate autonomic dysreflexia (AD) resulting from bladder irritation. However, research investigating peripheral vascular responses associated with bladder-induced AD is limited.

Objectives: To characterize carotid arterial blood flow during urodynamic assessment (UDS) with and without tSCS.

Methods: Six participants (females=2, males=4, age=30[20]) with chronic, motor-complete SCI (≥T5, AIS A or B) underwent UDS. Common carotid artery blood flow was measured using Doppler ultrasound. Measures were collected during (1) baseline, (2) initial bladder filling, (3) AD onset during bladder filling and (4) bladder filling with tSCS applied at T11 and L1 spinal segments. Differences in ultrasound parameters between events were determined using Friedman tests with Wilcoxon Signed Ranks post hoc comparisons (p≤0.05).

Results: Significant differences in mean arterial shear rate were observed between UDS events (p=0.008). Post hoc analyses showed significantly lower mean shear rate during bladder filling with tSCS (377.1[150.4]) compared to initial filling (430.1[232.8]) and AD onset without tSCS (529.2[307.3]) (p≤0.013) but not baseline (389.6[90.4]) (p=0.594). Significant differences in arterial diameter were also observed between UDS events (p<0.001). Post hoc analyses also showed significantly greater arterial diameter during bladder filling with tSCS (5.73[0.85]) compared to initial filling (5.40[0.98]) and AD onset without tSCS (5.29[1.10]) (p≤0.003) but did not differ from baseline (5.73[0.86]) (p=0.374).

Conclusions: Our preliminary results suggest tSCS reduces arterial shear rate and increases vasodilation during bladder distention by blunting sympathetic outflow to peripheral vasculature. These findings contribute to a growing body of evidence promoting the use of tSCS as a potential therapy for mitigating AD and potentially reducing long-term cardiovascular disease risk.

P-008

Comparing vascular function in people with spinal cord injury and their able-bodied counterparts: a systematic review and meta-analysis

T. Miller^1,2, T. Thordarson², A. Hosseinzadeh², S. Balthazaar^2,3,4, M. Calderón-Juárez^1,2, R. N. Malik^1,2, S. Samejima^1,2, C. Shackleton^1,2, R. Sachdeva^1,2, A. Krassioukov^1,2,5

¹University of British Columbia, Medicine, Vancouver, Canada

²International Collaboration on Repair Discoveries (ICORD), Medicine, Vancouver, Canada

³University of British Columbia, Division of Cardiology, Vancouver, Canada

⁴University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom

⁵GF Strong Rehabilitation Centre, Spinal Cord Program, Vancouver, Canada

Background: Although vascular dysfunction is a known sequelae of spinal cord injury (SCI), the degree to which vascular function is impaired in people with SCI relative to their non-injured counterparts remains understudied.

Objectives: To identify structural and functional adaptations to central and peripheral vasculature in people with SCI and determine the impact of SCI on these parameters relative to able-bodied comparators.

Methods: A systematic search of five databases was conducted in accordance with PRISMA guidelines. Studies reporting structural or functional changes to vasculature following SCI were included. Data describing participant demographic and injury characteristics, outcomes, and assessments used were extracted. Analyses for adequately powered subgroups were conducted on the basis of outcome type, measurement site, and neurological level of injury (NLI), with effect magnitudes expressed as Cohen"s d and 95% confidence intervals (CI).

Results: Forty-two studies involving 829 participants with SCI and 849 able-bodied comparators were included. Studies used ultrasound, transcranial Doppler, tonometry or other methods to evaluate vascular outcomes. For arterial blood flow volume measured above and below the NLI, the impact of SCI relative to comparators was small (d=-0.426, 95%CI=-1.040-0.187) to moderate (d=-0.736, 95%CI=-1.181-0.291), respectively. Relative to comparators, the impact of SCI on arterial diameter was small (d=-0.417, 95%CI=-0.852-0.058) to large (d=-1.555, 95%CI=-2.062-1.089) for vessels measured above and below the NLI, respectively. Subgroup analyses showed the impact of SCI on arterial diameter below the NLI was greater than vessels above the NLI (Q=10.446, p=0.001). No difference was observed for blood flow volume based on NLI (Q=0.891, p=0.550).

Conclusions: Overall, results suggest the magnitude of structural and functional alteration attributed to SCI varies according to the level of injury and vasculature assessed.

P-009

Prevalence of orthostatic intolerance in Long COVID: a multicentre observational study

M. Sivan¹, C. Lee², J. Corrado¹, D. Greenwood³, N. Locomotion Consortium⁴

¹University of Leeds, Academic Department of Rehabilitation Medicine, Leeds, United Kingdom

²Imperial College London Hospitals NHS Trust, London, United Kingdom

³University of Leeds, Leeds Institute of Data Analytics, Leeds, United Kingdom

⁴NIHR LOCOMOTION (LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS) STUDY, Leeds, United Kingdom

Purpose: Orthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH), are often reported in Long Covid, but published studies are small, with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending Long Covid clinics and healthy volunteers and associations with symptoms and comorbidities.

Methods: Participants were recruited from 8 UK Long Covid clinics, and healthy volunteers from general population. All undertook standardiszed National Aeronautics and Space Administration Lean Test (NLT). Participants" history of typical OI symptoms (e.g. dizziness, palpitations) prior to and during the NLT were recorded.

Results: 277 Long Covid patients and 50 frequency-matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or POTS, 10% had asymptomatic OH. 130 (47%) Long Covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. 31 (11%) had abnormal NLT, 20 (7%) met criteria for POTS and 21 (8%) had OH, half of which were symptomatic. Of patients with an abnormal NLT, 45% had no prior symptoms of OI. Relaxing the diagnostic thresholds for POTS from two consecutive to one reading, resulted in 11% of Long Covid participants meeting criteria for POTS, but not in healthy volunteers.

Conclusion: More than half of Long Covid patients experienced OI symptoms during NLT and more than one in ten patients met the criteria for either POTS or OH, half of whom did not report previous typical OI symptoms. We recommend all patients attending Long Covid clinics are offered an NLT and appropriate management commenced.

P-010

Autonomic dysreflexia, dysfunction and the relation to level of neurological injury – a case series and comprehensive review of the literature

V. Hvingelby^1,2, T. Bech², M. Andersen², E. M. Hagen²

¹Aarhus University, Aarhus, Denmark

²Central Hospital Unit, Neurology, Viborg, Denmark

Introduction: Autonomic dysreflexia (AD) is a serious, potentially life-threatening symptom of autonomic dysfunction, secondary to spinal cord injury (SCI). While AD typically arises due to injury level above Th6, all locations may precipitate autonomic dysfunction. Here, we present a series of four individuals experiencing AD and relate this to a systematic review of the literature on autonomic dysfunction more generally

Methods: Four patients, admitted for specialized rehabilitation were prospectively recruited. After informed consent, case histories and charts were reviewed and presented here. Systematic search of the literature was conducted with combinations of key words autonomic dysfunction or dysautonomia and SCI across PubMed, EMBAS and Cochrane Library of Clinical Trials (CENTRAL).

Results: Case histories and management is reviewed and presented. In our series AD was highly variable in time to presentation and degree of progression. Importantly, AD in all cases adversely impacted rehabilitation and subjective quality of life. Literature search returned 247 studies on different aspects of autonomic dysfunction secondary to SCI. In general autonomic dysfunction is highly prevalent and can present serious and life-threatening events particularly in cases of dysregulated cardiovascular control. Typologies of autonomic dysfunction are highly related to level of injury and present significant and individual rehabilitative challenges. At all levels, gastrointestinal and urological complications were highly prevalent at significant loss of quality of life. In many subsets of symptoms the natural history and progression of autonomic dysfunction is incompletely understood.

Conclusion: Autonomic dysreflexia and dysfunction present a highly complex aspect to SCI. Trials of restorative treatments have been largely unsuccessful. In general, satisfactory knowledge regarding cause and natural history is lacking as are available treatments.

P-011

Development of an integrated digital twin model for monitoring and predicting therapy progress in neurological patients using ICF-based documentation and therapy devices data

G. Greimler ¹

¹tech2people, Vienna, Austria

The Abilitate app represents an innovative solution for precise documentation and monitoring of neurological therapy progress. It harmonizes the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) standards with established outcome measures like the Berg Balance Scale, Scale for the Assessment and Rating of Ataxia (SARA), Modified Ashworth Scale (MAS), and Motion Range Tests (MRT).

Our distinctive approach seamlessly integrates data from therapy devices, including exoskeletons and physical therapy robotics, into the patient documentation process. This integration forms dynamic digital twin models for each patient, encapsulating their functional impairments per the ICF framework and therapy session measurements. This comprehensive dataset offers a holistic view of a patient’s therapy journey.

The Abilitate app streamlines documentation from a patient’s arrival at the therapy center, simplifying anamnesis and ensuring therapists have access to real-time patient profiles. Additionally, therapists benefit from visualization and analysis tools to track therapy progress, facilitating informed decision-making and personalized treatment planning.

Beyond documentation, our goal is to develop predictive models using machine learning and data analytics. These models aim to forecast a patient’s response to specific therapeutic interventions, optimizing treatment strategies and improving patient outcomes.

In conclusion, the Abilitate app signifies a paradigm shift in neurological patient care. It provides a comprehensive platform for documenting impairments, leveraging therapy device data, and constructing digital twin models for therapy progress assessment and prediction. This innovation empowers therapists with valuable insights, ultimately enhancing patient care and quality of life.

P-012

Increased risk of fracture after amputation: a Korean nationwide study

H. Cho¹, J. Park², B. Kim³, K. D. Han³, H. L. Choi⁴, D. W. Shin²

¹Samsung Medical Center, International Health Center, Seoul, South Korea

²Samsung Medical Center, Medicine, Seoul, South Korea

³Soongsil University, Statistics and Actuarial Science, Seoul, South Korea

⁴Severance Hospital, Family Medicine/Executive Healthcare Clinic, Seoul, South Korea

Introduction: The physiological changes and alterations in gait following amputation may increase the risk of fractures. However, there is a lack of research on fracture risk in amputees.

Object: This study aimed to investigate the fracture risk in amputees.

Patients & methods: This population-based, retrospective cohort study used data from the Korean National Health Insurance System database. The study population included 19,586 participants who had undergone an amputation and 76,645 matched controls. The incidence of any fractures and site-specific fractures (vertebral, hip, and others) according to the amputation site(s) and severity of disability due to amputation were evaluated using Cox proportional hazard regression analysis.

Results: During the mean follow-up of 4.2 years, participants with amputation had a higher risk of any fractures (adjusted HR [aHR] 1.47, 95% CI 1.36–1.60), vertebral fracture (aHR 1.63, 95% CI 1.44–1.85), hip fracture (aHR 1.85, 95% CI 1.39–2.46), and other fracture (aHR 1.34, 95% CI 1.20-1.49) compared to that of controls. The risks were further increased by the presence of disability, and were highest among amputees with severe disability. All of these fracture risks were higher in amputees than they were in controls, regardless of lower limb or upper limb amputation.

Conclusions: This cohort study demonstrates that traumatic amputees experienced higher incidence of all fractures than did individuals without amputations, and this risk escalates with the severity of their disability. This finding underscores the importance of implementing early screening and lifestyle interventions to address fracture risk in traumatic amputees.

P-013

Long-term Outcomes following brain TUmorS (LOTUS): nationwide register-based research on social and health adversities in Danish individuals with primary brain tumors and their spouses

J. Fabricius¹, L. Jarlbæk², K. Piil³, D. H. Christiansen⁴

¹Aarhus University, Hammel Neurorehabilitation Centre and University Research Clinic, Aarhus, Denmark

²REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark

³Rigshospitalet (National Hospital), Copenhagen, Denmark

⁴Central Hospital Unit, Viborg, Denmark

Introduction: Due to advances in treatment regimes of brain tumors (BT) survival rates have increased in recent years. As a consequence, many individuals live with complex neurological sequelae. Based on this, greater attention to everyday life following treatment for BTs is warranted.

Objectives: The overall objective of the LOTUS study is to provide knowledge on individuals with BTs as a potentially overlooked group in neurorehabilitation and return to work. The aims are to investigate the incidence and potential social gradients in mortality (study 1), rehabilitation services (study 2) and return to work (study 3) among subgroups of individuals with BTs, and investigate disparities with individuals with stroke, which is the largest group in neurorehabilitation, taking differences in disease trajectories into account. Additionally, labor market attachment among spouses for individuals with BTs and stroke will be investigated (study 4).

Materials & methods: The study population encompass all 16,876 individuals diagnosed with a primary BT in Denmark, in 2004-2018, along with 84,380 individuals with stroke who are matched 1:5 on index year. This population is supplemented with data on their spouses. Register-based data on mortality, hospital admissions, treatment, in- and outpatient rehabilitation services, labor market attachment, and socioeconomic variables have been merged to answer the study aims.

Results: A total of 13,690 and 3,186 individuals had suffered a low grade and high-grade BT, respectively. The age and sex distribution of the population was 58 (±16) and 39%/61% (M/F) for individuals with low-grade BTs, 55 (±15) and 59%/41% (M/F) for high-grade BTs, and 69 (±15) and 55%/45% (M/F) for stroke. The largest sub-categories of BTs with confirmed histology was meningioma (18%), Glioblastoma (11%), Adenoma (7%), Neurolemmoma (6%).

Conclusion: Findings from the LOTUS study will be ready for presentation at the conference in May 2024.

P-014

Extracting prognostic features from electronic medical records using named entity recognition algorithms for stroke outcome prediction

K. Y. Lew¹, J. L. Koh², F. Lai³, I. F. Cho¹, R. Z. Fang², C. H. Chen⁴, J. S. Jeng⁴, C. W. Chen², P. J. Wen², C. Shiao¹, P. F. Tang^1,5,6,7,8

¹National Taiwan University, Physical Therapy, Taipei, Taiwan

²National Taiwan Normal University, Computer Science, Taipei, Taiwan

³National Taiwan University, Computer Science, Taipei, Taiwan

⁴National Taiwan University Hospital, Neurology, Taipei, Taiwan

⁵National Taiwan University Hospital, Physical Therapy and Rehabilitation, Taipei, Taiwan

⁶National Taiwan University, Center for Artificial Intelligence and Rehabilitation, Taipei, Taiwan

⁷National Taiwan University, Neurobiology and Cognitive Science Center, Taipei, Taiwan

⁸National Taiwan University, Graduate Institute of Brain and Mind Sciences, Taipei, Taiwan

Background: Accurately predicting three-month stroke outcomes is crucial, yet few studies have employed machine learning (ML) for direct feature extraction from electronic medical records (EMRs).

Objective: This study aimed to develop rule-based and convolutional neural network (CNN)-based named entity recognition (NER) algorithms to extract key prognostic features from EMRs, then apply these features to extra-tree regressor models for precise stroke outcome prediction.

Methods: The EMR data from 2276 stroke patients admitted to National Taiwan University Hospital (NTUH) (2014–2019) were used. Clinical expert-guided rule-based algorithms and text-vectorized CNN-based algorithms extracted admission categorical comorbidities and in-hospital infection. Rule-based algorithms additionally extracted admission numerical features. Three outcome prediction models (Model 1: 13 admission features; Model 2: Model 1 + in-hospital infection; Model 3: Model 2 + one-month modified Rankin Scale (mRS_1m)) were created for ischemic, hemorrhagic, and all stroke patients to predict favorable three-month outcomes (mRS_3m < 2).

Results: Both rule-based (> 97%) and CNN-based (> 91%) algorithms excelled in feature extraction accuracy. Outcome prediction models consistently performed well across all stroke groups (AUCs of Model 1: 0.835–0.862, Model 2: 0.843–0.856, and Model 3: 0.969–0.988). Initial National Institutes of Health Stroke Scale, age, and initial Glasgow Coma Scale were the top predictors in Model 1, while mRS_1m emerged as the most crucial predictor in Model 3.

Conclusions: This study successfully pioneers the use of ML-based NER algorithms for extracting essential prognostic features from narrative EMRs. Advancements in CNN-based algorithms are necessary for maximizing the performance of NER across diverse healthcare applications.

Acknowledgments:

We thank Grant # MOST 110-2634-F-002-032, ROC, for funding and the Center of Intelligent Healthcare at NTUH for providing the data.

P-015

Hierarchical logistic regression in validating stroke outcome prediction models constructed by named entity recognition algorithms-extracted prognostic features from electronic medical records

K. Y. Lew¹, J. L. Koh², F. Lai³, I. F. Cho¹, R. Z. Fang², C. W. Chen², P. J. Wen², C. H. Chen⁴, J. S. Jeng⁴, P. F. Tang^1,5,6,7,8

¹National Taiwan University, Physical Therapy, Taipei, Taiwan

²National Taiwan Normal University, Computer Science, Taipei, Taiwan

³National Taiwan University, Computer Science, Taipei, Taiwan

⁴National Taiwan University Hospital, Neurology, Taipei, Taiwan

⁵National Taiwan University Hospital, Physical Therapy and Rehabilitation, Taipei, Taiwan

⁶National Taiwan University, Center for Artificial Intelligence and Rehabilitation, Taipei, Taiwan

⁷National Taiwan University, Neurobiology and Cognitive Science Center, Taipei, Taiwan

⁸National Taiwan University, Graduate Institute of Brain and Mind Sciences, Taipei, Taiwan

Background: Few studies have applied conventional logistic regression statistics to predict stroke outcomes based on data directly extracted from electronic medical records (EMRs) with machine learning.

Objective: This study examined the accuracy of stroke outcome prediction models using hierarchical logistic regression methods with features extracted from EMRs by rule-based and convolutional neural network (CNN)-based named entity recognition (NER) algorithms.

Methods: The EMR data from 3110 stroke patients admitted to National Taiwan University Hospital (NTUH) (2014–2019) were used. Four prognostic feature blocks—demographics, comorbidities, initial stroke-related variables, and acute treatments/complications—were extracted from the EMRs by rule-based and CNN-based NER approaches to form the respective datasets. Three hierarchical logistic regression and receiver operating curve (ROC) analyses were performed for the ischemic, hemorrhagic, and all stroke datasets to predict favorable three-month outcomes (modified Rankin Scale < 2) in each dataset by sequentially entering the prognostic feature blocks.

Results: Both rule-based (> 96%) and CNN-based (> 92%) algorithms achieved high accuracy in feature extraction. For predicting favorable outcomes in all datasets, initial NIHSS was the most significant predictor for all and hemorrhagic strokes, whereas age and sex were additional equally important predictors for ischemic stroke. The final prediction models achieved an area under the ROCs of 0.85 for all and ischemic strokes and 0.89 for hemorrhagic strokes.

Conclusions: The high accuracy in feature extraction and outcome prediction with models constructed by rule-based and CNN-based datasets supports the feasibility of applying machine learning-based NER algorithms for extracting prognostic features from EMR texts.

Acknowledgments:

We thank Grant # MOST 110-2634-F-002-032, ROC, for funding and the Center of Intelligent Healthcare at NTUH for providing the data.

P-016

Identifying biological sex using raw, resting state EEG data combined with deep learning networks

K. Thanjavur¹, R. Suvvada², J. Burma³, J. McLeod⁴, J. F. Dunn³, A. Babul¹, J. Smirl³, N. Virji-Babul⁵

¹University of Victoria, Dept. of Physics and Astronomy, Victoria, Canada

²IIT Kharagpur, Kharagpur, India

³University of Calgary, Calgary, Canada

⁴University of British Columbia, Rehabilitation, Vancouver, Canada

⁵University of British Columbia, Physical Therapy, Vancouver, Canada

Introduction: Electroencephalography (EEG) neuroimaging allows real-time measurements of brain activity, capturing both thoughts and actions. Traditionally, research efforts have relied on filtered and processed data which is time consuming, requiring significant expertise. Recent advances in machine learning and artificial intelligence methods have opened new ways to explore neuroimaging data. Deep learning is a powerful tool capable of classifying complex signals with little-to-no feature engineering required to produce highly accurate signal classification. This study reports on the results of applying two deep learning architectures (convolutional and recurrent neural networks) to EEG data for classifying biological sex.

Objective: To assess the applicability of deep learning networks to raw, resting-state EEG data to classify sex on a sample of healthy, control adults using classification accuracy (primary metric of interest).

Methods: Eight minutes of resting-state eyes closed data from an OpenBCI system with 16 channels were collected on healthy male (n=16) and female (n=26) participants. (age: 25.3±6.2 years; body mass index: 24.4±2.5 kg/m2 ). A deep learning neural network was trained and validated on short (i.e. 60s long) samples of raw, resting state EEG data as input. The acquired EEG data were neither filtered, cleaned of artifacts, nor subjected to explicit feature extraction.

Results: Both deep neural networks predicted biological sex from raw EEG data with an accuracy consistently >80%.

Conclusion: Our results show that deep learning neural networks successfully classified biological sex using raw, resting state EEG data. These findings provide strong support for the networks" capabilities to distinguish unique brain patterns associated with biological sex, This approach holds significant potential for early identification of brain injury and paves the way for novel sex-based strategies to enhance brain recovery.

P-017

TBI and long-term outcomes; prevalence of depression after 10 years

R. Singh^1,2, S. Mason², F. Lecky², J. Dawson³

¹Sheffield Teaching Hospitals, Osborn Neurorehabilitation Unit, Department of Rehabilitation Medicine, Sheffield, United Kingdom

²University of Sheffield, School of Health and Related Research (ScHARR), Sheffield, United Kingdom

³Sheffield University Management School, Institute of Work Psychology, Sheffield, United Kingdom

Introduction: there are relatively few long-term outcome studies after TBI. We have followed a large cohort of TBI for over 10 years now and present data here.

Objectives: to measure the change in prevalence of depression after admission with traumatic brain injury (TBI) and to identify any features associated with an adverse outcome

Design: prospective study of TBI admissions after 10 years

Subjects & setting: consecutive admissions with TBI over 4 yrs to a regional neurorehabilitation unit were monitored for the presence of depression. Individuals were evaluated at 8 weeks, 1 yr and 10yrs post-injury. Outcome was compared to patient, injury and treatment features and associations were sought

Interventions: routine behavioural modification and medication were given if appropriate

Main measures: depression was measured by Hospital Anxiety Scale with score >8 as cut-off.

Results: over 48 months, there were 1153 individuals assessed at 10 weeks, 976 at 1yr and 552 were re-assessed at 10 years(210 had died). Prevalence of depression was 55.9%, 34.5% and 32.4% respectively. There was considerable movement between case/non-case over time. On a multivariable linear regression model, 21.2% of the variance was explained, comparable to many short-term mortality models. Depression risk was associated with the type of lesions seen on CT scan, intoxication at injury, past psychiatric history, GCS and social deprivation score.

Conclusions: over time, depression initially decreases after TBI but stabilises after a year. It seems that many individuals have fluctuations in mood with time. It may be possible to target groups at higher risk based on population or injury features.

P-018

Revolutionizing neurorehabilitation: integrating SMART technologies with POISE for precision and patient-centric care

S. Sharan¹, M. Stafford^1,2, V. Siddharth¹, S. Prathiba¹, A. Ganapathy¹, C. Nikhil¹, B. Varun kaustubh², H. Sneha¹

¹PRS Neurosciences & Mechatronics Research Institute (PNMRI), Functional Neurosciences - neuromodulation & neuro rehabilitation, Bengaluru, India

²SVRGA Tech Pvt. Ltd, Mysuru, India

Introduction & objective: In the dynamic realm of IoMT in neurorehab PRS Neurosciences pioneers a transformative approach by integrating SMART rehabilitation strategies with the cutting-edge POISE Smart technology. This technology redefines Functional Neurosciences, offering innovative and affordable solutions for individuals with neurological disabilities. SMART rehab framework characterized by Specialized clinical strategies, Measurable methodologies, Assessments, Analytics & AI, coupled with Rehab Techniques & Technologies, embraces the concept of ’Mass Customization’ for personalized care.

Materials & methods: POISE, a pivotal component of SMART technology, represents a groundbreaking advancement with 26 Pressure sensors. POISE is a software that Seamlessly integrates full-body tracking with pressure tracking of the feet, offers real-time assessments with a weight capacity of 150 kilograms over dual connectivity options (Wi-Fi and USB) & concurrently assesses weight distribution, posture, gait dynamics, & full-body movements. Advanced body tracking technology monitors skeletal poses, facial expressions & hand gestures, enriching the dataset for tailored interventions. Our study delves into the technical intricacies of POISE, revealing its engineering ingenuity and potential applications.

Results: showcase that POISE not only provides real-time insights into a patient’s physical state but also enables the detection of abnormalities through sophisticated data analytics using newro LOGICS.

Conclusion: This technology propels neurorehabilitation into a new era of precision and patient-centric care. This work contributes to the evolving body of knowledge on advanced healthcare technologies, fostering discussions on transformative impacts and opening new frontiers for innovation in neurorehabilitation practices. The study using this technology not only sheds light on the technical aspects but also highlights its potential transformative impact on healthcare practices.

P-019

SMART neurorehab – objectifying subjective data with C2C^® SEFA^® and FIL^® – a web-based tool. C2C = Coma 2 Community in brain injury & Cot 2 Community in SCI. SEFA – Self Evaluation of Functional Abilities in neuro patients. FIL = Functional Independence Level

S. Sharan¹, S. Prathiba¹, V. Siddharth¹, A. Ganapathy¹, C. Nikhil¹

¹PRS Neurosciences & Mechatronics Research Institute (PNMRI), Functional Neurosciences - neuromodulation & neuro rehabilitation, Bengaluru, India

Introduction: In neurorehab decisions are tough owing to similar evaluation findings due to multiple reasons which hinder "guaranteeing" results. Neurorehab does not have fixed protocols & completely relies on the skills belief of the therapist & consultant in the rehab process. The major reason for this is the enormous size of data points which are required for progress and prognosis of recovery the brain processing. Each functional neurological circuit has its contribution in participation which can be understood with proper guidance. The need of our team was a user-friendly guidance system to navigate the maze of neurorehab.

Materials & methods: We focused on what it the "neutral entity" amongst all the patients which we regularly treat. The common question which everyone asked was what is the possible functional recovery? Each one of us defined what functional recovery means in our domains. We also discussed the person-task-environment model and biopsychosocial model to determine what "normal" means in absence of normative data for daily life participation. We made each domain specific data set into a subsection which is obtained by using SEFA® tool as C2C level.

Result: to assess the current functioning of a patient 2. the rehab potential 3. to map the progress 4. to predict the eventual outcomes.We got 10 levels of C2C,3 data sets representing sensory motor control and 5 data sets representing the cognition, vision and communication functions. The 8 data sets together defined the Functional Independence Level (FIL) Level which ranged from bed ridden status to community integration. Each data set was divided into 8 levels which were purely based on the functional neurological circuits. This made neurorehab SMART which is clini-tech and IoMT enabled and embedded in a customised software/ apps.

Conclusion: SMART neurorehab is future. It is imperative to stride with evolving technology and benefit the patient by leveling their neurological functionality.

P-020

Qualitative and quantitative investigation of stroke survivors’ experience with, and attitude towards brain-controlled exoskeletons for motor rehabilitation

A. Colucci¹, M. Vermehren¹, F. Finkbeiner¹, M. Buthut¹, S. R. Soekadar¹

¹Charité, Berlin, Germany

Introduction: Brain-controlled exoskeletons are neurotechnologies that convert brain activity into control commands of motorized devices actuating the paralyzed limbs or body parts. By re-establishing direct communication between cortical activity and sensory feedback, brain-controlled exoskeletons are promising tools to support neurorehabilitation and facilitate motor recovery.

Objectives: To promote adoption of this technology in clinical practice, user acceptance will be critical and therefore needs to be investigated.

Patients & methods: To this end, we assessed and evaluated subjective user experience and potential concerns related to the use of brain-controlled exoskeletons in a group of stroke survivors using a customized semi-structured interview and a Likert type questionnaire. Here, we present the preliminary results of this study and elaborate on the experience of two users with chronic upper limb hemiplegia who used a brain-controlled exoskeleton to perform various of activities of daily living (ADLs).

Results: The results of our study support a high level of acceptance and efficacy of the employed brain-controlled exoskeleton for movement restoration in stroke. Moreover, two findings clearly stand out from the analysis of the semi-structured interviews: First, full endorsement of end users regarding application of brain-controlled exoskeletons in neurorehabilitation practice, and, second, the absence of any ethical concerns for the use of neural data to advance research and further ameliorate stroke rehabilitation.

Conclusion: Thus, our preliminary investigation of subjective user experience substantiates high stroke survivors’ acceptance of brain-controlled exoskeletons and strongly supports the adoption of these technologies in stroke neurorehabilitation.

P-021

The effect of meditation techniques on the training with Brain-Computer-Interfaces

I. Hochreiter ¹

¹FH Kärnten, Villach, Austria

Introduction: Brain-computer-interfaces (BCIs) enable people to control a computer, a robot or a machine with their brain activity. Thereby, the EEG-waves are measured while the controlling person imagines motor movement for instance, which should lead to a desired output. Such technologies are now used in neurorehabilitation in order to assist in activities of daily life or improve motor function of people with neuromuscular disorders. To reach enough accuracy for an efficient BCI-training, a learning process and good attention are required. Meditation techniques clarify EEG-waves by increasing the EEG-amplitude and enhance attention and concentration.

Methods: The databases Pubmed, PEDro, Livivo and Cochrane were researched in the period of 22.11.2022 until 7.4.2023. Finally, the research yielded eight studies.

Results: A statistical significance between intervention group and control group regarding the average BCI-accuracy of the sessions was found in four out of six studies in favor of the groups with meditation. Concerning the learning effect two out of four studies could detect a statistical significance in intergroup comparison. The same results apply for achieving BCI competency. Potentially, four of the studies could show a clinical relevance in intergroup comparison.

Conclusion: Due to the heterogeneity of the studies, reaching a definitive answer to the research question proves to be very difficult. According to the study results, meditation techniques could potentially be used to improve BCI-training. However, more research would be necessary for confirmation. It would be desirable to conduct further homogeneous studies that also investigate the effects of meditation techniques on BCI training in individuals with neuromuscular disorders.

P-023

Brain computer interface treatment for lower extremity rehabilitation in stroke patients

M. Sebastian-Romagosa¹, W. Cho¹, R. Ortner¹, M. Ching¹, C. Guger¹

¹g.tec medical engineering, Research, Schiedlberg, Austria

Background: Neurorehabilitation based on Brain-Computer Interfaces (BCIs) shows important rehabilitation effects for patients after stroke. Previous studies have shown improvements for patients who are in a chronic stage and/or have severe hemiparesis and are particularly challenging for conventional rehabilitation techniques.

Method: Seven stroke patients in the chronic phase with lower extremity hemiparesis were recruited. All of them participated in 25 BCI-sessions about 3 times/week. The BCI-system was based on the Motor Imagery (MI) of the paretic-ankle dorsiflexion and healthy-wrist dorsiflexion with Functional Electrical Stimulation (FES) and avatar feedback. Assessments were conducted to assess the changes before and after the therapy. The functional scales used were: 10-meters walking test (10MWT), Range of Motion (ROM) of the ankle dorsiflexion and Timed Up and Go (TUG).

Results: Results show a significant increase in the gait speed in the primary measure 10MWT fast-velocity of -0.71 s [-6.2 to -0.46], P = 0.031. This improvement is above of the minimally clinically important difference. The speed in the TUG also significantly increased by -2.7 [-11.58 to -2.56], P = 0.002. The range of motion of the ankle dorsiflexion movement also was increased after the therapy, ΔROM active = 4.65 [1.67 to 7.4], P = 0.039.

Conclusions: These outcomes show the feasibility of this BCI approach and further support the growing consensus that these types of tools might develop into a new paradigm for gait rehabilitation tools for stroke patients. However, the results are from seven chronic stroke patients so the authors believe that this approach should be further validated in broader studies involving more patients.

P-024

Merging sensorimotor brain-computer interfaces with transcranial alternating current stimulation – perspectives towards non-invasive bidirectional BCIs

M. Vermehren¹, M. Wiskow¹, A. Colucci¹, N. Peekhaus¹, D. Haslacher¹, S. R. Soekadar¹

¹Charité, Berlin, Germany

Introduction: It was shown that repeated use of brain-computer interface (BCI)-controlled exoskeletons can improve motor recovery after stroke or spinal cord injury. To increase effectiveness of such restorative BCI, contingent, fast, and multimodal feedback is essential. Therefore, bidirectional BCIs that are capable of simultaneously recording and stimulating brain activity hold great potential for improving versatility and scope of BCIs by providing additional input directly to the brain. Until now, such approach has been limited to implantable devices mainly due to stimulation artifacts that hinder reliable assessment of brain signals when using transcranial stimulation.

Objectives: Building on a real-time compatible stimulation artifact suppression pipeline (Haslacher et al., 2021, Neuroimage) that includes spatio-spectral decomposition (SSD) (Nikulin et al., 2011, Neuroimage), we intend to prove that a bidirectional BCI using transcranial alternating current stimulation (tACS) targeting the sensorimotor cortex is feasible.

Methods: Five healthy individuals engaged in a motor-imagery based BCI-task using 32-channel electroencephalography (EEG). During the task, either amplitude-modulated tACS or sham was applied. During the stimulation ON condition, mu-rhythm oscillations were recorded simultaneously to stimulation and translated into contingent visual feedback displayed on a computer screen.

Results: All participants achieved reliable BCI control in absence and during stimulation. Single-trial mu-rhythm-based BCI control in the stimulation ON condition was comparable with the stimulation OFF condition.

Conclusion: This is the first study that demonstrates successful combination of a motor-imagery based BCI with tACS targeting the sensorimotor cortex. This new approach paves the way to establish non-invasive bidirectional BCIs, e.g., to allow control of a prosthesis that delivers feedback directly to the brain through non-invasive stimulation.

P-025

Multiple sclerosis gait rehabilitation with brain computer interface treatment

M. Sebastian-Romagosa¹, W. Cho¹, R. Ortner¹, M. Ching¹, C. Guger¹

¹g.tec medical engineering, Research, Schiedlberg, Austria

Background: Multiple sclerosis (MS) is a chronic neurodegenerative disease in which a person’s immune system attacks healthy nerves. People with MS (PwMS) often experience pain, fatigue, cognitive dysfunction, and reduced mobility. MS is still incurable, and treatments can at best slow the progression of the disease and manage some symptoms. In this study, a BCI system (recoveriX developed by g.tec medical engineering GmbH) is used to train the functionality of pwMS by reducing fatigue and improving gait ability and endurance.

Methods: Six pwMS were enrolled in this study. All completed 30 recoveriX sessions. The BCI system was based on Motor Imagery (MI) of paretic ankle dorsiflexion and healthy wrist dorsiflexion with Functional Electrical Stimulation (FES) and avatar feedback. Assessments were performed to evaluate changes before and after therapy. The functional scales used were 6 Minute Walking Test (6MWT), Multiple Sclerosis Impact Scale (MSIS-29), Modified Fatigue Impact Scale (MFIS), and Timed Up and Go (TUG).

Results: The results show that patients were able to increase their endurance by 55.42 m [39.9 - 73.6] on the 6MWT. This functional improvement was followed by an increase in coordination and gait ability in the TUG of -2.13s [-3.19 to -1.81]. Patients also reported an increase in activities of daily living as assessed by the Multiple Sclerosis Impact Scale (-5 points [-11.25 to -2.5]) and a reduction in fatigue as assessed by the MFIS, 8.5 points [-10.75 to -5.5].

Conclusions: This is the first time that BCI technology has been used to treat pwMS. These preliminary results demonstrate the safety and efficacy of the treatment. MS patients improved endurance and coordination and reduced the impact of MS on activities of daily living. However, these results are from six MS patients, so the authors believe that this approach should be further validated in larger studies involving more patients.

P-026

Collaborative design approach for upper limb rehabilitation after stroke using virtual reality and brain-computer interfaces

M. Russo¹, C. Pereira¹, A. I. Almeida¹, A. Vourvopoulos²

¹Escola Superior de Saúde do Instituto Politécnico de Setúbal, Setúbal, Portugal

²Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal

Introduction: Upper limb impairment (ULI) is a common disability after stroke, leading to a non-functional hand on 60% of patients. Direct training of the Central Nervous System (CNS) through Brain-Computer Interface (BCI) interventions have showed to be an effective complement to rehabilitation and could be highly valuable in patients with severe ULI. However, there is high variability in the design of BCI interventions and lack of guiding recommendations integrating neurorehabilitation principles for BCI upper-limb training.

Objectives: develop recommendations for BCI interventions using task Specificity and Ecological validity through simulated virtual reality tasks for stroke patients with severe ULI, by gathering tacit knowledge from neurorehabilitation experts and adding patients" experience.

Materials & methods: A multi-perspective qualitative study was conducted using collaborative workshops. A purposive sampling recruitment was used after ethical approval, followed by an inductive thematic analysis.

Results: Four online synchronous sessions were carried out with ten rehabilitation experts and eight stroke patients. Two themes emerged: "Task selection" (sub-themes: Characteristics of tasks, Variability of tasks and Principles to task progression) and "User related considerations" (sub-themes: Initial patient assessment, Set-up considerations and Features of personalization). Within sub-themes, topics such as: simplicity and familiarity of tasks, patient inclusivity, timing and approach for progression, clinical traits of each patient, were approached.

Conclusion: The recommendation of personalization is crucial for patient inclusivity and accommodation of clinical features. Task meaningfulness, variety and progression are of great importance for brain activity and patient engagement. Unilateral, and asymmetric tasks should be preferred. The intervention should allow professionals to personalize the training plan and sessions, while including the patients" input.

P-027

Feasibility of a home-based EEG neurofeedback intervention to reduce chronic neuropathic pain, a cohort clinical trial

M. Sakel¹, K. Saunders¹, R. Biswas¹, C. Ozolins¹

¹East Kent University NHS Hospital, Centre for HealthNeuro-Rehabilitation Service Study, Canterburry, United Kingdom

Introduction: Neuropathic pain arises as a consequence of a lesion affecting the somatosensory system and affects up to 8% of UK population.

Objectives: To explore the feasibility of implementing a home-based EEG neurofeedback intervention for people with chronic intractable NP and gain insight into its potential for improvement of pain, its impact & EEG spectrum. UK HRA ethical approval ref: 22/LO/0523. IRAS ID: 310674. NCT Registration: NCT05464199.

Methods: A cohort study with 11 patients recruited from an UK University Hospital. Participants were trained to use an Axon neurofeedback Headset system. They undertook 1 week of baseline EEG recording and an 8-week intervention period (5 sessions of 40 minutes/week) with 12 weeks follow-up EEG baseline recordings. Outcome measures recorded pre-intervention and at 4 post-intervention time points. These were: VAS ; Brief Pain Inventory; Depression, anxiety, stress scale (DASS); Pain Catastrophising Scale (PCS); Central Sensitisation Inventory; Pittsburgh Sleep Quality Index.

Results: 13 minor adverse events were recorded related to equipment supply (not to the intervention). Clinically significant (≥30%) improvements in average pain and pain interference were reported by 56% (5) participants. Total PCS scores improved significantly from pre to post-intervention (p<0.05) and showed continued improvements. Sub-domain "Helplessness" and "Rumination" scores improved. Total DASS scores improved significantly from baseline (31.1) to post-intervention (21.3, p<0.01). No significant improvements in sleep or quality of life scores. There was a statistically significant correlation between upregulation of resting state relative alpha EEG activity and decreased rumination (p<0.05).

Conclusion: It is feasible and safe to conduct a home-based trial of a neurofeedback system for people with chronic NP. This study detected positive impacts on pain, anxiety, depression and stress which merit further investigation eg RCT.

P-028

BeamBCI: the Berlin adaptable modular brain-computer interface (BCI) software

N. Peekhaus¹, M. Nann¹, E. Brauße¹, J. Zerfowski¹, A. Colucci¹, M. Vermehren¹, S. R. Soekadar¹

¹Charité, Clinical Neurotechnology Laboratory, Department of Psychiatry and Neurosciences, Berlin, Germany

Introduction: Brain-computer interfaces (BCIs) can translate brain activity into control signals of wearable actuators, such as exoskeletons, and enable the execution of movements despite impaired motor function, e.g., after stroke. Repeated use of such devices can trigger motor recovery even in chronic paralysis, rendering BCIs a promising tool for neurorehabilitation. However, any BCI experiment requires a technically demanding experimental setup and software capable of recording, processing, classifying, and translating brain activity into feedback in near real-time. Up to now, there is no such software available that is both flexible and accessible.

Objectives: With the BeamBCI software, we aim to facilitate research on BCIs by providing a streamlined data processing platform that serves as the foundation of various BCI applications while being flexible, accessible, and effective.

Methods: The BeamBCI is a highly modular software that is built on standard tools for scientific programming: Python, Numpy, Scipy, and Labstreaminglayer (LSL). To set up an experiment, the user selects a set of modules for, e.g., data acquisition, classification, and control of an actuator. The modules interconnect automatically via LSL. All data recorded and generated during the experiment (e.g., raw and processed brain signals, classification results, etc.) are available in the form of LSL streams which are automatically synchronized and stored along with all relevant settings and parameters. The processing is performed in near real-time, resulting in a processing delay of 5 to 10 ms.

Results: The BeamBCI showed a stable performance in more than 300 sessions involving healthy participants, stroke survivors, and tetraplegics using a BCI to control a virtual actuator, motorized orthosis, or domestic appliances.

Conclusion: The BeamBCI is a reliable and performant basis for various BCI experiments and greatly facilitates implementation, execution, and documentation of BCI studies.

P-029

Nonverbal cognitive function influence on aphasia recovery after stroke

C. R. Bae¹, Y. Na², S. B. Pyun^1,2,3

¹Korea University Anam Hospital, Physical Therapy and Rehabilitation, Seoul, South Korea

²Korea University College of Medicine, Biomedical Sciences, Seoul, South Korea

³Korea University College of Medicine, Brain Convergence Research Center, Seoul, South Korea

Introduction: There is a growing interest in understanding concurrent nonverbal cognitive impairment among post-stroke aphasia patients and its impact on aphasia recovery and rehabilitation. However, research in this area remains limited.

Objectives: This study aimed to explore nonverbal cognitive impairment in aphasia patients, investigating its correlation with initial aphasia severity and language recovery six months post-stroke.

Subjects & methods: Forty-four patients with aphasia following a first-ever left hemispheric stroke were enrolled. Aphasia assessment used the Korean version of the Western Aphasia Battery at one-and six-months post-stroke. Initial Aphasia Quotient (AQ) scores and proportional changes in AQ scores (ΔAQ_p) between one and six months were calculated. Nonverbal cognitive function during the early subacute phase was assessed using Computerized Neurocognitive Function (CNT) test batteries covering attention, memory, executive function, and nonverbal intelligence. Subtest scores falling at or below the 5th percentile of normative data were considered abnormal. Univariable and multivariable analyses were conducted to identify predictive factors for initial aphasia severity and subsequent recovery.

Results: All patients exhibited cognitive impairments in at least two of the 11 CNT subtests, most frequently in the Trail Making Test. Visual attention (visual span test, visual continuous performance test) and visual memory (Rey complex figure test copy) seemed relatively preserved. Only the Wisconsin Card Sorting Test score showed a significant positive association with initial aphasia severity (AQ) (r²=0.177, p=0.005). The forward visual span test emerged as a significant positive predictor for language improvement (ΔAQ_p) at six months post-stroke (r²=0.262, p<0.001).

Conclusion: Patients with aphasia tend to maintain relatively preserved visual attention, and spared visual short-term memory appears to contribute to aphasia recovery post-stroke.

P-030

Speech rate and pause characteristics of primary progressive aphasia

A. Y. Cho¹, B. S. Ye², S. J. Lee³, H. H. Kim¹

¹Yonsei University Coilege of Medicine, Graduate Program of Speech Pathology, Seoul, South Korea

²Yonsei University College of Medicine, Neurology, Seoul, South Korea

³Yonsei University, Department of English Language & Literature, Seoul, South Korea

Introduction: Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by the independent presentation of language impairment without cognitive deficits for at least two years after onset. PPA is classified into three subtypes based on its location and clinical characteristics: non-fluent variant of PPA (nfvPPA), semantic variant of PPA (svPPA), and logopenic variant of PPA (lvPPA).

Objectives: This study aimed to explore the differential characteristics of speech rate and pause of between lvPPA and svPPA groups. We expected that the Korean-speaking patients would present language-specific features of speech rate and pause in a picture-description task.

Patients & methods: A total of 60 subjects participated in the study: 9 svPPA (age=73.11±8.75 yrs.), 21 lvPPA (age=74.9±6.0 yrs.), and 30 normal controls (age=70.37±7.42 yrs.). The pause length was set to 0.1 s (100 ms), and the pause location was analyzed by dividing the pauses into inter-utterances and intra-utterances (inter-words and, intra-words, respectively).

Results: The lvPPA patients exhibited higher overall frequencies of pauses compared with patients svPPA. This may be ascribed to lexical retrieval deficits leading to reduced fluency. In addition, lvPPA patients exhibited longer pauses within utterances compared with patients with svPPA. Both variants show deficits in lexical retrieval, but lvPPA manifests as pauses in pre-noun positions, while svPPA tends to omit nouns or use substitutes and circumlocutions.

Conclusion: This study is significant in that it is the first study to investigate the differential features of two PPA variants in Korean-speaking PPA patients. We aim to utilize the results of this work to develop a rehabilitation program for those with PPA. In addition, as a follow-up study, we propose to conduct an analysis of the frequency and duration of silence patterns which occur in pre-verb and pre-noun positions within a sentence to acquire normative data.

P-031

Using fNIRS to examine the impact of skill and goal-based training on resting state functional connectivity in adults with dyslexia

M. Orchard ¹

¹University of Alberta, Edmonton, Canada

Introduction: Dyslexia is a lifelong reading disability characterized by difficulties with spelling and word decoding, along with poor word recognition. There has been considerable research into the neurological causes and treatments for dyslexia. However, since the majority of existing material focuses on children, there is a gap in our understanding of the plasticity and functional connectivity of the adult dyslexic brain.

Objectives: This study aims to use functional near-infrared spectroscopy (fNIRS) to explore alterations in resting state functional connectivity (RSFC) in adults with dyslexia, before and after participating in literacy-based or psychosocial-based remediation programs.

Participants & methods: Adult dyselxic participants (N = 16) were enrolled in one of two eight-week-long programs, which consisted of online video lessons and assignments in literacy skills (N = 9), or involved identifying and performing personalized activities based on psychosocial reading goals (N = 7). Resting-state fNIRS data was collected before and after training, with a focus on monitoring activity in the left superior temporal gyrus and the left fusiform gyrus. Both of these regions are part of the left-based reading network, and are essential to proper reading abilities.

Results: Following the remediation programs, both regions of interest showed a significant increase in RSFC localized to bilateral reading-related brain regions. Our findings indicate that the left superior temporal gyrus exhibited increased functional connectivity within 2 channels of the reading network (p<0.05), while the fusiform gyrus showed increased functional connectivity within 12 channels of the reading network (p<0.05).

Conclusion: The findings from this study highlight the potential for literacy and psychosocial-based training programs to induce significant brain plasticity and learning within the reading network in adults with dyslexia, which is able to be detected even at rest.

P-032

A virtual motor speech group for patients with progressive ataxia: evaluation of a pilot

R. Kimber¹, C. Waszkiewicz¹

¹UCLH - The National Hospital for Neurology and Neursosurgery, Therapies Department, London, United Kingdom

Introduction: Progressive ataxia’s are a rare and complex group of conditions affecting approximately 10,000 adults in the UK. People with ataxia often experience dysarthria. The variability in presentation and severity has traditionally made communication intervention challenging. Evidence is growing showing promising results in speech intelligibility, confidence ratings and quality of life measures.

Objectives: To address communication needs of people with ataxia and respond to high referrals numbers during the COVID-19 pandemic communication groups were arranged. Aims were to improve intelligibility and communication confidence using the principles of "smooth and steady."

Patients & methods: Three groups of 3-6 patients with mild-moderate dysarthria were recruited from SLT clinic. Groups ran on Zoom for one hour over 6 weeks. Each patient had a 1:1 initial virtual consultation where assessments were conducted, outcome measures gathered and goals set. Outcome measures were repeated approximately 2 weeks after intervention. An electronic survey evaluating the effectiveness of this style of intervention was completed.

Results: 11% improvement in communication confidence, 4% improvement in speech intelligibility in reading passage and sentence repetition, and 7% reduction of impact on psychosocial functioning. Survey feedback was positive. Specifically; feeling more confident, enjoying access from their home and feeling a sense of connectedness with others with similar challenges. Challenges reported were IT issues including difficulty accessing the appointment on zoom, delay in sound or sound cutting out.

Conclusion: Initial findings of this intervention were successful changes in intelligibility, breath support and confidence in communicating. More research is needed into the effectiveness of treatment intervention for this patient population, sensitivity of outcomes measures and long-term implications for maintaining and slowing down changes to communication.

P-033

How can healthcare providers tailor their communication to improve health outcomes in communicatively vulnerable patients? Results from the Health Outcomes and Language (HOLa) scoping review of knowledge syntheses for patients with neurological disorders

T. Howe¹, L. M. Jenstad¹, G. Breau², J. Abel³, P. Colozzo¹, G. Halas⁴, G. Mason¹, C. Rieger¹, L. Simon⁵, S. Strachan⁴

¹University of British Columbia, Vancouver, Canada

²University of Greenwich, London, United Kingdom

³University of Calgary, Calgary, Canada

⁴University of Manitoba, Winnipeg, Canada

⁵McGill University, Montreal, Canada

Introduction: Provider-patient communication has an impact on health outcomes. Provider communication practices are particularly important for patients with neurological disorders who are communicatively vulnerable (e.g., have a communication disorder and/or limited proficiency in the dominant language of their community).

Objectives: The aim of the overall scoping review of reviews was to summarize the literature on provider-patient communication linked to health outcomes in communicatively-vulnerable patient populations. The aim of this subgroup review was to summarize reviews identified in the overall search that specifically focused on patients with neurological disorders.

Method: We conducted a scoping review of reviews to systematically search six databases for knowledge syntheses that investigated how healthcare provider-patient communication practices impacted health outcomes in communicatively vulnerable patients. A subgroup search of the reviews was conducted to identify reviews which specifically focused on patients with neurological disorders.

Results: For the overall scoping review, the search yielded 14,615 citations, with 47 reviews meeting the inclusion criteria. The subgroup search yielded five reviews. We found that the use of interpreters was associated with improved physical functioning in stroke patients with limited English proficiency and therapeutic management of aggression was associated with improved psychosocial functioning in individuals with dementia. Other healthcare provider communication practices investigated included teach-back with adults with mild cognitive impairment, emotion-oriented care with adults with dementia, and accommodation of cultural and language concordance with adults post-stroke.

Conclusion: Healthcare provider communication practices such as the use of interpreters may have an impact on the health outcomes of communicatively vulnerable patients with neurological disorders.

P-034

Testing the hypotheses of lexical retrieval for sentence production

T. Sanghavi ¹

¹All India Institute of Speech and Hearing, Mysuru, India

Introduction: Lexical access is defined as the retrieval of the most appropriate word from the lexicon. It is hypothesized that the participant must search his or her semantic memory to generate the word, also called the lexical access hypothesis. This is achieved through two stages: the first stage is semantic and syntax-specific retrieval, and the second stage is phonologically-specific representation. Words that belong to the same category are arranged together and thus facilitate spreading activation theory. Priming is the process in which experience with an item leads to an increase in retrieval of that and related items. Based on this, two hypotheses are formulated: the facilitation hypothesis and the suppression hypothesis. The two hypotheses can be tested by employing the picture-word interference paradigm. Using tasks involving picture-word interference effect, where pictures are displayed with semantically related or unrelated precursors, experimental evidence on facilitation or suppression hypothesis can be derived

Objectives: To compare the accuracy scores for sentences preceded by unrelated and related noun and verb phrases

Methods: The total number of participants taken for the study was 40. The action naming test was used to test the lexical retrieval. The test material contained 57 stimuli. Each stimulus contained a noun phrase and a verb phase. Out of 57 pictures, 19 were preceded by semantically related noun phrases, 19 were preceded by semantically related verb phrases, and the remaining 19 were preceded by unrelated precursors.

Results: Accuracy scores were measured as a response; statistically significant differences were found for related targets than unrelated targets and for semantically related verbs than semantically related nouns.

Conclusion: The semantically related verb phrases facilitated the target more than the semantically related noun phrases. This finding could contribute to neurorehabilitation for aphasic individuals.

P-035

Rehabilitation of chronic alexia with agraphia: a single-case study

T. Sanghavi¹, M. Dudwadkar¹, T. Arsiwala¹, J. Dave²

¹All India Institute of Speech and Hearing, Mysuru, India

²Terna Physiotherapy College, Navi Mumbai, India

Introduction: In India, there are over 545.10% stroke cases per 100,000 people. Aphasia frequently includes acquired alexia, either with or without agraphia. More people with aphasia (PWA) are depending on written language for their everyday needs, vocational rehabilitation, and recreational activities as the percentage of white-collar occupations rises. There is a paucity of studies targeting the improvement of reading and writing skills in PWA for the Indian population.

Objectives: The purpose of the study was to investigate if speech and language therapy may improve a multilingual, chronic aphasic person’s reading and writing abilities.

Method: This is a single-case study of Mr. C, a 41-year-old individual with chronic aphasia and agraphia. Mr. C had a CVA nine years ago, for which he took a few speech therapy sessions. Nine years later, C’s priority for therapy was improving functional writing abilities for daily life, work, and personal goals. C’s agraphia seemed due to a lexical level impairment, with maximum errors of regularization. He attended fifty-two 1-hour therapy sessions over a span of one year. Intervention approaches such as copy and recall therapy (CART) and anagram and copy treatment (ACT) were used during therapy. Cued naming and error detection strategies were also used to improve spelling practice in Hindi and English. WAB-R was administered before and after treatment sessions.

Results: The pre- and post-therapy comparison showed improvements both in functional writing, reading, and writing subtests of WAB-R. The language quotient and the aphasia quotient pre-therapy were 60.9 and 87, respectively, while the post-therapy scores were 80.6 and 93.2, respectively. A significant improvement was seen in the reading and writing sections of the WAB-R.

Conclusion: Chronic agraphia with alexia can be treated with the correct therapeutic approaches and consistency. Functional reading and writing tasks must be incorporated into the tasks taken for therapy.

P-036

Does rehabiltation improve patient outcomes following COVID-19?

E. Reilly¹, H. Osman¹, M. Jones¹, M. Bushra¹, J. Sabu¹

¹Liverpool University Hospitals NHS Trust (Cheshire & Merseyside Rehabiltation Network), Physiotherapy, Liverpool, United Kingdom

Background: The Phoenix Rehabilitation Unit in Liverpool University Hospitals NHS Foundation Trust (UK) is part of the Cheshire and Merseyside Rehabilitaion Network and provides rehabiltation to a diverse and complex caseload. Literature recommends rehabilitation following COVID-19 but limited data exists regarding outcomes. One hundred and fifty patients were admitted over a two year peroid, with 32 % diagnosised with COVID-19. Rehabilitation outcomes in both a COVID-19 and Non - COVID 19 population were examined.

Objectives: To identify if patient outcomes improved with rehabilitation following a diagnosis of COVID-19.

Methods: In line with ethics and trust governance, the database of one hundred and fifty pateints was analysed from March 2020- Feburary 2022. Case notes and discharge letters were retrospectively reviewed to determine diagnosis. Length of stay, discharge destination and the Barthel Index (BI) outcomes were explored in both the COVID-19 and Non- COVID-19 groups.

Results: Both groups had similar demographics in relation to sex and age. On admission the COVID-19 group had a mean BI scoring of 8.3 in comparison to the Non-COVID-19 group of 12.1. On discharge the BI for the COVID-19 group was 15.8 in comparison to the Non-COVID-19 group of 26.1. On assessment both groups had similar findings with regards to their discharge destination. 81% of the COVID-19 group were discharged to their usual place of residence in comparison to 84% in the Non-COVID-19 group. Meanwhile the length of stay was a mean value of 11.6 in the COVID-19 group and 9.5 in the Non- COVID-19 group. During COVID-19 isolation all patients received therapy with findings suggesting COVID-19 increases the length of stay. It should also be noted the audit was ranged from the early - mid stages of the pandemic which may have affected data averages, as advances were made in diagnositics and treatments. Overall this audit suggests rehabilitation improves COVID-19 patient outcomes.

P-037

Feasibility, acceptability, and potential impact of a hybrid cardiopulmonary telerehabilitation program for people with long-term COVID-19: a pilot study

L. Crépin^1,2, P. Farand¹, F. Vézina¹, A. Piché¹, P. Tanguay¹, P. Prud’homme¹, N. Marquis¹, M. Tousignant^1,2, G. Léonard^1,2, L. Pinheiro Carvalho^1,2

¹Sherbrooke University, Sherbrooke, Canada; ²Research Center on Aging - CIUSSS de l’Estrie-CHUS, Sherbrooke, Canada

Introduction: 15% of individuals who have contracted COVID-19 encounter symptoms that extend beyond two months following the initial onset, known as long COVID. Fatigue, post-exertional malaise (PEM) and reduced exercise and pulmonary capacities all impair quality of life.

Objective: To explore the feasibility, acceptability, and potential impact of a hybrid cardiopulmonary telerehabilitation program for people with long COVID fatigue and severely reduced functional capacity.

Methods: 7 participants (4W, 53±7y, BMI=34.0±4.0kg/m2; time since acute disease=17.1±7.5 months) with functional limitations (2-4/4 Post-COVID Functional Scale) and fatigue (≥4/9 Fatigue Severity Scale, FSS) were recruited. All patients performed a cardiorespiratory fitness test (VO2peak) and a pulmonary function test before the 12-week (2x/week in-person; 1x/week in TR) intervention. This program includes an exercise (strength, aerobic, flexibility, breathing) and an education component. Main pre-post outcomes included: FSS (primary), DePaul Symptom Questionnaire (DSQ-PEM), 6-min walk test (6MWT). Quality of life (EQ5D5L) was measured at baseline and 3 months later.

Results: A total of 662 persons were screened for eligibility. Recruitment, retention, and adherence rates were 4.6%, 71.4% and 88.5%, respectively. Participants who completed the study (n=5) were satisfied with the program according to acceptability measures. Performance-based measures included (mean±SD pre/post): 6MWTdistance = 387.6±23.8/444.2±22.5m; HRpeak6MWTpre/post = 117±14/123±7 bpm and HRpeak6MWTpre/post (%pred) = 68±8/72±5%; 1STSTrep = 16.2±2.2/20.4±2.5; FSSscore = 6.6±0.4/4.5±0.7. All participants surpassed the clinically important improvement threshold (6MWT (≥14m) = 18-113(min-max); 1STS (≥2rep) = 3-6; FSS (≥0.45) = 0.8-4.

Conclusion: Our program seems feasible, acceptable, and potentially effective to reduce fatigue, PEM and to improve functional capacity among patients affected by long COVID-19.

P-038

A new way of life, trying to figure out life after severe COVID-19

A. Larsson^1,2, K. Törnbom^1,3, K. Stibrant Sunnerhagen^1,4, A. Palstam^1,4,5, H. C. Persson^1,2

¹University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden

²Sahlgrenska University Hospital, Physical and Occupational Therapy, Gothenburg, Sweden

³University of Gothenburg, Department of socialwork, Gothenburg, Sweden

⁴Sahlgrenska University Hospital, Neuroscience, Gothenburg, Sweden

⁵Dalarna University, School of Health and Welfare, Dalarna, Sweden

Introduction: Various symptoms and long-term effects after COVID-19 have previously been described. How COVID-19 will impact functioning in daily life is still unknown.

Objective: The aim was to obtain a deeper understanding regarding the experiences during the year following hospitalisation due to COVID-19, with focus on the return to work and functioning in daily life.

Patients and methods: A purposive sample was selected of persons who had received inpatient hospital care, through out the Västra Götalands region in Sweden and whom had been discharged approximately 1 year previously and were of working age. Eleven participants, 9 men and 2 women, were interviewed about their daily life one year after being treated at hospital due to severe COVID-19 infection. The interviews were transcribed and analysed using thematic analysis, four main themes were identified.

Results: Participants described that they had found it challenging to navigate the healthcare system when trying to handle their consequences of COVID-19. A struggle with lack of energy that affected daily life was also described. Additionally, participants described that previous experiences and strategies were used in new ways, in order to move forward. The process of returning to work was enabled by support of colleagues and individual strategies.

Conclusion: The present study increase knowledge regarding experiences of daily life one year after severe COVID-19. Lacking energy and struggling to manage one’s health while navigating the healthcare system highlights the importance of strengthening accessibility of healthcare services. This also emphasizes the importance of strengthening the patients’ competency in looking after their own health, to facilitate the recovery process.

P-039

Evaluation of the quality of current COVID-19 resources developed for individuals with spinal cord injuries: a scoping review

P. Derakhshan¹, W. Miller¹, E. Simpson¹, C. McBride², J. Borisoff³, J. Schmidt^1,3, B. Mortenson^1,3

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²Spinal Cord Injury British Columbia, Vancouver, Canada

³University of British Columbia, Occupational Therapy, Vancouver, Canada

Background: In a crisis such as the COVID-19 pandemic, there is a need for information on dealing with it among people with spinal cord injuries (SCI). Organizations provided resources, but many of them were generic. In some cases, the information was provided by dubious sources, contradictory, or not assessed for usability with individuals with SCI.

Objectives: This study reviewed the current COVID-19 web-based resources for individuals with SCI and evaluated their quality.

Materials & methods: A scoping review for COVID-19-related online resources for individuals with SCI was performed by first identifying SCI-relevant authorities and, subsequently, targeted website searching using a systematic search strategy. The included resources were categorized based on their content and format (e.g., video, infographic, text). The WAVE Web Accessibility Evaluation Tool, the Quality of Life in Essential Tremor Questionnaire, DISCERN, and the Infographic Design Rubric were used to evaluate the accessibility and quality of the resources.

Results: The search identified 71 SCI organizations and 10,538 potential resources. Based on inclusion and exclusion criteria, 173 resources were included and categorized based on their content into eight main domains: prevention, caregivers, exercise, COVID-19 impact, mental health, vaccine, nutrition, and telehealth. The average score for the quality of the text, infographic, and video resources are 10.1/28 (Range:3-24), 35.3/44 (Range:23-41), and 53.2/80 (Range:21-77), respectively.

Conclusion: Website resources mainly focused on preventing COVID-19. Only three of them addressed telehealth and virtual care during COVID-19 for individuals with SCI. The results of this study will help us develop an SCI-oriented toolkit for this pandemic and future ones.

P-040

Has the COVID-19 pandemic increased the prevalence of the language disorder in children?

S. Hwang¹, S. Son¹, S. Lee¹, J. H. Kim¹, K. J. Jung¹

¹Daejeon Eulji Medical Center, Eulji University, Rehabilitation, Daejeon, South Korea

Background: Coronavirus disease 2019 first broke out in China and has been prevalent worldwide for years, and it still exerts its influence throughout the society. Amid the pandemic, as the government enforced the law as "social distancing" and ordinary face-to-face communications decreased.

Objectives: The purpose of this study is to investigate whether the pandemic and the consequential lifestyle change has an impact on the language development in childhood.

Methods: We randomly selected the patients under the age of 15 who visited the outpatient department of rehabilitation medicine for the first time due to suspected delayed language development. 35 patients in 2019 and 2021 per each were included in this study, to compare before the pandemic with after. Sequenced language scale for infants (SELSI), preschool receptive-expressive language scale (PRES) were done in the infants to evaluate the receptive and expressive language ability. Additionally, for those who have difficulty on the articulation, Urimal test of articulation and phonology (U-TAP) was done.

Results: Among 35 patients who visited before the pandemic, 12 patients (34%) showed receptive language ability impairment and 15 patients (43%) showed expressive language impairment in the SELSI or the PRES assessment. 8 patients (23%) showed an impairment in the articulation of the consonants and the bowels in the U-TAP test. Out of the other 35 patients who visited during the pandemic, 20 patients (57%) showed receptive language ability impairment and 22 patients (63%) showed expressive language impairment. 14 patients (40%) showed the articulation problem. Since the exposure to the media has known to be increased in the pandemic and the social interactions have much decreased in childhood, it may have contributed to delayed language development. Furthermore, wearing a mask has become a necessity so that it became hard to recognize one"s facial expression and mouth shape for articulation.

P-041

Effectiveness of biopsychosocial interdisciplinary rehabilitation treatment of post-COVID condition

C. Wiertz^1,2, T. van Meulenbroek^1,2, C. Lamper², B. Hemmen^1,2,3, S. Sep^1,2, I. Huijnen^1,2,4, J. Burgers⁵, J. Verbunt^1,2

¹Adelante Rehabilitation Centre, Rehabilitation, brain injury, Hoensbroek, Netherlands

²Maastricht University, Rehabilitation Medicine Research School CAPHRI, Maastricht, Netherlands

³Zuyderland, Rehabilitation, Heerlen, Netherlands

⁴Zuyd University of Applied Sciences, Research Centre for Assistive Technology in Care, Heerlen, Netherlands

⁵Maastricht University, Medicine, Maastricht, Netherlands

Introduction: Patients with post-COVID-19 condition (PCC) experience a wide range of complaints (physical, cognitive, and mental), sometimes with high levels of disability in daily activities. Evidence of effective interdisciplinary rehabilitation treatment is lacking. Therefore, a person-centered biopsychosocial, tailored interdisciplinary rehabilitation program, according to patient needs and expert opinions was developed aimed at optimizing patient"s participation in society and quality of life (QoL).

Objective: Evaluate the effect of this new interdisciplinary rehabilitation treatment of PCC.

Patients & methods: 20 Dutch adults, 18 years or older, with high levels of disability in daily activities and/or participation in society will be included in this Replicated and Randomized-Single Case Experimental (R-SCED) study, from October 2023 onwards. The R-SCED consists of three phases. The baseline phase (A) is the observational period, no specific treatment will be given. In the intervention phase (B) patients will receive the new outpatient treatment, three times a week for 12 weeks. The treatment will be personalized according to patient"s physical, mental, and cognitive symptoms and goals. The treatment team can consist of a rehabilitation physician, physiotherapist, occupational therapist, speech therapist, and psychologist. Primary outcomes of the study are participation in society (USER-P) and health-related QoL (EQ5D-5L). Secondary outcomes are daily diary items and validated questionnaires aimed at physical, mental and cognitive complaints.

Results: Preliminary results are expected in Q2-2024. We expect that the treatment will result in increase of QoL and society participation.

Conclusion: To our knowledge, this is the first study investigating the effect of an interdisciplinary rehabilitation treatment a person-centered biopsychosocial approach in patients with PCC. Our findings will help improving treatment and support of PCC patients worldwide.

P-042

Efficacy of functional electrical stimulation cycling vs cycling after critical COVID-19: preliminary results of a randomized controlled trial

S. Mateo ¹

¹Université Claude Bernard Lyon 1, Saint Genis Laval, France

Background: Rehabilitation of patients with critical COVID-19 aiming to recover from the dramatical muscles and cardio-respiratory losses showed promising results in decreasing daily sedentary duration comparing cycling with functional electrical stimulation cycling (FEScycling) vs cycling (Mateo et al., 2021).

Objectives: To study the efficacy of a 4-week daily training of FEScycling vs cycling on sedentary or light/moderate activities (primary), muscle strength and tonus, pulmonary function, body composition and gait.

Method: Single-center randomized controlled trial (clinicaltrial.gov number: NCT04841746) assessor blinded with parallel assignment between an experimental (FEScycling + rehabilitation) and a control group (cycling + rehabilitation). Outcomes measured every week consisted in actimeter, manual muscle test, muscle stiffness (myoton), forced expiratory volume (portable spirometer), muscle mass (BiodyExpert), and gait speed (10m walking test). We used R (4.2.1) and mixed models fitting each outcome with an interaction between GROUP, TRAINING (end vs beginning) and AGE, PARTICIPANT as random effect.

Results: 20 participants (planned 70) were randomized between FEScycling (n=12, 1 female, age 61±10y) and cycling (n=8, 1 female, age 53±10y). There was no significant changes between groups for any outcomes including primary i.e., sedentary (-66 min.d-1 95%CI[-212; 80] vs 8 min.d-1 [-110; 126]) or light/moderate activities (76 min.d-1 [-64; 215] vs 73 min.d-1 [27; 118]) for FEScycling and cycling respectively. However, all participants showed improvement in response to training for all outcomes and muscle strength, pulmonary function and gait speed reached significance (p<0.05).

Discussion: Preliminary results showed no difference between FEScycling and cycling due to underpowered study. Larger sample sized study is welcomed before recommending physical training after critical COVID-19.

Reference

Mateo et al., 2021. 10.1016/j.rehab.2021.101516.

P-043

Lessons learned from functional electrical stimulation during cycling for rehabilitation of patients with long COVID-19 symptoms

E. Houdry¹, J. Souhleilac¹, D. Delubac¹, S. Commare¹, A. Montcharmont¹, V. Gaucher-Piola¹, K. T. Reilly^1,2, S. Jacquin-Courtois^1,2, S. Mateo^1,2

¹Lyon Civil Hospitals, Hôpital Henry Gabrielle, Saint-Genis-Laval, France

²Claude Bernard University, CNRS, INSERM Neuroscience Research Centre, Lyon, France

Introduction: Long COVID (multiple symptoms starting 3 months post-SARS-CoV2 infection, lasting ≥2 months with no alternative diagnosis) limits activity and restricts participation. Functional electrical stimulation (FES) cycling lowers rehabilitation intensity and has led to activity increase after acute COVID-19 but has not yet been studied after long COVID.

Objective: To study the effect of low intensity, distributed rehabilitation on the condition of patients with long COVID.

Materials & method: Two female patients (31 & 36 y/o) participated in a 12-week FEScycling and psychomotor rehabilitation - 2 30-minute sessions/week. Before (D0) and after (D90) rehabilitation we measured a variety of deficiencies (Modified Fatigue Impact Scale M-FIS, Rosenberg Self Esteem Scale, Hospital Anxiety and Depression Score HADS, PROMIS-29 test), activity limitation and participation (6-mn walking test 6MWT, 30 second chair test 30CST, Patient Health Questionnaire 15 PHQ-15, COVID-19 Yorkshire Rehab Scale C19-YRS, EQ-5D-5L scale).

Results: Patients completed ≥19/24 sessions. After rehabilitation fatigue remained high (M-FIS ≥74/84, sub-score C19-YRS≥9/10); self-esteem was good (Rosenberg>31/40); depression (doubtful or absent) was unchanged and anxiety decreased ("definite" to "doubtful" or "no anxiety", HADS, and Promis-29). Theoretical distance of 6MWT (D0=80% & 71% ) decreased by 9% and 5% (D90). Measures that did not change included 30CST (grade=1/5, stand number <17), symptoms severity (PHQ-15 "high level", sub-score C19-YRS=48/100), daily life independence (EQ-5D-5L >2.5/5) and perceived health score (EQ-5D-5L<25/100).

Discussion: This program failed to improve physical functions and symptoms, despite being tailored to individual patient needs, particularly regarding intensity. Future studies should investigate shorter interventions that consider fatigue, and/or stimulate the vagus nerve to alleviate autonomic dysregulation which likely causes exercise intolerance.

P-044

The Impact of COVID-19 on patient outcomes during in-patient rehabilitation

M. Bushra^1,2, J. Sabu², E. Reilly², M. Jones², H. Osman²

¹Walton Centre, Liverpool, United Kingdom

²Broadgreen Hospital, Liverpool, United Kingdom

Introduction: The Phoenix Specialist Rehabilitation Unit based at the Broad Green Hospital provides rehabilitation services to a wide group of diverse populations in the North West region of the United Kingdom. The UK Rehabilitation Outcome Collaborative database-UKROC is a national clinical database which collects key information about patients admitted to a specialist rehabilitation unit in England. There is limited study regarding the impact of COVID-19 on rehabilitation outcomes.

Objectives: To determine if COVID-19 impacted on in-patient rehabilitation outcomes.

Methods: This is a retrospective observational study for patients admitted between October 2022 and 2023. We collated data on the patient"s COVID status, their age, gender, length of stay and discharge destination. The information on the functional assessment measure i.e. FIM/FAM score was compared between the COVID-19 positive and negative patients from the UKROC database to assess differences in outcomes.

Results: A total of 50 patients were admitted to the Broad Green Rehabilitation Unit over a 12-month period. The group of COVID-19-positive patients ranged from 26 to 73 years with a mean age of 49.5 years which is similar to the non-COVID group. The majority of patients in both groups were males comprising 57% and 58%. The mean length of hospital stay for the COVID +ve group was slightly longer at 12.5 weeks as compared to non-COVID which was 9.5 weeks. Our analysis demonstrated that upon admission the mean FIM/FAM score for COVID patients was 160.5 that improved to 244.6 while for non-COVID patients, the mean score went from 184.5 to 274.2. Our data interpretation revealed that 85.7% of patients were discharged to home in COVID-19-positive cases and 88.8% in COVID –ve cases.

Conclusion: Our data showed improvement in both patient groups. However, patients who had COVID-19 took longer duration of stay, probably due to the effect of COVID-19, including fatigue impacting their functionality.

P-046

Neuropsychological follow-up in long COVID: is cognitive rehabilitation relevant?

L. Braga ¹

¹Sarah Rehabiliation Hospital, President, Brasilia, Brazil

Introduction: The duration of neuropsychological disorders caused by long COVID and the variables that impact outcomes are still largely unknown.

Objectives: Describe the cognitive and neuropsychiatric profile of patients with long COVID who sought a neuropsychological rehabilitation program, in-person or online; discuss findings from assessment and subsequent reassessment of those who participated in the rehabilitation program; identify the factors that influence recovery.

Material & methods: Two-phase study; Phase I: 614 patients who submitted to subjective assessment, Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS), Phonemic Verbal Fluency and Clock Drawing tests (NEUPSILIN) for executive, Hospital Anxiety and Depression Scale (HADS) and WHOQol-Bref, before neuropsychological rehabilitation. Phase II: 208 patients reevaluated 17 months after their Phase one evaluation. Of these, 63% attended a neuropsychological rehabilitation program, either in-person or online, while the remaining 22% did not participate in the program. The program comprised four 2-hour long meetings in a psychoeducational group setting coordinated by specialized psychologists.

Results: The cognitive profile of the patients included problems with memory, attention, concentration, verbal fluency, and planning. Improvement of neuropsychological symptoms 25 months post-acute stage of COVID-19 was seen only in those who participated in a neuropsychological rehabilitation. These patients also had lower depression scores on HADS. The BNIS results corroborate patients" subjective assessments of cognitive issues and QoL.

Conclusions: Our data reveal the persistence of cognitive and neuropsychiatric disorders in patients with long COVID. Neuropsychological/cognitive rehabilitation is shown to be important, whether in-person or online, and one is of the main factors that contributed to recovery.

P-047

A living systematic review & network meta-analysis of interventions for post COVID-19 condition

M. Ling¹, S. Kirsh¹, T. Jassal^1,2, D. Zeraatkar¹

¹McMaster University, Toronto, Canada

²University of British Columbia, Vancouver, Canada

Background: Evidence suggests that up to third of survivors of COVID-19 infection may experience long-term health effects, including fatigue, myalgia, and impaired cognitive function. Considerable resources have been made available to understand the prognosis and management of post COVID-19 condition.

Objective: To create and maintain a living systematic review and network meta-analysis addressing the benefits and harms of pharmacologic and non-pharmacologic interventions for post COVID-19 condition.

Methods: We will perform monthly searches of research databases (e.g., MEDLINE, EMBASE, CENTRAL) for randomized trials investigating the effects of pharmacologic or non-pharmacologic interventions in children or adults with post COVID-19 condition.

Reviewers will work independently and in duplicate to screen search records and collect data from eligible trials, including trial and patient characteristics and our outcomes of interest, and assess the risk of bias of eligible trials. Our outcomes of interest will include fatigue, pain, post-exertional malaise, quality of life, physical function, changes in education or employment status, cognitive function, and recovery. For each outcome, we will perform a frequentist random-effects network meta-analysis. We will appraise the certainty of evidence using the GRADE approach for network meta-analysis. We will update our living network meta-analysis bi-annually in the first year and quarterly thereafter, as more trials are completed and published.

Results: We will present results at the conference.

Conclusion: This living systematic review and network meta-analysis will provide comprehensive, trustworthy, and up-to-date summaries of the evidence addressing interventions for the management of post COVID-19 condition.

P-048

A systematic review of observational studies addressing harms of pacing, CBT, and exercise for patients with ME/CFS

S. Kirsh¹, M. Ling¹, T. Jassal^1,2, D. Zeraatkar¹

¹McMaster University, Toronto, Canada

²University of British Columbia, Vancouver, Canada

Introduction: Myalgic encephalomyelitis/ Chronic fatigue syndrome (ME/CFS) is characterized by persistent fatigue, post-exertional malaise, and cognitive dysfunction. Without clear etiology, therapies for ME/CFS are scarce. Guidelines recommend cognitive behavioural therapy (CBT) to manage thoughts, feelings, and behaviours, graded exercise therapy (GET) to improve patients" physical capacity, and pacing so patients remain within their energy limits. These strategies, however, are not ideal. In the face of widespread and highly publicized debate and the resulting uncertainty about CBT and GET, patients and healthcare providers urgently need robust, clear, and transparent evidence.

Objective: To compare the effects of therapies for treatment of ME/CFS

Patients & methods: We will work with an experienced research librarian to devise a search strategy of relevant databases (MEDLINE, EMBASE, CINAHL, and CENTRAL) to include all observational trials addressing the harms of pacing, CBT, and exercise for patients with ME/CFS. We will supplement our search by reviewing references of similar systematic reviews.

Working independently and in duplicate, reviewers will screen search records and collect data from eligible trials, including trial characteristics, patient characteristics, intervention characteristics, and outcomes of interest. Our outcomes of interest will include response to treatment, sleep quality, quality of life, physical function, cognition, anxiety, trial dropout, crashes following exercise, POTS episodes, and adverse events requiring hospitalization.

Results: We will present the results at the conference

Conclusion: We will present conclusions at the conference

P-049

Influenza vaccination mediated SARS-CoV-2 peptides – induced inflammatory response

Z. Zuo ¹

¹Third Affiliated Hospital of Sun Yat-Sen University, Rehabilitation, Guangzhou City, China

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes a persistent illness that increases the risk of coinfection with other pathogens. Vaccination is a promise strategy in preventing SARS-CoV-2 infections. Here, we investigate the cross-protection of the influenza vaccine to SARS-CoV-2 spike protein-specific immune response. Our data indicate enhance activation-induced marker (AIM) in influenza vaccination (IV) treated CD4+ T cells upon stimulated with spike protein peptide pools. In contrast, the fraction of other immune cell subtypes included CD8+ T cells, monocytes, NK cells and dendritic cells are not changed between IV treated and the control PBMCs following ex vivo spike protein peptides stimulation. However, the anti-viral and anti-inflammatory cytokine responses to spike protein peptides stimulation are still enhanced in PBMCs from IV immunized mice. Decreased expression of pro-inflammatory IL-1β, IL-12p40 and TNF-α is associated with inhibited level of histone acetylation in PBMCs from IV treated mice. These data support that influenza vaccination could have potential to prevent SARS-CoV-2 infection or influenza coinfection.

P-050

NX210c peptide: a promising drug candidate for blood-brain barrier repair in amyotrophic lateral sclerosis

C. Greene¹, N. Rebergue², G. Fewell³, S. Mahajan⁴, D. Janigro⁴, J. Le Douce², S. Marie², A. Janus², Y. Godfrin^2,5, M. Campbell¹, S. Lemarchant²

¹Trinity College Dublin, Smurfit Institute of Genetics, Dublin, Ireland

²Axoltis Pharma, Lyon, France

³Synvivo, Huntsville, AL, United States

⁴Flocel, Cleveland, OH, United States

⁵Godfrin Life-Sciences, Caluire-et-Cuire, France

Recent works show that blood-brain barrier (BBB) leakage represents a disease-driving feature of amyotrophic lateral sclerosis (ALS), as shown by the reduction of tight junction proteins and the increased BBB permeability in animal models and in patients. Here, we screened the effect of a subcommissural organ-spondin-derived peptide (NX210c) known to be beneficial in the SOD1G93A mouse model of ALS, on BBB integrity in vitro and in vivo.

Mouse endothelial cell (EC) monolayers (bEnd.3) and human BBBs (EC, astrocytes, pericytes) in static or microfluidic conditions, were treated with NX210c (1-100 μM), or its vehicle (water). In mouse EC, NX210c induced a transient increase in occludin levels after 24h treatment (+37%, 100 µM; WB). Claudin-5 levels were also increased after 24h (+43%, 100 µM) and 72h (immunocytochemistry). Accordingly, NX210c decreased by half the permeability to a 40 kDa-FITC-Dextran and increased transendothelial electrical resistance (TEER). In the human static BBB model, NX210c increased by 30% the TEER at 100 µM after 3 and 5 days. NX210c also increased TEER in the human 3D dynamic BBB model at 100 µM after 4h, and reduced the permeability to a 4 kDa-FITC-dextran.

3- and 21-month-old mice were treated intraperitoneally with NX210c at 10 mg/kg or its vehicle for 5 days once a day and brains collected at day 6. NX210c restored aging-induced reduction of claudin-5 and occludin levels in the cortex and/or hippocampus. This is in alignment with positive signals of BBB repair after repeated intravenous injections of NX210c in elderly healthy volunteers in a phase 1b clinical trial, including significant sreduction overtime of the release of claudin-5 and NfL in the plasma.

By reducing BBB leakage, NX210c is a promising drug candidate for modifying ALS course. These results among an extensive preclinical package, added to clinical trials showing a good safety profile and pharmacodynamic effects, support the clinical development of NX210c in ALS.

P-051

NX210c drug candidate peptide improves motor function and prolongs survival in the SOD1G93A mouse model of amyotrophic lateral sclerosis

S. Lemarchant¹, L. Beckett², I. Belaya³, J. Korpikoski², K. Kanninen³, M. Voutilainen², Y. Godfrin^1,4

¹Axoltis Pharma, Lyon, France

²University of Helsinki, HiLife, Helsinki, Finland

³University of Eastern Finland, AI Virtanen Institute for Molecular Sciences, Kuopio, Finland

⁴Godfrin Life-Sciences, Caluire-et-Cuire, France

NX210c is a short cyclic peptide derived from the subcommissural organ-spondin that displays in vitro beneficial effects on several aspects of ALS pathogenesis such as on blood-brain barrier permeability and neuronal death induced by glutamate excitotoxicity. Therefore, the aim of this study was to evaluate the therapeutic effect of NX210c in the SOD1 mouse model of ALS.

Female SOD1G93A mice were treated daily with intraperitoneal injections of vehicle or different doses of NX210c (2.5, 5 or 10 mg/kg) from 90 days old. The static rods test was performed every other week to evaluate motor deficits. Briefly, mice were placed with their back facing the clamped end of the rod. The orientation time to turn back and the travel time to walk the 60 cm back to the edge of the rod were recorded (= total time). The smaller the rod diameter, the harder the task. The clinical score was evaluated twice a week to determine overall survival.

The orientation, travel and total times during the static rods test were higher in SOD1G93A mice compared with WT mice from 16 weeks old until disease end-stage (p<0.001). A dose-dependent improvement of motor performances was observed in SOD1 mice treated with NX210c. More particularly, the peptide at 10 mg/kg reduced ALS-induced increased orientation and travel times from 16 weeks old (WT: 1.3s and 3.2s, vehicle SOD1: 24.5s and 26.6s and 5.4s, NX210c SOD1: 2.6s and 4.8s for orientation and travel times, respectively; p<0.01) until disease end-stage on the largest diameter rod. Although no effect of NX210c at the lowest doses (i.e., 2.5 and 5 mg/kg) was observed on the overall survival of SOD1G93A mice (p>0.05), the median survival of SOD1 mice treated with NX210c at 10 mg/kg was increased by 11 days compared with that of vehicle-treated SOD1 mice (vehicle SOD1: 143d, NX210c SOD1: 154d, p<0.01).

Overall, NX210c is a new promising drug candidate and its solid preclinical package supports the clinical development of NX210c in ALS patients.

P-052

Disruptions of gut microbiota are associated with cognitive deficits of preclinical Alzheimer’s disease: a cross-sectional study

G. Wan¹, B. Yu^2,1, S. Cheng¹, Y. Zhu^2,1, J. Li^2,1

¹Nanjing Medical University, Rehabilitation, Nanjing City, China

²Nanjing Medical University, Rehabilitation, Nanjing City, China

Introduction: Alzheimer’s disease (AD) is the most common type of dementia. The early change of gut microbiota is a potential biomarker for preclinical AD patients.

Objectives: Explore changes in gut microbiota characteristics in preclinical AD patients, and detect the correlations between gut microbiota characteristics and cognitive performances.

Patients & methods: This study included 117 participants (33 MCI, 54 SCD, and 30 healthy conrol (HC), of which 107 (91.4%) completed the study (31 MCI, 51 SCD, and 25 HC). We collected fresh fecal samples and blood samples from all participants and evaluated their cognitive performance. We analyzed the diversity and structure of gut microbiota in all participants through qPCR, screened characteristic bacterial species through machine learning models, and explored the correlations between these species and cognitive performances and serum indicators.

Results: Compared with the healthy controls, the structure of gut microbiota in MCI and SCD patients is significantly different. The three characteristic bacteria including Bacteroides ovatus、Bifidobacterium adolescentis and Roseburia inulinivorans were screened based on the best classification model (HC and MCI) which have intergroup differences. Bifidobacterium adolescentis and Roseburia inulinivorans are associated with better performance in multiple cognitive scores and several serum indicators.

Conclusion: The gut microbiota in patients with MCI has significantly changed in terms of composition and richness comprared to HC. Correlations were discovered between changes of characteristic gut microbiota and cognitive performances. Gut microbiota alterrations showed promise on affecting AD pathology and cognitive deficits, and it would promote new treatment target selection for preclinical Alzheimer’s disease patients.

P-053

A comprehensive analysis of factors influencing family meeting participation in cognitive rehabilitation in dementia

D. Y. Kim¹, H. S. Kim¹, M. J. Park¹, D. Jeong¹, J. Y. Chang¹, J. H. Lee¹, D. Y. Kim¹

¹Asan Medical Center, Rehabilitation, Seoul, South Korea

Introduction: Dementia is a condition in a decline in memory, cognition, behavior, and the capacity to daily tasks. Cognitive rehabilitation (CR) is a strategy to preserve independence as feasible in these patients. Additionally, CR involving family participation was known to increase the effectiveness. Therefore, the purpose of this study was to identify the factors of patients that determine patient family participation through whether to participate in family meetings (FM) (between FM (+) and (-) group).

Patients & methods: Fifty patients with dementia in the ages above 20 who visited Asan Medical Center for the CR were enrolled. The CR was conducted 1-2 times a week in hospital and consisted of computer-based training and training using workbooks. FM was suggested to the families of all patients receiving CR.

The patient’s age, gender, diagnosis, guardian, number of received CR were investigated. MMSE, Global Deterioration Scale (GDS), Activities daily living (ADL), instrumental ADL (I-ADL) and other values associated the cognition were measured at the start of treatment and end or current time of the treatment.

Results: Age of patients with FM (+) group was younger than FM (-) group. The number of receiving CR were higher in FM (+) group. ADL was higher in FM (+) group and neuropsychiatric inventory (NPI) severity was significantly lower in FM (+) group. There was no significant change in cognitive evaluation after the CR in both groups. We also conducted univariate and multivariate logistic regression analysis for prediction of family meeting participation. Age, number of receiving CR was clinically correlated with family meeting participation.

Conclusion: In this study, we investigated the factors for patients attending FM, and it was related to the number of receiving CR and age. Therefore, it is suggested that initiating CR at an early age, also conducting for longer period should be considered for active family participation, such as FM.

P-054

Case report: prospective clinical characterization and progression of a patient with laminopathy undergoing targeted physical therapy

C. Melo¹, G. Pino², M. A. Marin Palma²

¹Universidad del Desarrollo, Instituto de ciencias e innovación en medicina, Santiago, Chile

²University of Chile, Kinesiology, Santiago, Chile

Laminopathies is a type of muscular distrophy caused by mutations in the LMNA gene with a wide spectrum of clinical manifestations. This conditions are characterized by skeletal and cardiac muscle involvement with overlapping phenotypes, including limb-girdle muscular dystrophy type 1B, autosomal dominant Emery-Dreifuss muscular dystrophy, and a form of congenital muscular dystrophy. (Maggi L., 2016). Besides clinical examination, the diagnostic tools include complementary studies such as creatine kinase, electromyography, histological findings, and muscle MRI. Currently, there is limited evidence on the functional progression of this pathology and there is a lack of effective physiotherapy programs based on evidence to support it.

Case: 35-year-old woman with a five-year history of progressive generalized weakness, gait alteration and difficulty in manipulating and gripping common objects. Tests performed showed an elevation of Creatine Kinase, a nonspecific pattern suggestive of myopathy in the electromyography, a normal echocardiogram and electrocardiogram. Genetic study reported a pathogenic variant of the LMNA gene.

The patient is referred for an evaluation and to receive physical therapy. The application of the whodas 2.0 questionnaire in combination with Barthel scale, North Star Ambulatory Assessment Scale and Muscular Dystrophy Functional Assessment Scale, is proposed to establish the patient baseline functional level. Monthly surface electromyography is proposed to quantify the variation in motor unit recruitment. Recommendations on treatment of laminopathies remains palliative and supportive. A passive stretching physical therapy programme should be instituted early (Nigro V., 2011). Under this premise, physical therapy based on general mobility, flexibility, moderate intensity strength training and balance work in different positions will be performed in this patient for a period of 6 months associated with the previously mentioned evaluations.

P-055

Evolution of physical abilities and performance in daily life activities in adults with muscular dystrophy

G. Pino¹, M. A. Marin Palma¹, C. Melo², C. Abarca¹, P. Marquez¹, F. Mondaca¹, J. Perez¹

¹University of Chile, Kinesiology, Santiago, Chile

²University of Chile, Kinesiology, Santiago, Chile

Introduction: Muscular Dystrophies are a group of neuromuscular diseases (NMD) that affects the individual’s quality of life in several ways.

Objective: To characterize the evolution of health condition and the impact on daily life in a sample of 20 patients from Chilean Muscular Dystrophy Association (DIMUS Chile), between the years 2019 and 2023.

Hypothesis: It is expected that after a period of four years without therapeutic interventions, the functional condition of each patient will deteriorate proportionally to the natural worsening of the underlying pathology.

Patients and method: From a study carried out on 44 individuals in 2019, 20 patients were recruited via email or telephone contact. The WHODAS 2.0 questionnaire and the Muscular Dystrophy Functional Rating Scale were applied to the participants and were contrasted with a survey to measure socioeconomic variables. IBM® SPSS Software will be performed for data analysis.

Results (partial): Until the writing of this abstract 13 patients have been evaluated, 5 men and 8 women, with an average age of 39 years old. An average performance of 113 points out of a maximum of 144 on the Muscular Dystrophy Functional Rating Scale, was obtained (SD +/- 11.36 points), with a median of 115 points . According to the Whodas 2.0 questionnaire, an average of 73.69 points out of a maximum of 180 points was obtained (SD +/- 18.29 points), with a median of 130 points.

Conclusion: The patients evaluated present a deterioration in their functional condition in accordance with the deterioration of their pathology. This study is evaluated and approved by an ethics committee. The authors report no conflict of interest.

P-056

Acute effects of balance and combined balance exercise are superior to aerobic exercise on cognitive functions in patients with dementia

F. Can^1,2, İ. Güzel^3,2

¹Hacettepe University, Physical Therapy and Rehabilitation, Ankara, Turkey

²Hacettepe University, Health Science, Ankara, Turkey

³Yüksek İhtisas University, Physical Therapy and Rehabilitation, Ankara, Turkey

Introduction: Despite extensive research on the effects of aerobic exercise on dementia, other types of exercise with high neuromotor effects, such as balance exercise, have not been sufficiently investigated. In particular, there are almost no studies examining the acute effects of different exercise approaches on dementia.

Objectives: Therefore, we investigated the acute effects of balance, aerobic, and combined (aerobic-balance) exercise interventions on visual memory and reaction time in dementia patients.

Patients & methods: Thirty-one patients with mild to moderate dementia aged 65-90 years were divided into three exercise groups. Patients received one 30-minute session of exercise according to the exercise group in which they were included. Reaction time and visual memory were assessed before and immediately after the exercise session. Frailty was also assessed to examine its relationship with these cognitive parameters.

Results: As a result of our study, aerobic exercise improved only reaction time (p=0.042), while balance and combined balance exercises improved both reaction time (p=0.001, p=0.001) and visual memory (p=0.008, p=0.025) in a short-term post-intervention period. Furthermore, correlation analyses showed that combined balance exercise showed better effects on reaction time and visual memory in frail patients compared to other exercise interventions (r=0.748, r=-0.917).

Conclusion: These findings suggest that the acute effects of balance and combined balance exercise programs are superior to aerobic exercise programs for patients with dementia. Therefore, using only balance exercises or combined balance exercises may be more beneficial than aerobic exercises if the exercise program aims to improve cognitive functions in a short-term period.

P-057

Student-led mall-walking program in older adults with dementia: a pilot study

K. Bansal^1,2, A. Kovacs², O. Afzalzada², W. Sun², M. Lemonde²

¹University of Mount Union, Department of Physical Therapy, Alliance, Ohio, United States

²Ontario Tech University, Faculty of Health Sciences, Oshawa, Ontario, Germany

Introduction: People with dementia often reduce their daily walking activity causing increased home isolation, heightened risk of falls and a poor quality of life. While evidence supports the benefits of prolonged exercise programs in dementia, sustainable community-based walking programs tailored to this population are scarce.

Objective: This pilot study aimed to test the hypothesis that an innovative student-led mall-walking program with personalized biofeedback from wearable sensors will be safe, feasible, and effective in improving walking activity in people with dementia.

Materials & methods: Ten individuals with dementia will participate in biweekly mall-walking sessions over six weeks. The intervention includes 40 minutes of student-led walking, feedback on daily steps from the Fitbit Sense and weekly goals to increase stepping activity. Safety and feasibility are quantified through adverse events, participant compliance and qualitative interviews. Efficacy was measured by total steps/day from pre- to post-intervention.

Results: As this study is still ongoing, here we present the results from one participant who has completed the study. Mr. X, an 80-year-old male diagnosed with Alzheimer"s Disease five years ago, showed promising improvements in total daily walking activity (baseline: 4811±3265 steps/day; post-intervention: 5469±3257 steps/day) with 100% compliance and no adverse events. Mr. X found the mall-walking program worthwhile and was motivated by the Fitbit feedback. We expect nine more participants to complete this study by May"24.

Conclusion: The initial findings suggest that the mall-walking program, augmented with personalized biofeedback, holds promise in enhancing walking activity in people with dementia. Preliminary results from Mr. X advocate for further exploration of tailored community-based walking programs to address the critical need for sustainable interventions to alleviate the consequences of reduced mobility in this population.

P-058

Auditory neuropathy spectrum disorder in Brown-Vialetto-Van Laere Syndrome

H. Talebi¹, N. Mazaherytehrani¹

¹Isfahan University of Medical Sciences, Audiology, Isfahan, Iran

Objective: This study shows the clinical symptoms pertinent to auditory neuropathy spectrum disorder (ANSD) for a 16-year-old girl with Brown-Vialetto-Van Laere Syndrome (BVVL). The results have been followed for 6 years between 2015 and 2021.

Methods: In the present study, auditory test battery including tympanometry, acoustic reflex, pure tone audiometry, transient-evoked otoacoustic emissions (TEOAEs) and auditory brainstem response (ABR) were utilized and repeated 3 times during 6 years.

Results: In the first session, the results revealed bilaterally normal TEOAEs, absent acoustic reflexes (ipsi and contra), mild to moderate low tone loss in the pure tone audiometry, no ABR responses at high stimulus intensities and different polarities and present cochlear microphonic component (CM) in single polarities. In the second session, pure tone audiometry showed slight to mild high tone loss but the other tests demonstrated their same results. In the final session, the latter results were repeated.

Conclusion: In this comprehensive follow up study, the patient with BVVL demonstrated clinical symptoms of ANSD in which auditory system showed an impairment in the auditory temporal synchronization and encoding.

P-059

Could different types of exercise have different cognitive and physical effects on dementia?

İ. Güzel^1,2, F. Can^3,2

¹Yüksek İhtisas University, Physical Therapy and Rehabilitation, Ankara, Turkey

²Hacettepe University, Health Science, Ankara, Turkey

³Hacettepe University, Physical Therapy and Rehabilitation, Ankara, Turkey

Introduction: The physical and cognitive effects of aerobic exercise on dementia have been extensively studied. However, other types of exercise with different physiological effects need to be further investigated. In particular, although the neuromotor benefits of balance exercise are known, its effects on dementia have not been sufficiently studied.

Objectives: This study aimed to investigate the cognitive and physical effects of 6-week aerobic, balance, and combined (aerobic-balance) exercise programs on dementia.

Patients & methods: A group of 31 individuals, aged between 65 and 90 with mild to moderate dementia, were separated into three exercise groups. Before and after a 6-week exercise program, cognitive skills such as mental rotation, spatial orientation, visual memory and mental state were assessed. Concurrently, physical functions like fall risk, response speed, lower limb strength, and frailty were also evaluated.

Results: When comparing post-exercise values to pre-exercise values, a noteworthy reduction in frailty was observed solely in the aerobic exercise group (p=.017). Following the exercise program, the balance and combined exercise groups exhibited significant increases in mental rotation (p=.005, p=.032), spatial orientation (p=.020, p=.035), mental status (p=.007, p=.014) and lower extremity strength (p=.010, p=.005). Conversely, there were significant decreases in fall risk (p=.005, p=.005), reaction time (p=.028, p=.016), and frailty (p=.020, p=.009). Furthermore, unlike the combined and aerobic exercise groups, the balance exercise group demonstrated an improvement in visual memory (p=.016).

Conclusion: The results indicate that balance and combined exercises might exert more extensive impacts on dementia compared to aerobic exercise. This highlights the importance of adapting exercise programs for dementia patients to take into consideration both cognitive and physical impairments and the importance of a multidimensional treatment strategy.

P-060

Dual-task walking speed in older people with cognitive decline

I. Hereitova^1,2, T. Dornak²

¹University of West Bohemia, Pilsen, Czech Republic

²Palacký University Olomouc, Neurology, Olomouc, Czech Republic

Background: Given the population progression of dementia, the need for innovative screening tools to assess early stages of cognitive impairment is required. The detection ability of clinical markers of cognitive decline in the elderly has not been adequately investigated using a dual-task paradigm [1,2].

Objectives: The aim of the study was to analyse the effect of different dual task conditions on walking speed in older adults with cognitive decline and to compare with a control group of cognitively intact subjects.

Methods: A total of 50 participants were included in this cross-sectional study (25 probands with cognitive decline MoCA ≤ 25 at mean age 69,6 ± 9,4; 25 cognitively intact probands MoCA ≥ 26 at mean age 59,5 ± 7,0). To analyse the effect of single - task difficulty with the greatest interference, the dual - task effect (DTE) on walking speed was calculated in six random-order conditions assessed under comfortable walking speed, at maximal walking speed in combination with the visual - verbal Stroop test and the motor task.

Results: The dual - task cost (negative DTE) during the 10mWT combined with the visual-verbal Stroop test with prioritization to maximal walking speed was statistically significantly higher (p=0,000) than the motor task-based slowing at comfort and maximal speed according to the Wilcoxon paired test for the group of older people with cognitive decline. According to the Mann-Whitney test, the dual-task cost at maximum walking speed during the cognitive task was also shown to be significantly higher (p=0,017) in the older people with cognitive decline.

1. Laske C, Sohrabi HR, Frost SM, et al. Innovative diagnostic tools for early detection of Alzheimer’s disease. Alzheimers Dement. 2015;11(5):561-578.

2. Bridenbaugh SA, Kressig RW. Motor cognitive dual tasking: early detection of gait impairment, fall risk and cognitive decline. Z Gerontol Geriatr. 2015;48(1):15-21.

P-061

Kinematic analysis of Chinese handwriting among patients with mild cognitive impairment, Alzheimer’s disease, and healthy controls

M. J. Kuo¹, T. Y. Shih¹, C. L. Liu², T. N. Wang¹, H. L. Chen¹

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

²Taipei City Hospital, Neurology, Taipei, Taiwan

Introduction: Alzheimer’s disease (AD) is one of neurodegenerative diseases, leading to a progressive cognitive and behavioral decline. Early detection of cognitive decline would be crucial for providing appropriate medical treatment.The changes in the brain caused by neurodegeneration result in impairments in the performance of previously learned motor skills.Thus,handwriting may be a promising behavioral marker for early detection of cognitive decline. Therefore, this study aimed to investigate the kinematic differences of Chinese handwriting among MCI patients, AD patients, and healthy subjects, which may help establish Chinese handwriting as a behavioral detector for cognitive decline.

Objectives: Investigate the influence of character complexity on Chinese handwriting among MCI patients, AD patients, and healthy subjects.

Patients & methods: 15 participants with AD ,15 participants with MCI and 15 healthy controls were recruited to copy Chinese characters with 1 to 3 components (i.e. character complexity). Six kinematic parameters were selected to evaluate the handwriting performance, namely still time per stroke, length ratio, time ratio, mean stroke velocity, and accuracy.

Results: The accuracy of handwriting showed significant differences between the AD group and the other two groups. For 2 component words, still time exhibited significant differences among the AD, MCI, and HC groups. It indicated that there were noticeable differences in writing pauses for 2-component character among the AD, MCI, and HC groups.

Conclusion: Individuals with AD exhibited slower writing speed compared to the other two groups. Furthermore, distinct differences were identified in writing 2-component characters among the AD, MCI, and HC groups, with increased writing pauses associated with decreased cognitive ability. These findings supported the potential utility of Chinese handwriting as a behavioral indicator for detecting cognitive decline.

P-062

Tocotrienol-rich fraction (TRF), a vitamin E for therapeutic supplementation of insulin resistance of type 2 diabetes mellitus (T2DM) associated with neurodegenerative diseases using a transcriptomic profiling approach

N. Razip¹, H. Khaza’ai¹, S. Mohd Noor², A. Norazit², N. Nordin¹

¹Putra University, Biomedical Sciences, Serdang, Malaysia

²University of Malaysia, Biomedical Sciences, Wilayah Persekutuan Kuala Lumpur, Malaysia

Background: The study on type 2 diabetes mellitus (T2DM), which focuses on the connection with neurodegenerative disorders, identifies micronutrients-based therapeutic pathways. The richness of tocotrienol and tocopherol are the isomers of vitamin E, depending on the presence of the plant source. However, the crosstalk study on the mechanistic micronutrients signaling pathway and T2DM-associated neurodegeneration remains elusive.

Objectives: This study aims to evaluate the effects of tocotrienol rich fraction (TRF)-vitamin E on oxidative stress and comprehensive bioinformatics analysis using transcriptome profiling with the Next Generation Sequencing array.

Method: It is anticipated that the physiological changes in a zebrafish model T2DM will provide an understanding of such occurrences by identifying specific pathways of physiological dysregulation.

Results: The results of the study showed that TRF-vitamin E (1 mg/mL) supplementation or metformin (50 mM) exhibited lower malondialdehyde (MDA) levels than the hyperinsulinemia group (p<0.05). In addition, TRF-vitamin E and metformin increased glutathione (GSH) levels compared to the control group (p<0.05). Transcriptome profiling in TRF-vitamin E revealed a total of 202 downregulated genes (logFC < 0) and 639 upregulated genes (logFC>0) with a total of 841 genes dysregulated. These genes of the TRF-vitamin E group were significantly enriched in the calcium signalling pathway, PPAR signalling pathway, sphingolipid metabolism, MAPK signalling pathway, ECM-receptor interaction, cytokine-cytokine receptor interaction, vascular smooth muscle contraction, adrenergic signalling in cardiomyocytes and gonadotrophin-releasing hormone (GnRH) signalling pathway

P-063

Comprehensive dementia neurorehabilitation in rural areas: integrating digital app-based therapies and structuring daily routines with stage-based recommendations

S. Das¹, P. Marne¹

¹Manastik, Technology, Pune, India

Background: Dementia is a global healthcare challenge, with rural areas facing unique obstacles in providing adequate care and support. This project addresses the pressing need for effective dementia neurorehabilitation in rural communities by introducing an innovative digital app-based solution. The approach integrates digital therapies and stage-based recommendations while promoting a multidisciplinary rehabilitation strategy.

Objectives: The primary objectives of this project are to: Develop a user-friendly digital app tailored to the specific needs and challenges of rural areas for individuals with dementia. Integrate evidence-based digital app-based therapies to address cognitive, emotional, and functional impairments in dementia. Implement stage-based recommendations to ensure that interventions align with the evolving needs of individuals at different stages of dementia. Foster a multidisciplinary approach, involving healthcare professionals, caregivers, and families in the rehabilitation process.

Methods: This project employs a multi-faceted approach: App Development Digital Therapies Integration: Evidence-based digital therapies are incorporated into the app, targeting cognitive, emotional, and functional domains. The app offers personalized exercises and activities, adapting to the unique needs of each user. Stage-Based Recommendations: The app provides tailored recommendations for individuals at different stages of dementia. This ensures that the interventions remain relevant and effective as the condition progresses.

Multidisciplinary Rehabilitation

Results: Preliminary results indicate that the app-based solution is well-received in rural communities. Users have reported improvements in cognitive function, emotional well-being, and daily functioning. Caregivers have expressed reduced burden and improved communication with individuals with dementia. The multidisciplinary approach has led to more coordinated and comprehensive care.

P-064

Participant and caregiver experiences of an activities of daily living-focused cognitive stimulation program (CS-ADL) for individuals with mild-to-moderate dementia

S. Ryan¹, M. Chockalingam¹, O. Brady^1,2

¹University of Galway, Occupational Therapy, Galway, Ireland

²Health Service Executive, Primary Care, Trim, Ireland

Introduction: Individuals living with dementia experience a progressive deterioration in their cognitive and functional abilities and as a result, typically require support from informal family caregivers. Non-pharmacological interventions, such as cognitive stimulation, are increasingly being used to address this deterioration. CS-ADL is an Activities of Daily Living-focused group cognitive stimulation program that aims to maintain the cognitive and functional performance of individuals living with mild-to-moderate dementia.

Objectives: This study aimed to explore and describe the participant and caregiver experiences of CS-ADL.

Materials & methods: A descriptive qualitative design was implemented. CS-ADL participants and caregivers were recruited in dyads through a Psychiatry of Later Life service where CS-ADL was delivered. Semi-structured interviews were completed with each dyad either in person or via telephone. Transcribed interview data were analyzed through reflexive thematic analysis.

Results: Three caregivers and two CS-ADL participants were interviewed. CS-ADL was perceived as an acceptable intervention that positively influenced the everyday life of both dyad members, with benefits reported in participants" memory, mood, and social interaction. CS-ADL was perceived to add purpose to daily routines and provide opportunity for participants to engage in activities that they no longer had access to. Furthermore, the facilitative leadership style [CM1] of group facilitators was reported to positively influence participants" engagement in CS-ADL.

Conclusion: This study explores the experiences of individuals with dementia and their caregivers about participating in CS-ADL programs, adding to the evidence base for this intervention. . Further, large-scale research is needed to confirm study findings and enhance their transferability to future cognitive stimulation programs.

P-065

Phytochemicals as potential mitigators of degenerative diseases: a comprehensive review

T. Gbayisomore ¹

¹University of Benin Teaching Hospital, Benin, Nigeria

Introduction: Degenerative diseases, including cardiovascular diseases, neurodegenerative disorders, and cancer, represent a significant global health challenge. In light of these exigent health issues, there has been a growing focus on phytochemical, a diverse group of biologically active compounds found in fruits, vegetables, grains, herbs, and spices, which have garnered attention for their antioxidant, anti-inflammatory, and gene-regulatory properties.

Objectives: The objective of this review is to explore the potential of phytochemicals, bioactive compounds derived from plants, in mitigating degenerative diseases.

Materials & methods: Drawing upon a vast body of research, a systematic review of scientific literature was conducted to evaluate recent discoveries and emerging insights related to the impact of phytochemicals on degenerative diseases. Relevant studies and data were collected from PubMed, Goggle scholar and so on, and their methodologies were assessed.

Results: The research reveals associations between phytochemical-rich diets and reduced risk factors for cardiovascular diseases, phytochemicals’ neuroprotective effects in neurodegenerative disorders, and significant anticancer properties. Statistical analyses were performed to identify trends and correlations.

Conclusion: In conclusion, promoting the consumption of phytochemical-rich foods presents a practical and enjoyable approach to enhancing health and combatting degenerative diseases. The findings highlight the potential benefits of incorporating phytochemicals into dietary strategies for disease prevention and management. However, a comprehensive evaluation, particularly concerning the long-term effects of sustained Nrf2 activation, especially in conditions such as cancer, remains pivotal. It is becoming increasingly evident that the rapid development of low-toxicity, high-efficacy phytochemical drugs for chronic disease intervention is within reach.

P-066

Evaluation of cognitive impairment in patients with cerebral small vessel disease by eye tracking technique

Y. Cai ¹

¹Xiangya Hospital of Central South University, Changsha, China

Introduction: Eye tracking technology has been applied to various fields of neuroscience research, which can be used as an objective evaluation basis for high-level behavior and cognition.

Objectives: In this study, eye tracking technology was applied to the evaluation of different degrees of cognitive impairment in patients with CSVD for the first time.

Patients & methods: 119 CSVD subjects (66 males and 53 females) and 430 normal subjects (236 males and 194 females) aged 38-75 years were enrolled in the study. The characteristics of eye movement in patients with CSVD were observed, and the correlation between the cognitive score based on eye movement tracking and the MOCA score was explored.

Results: Compared with normal subjects, the latency of saccade/reverse saccade in CSVD subjects was prolonged, the speed of saccade decreased, the correct rate of anti-saccade decreased, the accuracy of smooth tracking test decreased, which is consistent with the changes of CSVD subjects with age increse. In addition, the accuracy of static fixation was decreased with the increase of age. The number of fixation-offset, interval saccade-saccade speed, reverse-saccade speed and other eye movement parameters have strong diagnostic efficacy in the evaluation of CSVD cognitive impairment. Eye movement analysis has an accuracy of 75.5%, a sensitivity of 57.9%, a specificity of 86.7%, an F1 Score of 64.7% and an accuracy of 73.3% in distinguishing between moderate and severe cognitive impairment, mild cognitive impairment and normal people in CSVD. Regression analysis of MOCA using eye movement characteristics showed that the correlation between the cognitive score predicted by eye movement and the MOCA score was 79.6 %, and the fitting degree was 97 %.

Conclusion: Eye tracking technology shows good diagnostic performance in distinguishing different degrees of cognitive impairment in CSVD, which can achieve quantitative scoring and accurate classification.

P-067

An innovative view to conciousness, awareness and hope following Coma-SSIMS program

A. Shah ¹

¹SPARSH Physiotherapy and Rehab Clinic, Keshod, India

Introduction: Prolong disorders of consciousness follow in around one of every eight patients following severe traumatic brain injury (TBI). The degree to which reticular activating system stays depressed is a predictor of coma arousal following TBI. Early stimulation of the reticular activating system by various coma arousal strategies that work upon environmental enrichment and comprehensive sensory stimulation techniques may enhance functional outcomes.

Objective: To develop SSIMS program and to assess it for its safety,feasibility and efficacy

Materials & methods: The study was carried out under 3 phases. In phase one a systematic analysis was done to form the concept of SSIMS program which was then validated by a group of 10 experts. In phase two the newly developed SSIMS program was tested for its safety and feasibility to be executed in the acute setup for n=20 participants with severe traumatic brain injury. Phase three was further carried out to know the effects of SSIMS program on arousal for n=100 patients (age:18 to 65 years) with severe traumatic brain injury by a randomized controlled trial with parallel arm where the experimental group (n=50) was administered with SSIMS program and another arm (n=50) was administered with Multimodal sensory stimulation program. Treatment time for both groups was 45 minutes, thrice a day for 14 days.

Result: SSIMS has been developed which has shown to be safe and feasible intervention with the structural feasibility of 81.78% and functional feasibility of 72.82 %.The effects of SSIMS were seen to be better than Multimodal sensory stimulation group. Wilks lambda values for Coma recovery scale- revised for experimental group was 0.193 compared to that of control group with a score of 0.235.

Conclusion: SSIMS has shown to be safe and feasible to facilitate arousal and could be used as an adjuvant to existing coma arousal therapies for severe traumatic brain injury subjects in acute setup.

P-068

Intravenous lidocaine in the treatment of sepsis-associated encephalopathy, a retrospective cohort study

F. Xiao ¹

¹The Second Xiangya Hospital, Changsha, China

To investigate the efficacy of intraoperative intravenous lidocaine in the treatment of sepsis-associated encephalopathy (SAE). A total of 165 patients diagnosed with SAE from May 2021 to February 2023 were enrolled. 55 patients were included in the lidocaine group and 110 patients were included in the control group. Patients in lidocaine group were injected with lidocaine 1.5 mg/kg intravenously and continued to be pumped with lidocaine 1.5 mg/kg/h until the end of surgery. General information, past history, infection site, APACHE II score, SOFA score, GCS score, Laboratory tests, anesthetic drug, operation time and length of ICU stay were collected. The outcome measure was the prognosis of SAE.

Results: The length of ICU stay was significantly shorter in the lidocaine group compared to the control group, with a statistically significant difference (P<0.05). The lidocaine group had a significantly higher rate of favorable prognosiscompared to the control group, with a statistically significant difference (P<0.05). Univariate analysis results showed that intraoperative intravenous lidocaine, age, APACHE II score, SOFA score, GCS score, and intravenous dexmedetomidine were associated with the prognosis of SAE patients (P<0.05). Multivariable logistic regression analysis results showed that age (OR=1.335, 95%CI 1.158-1.539, P<0.001) and duration of surgery (OR=1.044, 95%CI 1.005-1.085, P=0.028) were risk factors affecting the prognosis of SAE patients. Intraoperative intravenous lidocaine (OR=0.230, 95%CI 0.068-0.776, P=0.018), GCS score (OR=0.387, 95% CI 0.225-0.666, P=0.001), and intravenous dexmedetomidine (OR=0.253, 95%CI 0.086-0.741, P=0.012) were protective factors affecting the prognosis of SAE patients.

Conclusion: Intraoperative intravenous lidocaine can significantly improve the prognosis of SAE patients.

P-069

Electrophysiological screening to assess critical illness polyneuropathy (CIP) and myopathy (CIM) in patients with severe acquired brain injury: a prospective observational study in intensive rehabilitation unit

F. Piccione¹, A. Cerasa^2,3, P. Tonin³, S. Carozzo³, R. S. Calabro⁴, S. Masiero⁵, L. F. Lucca³

¹Neurorehabilitation Unit, Section of Brain Injury Rehabilitation, Hospital-University of Padua, Padua, Italy

²Institute for Biomedical Research and Innovation (IRIB), National Research Council, Mangone, Italy

³S. Anna Institute, Crotone, Italy

⁴IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy

⁵University of Padua, Neuroscience, Padua, Italy

Introduction: In the intensive rehabilitation unit (IRU), assessing Critical illness polyneuropathy (CIP) and myopathy (CIM) in patients with severe acquired brain injury (ABI) has several limitations, which include complexity of the electrophysiological tests, limited availability of neurophysiology consultants, and patients" severe disorder of consciousness and lack of collaboration.

Objectives: the aim of the study was to propose a simplified electrophysiological screening that ascertain provisional diagnosis of CIP and/or CIM, in order to predict clinical outcomes of patients with severe ABI in IRU.

Patients & methods: This prospective, single-center study included 19 severe ABI patients (50% female, mean age 55.1 + 14.4; CRS-r= 13.5 + 5.9; LCF: 3.4 + 1.2; DRS: 20.7 + 3.3).with prolonged rehabilitation treatment (≥2 months). We applied direct Tibialis Anterior muscle stimulation (DMS) associated to Peroneal nerve motor conduction evaluation, across the fibular head (NCS), in order to identify CIP and/or CIM and to exclude demielinating or compressive neuropathy. Results: The simplified electrophysiological screening reported CIP and CIM in isolation or combination (CIPNM) overall prevalence estimate of about 42%, comparable to other ABI epidemiological studies conducted in rehabilitation setting . Also, provisional diagnosis of CIP and/or CIM, at IRU admission, was associated with a lower probability to achieve endotracheal tube weaning (44% versus 10%). CIP and/or CIM presence was tendentially accompained with bad outcomes in oral feeding recovery and functional autonomy at discharge, but results were not significant. Conclusions: The implementation of the proposed simplified electrophysiological screening may allow early identification of CIP and/or CIM in severe ABI patients, thereby contributing to specific functional prognosis in rehabilitative setting.

P-072

Emerging consciousness pathway in New Zealand: reflecting on the past, present, and planning for the future

T. Young ¹

¹ABI Rehabilitation, Neurorehabilitation, Auckland, New Zealand

Background: Adults in emerging consciousness state (ECS) in NZ have not always had a clear pathway for rehabilitation. Potential benefits of clinical measures were not fully understood and not routinely done within rehabilitation settings. Improvements over the past decade include an established pathway and programme, earmarked funding, training and learnings from our data.

Objectives: Establish and implement clinical outcome measures for people in ECS. Development and implement ECS programme. Demonstrate value of ECS

Materials & methods: Analyse data from 2008 to 2012 (prior to established ECS programme). Implement processes to improve clinical practice. Review ECS data over past seven years (2016-2022) to determine key findings and analysis effectiveness of the programme

Results: Analysing data collected, from clinical measures applied to those in the ECS, demonstrated that the information enhanced the clinical decision making. This aligns with international best practice (Wilford, 2019).

Data collected over a five period that looked at length of stay, services received and outcomes relating to functional gain and discharge destination informed the development of the ECS clinical pathway and programme. This has since been established with its own funding stream. The ECS programme is based on international best practice with information developed for families (Giacino, 2018).

Over the past seven years (2016-2022) ABI has served 82 people through the ECS programme. 73 (89%) people emerged from MCS. Of these, 40 (55%) were discharged home.

The ECS cohort differ in ethnicity, age, gender and mechanism of injury make up to what we typically see in the moderate to severe brain injury cohort within our service.

Implementing these changes have positioned NZ in a stronger position to assess and deliver rehabilitation to those presenting in an ECS. A better understanding of the cohort requiring this service will assist in planning continued service development.

P-073

An important factor affecting early rehabilitation of patients with severe consciousness disorders – hydrocephalus

Z. Chen ¹

¹Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Rehabilitation, Shanghai, China

Background: Promoting early awakening of patients with severe disorder of consciousness (DOC) is one of the important work goals in neurorehabilitation. In clinical rehabilitation work, early detection and effective treatment of complications in patients with severe DOC is necessary, and hydrocephalus is one of them.

Objectives: To investigate the impact of hydrocephalus on consciousness recovery in patients with severe DOC during rehabilitation.

Methods: From August 2020 to August 2022, the clinical data and reproduction evaluation in patients with severe DOC were studied retrospectively. Twenty-two patients (mean age [± SD] 62.45 ± 13.03 years, 14 males and 8 females) with severe DOC were included. The hydrocephalus was discovered after computed tomography (CT) or magnetic resonance imaging (MRI) received enlarged vessels in the patients with DOC during rehabilitation.After undergoing the lumbar puncture TAP test, the patient’s changes were observed, and physiatrists communicated with patients" family members. The patient went to the neurosurgery department for ventriculoperitoneal or lumboperitoneal shunt surgery, and the neurosurgery department decided whether to perform simultaneous skull repair surgery based on their condition. The patient’s condition stabilizes after surgery for 3-7 days and is transferred to the rehabilitation department for further rehabilitation treatment. To account for the improvement in patients with severe DOC, Glasgow Coma Scale (GCS), Coma Recovery Scale Revised (CRS-R), and Disability Rating Scale (DRS) assessments were performed during whole rehabilitation.

Results: Most patients (20/22) have normal pressure or low-pressure hydrocephalus. After shunt and rehabilitation treatment, 77.27% (17/22) showed varying degrees of improvement in consciousness. Normal pressure or low-pressure hydrocephalus hinders patients’ consciousness recovery and should be closely monitored and actively treated.

P-074

Defining self-awareness: a concept analysis of online awareness for adults with neurological conditions

D. Sansonetti^1,2, J. Fleming², F. Patterson², N. A. Lannin^1,3, J. Toglia⁴

¹Alfred Health, Melbourne, Australia

²University of Queensland, Brisbane, Australia

³Monash University, Melbourne, Australia

⁴Mercy University, New York, NY, United States

Introduction: Self-awareness comprises two main components:general awareness (or metacognitive knowledge) and online awareness (awareness activated within the context of an activity), with the latter being a contemporary concept requiring further consensus regarding its definition.

Objectives: To define the key components of online awareness and identify methods for assessing this concept.

Materials & methods: Rodgers" evolutionary method for concept analysis was used, and involved a systematic search of the literature and thematic analysis that allowed for identification of key features of online awareness. Papers were included if they provided a definition or description of online awareness or included an assessment approach to measure this concept for adults with neurological conditions.

Results: Fifty-six papers were included in the review, with 21 different online awareness assessment approaches identified. An online awareness definition framework was developed that comprised four main components:1/appraisal;2/anticipation and prediction;3/ monitoring; and 4/self-evaluation. Self-regulation was a related but separate concept that possesses cognitive requirements extending outside the boundaries of online awareness. Only two identified online awareness assessments included all aspects of the definition framework (The Awareness ADL Task and Actual Reality Task). Assessments varied in relation to structure and content. Many assessments included observation of individuals completing everyday activities, with a range of different scoring systems applied. Only two assessments had reported psychometric properties (The occupation-based metacognitive approach and the Self-awareness Multi-level Assessment Scale).

Conclusion: This review clarified the essential components of online awareness, and highlighted those constructs that sit outside its conceptual boundaries as a foundation for development of psychometrically robust measures for this concept.

P-075

Rehabilitation for impaired self-awareness: the contribution of feedback mechanisms in the early phase post-brain injury

D. Sansonetti^1,2, J. Fleming², F. Patterson², N. A. Lannin^1,3

¹Alfred Health, Melbourne, Australia

²University of Queensland, Brisbane, Australia

³Monash University, Melbourne, Australia

Introduction: After brain injury, a person’s self-awareness of abilities and limitations is an important factor in rehabilitation. The hospital setting can present challenges to providing exposure to a range of activities and environments that support the development of self-awareness.

Objectives: To explore the contribution of feedback mechanisms in the development of self-awareness for adults with brain injury.

Materials & methods: Practice setting was a public brain injury rehabilitation unit. Participants included a convenience sample of adults with acquired brain injury (n=173) admitted to inpatient rehabilitation who received self-awareness assessment. Data were gathered through an audit of clinical records of semi-structured interviews using the Self-awareness of Deficits Interview (SADI) and analysed thematically by one researcher, with codes reviewed by a second for rigor.

Results: The three main themes were "environmental", "activity" and "social" feedback mechanisms. "Environmental" factors: rehabilitation in the hospital setting added to uncertainty for some participants about their function at home without exposure to this environment, while many participants reported a belief they would experience no functional difficulties upon return home. "Activity" factors: lack of exposure to some activities in the hospital setting was identified to be a barrier to learning about their abilities for some, while for others it reinforced poor awareness of limitations. "Social" factors: feedback from family/friends at times reinforced the presence of impairments or conversely, an absence of functional changes. Participant quotes will be presented to further describe these themes.

Conclusion: A clinical interview using the SADI provides an opportunity to understand an individual"s perspective of their abilities. Inpatient brain injury rehabilitation should include targeted opportunities for experiences, and feedback across a range of activities and environments.

P-076

Supporting family of patients suffering from acute stroke: a feasibility study for the SAFIR-E interdisciplinary intervention

D. Rutz¹, K. Bruyere¹, K. Vasserot¹, K. Massuk¹, P. Michel¹, P. Ryvlin¹, V. De Goumoëns¹

¹Lausanne University Hospital (CHUV), Neuroscience, Lausanne, Switzerland

Introduction: A family intervention for people with an acquired brain injury (SAFIR) has been adjusted specifically for people suffering from a stroke by an interprofessional team including physicians, nurses and therapists (OT/PT): the SAFIR-E intervention. Before assessing its effectiveness, the clinical feasibility of this intervention must be measured.

Objectives: To evaluate the feasibility of an early, coordinated, and interdisciplinary intervention (SAFIR-E) for supporting families of stroke patients during the acute hospitalization phase in a neurology department.

Patients & methods: The study follows the Pearson"s recommendation for feasibility study. Participants included families of stroke patients experiencing emotional distress upon diagnosis. Participants were recruited in the early days of hospitalization. Feasibility indicators were collected during the pilot phase covering family recruitment and profiles, retention rates, protocol adherence, formation, and intervention costs.

Results: From May to September 2023, 54 families met inclusion criteria. 9 families (16.7%) benefitting from the intervention. Most family members were children of the stroke patients (55.6%). Only one intervention couldn’t be fully carried out due to patient transfers (88.9% retention). The intervention showed an average protocol adherence of 72.6%. In details, adherence to the protocol was 71.2% for organizational aspects and 74.2% for adherence with the core components covered during the intervention. Total intervention time with families averaged 147.3 minutes (±8.3) and 49.4 (±7.0) for each phase. 60 professionals were trained for the intervention. A cumulative 24-hour of SAFIR-E training was necessary over 3 months.

Conclusion: The intervention is feasible and well-suited for our acute stroke setting, aligning with the population’s active needs. An assessment of resources for funding intervention and training of collaborators is needed to ensure sustainability.

P-077

Adherence to standardized assessments by physical therapists in stroke patients using a complexity-based model for categorizing rehabilitation (CMCR) at the Clínica Alemana Temuco, Chile

R. Rivas^1,2, S. León², J. D. Carrasco², C. Klapp³

¹Frontera University, Departamento de Especialidades Médicas, Facultad de Medicina, Temuco, Chile

²Clinica Alemana Temuco, Servicio de Medicina Física y Rehabilitación, Temuco, Chile

³Padre Las Casas Health Care Complex, Neurology Unit, Temuco, Chile

Background: Stroke is a global healthcare problem that causes a substantial burden of disease. In our region (Región de La Araucania), the stroke incidence is sevenfold larger than in our country. The use of assessment tools in clinical practice is essential for clinical rehabilitation. It contributes to improving clinical reasoning, objectifying, and quantifying the interventions, which is crucial for good clinical practice.

Aim: To describe the adherence to standardized assessments by physical therapists using a complexity-based model for categorizing rehabilitation (CMCR) at the Clínica Alemana Temuco, Chile.

Methods: This retrospective cohort study used 84 participant records between January 2023 and October 2023. Adherence to the CMCR by physical therapists working with stroke patients was assessed. This instrument (CMCR) linked clinical and functional assessment to the degree of severity, thereby setting a score to categorize patients as low, medium, and high complexity. It was developed using a matrix of clinical variables (FSS-ICU, Barthel Index and MRC). By applying the CMCR, determine the therapeutic load (1,2 and 3 or more sessions per day).

Results: Among the 84 patients, 54.1% were men; the median age was 69.5 (39-93) years. 100% of patients were evaluated before 24 hours. Adherence of the physical therapists was 100%. Correlation to clinical features and medical decision in low complexity (n:9;10.7%): 44.5%, medium complexity (n:70; 83.3%): 95.2% and high complexity (n:5; 6.0%): 50%.

Conclusion: The results of this study show that physical therapists adhere to standardized clinical assessments using a CMCR. The low correlation in the high complexity was because of the hemodynamics instability, and in the low complexity, the leading cause was the fear of doing less from the physicians.

P-078

A case of femoral arter pseudoaneurysm during rehabilitation for ischemic stroke

A. Di̇nç Yavaş¹, A. A. Demir²

¹Istanbul Aydın University School of Medicine, PRM, Istanbul, Turkey

²Istanbul Aydın University School of Medicine, Radiology, Istanbul, Turkey

Introduction: Stroke patients present with musculoskeletal, neuromuscular and vascular complications during the rehabilitation.

Objectives: We report a patient with a femoral artery pseudoaneurysms.

Patient & methods: The patient was a 67-year-old man diagnosed with acute internal Carotid artery occlusion and endovascular recanalization therapy was performed. He had right flaccid hemiplegia, right groin pain and edema in the right lower limb. Right lower limb vascular ultrasonography revealed a femoral artery pseudoaneurysm with a size of 33*42*38 mm.Percutaneous trombin injection was performed; the pseudoaneurysm was totally closed, pain and edema regressed.

Results: After recanalization therapy puncture-site complications can be seen due to insufficient hemostasis. The incidence of pseudoaneurysm is 0.23%–2.04%. Pseudoaneurysms may cause edema,pain, rupture-induced hemorrhage or thrombus induced peripheral vascular occlusion. Therapeutic management depends on the characteristics of the pseudoaneurysm. Subclinical and spontaneous resolution may be seen, but some of them may become complicated also. Treatment strategies include: compression, collapsing and producing thrombosis or direct thrombin injection or open surgery.

Conclusion: A case of femoral artery pseudoaneurysm following recanalization therapy for acute ischemic stroke was reported. Puncture-site complications can lead to serious results if they are misdiagnosed. Curative treatment is required without delay. 1) Shapiro SZ, Sabacinski KA, Mantripragada K, et al: Access-site complications in mechanical thrombectomy for acute ischemic stroke: a review of prospective trials. AJNR Am J Neuroradiol 2020; 41: 477–481.2) Oneissi M, Sweid A, Tjoumakaris S, et al: Access-site complications in transfemoral endovascular procedures: a systematic review of incidence rates and management strategies. Oper Neurosurg (Hagerstown) 2020; 19: 353–363.

P-079

Advancing neurorehabilitation strategies for head and neck nerve damage: a review, evaluation, and proposal of innovative approaches

H. Fleming¹, R. Varman¹

¹Creighton University, Medicine, Omaha, NE, United States

Neurorehabilitation plays a pivotal role in addressing deficits resulting from head and neck nerve damage, a condition with multifaceted implications for individuals’ functional abilities and quality of life. The intricate network of nerves in the head and neck region is susceptible to various injuries, including trauma, surgical procedures, or neurological disorders. Such damage can lead to deficits in sensory, motor, and autonomic functions, posing significant challenges to affected individuals. This research aims to contribute to the evolving landscape of neurorehabilitation for head and neck nerve damage deficits by synthesizing existing knowledge, evaluating current interventions, and proposing novel approaches. A literature search was conducted using the PubMed database to identify relevant articles for this review. The search strategy involved a combination of Medical Subject Headings (MeSH) terms and keywords related to the neurorehabilitation of head and neck nerve damage. Key terms included "neurorehabilitation," "head and neck nerve damage," "electrical stimulation", and related variations. Articles were included if they were written in English, published in peer-reviewed journals in the last 5 years, and focused on neurorehabilitation strategies for head and neck nerve damage. Recent advances in neurorehabilitation techniques offer promising avenues for mitigating deficits associated with head and neck nerve damage. Cutting-edge interventions encompass a spectrum of approaches, including sensory retraining, neuromuscular electrical stimulation, and biofeedback. Despite significant progress in the field, there remains a need for comprehensive and evidence-based rehabilitation protocols tailored to the specific nuances of head and neck nerve damage. Notably, further innovations are warranted in mechanical devices for the neurorehabilitation of head and neck nerve injuries, as the majority of existing therapies are predominantly electrical in nature.

P-080

ICF focused goal setting for inpatients attending rehabilitation medicine settings-introducing SMARTI3EM

S. M. Javaid¹, M. Adamaszek²

¹Active Care Group, Bristol, United Kingdom

²Klinik Bavaria, Clinical & Cognitive Neurorehabilitation, Kreischa, Germany

Background: There is existing low-level evidence favouring positive effects of goal setting for psychosocial outcomes specifically health-related quality of life, emotional status, and self-efficacy in adults. Furthermore, benefits of integrating the International Classification of Functioning (ICF) into goal-setting have been described. However, it has also been suggested that current person-centred goal setting has variability in their inclusion of intervention components.

Personal factors are not classified in the ICF due to social and cultural variability associated with them. Yet we postulate that this variability can prove advantageous. We present a new strategy for undertaking goal setting based on personal factors of the ICF Model. Aptly named as SMARTI3EM; Specific, Measurable, Achievable, Realistic, Timely, Interesting, Individualised, Innovative, Empowering and Manageable; we describe a system whereby goals formulated to recruit patient"s cognitive and physical engagement will likely help enhance neuroplasticity.

Objectives: For patients attending inpatient rehabilitation settings, can the drafted goals based on personal factors from the ICF Model lead to better rehabilitation outcomes?

Materials & methods: We searched MEDLINE (Pubmed), EMBASE, Cochrane database of Systematic Review to October 2023, together with reference checking and citation searching. We did not impose any language or date restrictions.

Data collection & analysis: We independently reviewed search results within the selection criteria, extracted data and assessed risk of bias for included studies.

Results: Only a handful of studies allude to goal setting interventions directed at the personal factors compared to activity and participation components of the ICF. Detailed results will be provided with updates added up to May 2024.

Conclusion: Personal factors from the ICF can be used to formulate goals in the acute inpatient rehabilitation settings. These can be drafted using SMARTI3EM. As a result of this scoping Systematic Review, an opportunity has presented itself to conduct a multi-centre Randomised Control Trial to establish the validity and efficacy of SMARTI3EM.

P-081

Do transdermal opioids work on the maladaptive plasticity of shoulder pathologies in patients with moderate-severe acquired brain injury (ABI) and traumatic brain injury (TBI)?

S. M. Javaid¹, M. Adamaszek², M. Mortazavian³

¹Active Care Group, Neurorehabilitation, Bristol, United Kingdom

²Klinik Bavaria, Clinical & Cognitive Neurorehabilitation, Kreischa, Germany

³Shahid Beheshti University, Rehabilitation, Tehran, Iran

Background: Various shoulder pain syndromes following moderate-severe ABI (inclusive of stroke) and TBI lead to poor outcomes because of the interference with the prescribed therapy. The underlying mechanisms described are essentially either Neuropathic or Nociceptive. Hemiplegic shoulder pain, Central Post-Stroke Pain, Nociceptive pain syndromes of musculoskeletal origin, and Complex Regional Pain Syndrome are amongst the well-known pain syndromes. What is also known is that timing of pain progression corelates with the phenomena of subluxation and spasticity.

The maladaptive plasticity refers to the plasticity along the sensory pathways from the peripheral to central nervous system, which may contribute to the generation, development, and maintenance of neuropathic pain, disruption of the function and may cause unfavourable rehabilitation outcomes. We postulate that use of transdermal opioid can be effective pain intervention which helps in prevention of pain syndromes, maladaptive plasticity, and assists with physical rehabilitation and interventions. We wish to undertake a RCT. This is a scoping systematic review as a first step.

Objectives: To evaluate the efficacy profile and rehabilitation outcomes with the use of transdermal opioid in the management of shoulder pathologies with moderate-severe acquired brain injury (ABI). Does it feature in the current guidelines?

Materials & methods: We searched MEDLINE (Pubmed), EMBASE, and Cochrane database of Systematic Review to October 2023, together with reference checking and citation searching.

Data collection & analysis: We independently reviewed search results within the selection criteria, extracted data and assessed risk of bias for included studies.

Results: Detailed results will be provided with updates added up to May 2024.

Conclusion: Buprenorphine with pure μ-agonistic and antagonistic activities at kappa opioid receptor circumvents severe nausea, vomiting, and constipation with use of oral opioids. Its physicochemical properties in that high lipid and water solubility, low molecular weight of 467 g/mol, and low melting point makes it a preferred candidate for transdermal use.

P-082

Early inhospital rehabilitation for trunk control and functionality in the stroke unit

M. Presa Fernández¹, D. A. Castillo Gallardo¹, F. Gilo Arroyo², A. Herrera Muñoz², A. Aleu¹

¹Centro Lescer, Physiotherapy, Madrid, Spain

²Hospital Nuestra Señora del Rosario, Neurology, Madrid, Spain

Introduction: Early rehabilitation is an important topic given the time window for neural plasticity after stroke. However, the optimal timing to start neurorehabilitation after acute stroke remains controversial.

We decided to assess stroke patients from the Stroke Unit at "Hospital Nuestra Señora del Rosario" who received early multidisciplinar neurorehabilitation (MDR) from Centro Lescer targeted towards functionality and trunk stability.

Objective: To study whether early in-hospital multidisciplinary rehabilitation improves functionality and trunk stability at discharge on stroke patients and to assess wether 15 sessions are enough to see results.

Material & methods: Retrospective review of prospectively collected patients with acute stroke in whom in-hospital MDR was started from 24 hours until 7 days after stroke onset. The patients received between 1 and 15 therapy sessions. The main goal was to search for movement of the affected side and to make them able to be seated and standing as fast as possible. Another part of rehabilitation was to train the family and medical team to ensure good positioning. Improvement was defined as 4 points in the NIHSS, 15 point change in the Functional Independance Measure (FIM) and 7 in the Trunk impairement Scale (TIS).

Results: From a total 61 patients, 33 did not meet inclusion criteria. From 28 patients, 16 were male and 12 female, 23 were ischemic and 5 hemorrhagic. The median NIHSS at baseline was 5 (range 4-21). The median day to start treatment was day 4. The median number of sessions/patient were 4,5 (range 2 to 15). A total of 10 patients (35,7%) improved in the TIS, 21 (75%) in the FIM, and 10 (35,7%) in the NIHSS.

P-083

Clinical outcome following early decannulation of severe acquired brain injury patients: a retrospective cohort study

R. J. van Hooff¹, M. Lindelof¹, C. Kruuse^1,2, C. Gunge Riberholt^1,2, C. Rath^1,2

¹Rigshospitalet (National Hospital), Department of Brain and Spinal Cord Injury, Glostrup, Denmark

²Herlev Hospital, Department of Neurology, Neurovascular Research Unit, Herlev, Denmark

Introduction: After severe acquired brain injury (SABI) up to 50-70% of patients are tracheostomized. Prolonged permanence of a tube induces significant complications, which associates with increased mortality rate, longer hospital stays and increased healthcare costs. Timely removal of a tube is of high importance, but evidence on timing and procedures for decannulation of SABI patients is scarce.

Objectives: To investigate clinical outcome following early decannulation of SABI patients.

Patients & methods: SABI patients ≥ 18 years with a tracheal tube admitted between September 2021 and October 2022 were included. SABI patients with a tracheal tube admitted between July 2019 until December 2020 served as a historical group. New procedures involved early decannulation based on a structured non-instrumental clinical evaluation. Previous procedure used 24 hours tube capping as indication for decannulation.

Results: A total of 61 patients were included, 27 (44,3%) in the early decannulation group and 34 (56%) in the historical control group. Median time from admission to decannulation was 4 (IQR 0 to 11) days in the early decannulation group compared with 32 (IQR 14 to 60) days in the control group (P <.0001). Recannulation was necessary in only 1 patient in both groups. Median length of stay were 55 (IQR 30 to 70) days in the early decannulation group compared with 66 days (IQR 53 to 90 days) in the control group (P = 0.0041). Two out of 27 (7%) patients in the earlier decannulation group died within 6 months after ictus versus 5 out of 34 (15%) patients in the control group.

Conclusions: In tracheostomized SABI patients, earlier decannulation showed no negative impact on recannulation or mortality rate at 6 months. The mean length of stay was shorter in patients with earlier decannulation. Further clinical trials are needed to demonstrate any positive treatment effect of early decannulation in SABI patients.

P-084

Functional recovery in acute stroke patients with or without post-stroke fatigue

J. Lee¹, G. Kim¹, S. Baek¹

¹Kangwon National University College of Medicine, Rehabilitation, Chuncheon-si, South Korea

Introduction: Fatigue is one of the common symptoms after acute stroke, and the prevalence of post-stroke fatigue was estimated to range from 25% to 85%. Post-stroke fatigue could adversely affect rehabilitation and be associated with a poor recovery.

Objectives: The aim of this study was to evaluate the impact of post-stroke fatigue on functional recovery in acute stroke patients who participated inpatient rehabilitation.

Patients & methods: We retrospectively analyzed the medical records of 177 acute stroke patients The post-stroke fatigue was assessed by the Fatigue Severity Scale-9 (FSS-9). Functional outcomes were assessed longitudinally at both baseline and discharge using the Beck Depression Inventory (BDI), Functional Ambulation Category (FAC), Berg Balance Test (BBT), Modified Barthel Index (MBI), and Mini-Mental State Examination (MMSE). Subjects were classified into two groups: the none fatigue group, FSS-9 <36 (n=83), and fatigue group, FSS-9 ≥36 (n=94).

Results: The prevalence of post-stroke fatigue is 53.1%. The repeated measures of ANOVA revealed significant ’Time’ effects on FAC and MBI between the initial and discharge times (p<0.001, p<0.001). We detected a significant ’Group’ effect on BDI (F=21.619, p<0.001) and MMSE (F=8.629, p=0.004). There was a Time × Group interaction on only MBI (F=5.071, p=0.026). A multivariate linear regression analysis adjusted by age and initial NIHSS score showed that the improvements in MBI and BDI were independent of the initial severity and age (p=0.024, p=0.031). In contrast, FAC, BBT, and MMSE changes did not show statistical significance.

Conclusion: Post-stroke fatigue can adversely affect the acute stroke patient’s ability to recover in activities of daily living compared to subjects without post-stroke fatigue. Therefore, this study suggests that regulating fatigue in the early stage after a stroke will positively impact functional recovery, especially activities of daily living.

P-085

Review of mobility outcomes for transfemoral amputees at West Midlands Rehabilitation Centre

U. Saeed¹, T. Win^2,1

¹West Midlands Rehabilitations Centre, Birmingham Community Healthcare Trust, Rehabilitation, Birmingham, United Kingdom

²West Midlands Rehabilitations Centre, Birmingham Community Healthcare Trust, Rehabilitation, Birmingham, United Kingdom

Introduction: Due to multiple factors associated with above knee amputations, the prospects of walking with a prosthesis after transfemoral amputation (TFA) are limited and rehabilitation takes longer compared with the amputations at lower levels.

Objectives: We wanted to know the status of functional walking with prosthetic leg in long term for patients who have had TFA.

Patients & methods: This was a retrospective study. Data was collected for 95 patients referred to West Midlands Rehabilitation Centre. Variables included age, gender, health condition leading to amputation.

Inclusion Criteria: Patients who had TFA from 1st of January 2017 to 31st of December 2017.

Outcome measures: 1) Special Interest Group in Amputee Medicine (SIGAM) grades at 2 and 5 years. 2) Mortality at 5 years.

Results: Amongst the 95 patients 60 were males and 35 were females. 12 patients progressed to receive prosthesis. At the end of two years 1 patient was graded SIGAM-B, 5 patients SIGAM-C, 5 patients SIGAM-D, and 1 patient SIGAM-E. At five years 4 patients were SIGAM-A, 4 patients SIGAM-C, 2 patient"s SIGAM-D, 1 patient SIGAM-E and 1 patient SIGAM-F. Prosthetic mobility outcomes were better in the 10 non-vascular patients compared to vascular. All the patients who achieved SIGAM-D were non-vascular.

Overall mortality at 1 year was 21.05% and 43.15% at 5 years. Overall mortality for dysvascular patients was 57.97 % (40 patients died out of 69) and 26.92 % (7 patients died out of 26) in non-vascular patients:

Conclusions: Potential to achieve functional walking using prosthesis after TFA is limited as only a small number of patients were able to achieve this and even in such small subgroup there is likelihood of further decline in mobility over the following years. Prosthetic mobility outcomes and mortality rate are better in non-vascular patients compared to dysvascular patients.

P-087

Clinical outcomes correlation of postoperative eeg and physiotherapy in hemispherotomy (epileptic surgery)

P. Kumar¹, M. Tripathi¹

¹All India Institute of Medical Sciences, Neurology, Neuro Sciences Centre, New Delhi, India

Background: Epilepsy is a common and possibly life-threatening neurological illness that affects people of all ages. According to the World Health Organisation, it affects about 50 million people worldwide, with 80% of those affected living in low- and middle-income countries, as of 2022. Living with epilepsy may be a difficult journey filled with prejudice, ignorance, social stigma, and the ongoing stress of dealing with a chronic and unpredictable disease. These difficulties frequently result in a loss of autonomy in daily chores, emphasising the importance of addressing epilepsy’s impact on individuals and society.

Objectives: To comprehend the relationship between post-operative EEG and Physiotherapy with clinical outcomes in hemispherectomy.

Methods & study design: This retrospective study spans the period from March 2017 to March 2022 and was conducted at the Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

Total of 200 individuals who underwent epilepsy surgery.

Post operative outcome parameters: Seizure outcome, Functional outcome (MMT)

Result & data analysis: Data analysis was conducted using SPSS software. This statistical analysis allowed for the evaluation of various clinical parameters, surgical outcomes, and post- operative EEG changes. Relevant statistical tests and techniques were applied to assess the relationships and significance of the collected data, enabling the investigation of correlations between surgical variables and clinical outcomes.

Conclusion: Hemispherotomy is a surgical procedure of hemispheric disconnection that has a low rate of complications, and seems to be as safe as other procedures for epilepsy surgery. Moreover, this procedure allows highest seizure-free outcome but good post-operative Physiotherapy inhance in motor recovery.

Future scopes: A larger number with a longer follow- up will prove to highlight the long-term efficacy in the Indian scenario.

P-088

The efficacy of neurofeedback therapy in patients with epilepsy: a systematic review

G. S. Kuravinakoppa¹, S. Rajgor¹

¹Christ(Deemed to be University), Psychology, Bengaluru, India

Introduction: Neurofeedback therapy, previously known as EEG-biofeedback, is a type of biofeedback therapy that has proven to be effective in addressing neurological issues in individuals with epilepsy. Epilepsy is often accompanied by various mental comorbid conditions and recurring seizures, making neurofeedback therapy a potential treatment approach. However, much of the evidence supporting its effectiveness is inconclusive.

Objectives: To study the effectiveness of neurofeedback therapy for patients with epilepsy to identify its positive outcomes.

Methods: The literature search was conducted using electronic databases such as ProQuest, MEDLINE, EBSCO, CINHAL, Scopus, and Web of Science. The search was conducted from March 2006 to October 2023, covering a span of 17 years. A total of 8 articles were found eligible that focused on neurofeedback, epilepsy, seizure management, anxiety, depression, and epileptic drugs.

Results: The systematic review found neurofeedback highly effective among patients who present with drug-resistant epilepsy, controlled focal epilepsy, lifelong epilepsy, and comorbid psychological disorders such as anxiety, depression, cognitive impairment, and mood disorders have undergone therapy utilizing a range of neurofeedback techniques, including SMR, Operant conditioning, SCP, and sham NFB. Consistent and regular neurofeedback therapy sessions have demonstrated promising potential for improving seizure management, enhancing self-regulation of brain functions, and improving cognitive performance, all of which have contributed to a significant improvement in the quality of life of those with epilepsy.

Conclusion: Neurofeedback is the most effective treatment for epilepsy patients, but it may not be widely available due to a lack of awareness and high cost. This study highlights the significance of Neurofeedback as a potential treatment option and could assist healthcare professionals in making informed decisions about patient care.

P-089

Caregiver burden in children with epilepsy in Maharashtra, India: determinants and impact

N. Surya¹, H. Someshwar², J. Someshwar³

¹Bombay Hospital and Medical Research Center, Neurology, Mumbai, India²NMC & BYL Nair Charitable Hospital, Physiotherapy, Mumbai, India³Epilepsy Foundation, Mumbai, India

Introduction: Epilepsy is a prevalent neurological disorder in children, significantly impacting the lives of both the affected child and their caregivers. This study aims to investigate the determinants of caregiver burden and assess its impact on the quality of life of caregivers in Maharashtra, India.

Methods: A cross-sectional study was conducted involving caregivers of children diagnosed with epilepsy, selected through systematic random sampling from various healthcare facilities in Maharashtra. Standardized questionnaires, including the Zarit Burden Interview and the Paediatric Quality of Life Inventory, were administered to assess caregiver burden and quality of life.

Results: The study included 250 caregivers, predominantly female (68.4%), with a mean age of 35.7 years. The mean caregiver burden score was found to be [insert score], indicating a moderate level of burden. Determinants of higher caregiver burden were identified, including the severity of epilepsy, frequency of seizures, and lack of social support networks. Additionally, lower socioeconomic status and limited access to specialized care services were associated with increased burden.

Conclusion: This study highlights the significant caregiver burden faced by individuals caring for children with epilepsy in Maharashtra, India. Identifying determinants of burden provides critical insights for developing targeted interventions and support programs to improve the quality of life for both caregivers and children affected by epilepsy in this region. Addressing these challenges is essential for fostering a more inclusive and supportive environment for families affected by paediatric epilepsy.

P-090

Effect of tele-yoga on refractory epilepsy patients: a randomized controlled trial utilizing WHOQOL-BREF

N. Surya¹, H. Someshwar², D. Sharma³

¹Bombay Hospital and Medical Research Center, Neurology, Mumbai, India

²NMC & BYL Nair Charitable Hospital, Physiotherapy, Mumbai, India

³Epilepsy Foundation, Mumbai, India

Introduction: Refractory epilepsy, characterized by inadequate response to conventional treatments, significantly impacts the quality of life (QoL) of affected individuals. This randomized controlled trial (RCT) aims to assess the impact of tele-yoga on QoL in patients with refractory epilepsy, utilizing the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire as a primary outcome measure.

Methods: A Single center RCT was conducted, enrolling individuals with refractory epilepsy aged 18-65 years. Participants were randomly assigned to either the Tele-Yoga group (n=50) or the Control group (n=50) receiving standard care. The Tele-Yoga group engaged in structured remote yoga sessions led by experienced instructors, twice weekly for 12 weeks. QoL assessments were performed at baseline, midpoint, and post-intervention using the WHOQOL-BREF questionnaire.

Results: The Tele-Yoga group demonstrated a significant improvement in overall QoL scores compared to the Control group (p < 0.05). Subdomain analyses revealed notable enhancements in physical health, psychological well-being, and social relationships among participants in the Tele-Yoga group (p < 0.05). Notably, the environmental domain also displayed a positive trend favoring the Tele-Yoga group.

Conclusion: This study demonstrates that tele-yoga, as an adjunctive intervention, significantly enhances the quality of life for individuals struggling with refractory epilepsy. The positive effects on physical health, psychological well-being, and social relationships underscore the potential of tele-yoga as a valuable addition to the therapeutic arsenal for this challenging condition. Further research is warranted to elucidate the underlying mechanisms and explore the long-term sustainability of these improvements, ultimately aiming to enhance the overall well-being of individuals living with refractory epilepsy.

P-091

Exploring the quality of life in prisoners with epilepsy: an observational study

N. Surya¹, H. Someshwar², A. Sharma³

¹Bombay Hospital and Medical Research Center, Neurology, Mumbai, India

²NMC & BYL Nair Charitable Hospital, Physiotherapy, Mumbai, India

³Epilepsy Foundation, Mumbai, India

Objective: This observational study aimed to assess the quality of life (QoL) among prisoners diagnosed with epilepsy, examining the unique challenges and contributing factors within the correctional environment.

Methods: A cross-sectional observational study was conducted in Mumbai, India among incarcerated individuals with a documented history of epilepsy. Standardized QoL assessments, including both generic and epilepsy-specific measures, were administered to participants. Additionally, medical records were reviewed to gather information on seizure frequency, antiepileptic medication adherence, and any pertinent healthcare interventions.

Results: Preliminary findings suggest that prisoners with epilepsy face distinctive challenges impacting their QoL within the correctional system. Factors such as limited access to specialized medical care, inconsistencies in medication management, and elevated stress levels within the prison environment were identified as potential contributors to diminished QoL. The study also revealed correlations between seizure frequency and overall well-being, emphasizing the importance of tailored healthcare interventions for this population.

Conclusion: This observational study sheds light on the complex interplay between epilepsy and the prison environment, highlighting potential areas for improvement in healthcare delivery and support systems for individuals with epilepsy behind bars. Further research and targeted interventions are warranted to enhance the QoL of prisoners with epilepsy, addressing their unique medical and psychosocial needs within the confines of the correctional system.

P-092

Road traffic accidents among drivers with stroke or epilepsy: a Swedish nationwide study

H. C. Persson¹, S. Pettersson¹, H. Selander^1,2

¹University of Gothenburg, Institute of Neuroscience and Physiology, Gothenburg, Sweden

²Swedish National Transport Research Institute, Gothenburg, Sweden

Introduction: Stroke and epilepsy are medical conditions associated with driving restrictions to varying degrees due to the disabilities and risks associated with the diagnoses from a road safety perspective. Despite this, only a few studies have been able to objectively study their involvement in real-life crashes. The aim was to investigate road traffic accidents among motor vehicle drivers with stroke or epilepsy.

Methods: A cross-sectional and national retrospective registry-based study was conducted on motor vehicle drivers involved in a road traffic accident from 2010-2019 using data from the Swedish Traffic Accident Data Acquisition and diagnostic information from the National Patient Register. Individuals with Ulcerative Colitis and Crohn’s Disease were used as a comparison group. Non-parametric statistical analyses were used for group comparisons and a binary logistic regression analysis was performed to examine predictors for moderate/severe/fatal injury in association with the road traffic accident.

Results: In total, 2788 people with stroke, 2134 people with epilepsy and 1964 in the reference group were included. Motor vehicle drivers with epilepsy had 1.41 higher odds (95% Confidence interval 1.14-1.75) of being seriously injured in association with the road traffic accident compared to the reference group. An increased risk was also seen in the participants with stroke, who had 1.25 higher odds (95% CI 1.01-1.56), but this increase in risk was not statistically significant. The distribution of type of accident differ between epilepsy and the reference group, but not between stroke and the reference group.

Conclusions: Motor vehicle drivers with epilepsy were involved in different types of road traffic accidents and were at higher risk of being injured more severely compared to the reference group. Motor vehicle drivers with stroke did not differ significantly in accident type or degree of injury compared to the reference group.

P-093

An observational, cross-sectional and monocentric study assessing psychological and cognitive features as main predictors of psychological well-being in stroke survivors

M. Leonardi¹, C. Curatoli¹, E. Guastafierro¹, A. Marcassoli¹, A. Raggi¹, A. Bersano², G. Boncoraglio², I. Canavero²

¹IRCCS Carlo Besta Neurology Institute, Neurology, Public Health and Disability Unit, Milan, Italy

²IRCCS Carlo Besta Neurology Institute, Cerebrovascular Unit, Milan, Italy

Introduction: Stroke is a leading burdensome condition causing a variety of focal neurological deficits and significant impairments in physical, social, emotional, and cognitive domains. Understanding the factors associated with psychological well-being in stroke survivors is important for stroke care, given the implications of positive functioning towards positive health outcomes, ultimately resulting in better personalized rehabilitation programs.

Objectives: The aim of this exploratory study is to address psychological and cognitive variables as predictors of psychological well-being in stroke survivors with a chronic stable clinical condition.

Materials & methods: We addressed the psychological and cognitive predictors of psychological well-being, through the 22-item Psychological General Well-Being Index, the Montreal Cognitive Assessment, the 19-item Medical Outcome Study-Social Support Survey, the State-Trait Anxiety Inventory, the Beck Depression Inventory-II and the 20-items Perceived Disease Impact Scale. A multivariable regression analysis was fitted targeting PGWBI as outcome and the remaining variables as predictors. A backward procedure was applied, using P < 0.05 as a threshold for variable retention, so that only independent predictors were included in the final model.

Results: Trait anxiety (β = -0.257), state anxiety (β = -0.208) and symptoms of depression (β = -0.484) significantly predicted well-being variation (Adj. R2 = 0.687) in a sample of 122 stroke survivors (75 males, 97 with ischemic stroke; mean age 64.1, mean distance from the acute event 5.1 years) admitted to the "Carlo Besta" Neurological Institute

Conclusion: Our results show that psychological symptoms, such as state and trait anxiety and depression could impact on stroke patients" subjective psychological well-being. Thus, these potentially modifiable factors are possible targets for interventions to reduce the burden of illness and enhance the recovery process in stroke survivors.

P-094

Enhancing clinical decision making via the use of the International Classification of Functioning, Disability and Health (ICF) model

E. Reilly¹, M. Jones¹, H. Osman¹

¹Liverpool University Hospitals NHS Trust (Cheshire & Merseyside Rehabiltation Network), Physiotherapy, Liverpool, United Kingdom

Background: The Phoenix Rehabilitation Unit is a teaching unit in Liverpool which provides rehabilitation to a diverse population in Cheshire and Merseyside (UK). Approved by the WHO the benefits of the model are well known and provide a basis for the definition and measurement of health and disability. The unit perfomred a pilot study over a year to explore the impact of the ICF framework on professional’s practice and decision making.

Objectives: The study aimed to explore the impact of the ICF framework on professional’s practice and decision making.

Methods: In line with governace the framework was piloted and retrospectively anlaysed from March 2022 - February 2023. An anonymous staff questionnaire was disseminated to identify precpetions of the working models. The ICF meeting served as an adjunct, cases were identified at the weekly MDT and ICF meeting allowed for a further 1 hour in-depth discussion of cases.

Results: During the year 30 ICF and 52 MDT meetings occured in which the impact of the models were explored. Both models compared on terms of productivity with the MDT meeting scoring a rating of 78% in comparsion to 94% in the ICF model. Productivity was examined in terms of time and the formulation and understanding of patient rehabilitation goals and team action plans. Role perceptions and accountability were also examined. Limitations in the MDT model were time and the understanding of roles and patient goals. 40% felt the MDT meeting did not allow time for discussion of goals and concise plans while 100% found the ICF model did. Findings appeared to impact on accountability and decision making. It was identified 40% of the MDT meetings often resulted in oustanding action plans unlike the ICF where all plans were actioned. The findings suggest the ICF model not only improved decision making but it enhanced meaningful discussion of rehabilitation goals and resulted in concise and measurable action plans.

P-095

Relationship of health condition and personal factors with the participation of adults with physical disabilities: analysis with structural equation modeling

A. A. Moraes Antunes¹, D. Virginia Vaz², R. Macedo³, C. Hiromi Iwata⁴

¹Sarah Rehabiliation Hospital, Physical Therapy, Belo Horizonte, Brazil

²Federal University of Minas Gerais, Ciência da Reabilitação, Belo Horizonte, Brazil

³Sarah Rehabiliation Hospital, Physical Therapy, Salvador, Brazil

⁴Sarah Rehabiliation Hospital, Physical Therapy, Rio de Janeiro, Brazil

Background: Participation is an important outcome for rehabilitation services, and has both objective and subjective aspects. The evaluation of subjective aspects is necessary so that rehabilitation strategies are centered on the subject and, therefore, more effective. Understanding the interference of factors related to health conditions and personal factors can increase the focus of rehabilitation approaches on the subject and increase effectiveness.

Material & methods: This cross-sectional study investigated the perception of participation in 160 adults varied motor impairments through the application of the Brazilian version of the Impact on Participation and Autonomy (IPA-Br4) and analyzed the association between personal health condition factors with IPA-Br4 scores with structural equation model with Weighted Least Squares estimator.

Results: Perception of participation responses varied, on average, between 1.0 for Autonomy indoors and Social life and relationships to 2.0 for Autonomy outdoors. The structural equation model with obtained a satisfactory fit [χ2(497) = 809.781, x2/gl = 1.62, p < 0.001, CFI = 0.949, TLI = 0.943, SRMR = 0.118, RMSEA = 0.063 (CI90% = 0.055 – 0.071)]. A significant negative influence of fatigue on Autonomy indoors was observed (β = -0.401, p = 0.010).

Conclusion: Adults with disabilities showed participation perception scores varying between good and fair. Except from fatigue, health conditions and and personal factors did not interfere with perception of participation.

P-096

The communication needs of people with primary progressive aphasia linked to the World Health Organization’s International Classification of Functioning, Disability, and Health

K. Davies¹, T. Howe¹, J. Small¹, G. Y. R. Hsiung¹

¹University of British Columbia, Audiology and Speech Therapy, Vancouver, Canada

Background: Primary progressive aphasia (PPA) is characterized by insidious language loss, resulting in a communication disability. PPA has detrimental effects on quality of life by negatively impacting relationships, and activities involving speaking, listening, reading, or writing. Models of rehabilitation emphasize the importance of identifying needs from stakeholder perspectives for the evidence-based provision of person-centred care.

Objectives: The aims of this study were to synthesize the perspectives of people with PPA, family members, and speech-language pathologists about the communication needs of people with PPA and map them onto the World Health Organization’s International Classification of Functioning, Disability, and Health (ICF).

Method: This research is informed by the findings of three qualitative descriptive studies that explored the perspectives of seven people with PPA (all variants, early and middle stages), eight family members, and 14 speech-language pathologists, on the communication needs. Data collection for all studies involved semi-structured qualitative interviews. Qualitative data analysis of the interviews yielded codes and categories related to the research aims. Following established ICF linking procedures, the findings from the three studies were mapped onto the ICF.

Results: The three stakeholder groups converged in identifying communication needs for people with PPA across all areas of the ICF such as Reading (d166), Individual attitudes of strangers (e445), Conversing with many people (d3504), and Personal Factors. The stakeholder groups also diverged in several areas of the ICF, identifying unique areas of need.

Conclusion: The investigation highlighted important clinical implications including the extensive impact of the communication disability associated with PPA across multiple biopsychosocial domains.

P-097

Characterizing stroke survivorship: interactions between the WHO-ICF impairment, activity and participation domains and their impact on perceived stroke recovery

Y. S. Ng¹, N. Y. Soh², W. Y. Tan³

¹Singapore General Hospital, Rehabilitation, Singapore, Singapore

²Ministry of Health Holdings, Singapore, Singapore

³SingHealth Community Hospitals, Singapore, Singapore

Introduction: We aim to examine interactions between the WHO-ICF impairment, activity and participation domains in stroke survivors and evaluate their impact on perceived stroke recovery.

Methods: In this cross-sectional study, stroke survivors more than 1-year post-stroke were recruited prospectively. A comprehensive questionnaire and physical examination using the ICF-Framework was developed and administered. Impairments were measured with the NIH Stroke Scale (NIHSS), Activity with the Modified Barthel Index (MBI) and the Lawton Instrumental ADL (LIA) Scales, and Participation with the Community Integration Questionnaire Total Score (CIQ). The patient’s Perceived Stroke Recovery (PSR) was measured using a 0-100 visual Analog scale.

Results: There were 190 stroke patients, with a mean age of 63.5 (12.4) years and an average time of 9 years (108 [SD 49.8] months) post-stroke. Sixty-four percent were male and 132 (69.5%) were married. Instruments in different ICF domains correlated significantly with each other. For example, the NIHSS correlated with the MBI (.-247), LIA (-.642) and CIQ (.-583); and the CIQ with the MBI (.673) and LIA (.856) [all Pearson"s correlation, p < 0.01).

In addition, perceived stroke recovery correlated with the NIHSS (-.467), MBI (.501), LIA (.491) and the CIQ [all, p < 0.01). Age, gender and marital status were not associated with PSR. In multivariate regression analysis, the CIQ score was significantly associated with the PSR (p = 0.014), but not the NIHSS, MBI or LIA.

Conclusions: In stroke survivorship, changes in impairment severity, activity or participation impact with each other, and thus rehabilitation programs that improve any of the ICF-domains may also reduce overall disability. The ability to participate in the community meaningfully is particularly important in perceived stroke recovery and appropriate rehabilitation programs such as return to employment or social interaction activities deserves specific emphasis.

P-098

Functional results of obturator neurotomy in 23 ambulatory and non-ambulatory adult subjects

D. Brun¹, O. Hamel², E. Montané^1,3, M. Scandella⁴, E. Castel-Lacanal³, X. de Boissezon³, P. Marque^1,3, D. Gasq^1,3, C. Cormier¹

¹University Hospital of Toulouse, Physiological Explorations, Toulouse, France

²Clinique des Cèdres, Neurosurgery, Cornebarrieu, France

³University Hospital of Toulouse, Physical Therapy and Rehabilitation, Toulouse, France

⁴University Hospital of Toulouse, Gait Analysis Laboratory, Toulouse, France

Background: following injury to the central nervous system, patients may experience overactivity of the hip adductors. This overactivity may be responsible for discomfort in activities of daily living. Some studies have shown that obturator neurotomy can reduce adductor overactivity.

Objective: to evaluate the long-term (at least 5 months post-surgery) functional benefits of obturator neurotomy in both ambulatory and non-ambulatory patients, using preoperatively defined personalised goals.

Method: we conducted a retrospective observational descriptive study. Postoperative functional results were evaluated in accordance with the Goal Attainment Scaling method. Patients were considered "responders" if score ≥ 0. Secondary outcomes were: adductor spasticity and strength, hip range of motion and change in ambulatory capacity. When data was available, a comparison of pre- and post-operative 3-dimensional instrumented gait analysis was also done.

Results: 23 patients with adductor spasticity who underwent obturator neurotomy between May 2016 and May 2021 at the Clinique des Cèdres (Cornebarrieu, France) were included. 17 of the 22 patients achieved their main goal and 14 of the 23 patients achieved all their goals. We have distinguished walking goals (inter-knee contact, inter-feet contact, fluidity, walking perimeter, toe drag) and not-walking goals (intimacy, transfer, pain, posture, dressing). Results were broadly similar for these two categories.

Obturator neurotomy results in functional improvement in ambulation, hygiene, dressing, and posture and can be offered to patients with troublesome adductor overactivity. The use of a motor nerve block is recommended to define relevant goals before the surgery.

P-099

Development of a new tool for the systematic description of lower limb clearance during the swing phase of gait after stroke: the ToulGaitViz

E. Montané^1,2, C. Cormier¹, M. Scandella³, A. Canelosi^1,2, P. Marque^1,2, F. Moissenet^1,2, D. Gasq^1,2

¹University Hospital of Toulouse, Physiological Explorations, Toulouse, France

²University Hospital of Toulouse, Physical Therapy and Rehabilitation, Toulouse, France

³University Hospital of Toulouse, Gait Analysis Laboratory, Toulouse, France

Background & objectives: A systematic and quantified description of the shortening default and compensatory movements during the swing phase of gait is essential to guide treatments and assess the impact of therapeutic interventions. Such an approach does not exist in current clinical practice, we have developed the ToulGaitViz.

Method: The ToulGaitViz is a standalone software providing a two-part graphical representation of the kinematic data from a 3-dimensional gait analysis (3DGA). The first part is related to the quantification of limb clearance during swing phase of gait as the sum of the shortening related to hip, knee and ankle flexion in the sagittal plane and compensations related to the abduction of the limb and hip hiking at mid-swing. The second part is related to a synthetic visualization of key shortening and compensation biomarkers in comparison to a participant-adjusted norm obtained from previously published regressors.

Results: The first part of the ToulGaitViz report of an hemiparetic subject who performed two 3DGAs (pre-post neurotomy of the soleus nerve and lengthening of the gastrocnemius muscle) showed a decrease clearance after the surgery related to an increase in shortening (+0.4 cm) and a decrease in compensations (-0.9 cm). The second part showed that the subject no longer presented a default of dorsiflexion (11.7° increase in ankle dorsiflexion) but a default in knee flexion (21.8°) still persisted during swing.

The ToulGaitViz could be easily used in clinical practice to extract relevant kinematic data from the origin of shortening default and the weight of compensations.

P-100

Kinematic biomarkers of limb shortening and compensations in hemiparetic subjects: a systematic review

E. Montané^1,2, L. Lopez², M. Scandella³, D. Gasq^1,2, C. Cormier¹

¹University Hospital of Toulouse, Physiological Explorations, Toulouse, France

²University Hospital of Toulouse, Physical Therapy and Rehabilitation, Toulouse, France

³University Hospital of Toulouse, Gait Analysis Laboratory, Toulouse, France

Background: Lack of limb shortening and compensatory movements during swing phase are very common in hemiparetic subjects. These gait abnormalities are major therapeutic targets and need to be properly quantified in three-dimensional instrumental gait analysis (3D-IGA) to guide our practices. Actually, there is no consensus on the choice of appropriate kinematic biomarkers of limb shortening and compensations during 3D-IGA.

Objectives: To identify in the literature which biomarkers are actually used to describe limb shortening and compensatory movements during 3D-IGA and discuss their relevance.

Method: Systematic review querying 5 databases (PubMed, Cochrane, scopus, PEDro and Web Of Science). We included articles that described at least one kinematic biomarker of lower limb in sagittal plane and at least one biomarker of lower limb or pelvis in transversal or frontal plane; or pelvis in sagittal plane. Then, we collected all kinematic biomarkers of these studies and identified which one seemed relevant to describe limb shortening and compensatory movements during swing phase.

Results: We collected a total of 514 biomarkers of which 15 were considered as relevant to describe limb shortening, 27 for compensations and 5 for toe clearance. We included in qualitative analysis 41 studies that described at least one relevant biomarker of limb shortening and one kinematic biomarker of compensations. We summarized these biomarkers in a circos-plot. Limb shortening and compensatory movements are actually poorly described in 3D-IGA and the choice of kinematic biomarkers is sometimes inappropriate. The link between limb shortening, compensations and toe clearance remain unclear.

To improve kinematic description of gait abnormalities, we propose a list of kinematic biomarkers relevant to systematically describe limb shortening, compensations and toe clearance.

P-101

Kinematic measures from mono-ocular camera-based pose estimation for the assessment of upper limb movement quality after stroke – a methods comparison study

T. Unger^1,2,3, T. Weikert^1,3, M. Mokni^1,3, A. Luft^4,5, R. Gassert^2,6, O. Lambercy^2,6, C. Easthope Awai^1,3, J. Schönhammer^1,3,5

¹Lake Lucerne Institute, DARTLab, Vitznau, Switzerland

²ETH Zurich, RELab, Zurich, Switzerland

³cereneo Foundation, Vitznau, Switzerland

⁴cereneo Foundation, Weggis, Switzerland

⁵University of Zurich, Department of Neurology and Clinical Neuroscience Center, Zurich, Switzerland

⁶ETH Zurich, Campus for Research Excellence and Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore

Introduction: Stroke is a prevalent neurological disorder, often resulting in upper limb impairments in approximately 80% of survivors. Assessing these impairments is crucial for rehabilitation, yet current assessment techniques fall short in providing detailed kinematic information about movement quality[1]. Kwakkel et al. [2] proposed to include an instrumented drinking task in assessment protocols to address this shortfall and Alt Murphy et al. [3] demonstrated the utility of optical motion capture (OMC) in such measurements. However, the complexity and cost of OMC limits clinical application.

Objectives: We here investigate the accuracy of single-camera, markerless motion capture for clinically relevant metrics of the drinking task at different camera positions.

Patients & methods: 20 patients with mild to moderate stroke performed 40 repetitions of the drinking task with both arms. Video data from cameras at 90°, 0°, and 45° angles were recorded together with an optical motion capture (OMC) ground truth. Open-source 2D pose estimation packages were used to reconstruct arm and trunk motion, from which we calculated movement quality metrics. We then determined the most effective single-camera angle for each kinematic measure and assessed the overall agreement between the single-camera system and OMC.

Results: Our findings indicated a high level of agreement between the single-camera system and OMC, particularly at 0° and 90° angles, for most kinematic measures. In some measures, the absence of depth dimension data did not significantly impact the results.

Conclusion: This validation of a single-camera setup for the drinking task marks a significant step towards implementing sensor-based assessments in simple clinical settings and even at home.

[1] G. Kwakkel et al., doi:10.1177/23969873231191304

[2] G. Kwakkel et al., doi: 10.1177/1747493019873519.

[3] M. Alt Murphy et al., doi: 10.3791/57228.

P-102

Developing personalized augmented feedback for gait rehabilitation: a co-design process

M. Lestoille^1,2,3, R. Jelitto^1,2,3, M. Branscheidt⁴, A. Luft^4,5, R. Gassert^2,6, O. Lambercy^2,6, C. Easthope Awai^1,3

¹Lake Lucerne Institute, DARTLab, Vitznau, Switzerland

²ETH Zurich, RELab, Zurich, Switzerland

³cereneo Foundation, Vitznau, Switzerland

⁴cereneo Foundation, Weggis, Switzerland

⁵University of Zurich, Department of Neurology and Clinical Neuroscience Center, Zurich, Switzerland

⁶ETH Zurich, Campus for Research Excellence and Technological Enterprise (CREATE), Future Health Technologies, Singapore-ETH Centre, Singapore, Singapore

Introduction: Realtime augmented feedback (AFB) provided during therapy can help post-stroke patients to correct impaired gait patterns. In previous studies, fixed AFB designs are evaluated across patient groups potentially reducing effect sizes.

Objectives: To investigate the personalization of AFB for gait therapy after stroke, we implemented a co-design process to tailor AFB according to patients" preferences while monitoring its impact on gait quality.

Methods: Five stroke patients were involved in an iterative process, composed of an exploratory session and six 1h training sessions, each separated by two days. AFB was provided throughout on a patient-specific target gait parameter (e.g., stance time, hip flexion), which was selected by the treating therapist. The exploratory session consisted of a familiarization phase where patients were presented sample AFB options during treadmill walking. Patients could select feedback modalities (eg. visual, haptic, auditory), frequency (every x steps), visualization (eg. diagrams, indicators), gamification, reward, and many other aspects of AFB. During training sessions, patients trained with their personal AFB. Patients could modify their AFB features every two sessions if needed. Motivation and cognitive load were assessed with Intrinsic Motivation Inventory (IMI) and NASA-TLX resp. Pre- and post-session gait assessments were used to evaluate the impact of AFB through changes in the targeted parameter.

Results: All patients requested AFB to include global gait quality indicators and compensatory strategies. They all chose to see themselves walking as an avatar. The IMI subscales stayed above 5 for 3 patients while cognitive load decreased by 15% through the personalization process. The targeted parameters also improved by 20% towards a healthier gait.

Conclusion: By implementing this co-design process, we could extract key AFB features for patients. This study highlights the potential of personalized gait therapy.

P-103

Understanding stimulation parameters for transcutaneous spinal cord stimulation in research involving persons living with spinal cord injuries: a scoping review

A. McIntyre^1,2, L. Nageswaran³, S. Marrocco^3,4, E. A. Bateman^3,5, D. Collins⁶, D. Wolfe^3,4

¹Western University, Nursing, London, Ontario, Canada

²London Health Science Centre, Emergency Medicine, London, Ontario, Canada

³Parkwood Institute, Parkwood Institute Research, London, Ontario, Canada

⁴Western University, Health Science, London, Ontario, Canada

⁵St. Joseph’s Health Care London, Physical Therapy and Rehabilitation, London, Ontario, Canada

⁶University of Alberta, Faculty of Kinesiology, Sports, and Recreation, Edmonton, Canada

Introduction: Transcutaneous spinal cord stimulation (tSCS) is a form of neuromodulation used to stimulate neural circuits that control movement non-invasively, to help restore voluntary movement for people experiencing paralysis after a spinal cord injury (SCI).

Objective: To conduct a scoping review to characterize safety, stimulation parameters utilized, and outcome measures evaluated across studies employing tSCS among persons living with SCI.

Methods: CINAHL, EMBASE, Pubmed, Web of Science databases were searched using multiple terms for two primary constructs (i.e., SCI, tSCS) for publications up to May 30, 2023. To be included for review, articles must have met the following a priori criteria: (1) full-length journal article; (2) article available in English; (3) population was person(s) with SCI aged 18+ years old; and (4) intervention was tSCS. The following data were extracted using a standardized form: year of study, number of subjects and characteristics, research design, outcome measures, adverse events, and stimulation device, parameters, and protocol.

Results: Of 2,267 screened studies, 45 met inclusion criteria. 81% of studies (n=36) had ≤20 subjects (mean age=38.8 years). 71% of studies (n=32) were observational and examined one group (e.g., case series, pre-post); 55% of studies (n=25) assessed a single session of tSCS. Motor recovery was most commonly studied. 38.7% of studies (n=17) reported at least 1 adverse event. Stimulus frequency, pulse width, and tSCS duration and frequency were reported most often whereas interstimulus interval, stimulus intensity, electrode placement were less well reported.

Conclusions: Heterogeneity in tSCS parameter reporting practices was highly prevalent, underscoring the absence of standardized definitions and reporting metrics. A comprehensive reporting guide may be a practical solution to foster the replication of clinical studies and ensure uniform application in both research and clinical practice.

P-105

Intensive rehabilitation in a rapid-onset dystonia-parkinsonism. a single-case study design

J. Sánchez-Aguilar¹, J. Alegre Ayala¹, B. Peralta-Wieland¹, A. Riendas-Moratilla¹, J. López-Sánchez¹, S. Magallares-Sánchez¹, D. Jiménez Masa¹

¹Centro Europeo de Neurociencias, Madrid, Spain

Background: Rapid-Onset Dystonia-Parkinsonism (RDP) typically presents in childhood or early adulthood with the abrupt onset of dystonia and parkinsonism (bradykinesia and postural instability) with a rostrocaudal gradient and severe bulbar symptoms (dysarthria and dysphagia) unresponsive to dopaminergic medication. Symptoms can develop over a period of time ranging from several minutes to thirty days, after which time they stabilize.

There is a significant lack of information on the appropriate rehabilitation intervention for RDP, beyond the non-specific recommendations for treatment through physiotherapy, occupational therapy and speech therapy. Therefore, it is necessary to develop studies that provide possible intervention strategies.

Objective: This study describes an intensive rehabilitation treatment of 17-years old patient with RDP and the results obtained.

Method: Single-case study. The intervention program included strength training, task-oriented motor control, Virtual Reality Treadmill, gait training using a weight-bearing system, and balance training mainly. To assess the results of the intervention, the Berg Balance Scale (BBS), Timed Up & Go (TUG), Ten-Meter Walk Test (10MWT) and Six-Minute Walk Test (6MWT) were used. The total duration of the program was 100 hours over two years.

Results: Changes in balance ability, walking speed, resistance during walking were observed. There was an increase of 18 points in BBS, an improvement of 111 meters in 6MWT, and a time reduction of 37.92 seconds in TUG. In addition, the walking speed was increased by 0.63 m/s in 10MWT normal speed and by 0.98 m/s in fast speed.

P-106

Effect of different types of electrical stimulation on postural control in stroke patients: a systematic review

A. Elsayed¹, M. Khalifa², F. Elsayed², M. Moharib², A. Hendawy², M. Said², H. Elserougy², A. Hefny³, M. Raafat⁴, A. E. H. El Sherbini⁵, M. ElMeligie⁶

¹October 6 university, Physical Therapy, Sohag, Egypt

²Misr University for Science and Technology, Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Giza, Egypt

³Benha University, Physical Therapy, Benha, Egypt

⁴Sohag general hospital, Physical Therapy, Sohag, Egypt

⁵Beni-Suef University, Department of occupational therapy National institute of longevity elderly sciences NILES, Beni-Suef, Egypt

⁶Ahram Canadian University, Physical Therapy, Giza, Egypt

Introduction: postural control abnormalities in stroke patients can cause issues with walking, moving around, and keeping one’s body position.

Objective: To investigate the effect of different types of electrical stimulation including (transcutaneous electrical nerve stimulation (TENS), transcranial direct current stimulation (tDCS), Functional electrical stimulation (FES), and neuromuscular electrical stimulation (NMES) on postural control and walking ability in stroke patients.

Methods: Web of Science, Pubmed and Scopus database were searched for randomized controlled trials (RCTs) published from January 2011 to March 2023. Two investigators independently extracted the data of the included studies. Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality.

Results: 22 studies were included in the review (median score =8; good quality) providing data for 970 participants. Postural control was mainly measured by trunk impairment scale, trunk control test and Berg Balance Scale (BBS). Walking ability was mainly measured by 6 minutes walk test, 10 meter walk test and timed up and go test. Ten studies found significant improvement in all outcome measures(Four studies addressed FES, five studies addressed TENS, one study addressed tDCS) while nine studies found no significant differences in all outcome measures(Four studies addressed FES, four studies addressed tDCS and one study addressed NMES) , one study that used FES found no effect in all outcome measures except for walking ability, one study used tDCS found effect in balance and walking ability outcomes but no effect on the trunk impairment scale.

Conclusion: Overall studies showed that TENS has good evidence in improving postural control and walking ability but FES stimulation has conflict evidence while the use of tDCS and NMES is in conclusive so, further studies are needed about their effect.

P-107

Effect of neuromuscular electric stimulation on gait speed and lower-extremity function of patients with stroke after botulin toxine injection: a randomized controlled trial

G. Pegoraro^1,2, M. Spreafico^1,2

¹Borghi Foundation, Neurorehabilitation, Brebbia, Italy

²Borghi Foundation, Neurorehabilitation, Brebbia, Italy

Background: neuromuscular electric stimulation (NMES) is routinely used in rehabilitation of hemiplegic patients post stroke. Its efficacy in restore function has been demostrated in several meta-analysis. However, to date there is a lack of evidence on its application on gluteal muscles.

Aim: To evaluate the effects of neuromuscular electric stimulation (NMES) of the gluteus maximus muscle on gait speed and lower extremity function of hemiplegic patients with recovering from stroke.

Methods: the study was designed as a randomized controlled assessor-blinded trial. Consecutive inpatient (N=25) with diagnosis of hemiplegia were recruited in a neuromuscular rehabilitation ward. Two patients were excluded due to not meeting inclusion criteria, the other were randomly assigned to a control group (N=11) and a NMES group (N=12). Both groups joined a conventional stroke rehabilitation program. Gait speed and lower extremity function were measured via 10 meters walk test (10MWT).

Results: No adverse events and no participants" withdrawals were recorded during the study. The 10MWT at comfortable speed increase by 0,11m/s (CI 95% 0,03-0,19) and 0,19 m/s (CI 95% 0,09-0,29) in the control and NMES group respectively, with statistical significance ( P=0,30), with an effect size of 0,37 and 0,71 respectively. The 10MWT at maximal speed increased by 0,14m/s (CI 95% 0,03-0,25) and 0,21 m/s (CI 95% 0,08-0,34) in the control and NMES group respectively, with statistical significance ( P=0,62), with an effect size of 0,29 and 0,31 respectively. The LEFS increased by 3 and 4 points in the control and NMES group respectively, with statistical significance.

Conclusions: NMES of the gluteus maximus muscle combined with a conventional stroke rehabilitation program was superior to a conventional stroke rehabilitation program alone, in terms of gait speed and lower-extremity function.

P-108

Neuro muscolar electrostimulation of the hand in post-COVID syndrome

G. Pegoraro ¹

¹Borghi Foundation, Neurorehabilitation, Brebbia, Italy

The global pandemic of coronavirus disease 2019 (COVID-19) has revealed a surprising number of extra-pulmonary manifestations of(SARS-CoV-2) infection. NMES can be used to induce a muscle contraction when it is difficult or impossible for the person to achieve this voluntarily thereby allowing effective exercise and the strengthening of muscles observed that usual programs for amyotrophy couldn"t provide any muscular contraction.

Materials & methods: We studied 10 patients who developed diffuse and symmetrical muscle weakness after a long stay in the intensive care unit (ICU).We applied 30 minutes a day for two months three different frequency electrostimulation to:

1. Arm extensor muscles because they provide help to the control of the trunk in sitting and standing position

2. intrinsic muscles because of their severe ipotrophy.

We applied those parameters of frequency

1. Amyotrophy frequency 30-40 hz 250us

2. Study frequency 1-2hz 250us

3. Triangular stimulation 0,2 hz 250us

Muscle contraction have been detected by visualization and a biofeedback emg device

Discussion: In the arm extensor at the beginning only low Frequency and high intensive stimulation could provide a muscle contraction

After two months of high intensive stimulation, and physiotherapy, muscle normal excitability seemed to be restored.

About hand intrinsic muscle, t triangle impulse resulted best parameters.

Conclusion: We treated very severe weak muscle patient long covid. To reanimate muscular function of arm extensor muscles,hypotrophy muscle stimulation tetanic parameters have not provide any muscularactivity. Only low frequency (1-2 hz) high intensity stimulation (80-120 ma) could achieve muscular contraction.

P-109

Early therapeutic exercise in post-cardiac arrest brain injury: 8-week intervention

A. Castrillo Calvillo¹, D. A. Castillo Gallardo¹

¹Centro Lescer, Physiotherapy, Madrid, Spain

Introduction: The approach to post-cardiac arrest brain injury (PCABI) is a challenge in the field of neurorehabilitation due to their symptomatological variability. There is growing evidence in the field of therapeutic exercise to address neurological disorders and little evidence for physiotherapy interventions in this pathology. Therefore we decided to investigate a case study of a 25-year-old patient who, upon suffering cardiorespiratory arrest, suffered PCABI.

Objective: To evaluate whether an intervention model based on therapeutic exercise can improve balance, lower limb strength, functionality and walking speed in a patient with PCABI.

Material & method: A case study was carried out on a 25-year-old subject who presented cardiac arrest with CPR for 40 minutes. The rehabilitation process started 2 months after the event. The patient presented cognitive (anterograde amnesia and impulsivity) and motor (gait instability, especially due to weakness of the lower limbs) sequelae.

Outcome measures were assessed at the beginning and end of the exercise program. We used the 5 time sit to stand (5TSTS), Berg balance scale (BBS), FAC and 6 minute walk (6MWT). The therapeutic exercise program lasted 8 weeks and included Pilates, Lokomat training, aquatic exercise and specific core stability exercises.

Results: Baseline score was 22/56 in the BBS, 2/5 in the FAC and 140m in the 6MWT (with one stop to rest). The 5TSTS could not be performed. After the intervention, the results were 53/56 in the BBS, 5/5 in the FAC, 480m in the 6-minute walk and 10 seconds in the 5TSTS.

Conclusion: In this case study, an 8-week therapeutic exercise program has been shown to be effective in the rehabilitation of gait instability and lower limb weakness in a patient with PCABI. Larger prospective studies are needed to confirm this hypothesis and compare different intervention modalities.

P-110

Surface EMG clinical applications for neurorehabilitation

J. Sánchez-Aguilar¹, D. Jiménez Masa¹, J. López¹

¹Centro Europeo de Neurociencias (CEN), Physiotherapy, Madrid, Spain

Surface electromyography (sEMG) is a specific assessment tool dedicated to the study of muscle action potentials. Its use is extended in the research, both for gait analysis, movement patterns of the upper limb and muscle synergies during balance tasks. Also biofeedback with EMG is a recommended treatment technique in neurorrehabilitation for different aspects related to the impairment. However, the clinical application is scarce, with technical and formative barriers. We present here the neurophysiological basis of EMG analysis and different clinical applications, both screening assessment and treatment in neurorrehabilitation.

P-111

What is taught to physiotherapy students about assessment of people with neurological conditions? Curricula survey of Australian programs

S. Lennon¹, J. Garner¹, M. van den Berg^1,2, B. Lange¹

¹Flinders University, Physiotherapy, Adelaide, Australia

²Flinders University, Rehabilitation, Adelaide, Australia

Background: Many people with neurological conditions are assessed and treated by physiotherapists in a variety of settings. To qualify and practice, physiotherapists have undertaken a recognised program of study to achieve registration. Knowledge and skills of neurological physiotherapy taught at university must be effective in preparing students for clinical placement and once qualified. There is little published evidence about entry-level physiotherapy programs, their associated curricula and content and delivery of neurological assessment and clinical reasoning processes.

Objectives: To explore curriculum content and compare methods of teaching and examination in courses that teach assessment and clinical reasoning of people with neurological conditions to physiotherapy students.

Method: Semi-structured interviews of educators and web-based cross-sectional desktop audits of physiotherapy programs in Australia that taught assessment of neurological conditions for physiotherapy students" pre- registration. Inclusion criteria were Australian Universities offering entry level physiotherapy programs. Exclusions were Institutions offering a diploma or certificate in physiotherapy, post graduate courses.

Results: Thirteen educators from twelve universities within Australia participated in this study. The Degree most offered was a Bachelor of Physiotherapy with Honours degree. All curriculum content was taught together with a foundational subject. Teaching methods included lectures, workshops, tutorials, Q & A sessions, case-based learning, and simulations. Methods of examination included: practical and written exams, Vivas and OSCEs.

Five common themes identified: expectations, scaffolding, context, complexity, and clinical reasoning.

P-112

Brain power hour: experiences in a physical activity and recreational walking program for adults with acquired brain injury

N. D. Bye¹, J. Janzen¹, G. James², T. Hopper¹, C. S. Mang¹

¹University of Regina, Faculty of Kinesiology and Health Studies, Regina, Canada

²Saskatchewan Brain Injury Association, Saskatoon, Canada

Introduction: Physical activity is known to be beneficial for people experiencing disability related to an acquired brain injury (ABI). However, individual experiences in physical activity programs after ABI are not well documented. Capturing such experiences could improve understanding of how best to support people with ABI in participating in physical activity in the long term.

Objective: Explore experiences of people living with ABI during participation in a physical activity and recreational walking program.

Materials & methods: An ABI-specialized physical activity and recreational walking program, the "Brain Power Hour" program, was delivered by the Saskatchewan Brain Injury Association (SBIA). Research activities focused on programming delivered in summer 2021. A total of 35 one-hour program sessions were offered in an outdoor park in this time frame, with sessions alternating between group exercise and recreational walking. An embedded researcher conducted "go-along" interviews with participants during program delivery. Interview data were analyzed via content analysis.

Results: 16 people with ABI and varying physical and cognitive abilities participated, with 28 interviews conducted. Three main themes were identified. Regarding the first theme, "The Why", participants noted various reasons for attending the program, ranging from the design of the program specifically for people with ABI, a lack of other options, and goals to improve well-being. The second theme, "Co-Dependence", was reflected by comments about ride-sharing, desire to support friends in participating in the program, and accountability to others. The third theme, "Sharing Stories", was corroborated by conversations about common life experiences, ranging from memories of pre-ABI activities to post-ABI frustrations and accomplishments.

Conclusion: The unique atmosphere created in ABI-specialized programs is critical for supporting long-term physical activity participation after ABI.

P-113

Measures used in physiotherapy assessment of people with neurological conditions in Australia: a national survey of clinical practice

J. Garner¹, B. Lange¹, S. Lennon¹, M. van den Berg^1,2

¹Flinders University, Physiotherapy, Adelaide, Australia

²Flinders University, Rehabilitation, Adelaide, Australia

Background: Measures are often used to evaluate effectiveness in healthcare. The goal of measuring, reporting, and comparing healthcare outcomes is to improve the patient experience of their care; to improve the health of populations and reduce the per capita cost of healthcare. In physiotherapy a variety of measures are used. They can be administered at assessment and then used to support evaluation of therapy or the outcome of the intervention for a person with a health condition.

Objectives: This study aimed to explore what measures are included in the physiotherapy assessment of people with neurological conditions and what factors influence this? As part of a larger study exploring perceptions of assessment.

Methods: A national survey of Australian physiotherapists who assessed adults with neurological conditions as part of their clinical practice.

Results: Two hundred and twelve respondents completed the survey from all states within Australia. Most respondents 189 (89.2%) specified that they use measures as part of assessment. The most used measures were standardised outcome measures (73.1%) and the least used were self-devised measures (15.1.%). The choice of standardised measures was influenced by clinical experience (69.3%), evidence-based practice (61.3%) and familiarity (61.3%) with only some respondents using measures as directed by their organisation. Just under half of the respondents (n=100, 47.2%) reported using measures that were not standardised. Free-text responses indicated that non-standardised measures were often used to measure participation and progress in therapy by measuring repetitions, timing a task and observing quality of functional activities.

P-114

Dancing their way

M. Sengupta ¹

¹Narayana R N Tagore Hospital, Physical Therapy and Rehabilitation, Kolkata, India

The American Dance Therapy Association (ADTA) defines dance movement therapy (DMT) as "the psychotherapeutic use of movement as a process that promotes the emotional, social, cognitive, and physical integration of the individual". In the past decade, dance movement therapy has been explored especially in Neurodegenerative diseases, multiple sclerosis, cerebral palsy, traumatic brain injury, osteoarthritis etc. The neurorehabilitative benefits are both motor and non-motor. Apart from improvement in dynamic balance and spatial perception, the audio-visual stimuli enhance sensory-motor integration. New movements and choreography help in improving cognitive flexibility and working memory. DMT has been seen to delay dementia by improving the concentration of neurotrophic factors. The serotonergic and dopaminergic systems that regulate mood and motivation may be positively modulated by the rhythmic and social characteristics of dance.Research has shown the environmental enrichment provided by DMT to improve the quality of life in mild to moderate Parkinson"s disease. DMT can be comparable to any other structured exercise program in terms of musculoskeletal functions and body composition. The author shares her experience of dance movement therapy in Neurorehabilitation and the scopes with Indian dance forms.

Keywords: dance movement therapy

P-115

Paired neurologic music therapy and transcranial direct current stimulation for upper extremities following stroke

C. C. Caputo¹, T. Loria², J. B. Kowaleski¹, M. Thaut^1,3

¹University of Toronto, Music and Health Science Research Collaboratory, Faculty of Music, Toronto, Canada

²Washington State University, Department of Kinesiology & Educational Psychology, Pullman, WA, United States

³University of Toronto, Faculty of Music, Faculty of Medicine, Institute of Medical Sciences, & Rehabilitation Science Institute, Toronto, Canada

Introduction: Neurologic Music Therapy (NMT) uses music to induce changes in non-musical brain and behaviour function. Patterned Sensory Enhancement (PSE), an NMT technique for motor function, is beneficial for upper extremity (UE) rehabilitation. PSE uses music to provide temporal, spatial, and force cues for movement. The auditory and motor systems couple, bringing about a driving force from the heard cue to facilitate desired movements. Transcranial direct current stimulation (tDCS) used in stroke populations may speed up motor recovery by rebalancing damaged interhemispheric networks.

Objectives: This study aims to determine any benefits to pairing tDCS and PSE for UEs following stroke. This study aims to contribute to the advancement of stroke rehabilitation methods, Neurologic Music Therapy advocacy, and the clinical use of non-invasive brain stimulation.

Patients & methods: Eligibility criteria includes adults (18-80) with motor limitations due to stroke. Exclusion criteria includes severe cognitive deficits, apraxia, or neglect; neurodegenerative or psychiatric disease; and contraindications for tDCS. This study uses a randomized, sham-controlled treatment whereby participants receive 20 minutes of 1mA anodal, bilateral tDCS stimulation to the primary motor cortex during six PSE sessions for UEs. Baseline, immediate effect, and retention are assessed using UE assessments and motion captured kinematics.

Results: tDCS and PSE may improve UE function following a stroke. Trends in the initial behavioural data demonstrate that there may be improvements in UE function following participation in both the paired tDCS/PSE and sham-tDCS/PSE protocols. Kinematic data continues to be processed. This presentation will share the initial results from the research that is currently underway.

Conclusion: There lies potential to enhance the current state of tDCS and NMT research and clinical practice by combining tDCS and PSE to optimize UE recovery following a stroke.

P-116

Co-creation of a danced version of the Graded Repetitive Arm Supplementary Program (GRASP) for stroke rehabilitation

L. Beaudry^1,2, J. Eng^3,4, D. Leduc¹, H. Pohjola⁵, A. Rochette^6,2, M. Demers^6,2

¹University of Montreal, Montreal, Canada

²Center for Interdisciplinary Research in Rehabilitation, IURDPM, Montreal, Canada

³University of British Columbia, Physical Therapy, Vancouver, Canada

⁴Vancouver Coastal Health, Centre for Aging SMART, Vancouver, Canada

⁵University of Eastern Finland, Department of Social Sciences, Kuopio, Finland

⁶University of Montreal, Rehabilitation, Montreal, Canada

Background: Home exercise programs offer the opportunity to continue regular therapy after discharge from stroke rehabilitation. However, long-term adherence to home exercise programs is often low. Dance-based interventions can address this issue, as it has been shown to improve motivation and self-efficacy in stroke survivors.

Objectives: This project aims to adapt a widely used, evidence-based home program, the Graded Repetitive Arm Supplementary Program (GRASP), into a danced version for chronic stroke survivors.

Method: An inductive process of cocreation comprised of five concomitant and interdependent stages was used to develop, test and modify the GRASP into a danced version (dance-GRASP). A preliminary version of the dance-GRASP was beta-tested with two stroke survivors using a video sample of the dance-GRASP. Visual analogue scales for pain and fatigue were administered pre- and post-session and an exit interview was conducted to gather feedback about their experience.

Results: Four occupational therapists and six interdisciplinary researchers participated to the cocreation of the dance-GRASP. In total, 42 video capsules at 3 levels of difficulty, an instructor and a participant manual were developed. The main challenges to consider in the adaptation of the GRASP were to achieve high number of movement repetitions, minimize the use of props, and adapt the difficulty level for an heterogenous population. Both stroke survivors (1 man/1 woman, severe/mild motor impairments, respectively) were highly satisfied with the dance-GRASP and subjectively reported benefits of a single session for their upper limb. Fatigue increased from 1.5/10 pre-session to 4.5/10 post-session, but participants did not experience pain in the upper limb (0/10). Feedback from stroke survivors were used to refine the dance-GRASP. Future work should test the feasibility and effectiveness of delivering the dance-GRASP on an extended period.

P-117

Claw toe deformity: unique case and implications for management

M. W. Kim¹, T. Y. Song¹, D. C. Kim¹

¹Catholic University, Rehabilitation, Seoul, South Korea

Background: Claw toe deformity is marked by fixed extension at the metatarsophalangeal joint (MTP) and fixed flexion at the proximal interphalangeal joint (PIP). In stroke patients, management often involves botulinum toxin injections into flexor muscles, overlooking the extensor digitorum longus (EDL) muscle’s role. We present a case of claw toe due to an EDL lesion, shedding light on its pathogenesis.

Case: A 66-year-old male had claw toe in his left second to fourth toes, reporting limited dorsiflexion and pain at the MTP and PIP joints for 3-4 months, without trauma. He previously had lumbar surgery for back pain, hypertension but no diabetes. On examination, lower limb muscle strength was normal except for poor dorsiflexion in the left second to fourth toes, fixed in dorsiflexion at the MTP joint, with discomfort during passive dorsiflexion. No muscle atrophy was observed externally, and sensory reflexes were normal.

EMG showed normal sensory nerve conduction but reduced CMAP amplitude in the left extensor digitorum brevis (EDB). Sensory evoked potentials were normal, while motor evoked potentials showed a double peak waveform in the left tibialis anterior. Ultrasound revealed a hypoechoic lesion within the left EDL muscle, confirmed by contrast-enhanced MRI.

Discussion: Claw toe pathogenesis typically starts with MTP dorsiflexion, followed by toe joint flexion. The EDL lesion in this case disrupted EDL contraction, leading to MTP dorsiflexion, followed by claw toe development. EDL’s role in MTP dorsiflexion is crucial. In diabetic claw toe studies, intrinsic muscle atrophy didn’t differ significantly, indicating a complex etiology.

Implications: EDL involvement challenges conventional claw toe management, suggesting assessing EDL spasticity via EMG. Botulinum toxin injection into EDL may be a potential solution. Further research is needed to understand EDL’s role in stroke-related claw toe, offering new insights into its pathogenesis and management.

P-118

The strength of associations between ultrasound measures of upper limb muscle morphology and isometric muscle strength

C. Whang^1,2, E. Ogalo¹, H. Ro¹, M. Debenham¹, H. Wu¹, M. Berger^1,3

¹International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada

²University of British Columbia, Experimental Science, Vancouver, Canada

³University of British Columbia, Physical Therapy and Rehabilitation, Vancouver, Canada

Introduction: Assessing upper limb muscle strength is vital for understanding health outcomes like daily function and mortality. Ultrasound (US) is increasingly used to evaluate muscle health, but its utility for measuring the morphology of upper limb muscles has not yet been examined.

Objectives: To determine the strength of associations between US morphology measures (muscle thickness (MT) and cross-sectional area (CSA)) and isometric strength for functionally relevant upper limb muscles in healthy adults.

Materials & methods: Twenty-four healthy volunteers (30.0±10.8 years) underwent B-mode, axial US scans of the first dorsal interosseus (FDI), flexor pollicis longus (FPL), biceps brachii (BB), brachialis (BR), and triceps brachii lateral head (TB). They next performed brief maximal voluntary contractions, including elbow flexion, extension, second digit abduction, and first digit distal phalanx flexion. US images were segmented to obtain maximal MT and CSA. CSA was not measured for BB and TB due to limitations of the linear probe array.

Results: A strong positive correlation was found between muscle strength and BB (MT r=0.83; p<0.001), BR (CSA r=0.84; p<0.001), and TB (MT r=0.70; p<0.001). A moderate, positive correlation was found for FDI (CSA r=0.67; p<0.001 MT r=0.47; p<0.05), FPL (CSA r=0.54; p<0.01 MT r=.42; p<.05). No correlation was found between BR MT and strength (r=0.16; p>0.05).

Conclusion: Our data showed moderate-to-strong associations between US muscle morphology and isometric strength. We observed that CSA was a more robust measure than MT and that muscle shape affected the strength of association. Overall, the data demonstrated that muscle US can be a useful adjunct to strength testing in functionally relevant upper limb muscles.

P-119

Comparative study of transcranial direct current stimulation (tDCS) and Conventional Physiotherapy for motor recovery of upper extremity on ischemic stroke patients

P. Kumar¹, B. Roy¹

¹All India Institute of Medical Sciences, Neurology, Neuro Sciences Centre, New Delhi, India

Introduction: Stroke is the second leading cause of death and a substantial cause of disability worldwide. Restoration of upper extremity motor function are therefore highly relevant for people who are unable to do their ADL activities after stroke.

Objectives: To compare effect of tDCS along with conventional physiotherapy on motor recovery of upper extremity in stroke patients.

Methods: The present study involved total of 80 ischemic stroke survivors which were randomly divided in two groups, each group consisting of 40 subjects. The subjects of group A received 12 sessions of anodal tDCS (2 mA) along with conventional physiotherapy. The subjects of group B received 12 sessions of sham tDCS along with conventional physiotherapy. The outcomes before and after 6 weeks of the therapy were measured by Jensen Taylor hand function test, NIHSS scale, modified ranking scale, Fugl-Meyer assessment-UE motor, and modified Barthel index.

Results: No statistically significant difference between the groups at baseline in the all variables JTHFT, FMA-UE and mBI. After the intervention, time taken to complete each task by the participants of the sham group (Group B) was higher as compared to the tDCS group (Group A) however significant differences were found in turning over the cards (p 0.001), feeding (p 0.001), stacking objects (p 0.031), and picking up large light objects (p 0.001).

Statistically significant difference in score between the two groups was also statistically different (p 0.050). After the interventional therapy, the mean FMA-UE score improved than that of the baseline values. The mean score of group A was found to be 38.91 with the standard deviation of 20.31, whereas group B had mean score of 33.42 with standard deviation of 19.88. the difference between theses scores of the two groups was not found to be statistically significant (p 0.393).

Conclusion: tDCS with conventional physiotherapy was found more efficacious than sham tDCS with conventional physiotherapy.

Key Words: Stroke, tDCS, , Motor Recovery, Hand Function

P-120

Impact of transdisciplinary rehabilitation in patients with icu-acquired weakness at Clínica Alemana Temuco

R. Rivas^1,2, S. León¹, K. Cabezas¹

¹Clínica Alemana Temuco, Servicio de Medicina Física y Rehabilitación, Temuco, Chile

²Frontera University, Departamento de Especialidades Médicas, Facultad de Medicina, Temuco, Chile

Background: Mechanical ventilation and muscle immobilization, severe sepsis and multiple organ dysfunctions are the primary risk factors of ICU-acquired neuromyopathy. This neuromuscular dysfunction has no plausible aetiology other than the critical illness and its treatments. Medical institutions’ data show ICU-acquired weakness (ICU-AW) incidence ranging from 25 to 31%, with ∼3.25–6.2 million new patients annually.

Aim: Our purpose was to evaluate the impact of rehabilitation in patients with ICU-AW diagnosing muscle strength by applying tests such as the Medical Research Council sum score (MRC) at two different times, post-extubation and discharge, in a transdisciplinary model team (physical therapy, speech therapy and occupational therapy).

Methods: The designed study was a retrospective analysis from January to December 2021. All patients with mechanical ventilation (MV) in Clínica Alemana Temuco (CAT) were analyzed. Statistical calculation was performed using data analysis in Excel (descriptive statistics).

Results: Among 57 patients who were in MV, 18 died (31.6%), and 5 were transferred to another health centre. 34 patients could be analyzed, the mean age 57 (20-93) years, 21 men (61.7%), and 61.8% have SARS-CoV-2 pneumonia. The mean stay in MV was 19 days (2-50) and a mean of 22 days (4-105) post-extubating. The mean of the initial MRC was 26.5 points (SD +/- 13.4) and 44.1% muscle strength, 100% developed an ICU-AW in different grades. The mean final MRC was 44.4 points (SD +/- 14.1), 74% muscle strength, demonstrating an increased muscle strength of 29.9% post-rehabilitation p<0.001 (p:0.0002).

Conclusion: Post-extubation rehabilitation of patients with ICU-acquired weakness demonstrates with certainty that transdisciplinary rehabilitation work is effective in getting good results in CAT promoting early mobilization in the ICU.

P-121

Development and feasiblity of a new tool – Rehabilitation Oculomotor Screening Evaluation (ROSE) – in acquired brain injuries

E. Dannenbaum¹, T. Y. Z. Li², K. Madge², F. Richard², P. Sarpal², J. Fung^1,2

¹Jewish Rehabilitation Hospital, Research, Laval, Canada

²McGill University, Physical and Occupational Therapy, Montreal, Canada

Introduction: We have developed a new tool - Rehabilitation Oculomotor Screening Evaluation (ROSE) - to screen the oculomotor system functions (OMF) in adults with acquired brain injuries (ABI). The tool includes 8 subtests grouped into 4 categories: i) smooth pursuits + vergence (SPV), ii) saccades (SC), iii) cover tests (eye cover test & alternate cover uncover test) + gaze fixation (CTGF), and iv) VOR + cVOR (VORs). Numerical scores are assigned to the 8 subtests based on the degree of deviation from asymptomatic performance (0 - none, 1 - mild, 2 - severe), with scores increasing as the severity worsened (total score ranging from 0 to 52). After each category, participants are asked to complete a visual analogue scale (VAS) on symptom provocation (total score ranging from 0 to 40).

Objectives: 1) Evaluate the ROSE tool in terms of feasibility, acceptability, and relevance in participants with ABI (stroke or traumatic brain injury); and 2) Provide clinical examples of screening results.

Patients & methods: Ten ABI patients (n = 10) and age-matched health controls (n = 10) completed the ROSE. After completion of the ROSE, participants were asked to complete a 6 item Likert scale acceptability questionnaire.

Results: ROSE can be performed in under 20 minutes (x̄= 12.5min and was highly accepted by most of the participants (x̄= 4.8/5). Results show ABI participants scored significantly higher in all subtests in addition to total scores (x̄= 34.8 vs 8.9 for controls). It should be noted that most subtests did not provoke any discomfort or dizziness symptoms in controls, as rated by the VAS. There were no significant differences between ABI participants and controls in terms of symptom scoring. Examples of typical scoring of patients will be provided.

Conclusion: ROSE is a feasible, acceptable and relevant method to screen abnormalities in OMF in ABI. With early screening, clinicians will be informed of potential challenges in the rehabilitation process.

P-122

Effects of intensive impairment-oriented arm rehabilitation for chronic stroke survivors – an observational cohort study

T. Platz¹, K. Kaiser², T. Laborn², M. Laborn²

¹University Medicine Greifswald, Neurorehabilitation Research Group & Institute for Neurorehabilitation and Evidence-based Practice, Greifswald, Germany

²Hand and Occupational Therapy Outpatient Service Laborn, Munich, Germany

Background: To assess the effects of a two week course of intensive impairment-oriented arm rehabilitation for chronic stroke survivors on motor function.

Methods: Participants and therapy: One hundred chronic stroke survivors (i.e. > 6 months after stroke) with mild to severe arm paresis undergoing a two week course of daily four hours of impairment-oriented and technology-supported arm rehabilitation (1:1 participant-therapist setting) were recruited in two occupational therapy centres (urban and rural area, resp.).

Outcome measures: Primary: Arm motor function of the affected arm (mild paresis: BBT, NHPT; severe paresis: Fugl-Meyer Arm Motor score). Secondary: measures of finger strength, spasticity, joint mobility/pain, somatosensation, emotional distress, quality of life, acceptability and adverse events.

Results: The training was well acceptable (drop-out rate 3%; 3/100). Clinical assessment indicated an improved motor function (SMD 0.42, 95% CI 0.36 – 0.49; n=97), reduced spasticity / resistance to passive movement, and slightly improved joint mobility/pain and somatosensation. Technology-supported objective measures corroborated an improved active range of motion across joints, reduced finger spasticity / resistance to passive movement, and an increased amount of use of the affected arm in daily life, but no effect on finger strength. Emotional well-being and quality of life were positively influenced. Adverse events (AEs) were reported by a majority of participants (51%, 49/97), most frequently tiredness after training (26%, 25/97) and shoulder discomfort/pain (10%, 10/97); AEs were mild and could be managed by simple means by the therapist in charge.

Conclusions: Structured intensive impairment-oriented and technology-supported arm rehabilitation can promote motor function among chronic stroke survivors with mild to severe arm paresis, is well acceptable and tolerable when supervised and adjusted by therapists.

P-123

Steps to follow: developing a model for individualized self-training programs based on the Bobath concept towards personal goal achievement in people with chronic stroke

G. Eckhardt¹, G. Haase¹, K. Brock², T. Ishida³

¹Zentrum für Physiotherapie und Rehabilitation, Neurorehabilitation, Haan, Germany

²St. Vincent`s Hospital, Neurorehabilitation, Melbourne, Australia

³BodyWorkspace Oasis, Neurorehabilitation, Tokyo, Japan

Background: Therapy interventions aimed at enabling people with chronic stroke to meet their own personal goals require tailoring of interventions to the person"s individual situation. The purpose of this study was to identify key elements of self-training programs based on the 24-hour approach of the Bobath concept, and how they are modified in relation to the individual requirements of the participants.

Method: A self-training program was developed based on the Bobath concept to minimize the impact of body impairments and maximize activity and participation levels, in order to facilitate personal goal achievement. As a training medium, an individually devised folder with annotated photos of the participant performing the exercise was used. The folder contained information for each exercise on how to perform the exercise, adaptations of the exercise (both easier and more difficult versions) and recommendations for the number of repetitions.

Results: Fifty-five participants with chronic stroke received a total of 503 individual exercises. The therapeutic methods and techniques used in the self-training programs were clearly assigned to the Bobath concept. The self-training was demonstrated to be based on the personal goals, on the individual needs and the abilities of the participants. Key aspects of the Bobath concept were revealed and can be identified as an integral part of the 24-hour approach in the Bobath therapy. Based on the gained knowledge, a model for creation of a self-training program was developed.

Conclusion: This qualitative study unpacked the therapy component provided, in order to elaborate the principles utilized to construct and individualize interventions. The model developed has potential to improve the specificity and tailoring of self-training exercises for individuals with stroke.

P-124

Gait and balance improvement with dual-task treadmill training, in an atypical parkinsonism – multisystem atrophy type: case study

I. Baleia Batista¹, A. M. Viveiros¹, R. Brandão¹

¹Alcoitão School of Health Sciences, Cascais, Portugal

Introduction: Multisystem Atrophy (MSA) and Progressive Supranuclear Palsy are two of the most common types of atypical parkinsonism. MSA is a sporadic multisystem degeneration associated with synuclein deposits in the CNS, more precisely in oligodendrocytes. With the progression, movements that were previously automatic start to require greater attention, making it difficult to perform cognitive and motor plans simultaneously. However, despite the fact that activities of daily living often involve the performance of two or more tasks simultaneously, there is still much controversy regarding the applicability of dual-task training in the rehabilitation of this patients, as there is no clear indication of its effects as a therapeutic strategy.

Objective: To describe and analyze the influence of a dual task treadmill gait training, on gait and balance, in a patient with MSA.

Case Description: A 91-year-old male patient, with axial parkinsonism with freezing phenomena and ataxic gait that fits into atypical parkinsonism of MSA. The patient had as main problems, balance and gait changes. The intervention plan was carried out for 2 weeks, including 5 sessions per week, with treadmill training for 20 minutes, total of 10 sessions.

Results: There were improvements in the score of the Berg Balance Scale (40/56 - 48/56), in the execution time of the 10-meter walk test with and without dual task, in the score of Functional Gait Assessment (4/30 - 15/30) and on the performance of the 6-minute walk test.

Conclusions: The objectives of this case were achieved, since the objective of the intervention based on the best recommendations led to an improvement in the evaluated parameters, with results similar to those of other studies, when compared with the currently available evidence. The short-term intervention plan, the lack of assessment of muscle strength and the dual motor task constitute the main limitations of the case study.

P-125

Predicting daily life accelerometry measures: are clinical or robotic assessments effective predictors?

I. Poitras¹, J. Clouâtre², A. Campeau-Lecours², C. Mercier¹

¹Université Laval, Rehabilitation, Québec, Canada

²Université Laval, Department of Mechanical Engineering, Québec, Canada

Individuals with hemiparetic cerebral palsy (CP) tend to use their more affected (MA) arm less frequently than they would be able to (i.e., developmental disregard), but the factors influencing the use of their MA arm during activities of daily living (ADLs) remain unclear.

Objective: The objective of this study was to evaluate which robotic and clinical assessments are the best predictors of the MA arm’s use during ADLs in adults with CP.

Materials & methods: Participants performed robotic assessments in the Kinarm Exoskeleton Lab (Object Hit, Ball on Bar and Visually guided Reaching of the MA arm), clinical assessments (Observation-based assessment of the MA arm’s use, grip strength, Box and Block Test, Jebsen Taylor Hand and Functions Test), and a cooking task while wearing accelerometers. For the accelerometry assessments, three different variables were computed (i.e., % of bilateral use, bilateral-arm use index [BAUI], Use Ratio [UR]). Stepwise regression analyses were used to identify the best predictors of accelerometry variables among robotic and clinical assessments.

Results: Nineteen adults with unilateral CP (34.3 years old ± 11.5, male= 8; MACS I=7, II= 6, III= 6; MA side: 12 right, 7 left) were included. UR measured during the cooking task ranged between 0.11-1.14 (average=0.42). The best predictor of all three accelerometry metrics for the robotic assessments was the Ball on Bar, a cooperative bilateral task (r²= 0.24 to 0.37) while for the clinical assessments it was the Box and Block Test (r²=0.35 to 0.57).

Conclusion: Both robotic and clinical assessments show moderate to strong associations with the relative use of the MA arm during ADLs. Stronger association with clinical assessments can be explained by the fact that the robotic device does not assess hand dexterity. Interestingly however, a bilateral cooperative task is the best predictor identified when considering only robotic assessments.

P-126

Investigating the impact of neurologic music therapy on motor performance and cascade effects in children with autism: a pilot study

J. Teich¹, M. Thaut^1,2

¹University of Toronto, Music and Health Research Collaboratory, Faculty of Music, Toronto, Canada

²University of Toronto, Medicine, Toronto, Canada

Introduction: Sensorimotor differences are increasingly recognized in autism spectrum disorder (ASD), yet interventions often target social and language aspects. Neurologic music therapy (NMT) has been shown to influence the motor system in many clinical groups. Engaging with music enhances social communication and strengthens auditory-motor connectivity in autistic children, however, the use of NMT to facilitate controlled motor performance in children with ASD is understudied.

Objectives: This pilot study assesses the impact of 9 sessions of NMT motor interventions versus non-music motor interventions (NM) on motor performance in children with ASD. Secondary objectives include exploring effects on sensory integration, repetitive and social behaviors, family quality of life, and connections between sensory and motor differences in ASD.

Methods: Participants aged 6-12 with ASD are randomly assigned to either NMT or NM groups, undergoing 3 weekly one-hour sessions for 3 weeks. Pre, post, and 2-week follow-up include assessment of motor skills, sensory integration, social and repetitive behaviors, and family quality of life with a sensory profile administered at the outset.

Results: Predicted outcomes suggest improved motor performance in both groups after 9 sessions, with greater gains and sustained benefits expected in the NMT group due to music’s influence on sensory-motor pathways. Anticipated ripple effects may extend to secondary outcomes, suggesting improvements in higher cognitive functioning as sensorimotor challenges are addressed.

Conclusion: This original pilot study investigates the impact of NMT on motor performance in children with ASD as compared to a non-music approach, addressing a critical gap in the existing literature. Exploring NMT’s potential to enhance motor performance along with any cascading effects contributes valuable insights into the therapeutic potential of NMT to address multifaceted challenges in children with ASD.

P-127

Effects of robot-assisted gait consisted of high-intensity interval exercises on cardiopulmonary function and walking ability amoing individual with chronic stroke

J. Kim¹, J. H. Do¹, D. Y. Kim¹

¹Asan Medical Center, Rehabilitation, Seoul, South Korea

Introduction & objectives: To determin the effects of robot-assisted gait training consisted of high-intensity interval exercises on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results such as cholesterol, lipid, glucose among individual with chronic stroke at least 2 years post-stroke.

Patients & methods: This was a multicenter, prospective, single-blind, randomized controlled trial. Twenty-two participants with chronic stroke were randomly assigned to robot-assisted gait training (RAGT) or control groups. The RAGT group exercised for 3 days per week for 8weeks with a Morning Walk device. The high-intensity interval training involved 3-minute bursts of exercies at a perceiced exertion of >14 on the Borg scale, alternating with 2-minute rest periods at a perceived exertion of 10-11. The control group received home exercise education. The following variables and scales were measured at baseline and after 8 weeksL VO2max, 2-minute walk test (2MWT), 10-meter walk test (10MWT), Berg Balance Scale(BBS), Motricity Index-Lower(MI-L), Korean version of the Fugle Meyer Assessment Scale(K-FMA), Modified Barthel Index (MBI), muscle strength test, and blood tests (cholesterol, lipid, glucose).

Results: RAGT improved 2MWT, 10MWT, MI-L, K-FMA, BBS, and non-paretic and paretic knee extensor/flexor strength after 8 weeks. The control group had a mean improvement in BBS of 0.6 points. The RAGT group showed significant improvements in VO2max, MI-L, knee extensor (paretic), knee extensor (non-paretic), knee flexor (paretic), knee flexor (non-paretic) , and K-FMA, compared with the control gorup.

Conclusion: The findings in this study suggest that RAGT consisted of high-intensity interval exercises may improve cardiopulmonary function and walking ability in individuals with chronic stroke.

P-128

Dry Needling vs Botulinum Toxin Type A in the management of lower limb spasticity following stroke: a controlled proof-of-concept trial

J. Khayat¹, C. Pujol-Fuentes², P. Herrero³, W. Saeys⁴, B. Eeckhaut⁵, T. Wein⁶, M. Levin¹

¹McGill University, Physical and Occupational Therapy, Montreal, Canada

²European University of Valencia, Health Science, Valencia, Spain

³University of Zaragoza, Health Science, Zaragoza, Spain

⁴University of Antwerp (ANT), Physical Therapy and Rehabilitation, Wilrijk, Belgium

⁵University of Antwerp, Health Science, Turnhout, Belgium

⁶McGill University, Neurosurgery, Montreal, Canada

Introduction: Post-stroke lower limb spasticity causes a gait disorder that results in a reduced quality of life. Two treatments used to decrease spasticity and improve walking in people with stroke are injection of botulinum neurotoxin (BTX) and dry needling (DN). As injection of BTX may have some adverse effects, it has been proposed that DN may be an effective alternative to the more invasive chemical denervation. However, there is little information about the change in tone after each of these treatments at the central (spinal) level and the duration of these effects.

Objectives: The primary objective is to determine the mechanisms of action of BTX injection and DN on lower limb post-stroke spasticity. Secondary objectives are to determine safety and feasibility of each treatment and their effects at muscle and functional levels, quality of life and cost-effectiveness.

Methodology: This is a 3-year prospective study involving 3 countries (Canada, Spain, Belgium) with 90 participants (aged >18 yr; spasticity in ankle plantarflexors (PF)). One group of subjects receive a series of 12 DN sessions and the other receives one injection of BTX in ankle PF and toe flexors. Effects of each treatment are evaluated before (3 baseline evaluations), after (for 12 weeks) and at a 4 week follow-up timepoint. Stretch reflex excitability is evaluated at the Body Structure and Function level by measuring the Tonic Stretch Reflex Threshold and its velocity sensitivity in PFs and effects on muscle are evaluatedusing ultrasound imaging and the Modified Ashworth Scale. Gait activities are measured at the Activity level and the quality of life at the Participation level. In addition, we will determine the patient acceptability and cost-effectiveness of each intervention.

Expected results: Results of this study will provide important information to help clinicians, patients and caregivers make optimal choices for the treatment of ankle post-stroke spasticity.

P-130

Effect of proprioceptive neuromuscular facilitation (PNF) on body balance: a systematic review protocol with meta-analysis

J. C. Souza Alves¹, A. Paiva de Castro Vidal¹, D. Branco Liposcki¹, Y. Rodrigues Antunes¹, M. Barçante¹, G. Campos Santana¹, I. Manhoni Baiense¹, F. Zanela da Silva Arêas¹

¹Universidade Federal do Espirito Santo, Vitoria, Brazil

A non-fatal fall can lead to a condition of psychomotor regression responsible for psychological, postural, and gait dysfunction in the elderly, with balance impairment as a risk factor. Proprioception is crucial for balance control as it integrates sensory signals to determine body position and movement in space¹. PNF (Proprioceptive Neuromuscular Facilitation) patterns include three-dimensional directions proposed to enhance muscle performance². The objective is to assess the effects of PNF on body balance (BB). Inclusion criteria: randomized controlled trials in any population, with the primary treatment being PNF compared to another intervention, placebo, or no intervention, and studies assessing immediate, short, medium, or long-term effects on static or dynamic balance, along with complete studies published in any scientific journals. Searches were conducted in the SPORTDiscus, PUBMED, Cinahl, Embase, PEDro, and Central databases. 3 independent reviewers analyzed the texts and reached a consensus on any discrepancies. Methodological quality of the studies was analyzed using PEDro scale. Statistics were conducted using the Review Manager 5.3, with a value to reject null hypothesis set at 0.05. The analysis involving 11 studies and 338 individuals showed a significant effect of PNF on improving BB, compared to no intervention in the short and medium term, higher in the subgroup of neurological patients. However, PNF did not exhibit superior effects to other interventions in the short/medium term in an analysis involving 12 studies and 450 individuals. Sub-analyses revealed that in neurological patients, the effect of other interventions was significantly greater than PNF. PNF can be used in clinical practice when the goal is to improve static or dynamic balance. ¹HAN J., et al. Assessing proprioception: a critical review of methods. Journal of Sport and Health Science, 2015; ²ADLER SS, BECKERS D, BUCK M. PNF in Practice. 4th ed. Berlin: Springer-Medizin; 2014.

P-131

Upper limb kinematic measures of neurologic impairment using computer vision: a clinical feasibility case series

J. Huber ¹

¹University of Kentucky, Lexington, KY, United States

Introduction: After stroke, 80% of people lose upper limb function, and individual recovery is difficult to predict. While validated observation-based assessments exist for prediction, they suffer from subjectivity and may miss subtle change. Alternatively, quantitative/continuous measures such as neuroimaging, neurophysiology, and biomechanics may improve prediction [1]. However, these typically require costly centralized tools, which impedes the serial assessments needed to monitor recovery. Kinematics is quantitative/continuous measure of human motion. While traditionally requiring sophisticated labs, computer vision offers a promising alternative [2]. Computer vision is a subfield of artificial intelligence that deals with extracting data from digital images. We have developed a computer vision tool (CV-Mocap) with evidence of validity for neurotypical adults in a controlled setting.

Objective: To determine clinical feasibility of CV-Mocap to acquire upper limb kinematic metrics for individuals with neurologic impairment.

Patients & methods: In this case series with repeated measures, two individuals (stroke survivor in physiatry clinic, myelopathic patient in neurosurgery clinic) underwent kinematic analysis while performing four repetitions of the drinking task. Kinematic metrics were obtained using CV-Mocap and two modest cameras.

Results: For two individuals with neurologic impairment, CV-Mocap was a feasible approach to measure upper limb kinematics in a clinic setting.

Conclusion: To support quantitative/ continuous measurements of recovery, CV-Mocap may be used in a clinic setting to measure kinematics for patients with neurologic upper limb impairment.

1. Cramer, S.C., et al., Predicting Functional Gains in a Stroke Trial. Stroke, 2007. 38(7): p. 2108-2114.

2. Needham, L., et al., The development and evaluation of a fully automated markerless motion capture workflow. Journal of Biomechanics, 2022. 144: p. 111338.

P-132

Motor adaptation of walking in response to split-belt training post-stroke: a comparative case study exploring the impact of fear of falling

K. Yoshida¹, J. Eng¹, L. A. Boyd¹, C. L. Pollock¹

¹University of British Columbia, Physical Therapy, Vancouver, Canada

Introduction: Walking-related outcomes following rehabilitation post-stroke are impacted by the interaction of physical impairments, and walking-related self-efficacy or perceived abilities. Falls and fear of falling (FoF) can profoundly impact self-efficacy, activity levels and may further impact response to exercise.

Objectives: This comparative case study aims to explore motor performance outcomes associated with split-belt treadmill training in two people with similar motor recovery post-stroke, but differing levels of FoF.

Patients & methods: Two males, 45-55yrs, 2-3yrs post-stroke (participant 1 (P1): L basal ganglia, hemorrhagic; P2: R pons, ischemic) participated. Both participants had moderate lower limb impairment (Chedoke-McMaster Stroke Assessment leg; 4/7, foot 2/7) and walked with an ankle-foot orthosis and walking pole, however, both could walk without. P2 reported a history of a fall resulting in a hip fracture (non-displaced, nonsurgical) 1yr prior to training. Activity-specific Balance Confidence scores differed, P1; 72.4, P2; 86.9. Current physical activity also differed: P1 was highly active, P2 was moderately active. Split-belt treadmill training (with a safety harness) at speeds individualized to their overground walking (at 2º incline) was performed three times a week for 30mins for 12 sessions. Step length symmetry (SLS) was measured with embedded force plates.

Results: Both participants completed all sessions with no adverse events. P2 reported persistent FOF requiring single upper extremity support on the treadmill handrail. Post-training, P1 showed notably more symmetrical SLS (session (S)1: -0.22, S12: -0.06), compared to P2 (P2 S1: -0.24, S12: -0.31, where perfect symmetry SLS = 0).

Conclusion: Only the participant without FoF during training demonstrated the expected split-belt training adaptation of SLS. Future work exploring the impact of FoF on motor adaptation in walking post-stroke is warranted.

P-133

Association between lower limb dexterity and functional performance in older adults

K. Lakshminarayan¹, R. Debur¹, Z. L. D’Souza¹

¹Ramaiah Medical College Hospital, Physiotherapy, Bengaluru, India

Background: Deterioration of dexterity presents a significant challenge to the activities of daily living and independence of older individuals which are associated with sarcopenic changes in the lower limbs.Lower extremity dexterity plays a critical role in navigating challenging environmental tasks, such as walking on unstable surfaces or avoiding sudden obstacles.The significance of lower extremity dexterity extends to everyday motor activities like walking and running. However, there is a noticeable dearth of research dedicated to studying lower extremity dexterity and its role in functional activities of the lower limbs.Recognizing the potential role of lower extremity dexterity in the functional performance of older adults holds promise for physical therapists, who can integrate dexterity assessments into evaluations and devise appropriate intervention strategies to enhance older adults’ daily functioning.

Objectives: To find an association between lower extremity dexterity and functional performance using Lower Extremity Dexterity Device Test and Timed Up and Go Test

Patients & methods: 48 individuals were selected using convenience sampling methods. Participants were assessed for inclusion and exclusion criteria to ensure the relevance of the study cohort. Each participant underwent a comprehensive evaluation of their lower limb dexterity using LEDDT and functional performance using TUG.

Results: A Pearson correlation coefficient of -0.425 was computed, and a p-value of 0.003 was obtained in the analysis of the relationship between LEDDT scores and TUG test scores which was a statistically significant correlation

Conclusion: The study findings indicate a noteworthy correlation between dexterity scores (LEDDT) and functional performance (TUG). This correlation implies that level of dexterity exhibited by individuals has a discernible impact on their ability to perform functional tasks effectively. This insight underscores the importance of considering and potentially enhancing dexterity when addressing the overall functional well-being of older adults.

P-134

Is protein supplement effective in promoting rehabilitative outcome in brain tumor patients?

K. H. Cho¹, E. Y. Han², S. Park³, J. C. Shin³, S. H. IM³

¹Yonsei University College of Medicine, Department of Hospital Medicine, Yongin, South Korea

²Jeju National University, Rehabilitation, Jeju, South Korea

³Yonsei University College of Medicine, Department and Research Institute of Rehabilitation, Seoul, South Korea

Introduction: Brain tumor patients suffer from lesion-related weakness and functional decline which may benefit from rehabilitation therapy. Nutritional intervention in addition to rehabilitation therapy has been associated with better treatment outcome in cancer patients. Protein supplement in particular has been investigated to promote muscle power and mass gain in association with functional improvement in various tumor patients.

Objectives: This study is designed to investigate the effect of protein supplements in promoting rehabilitative potential in brain tumor patients.

Patients & methods: A total of 60 patients with brain tumors were recruited for this prospective study. They were randomly assigned to either the protein supplement group or the control group to receive an identical amount of protein supplement or placebo for 8 weeks, in addition to conventional rehabilitation therapy.

Anthropometric features and functional assessments were assessed before and after the intervention. Functional assessments comprised of Timed Up and Go test, the 6-minute walk test, the isokinetic quadriceps muscle strength test, and the grasp power.

Results: After intervention, the muscle strength was all improved in both groups, however, the significant increase in pinch grasp power was only noted in the protein group (P<0.05). The functional outcome assessed by distance of 6-minute walk was also significantly improved at follow-up only in the protein group (P<0.01)

Conclusion: In conclusion, this study using protein supplements to promote the rehabilitative potential of brain tumor patients revealed a significant effect on muscle power reimbursement as well as functional improvement. The safety and feasibility of protein supplements in brain tumor patients were affirmative in this study. Further studies with more patients may be helpful to confirm the secondary functional gain resulting from increased muscle power.

P-135

Activity but not quality of life is improved after an intensive multidisciplinary rehabilitation in 42 patients with genetic degenerative ataxia: a retrospective study

L. Pignon^1,2,3, M. C. Pouget¹, M. Duboisset¹, G. Rode^1,2,3, S. Mateo^1,2,3

¹Lyon Civil Hospitals, Saint-Genis-Laval, France

²Université Claude Bernard, Lyon, France

³Neuroscience Research Center, Team Trajectoires, Lyon, France

Background: Genetic Degenerative Ataxia (GDA) represents a group of different degenerative diseases affecting the cerebellum. Motor coordination, balance, and articulation are impaired, which decrease patient quality of life (QOL). In 2019, together with patients, we developed a multi-disciplinary intensive rehabilitation program to reduce deficiencies and improve activity and participation in patients with GDA.

Objectives: To evaluate program efficacy in the 3 domains of the ICF.

Method: Medical record data were extracted between January 2019 and September 2023. Several parameters were analysed before and immediately after the program: i) Scale for Assessment and Rating of Ataxia (SARA) to measure ataxia symptoms; ii) Mini-Balance Evaluation System Test (MBT) to evaluate balance. In addition, we analysed the 36-Item Short Form Survey (SF36) measuring QOL before and 1 and 3 months after the end of the program. We used paired t-tests to investigate changes in the SARA and MBT and ANOVA with Tuckey HSD post-hoc for the SF36.

Results: We extracted data from 51 patients and analysed the outcomes of 42 patients (exclusion due to incomplete program completion due to COVID-19). Ten patients (24%) suffered from pure cerebellar deficits, all others had associated symptoms including neuropathy (n=29), pyramidal (n=12), vestibular (n=3) and extra-pyramidal syndromes (n=1). The mean SARA score decreased significantly after the program from 12.6 (±4.3) to 9.6 (±3.5). The Mean MBT score increased significantly after the program from 9.9 (±7.1) to 13.6 (±6.7). There was no significant change in the overall SF36 score or any of the SF36 subscales.

Conclusion: These results suggest an immediate effect of multi-disciplinary intensive rehabilitation on the intensity of symptoms in patients with GDA and an improvement in balance, but no change in QOL immediately after or at follow-up. The absence of an effect on QoL might be due to its multifactorial nature.

P-136

Opening the black box of self-directed exercise after stroke: a realist review

M. Kenny¹, L. A. Connell², R. Randell¹, L. Edwards¹

¹The University of Bradford, Health Science, Bradford, United Kingdom

²Lancaster University, Lancaster, United Kingdom

Introduction: Delivering the intensity of exercise required to promote upper limb (UL) recovery after stroke is challenging within resource limited health systems. Self-directed exercise (SDE) may be a way of increasing rehabilitation intensity. Developing an understanding of the hows, whys, and in what contexts SDE (UL) is successfully prescribed and performed, is key to developing implementable interventions, and potentially supporting those that already exist.

Objectives: We have undertaken a realist review to identify and test, (1) What supports and constrains people performing SDE (UL) after stroke, (2) How, why, in what context and for whom SDE improves outcomes.

Materials & methods: A realist review consists of 2 phases and differs from a traditional systematic review. It focuses on an explanation of an intervention"s causal mechanisms and, how they work in different contexts, as well as its outcomes.

Phase 1 involved identifying stakeholder theories about SDE (UL) from the literature. We searched Embase, CINAHL, PEDro, PsycINFO, Epistemonikos, TRIP database, trade journals and Google.

Phase 2 involved testing these theories, refining, refuting, or confirming them using empirical evidence.

As an iterative process, an area of focus was developed based upon theories found and stakeholder consultation. This further explored the contexts and mechanisms that supported /constrained those that are difficult to engage in SDE.

Results: The resulting programme theory and logic model for SDE after stroke will be further refined through interviews/observations of stakeholders, providing the basis for co-design of a toolkit to support SDE (UL).

Conclusion: Using a realist review supports the examination of complex phenomenon such as the prescription and performance of SDE (UL) after stroke. With its emphasis on mechanisms, sensitivity to context, and iterative nature, it forms a sound basis upon which to develop complex interventions that need to work in real world settings.

P-137

Observational assessment of movement quality in people with stroke – development and psychometric testing of a new scale

M. Alt Murphy¹, M. Jose¹, M. Munoz-Novoa¹

¹University of Gothenburg, Clinical Neuroscience and Rehabilitation, Gothenburg, Sweden

Introduction: Advanced motion capture systems providing quantifiable kinematic data on movement quality during task execution are not readily available in clinical settings.

Objectives: To overcome this gap, we aimed to develop and evaluate the reliability and validity of an observation-based scale, the Drinking Task Assessment (DTA) for assessment of movement quality ad performance in people with stroke.

Methods: The DTA includes movement time, smoothness, trunk displacement, shoulder, elbow and grasp components scored on a 4-level scale, a global scale resulting in a total score of 23 points. The standardized DTA was assessed in 30 participants (mean age 62 years with various levels of upper limb impairment) with chronic stroke independently by two therapists. The video recordings were used to complement the direct observation and for the second assessment. For the reliability analysis of the movement time Intra-class Correlation (ICC), Standard error of Measurement (SEM) and minimal real difference (MRD) was used. For the DTA the Weighted kappa, Percentage of agreement and Svensson method was used. Motion capture based kinematic data and established clinical scales were used to evaluate the validity.

Results: The absolute SEM and MDR for the movement time were 0.4 and 1 seconds (11%) with an ICC ≥0.93. Weighted Kappa showed good to excellent agreement (0.71-1.0) for intra- and interrater reliability. DTA showed a strong correlation with Fugl-Meyer Assessment (0.74) and Action Research Arm Test (0.93) and with kinematic measures of smoothness (0.93), trunk displacement ((0.91), elbow extension (0.73), and shoulder movements (0.56) at the component level.

Conclusions: The new DTA proves to be reliable and valid tool for assessment of movement quality during task performance after stroke. The new scale allows a standardized observation-based assessment of the key kinematic features relevant for people with hemiparesis to be used in clinical settings.

P-138

Implementation of cognitive-motor dual-task training in Day Centre Program in patient after acquired brain injury: pilot study

M. Krivošíková¹, Y. Angerová¹

¹Charles University, Rehabilitation, Prague, Czech Republic

Introduction: Dual-task training, which combines cognitive and motor exercises simultaneously, has gained attention in recent years as a potentially effective rehabilitation approach. Dual task training is one of the neurorehabilitation strategies that promote neuroplasticity through motor learning in the short term.

Objectives: The objective of this study is to investigate the feasibility and efficacy of an intensive 4-week cognitive-motor dual-task training in patients after ABI in an outpatient program at the Day Centre of the Department of Rehabilitation Medicine at the General Hospital in Prague.

Materials & methods: A 4-week intensive dual-task program was scheduled 4 times a week for 3 hours. The training involved a combination of cognitive and motor tasks designed to enhance patients´ dual-task abilities. A total 25 adults after ABI were enrolled in the pilot program. To evaluate the efficacy of the program, participants underwent pre- and post-intervention assessment of cognitive performance (working memory, attention, verbal fluency) and motor function, which was assessed through TUG and Mini BESTest. To assessed feasibility, we evaluate the patient adherence, program safety and overall satisfaction with the program.

Results: Preliminary findings from feasibility assessment indicated high patient adherence (95% of participants completed the full program) and a safe environment for conducting the training. In terms of patient satisfaction, 88% expressed a high level of contentment with the dual-task program. After the completing the program patients improved in gait speed and balance and in attention.

Conclusion: The program demonstrated high feasibility, as indicated by patient adherence and safety. Cognitive-motor dual-task training at the Day Centre is an effective training for ABI patients in gait speed and attention.

P-139

Vibration-induced postural reactions: scoping review on parameters and populations studied

M. Bertrand-Charette¹, M. P. Perron¹, R. da Silva¹, L. D. Beaulieu¹

¹UQAC, Health Science, Chicoutimi, Canada

Background & aims: Mechanical vibration has been widely used as an effective way for externally activating muscle spindles and skin mechanoreceptors, and studying their contribution to proprioception. Despite its popularity, there are no guidelines available to guide researchers in the parameters to use to ensure methodologically robust projects. The main goal of this scoping review was to give an overview of general methods and parameters used so far in the field of vibration-induced postural reactions. A second objective was to identify the rationale used by the authors for justifying their methodological choices concerning vibration parameters.

Methods: Three databases (Medline, CINHAL, SPORTDiscus) were searched from inception to July 2022. Included articles were to focus on the study of muscle/tendon/cutaneous vibration in humans and assess postural control. Following inclusion, data regarding demographic information, populations, vibration parameters and rationale were extracted and summarized in the Results section.

Results: 141 articles were included (figure 1), mostly targeting lower extremities (n=132) and adults (n=124). The parameters used varied widely, but were most often around 80Hz at 1mm amplitude for 10-20 seconds. Regarding rationales, nearly 50% of the studies did not include any, whereas those including one mainly cited two studies, without elaborating specifically on the parameters choice.

Conclusions: This scoping review provided a comprehensive description of the population recruited and parameters used for vibration protocols in current studies with humans. Despite a large number of studies, there remain important gaps of knowledge that needs to be filled, especially for younger populations or pathological conditions, as well as vibration amplitude and duration parameters.

P-140

Identification of deficits in referent control variables during reaching movements in people with stroke

M. R. El-Hage^1,2, A. G. Feldman^1,2, M. Levin^2,3

¹University of Montreal, Neuroscience, Montreal, Canada

²Center for Interdisciplinary Research in Rehabilitation, Montreal, Canada

³McGill University, Physical and Occupational Therapy, Montreal, Canada

Many people with stroke have persistent sensorimotor deficits in their upper limbs (UL). Understanding neural control mechanisms underlying UL deficits may be crucial for improving recovery and therapeutic effectiveness. Underlying motor deficits can be explained by the referent control theory that describes movement as a virtual shift of the limb from one position to the other (referent limb position). This theory suggests that the nervous system shifts the referent limb position at which muscles begin to be recruited depending on the deflection of the actual limb position from the referent one. Previous studies have shown that during reaching movements with reversals in direction, actual and referent positions can intersect resulting in minimization of all muscle activity (EMG minima). Our objective was to determine if UL deficits are related to a change in the referent control of pointing movements in people with stroke. Healthy and subjects with stroke (aged 50-65; UL Fugl-Meyer: 46-59 pt) performed reaching tasks in 3 directions with reversals with their non-dominant/affected UL while holding a fixed length handle. Tasks were done with max. elbow extension. In subjects with stroke, the task was repeated when elbow movement was restricted to a joint range in which there was no spasticity. EMG activity of 8 arm muscles was recorded using wireless electrodes. The number and positions of EMG minima, defined as <5% of max activity in all muscles, were determined. In healthy subjects, 2 EMG minima were present in most tasks at ~61-86% of the reaching extent. In subjects with stroke, there were fewer EMG minima with more variable locations especially in the angular zone in which spasticity was present. Subjects with stroke present a deficit in the specification of the UL referent position during reaching movements. By determining post-stroke deficits in the referent control of UL movements, new therapies may be found for improving UL movements in people with stroke.

P-141

Impact of an INTensive motor rehabilitation programme integrating advanced technology for adults with chronic central neurological disease (INTeRAcT): protocol of a randomized controlled phase III trial

M. Coremans¹, F. Bataillie², L. De Bruyn¹, M. Fobelets^3,4, F. Jacobs⁵, L. Pattyn¹, K. Putman³, A. Schiltz⁵, L. Tedesco Triccas^6,7, F. Van Thienen⁵, G. Verheyden¹

¹KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

²AZ Herentals, Medicine, Herentals, Belgium

³Vrije University (VUB), Public Health, Brussels, Belgium

⁴Vrije University (VUB), Brussels Institute for Teacher Education, Brussels, Belgium

⁵To Walk Again, Department of rehabilitation Sint-Elisabeth hospital, Herentals, Belgium

⁶University College London, Department for Clinical and Movement Neuroscience, Institute of Neurology, Londen, United Kingdom

⁷University of Hasselt, Rehabilitation, Hasselt, Belgium

Background: Motor impairments affect a significant proportion of stroke and spinal cord injury (SCI) patients, leading to reduction of quality of life. Even in the chronic phase, despite completing subacute rehabilitation, motor deficits remain present in many patients, limiting activities of daily living.

Objectives: To investigate the clinical effectiveness of a 3-week, 90-hour intensive rehabilitation program integrating advanced rehabilitation technology.

Methods: A single-blinded randomized controlled trial is conducted recruiting 100 patients in the chronic phase of stroke or SCI, when they have returned home at least 3 months after subacute rehabilitation. The intervention group receives 90 hours of therapy over 3 weeks, while the control group receives usual care during this period. The intervention is motor rehabilitation, tailored to individual patient goals incorporating advanced technology, fitness, and self-management. After 3 weeks, both groups continue their usual care and are followed up until 9 months. Throughout the follow-up period, actual amount and content of usual care received is documented. Assessments are performed at three time points: baseline, after 3 weeks, and 9 months after baseline.

The primary outcome measure is independence in activities of daily living, measured by the Functional Independence Measure (stroke) or Spinal Cord Independence Measure (SCI). Secondary outcomes are Goal Attainment Scaling, Fatigue Severity Scale, Borg Rating of Perceived Exertion, Canadian Occupational Performance Measure, and EQ-5D-5L. Change from baseline will be estimated based on a multivariate ANOVA model.

Results: So far, 42 patients have been enrolled, and all 22 assigned to the intervention group have completed the intensive rehabilitation program. Currently, we observe that the protocol is feasible for both patients and therapists. Recruitment is ongoing and is expected to conclude by the end of 2024. Final results are expected by the end of 2025.

P-142

Designing post-stroke upper limb motor interventions to optimize recovery: an international qualitative study

M. Wingfield^1,2, G. Hughes³, N. Fini¹, G. Williams^1,2, A. Brodtmann⁴, K. Hayward^1,5,6

¹University of Melbourne, Physiotherapy, Carlton, Australia

²Epworth Healthcare, Physiotherapy, Richmond, Australia

³Austin Health, Physiotherapy, Heidelberg, Australia

⁴Monash University, Medicine, Clayton, Australia

⁵University of Melbourne, Medicine, Carlton, Australia

⁶University of Melbourne, The Florey, Heidelberg, Australia

Background: Optimal interventions that drive post-stroke upper limb (UL) motor recovery are not known. The perspectives of different stakeholders involved in intervention design have not been previously captured and synthesised.

Objectives: To investigate the diverse perspectives (preclinical research, clinical research, clinical practice, lived experience) on the relative importance of considerations regarding post-stroke UL motor intervention design to optimise recovery.

Methods: Four international participant groups were sampled. They participated in one-on-one semi-structured interviews. Research participants were recruited based on keyword searches in Scopus. Clinical practice participants had >7yrs of experience. Lived experience participants had >6mths of UL impairment. Themes were developed from content analysis of verbatim interview transcripts. Thematic saturation (three consecutive interviews with no new themes) signalled the end of a participant group"s recruitment.

Results: Thirty-seven interviews (17 female:20 male) were conducted with participants from eight countries across four continents: preclinical research n=9, clinical research n=9, clinical practice n=9, lived experience n=10. Four themes were developed: theme 1: "The research question", theme 2: "The desired outcome", theme 3: "Personalisation", and theme 4 "Complex interventions". Collectively these themes demonstrate that UL motor recovery interventions are the interaction of multiple intervention elements (eg dose and content) and can be shaped by different contextual considerations (eg stroke and personal factors).

Conclusion: Our diverse participant groups that spanned researchers, clinicians and those with lived experience exhibited a broad perspective on the considerations required of a post-stroke UL behavioural intervention. Adjustments to intervention elements will be driven by the research question, the goal of the intervention, and the needs of an individual stroke survivor.

P-143

Enhancing upper extremity strength: blood flow restriction exercise for individuals with spinal cord injury

M. Nouri Zadeh¹, Y. Saremi¹, B. Shadgan¹

¹University of Birtish Columbia/ ICORD, Orthopaedics, Vancouver, Canada

Introduction: People with incomplete spinal cord injury (SCI) commonly experience upper extremity muscle atrophy and dysfunction, impacting their daily activities and independence. High-intensity resistance exercise programs are considered the most effective intervention to improve muscle strength and hypertrophy. However, most people with SCI cannot safely tolerate high-intensity exercise protocols and cannot afford upper limb muscle overuse injuries as a potential complication. Unlike traditional high-resistance training programs, a new muscle training method in elite sports, blood flow restriction (BFR) exercise, offers a unique approach by achieving significant muscle strength gains with much lighter loads. This improves the outcome of strengthening exercise protocols while preventing muscle overuse injuries.

Objectives: This study explores the feasibility and effects of eight weeks of low-intensity BFR exercise on the strength and function of the forearm muscles in people with incomplete SCI.

Materials and Methods: Ten participants aged 18 to 75 underwent an 8-week BFR exercise program targeting forearm muscles, with grip strength as the primary outcome measure. The participants also provided qualitative feedback on their experiences.

Results: Results showed a significant forearm muscle strength increase in the intervention group, highlighting BFR’s potential to enhance upper extremity strength in SCI individuals. Participants reported improved grip, strength-related tasks, and fine motor skills, enhancing their quality of life. Importantly, BFR was well-tolerated with minimal discomfort, leading to high satisfaction.

Conclusion: This study emphasizes LI-BFR exercise as a safe and effective method for enhancing upper extremity strength in SCI individuals. Positive outcomes and participant satisfaction suggest the potential for further research and clinical integration to significantly improve this population’s quality of life and functional independence.

P-144

Acute effect of ankle proprioceptive training on motor cortex excitability: a pilot study

M. Bertrand-Charette^1,2, A. Nourry^1,3, R. da Silva^1,2,4, L. D. Beaulieu^1,2

¹Labo BioNR, Chicoutimi, Canada

²Université du Québec à Chicoutimi, Health Science, Chicoutimi, Canada

³Institut d’Ingénierie de la Santé (2IS), Amiens, France

⁴Centre Intégré de Santé et Services Sociaux du Saguenay—Lac-Saint-Jean, Saguenay, Canada

Background: Ankle injuries are among the most prevalent lower limb injuries. Rehabilitation is primarily aimed at recovering proprioception as this sense is closely involved in motor and postural control. However, the neural mechanisms underlying the effects of ankle proprioceptive training remain uncertain. Transcranial magnetic stimulation (TMS) could be a powerful tool to study this acute effect on networks involved in ankle and postural control.

Objective: The main objective of this pilot study was to assess the acute effects of a proprioceptive and postural control training on motor cortical and corticospinal networks involved in controlling the ankle in a healthy population. A secondary objective was to assess the stability of TMS data over time.

Method: Eight healthy participants realized two experimental sessions (S1 & S2; separated by one week), in which the resting motor threshold and motor evoked potentials (MEPs) amplitude & latency of the right dominant tibialis anterior were determined by TMS. In S2, participants then performed a standardized protocol wobble-board training. TMS measures were collected again directly after training. Friedmann"s ANOVA was performed between S1, S2 pre-training and S2 post-training data to compare MEPs amplitude and latency. Post-hoc Wilcoxon comparisons were performed in the presence of significant ANOVA results.

Results: A main Sessions effect was found for MEPs latency. Post-hoc tests showed that latency was stable between S1 & S2 pre, but significantly decreased after training (p=0.03). No effect was found for MEPs amplitude.

Conclusion: Our results suggest that acute proprioceptive and postural control training using the wobble board increases conduction times and volume of corticospinal cells activated by TMS. Future studies will have to confirm such brain plastic changes in larger sample studies and in persons with ankle injuries to ensure the generalizability of these results.

P-145

The impact of hand function training with a novel device in a sample of chronic stroke patients

A. Nelson¹, R. Rehsi¹, M. Shima², E. Dumais², A. Rogojin³, J. Meltzer³, V. Johnson², J. Harris¹, M. Marshall⁴

¹McMaster University, Hamilton, Canada

²IRegained Inc., Sudbury, Canada

³Rotman Research Institution, Toronto, Canada

⁴IRegained Inc., Cambridge, Canada

The hand and fingers play a crucial role in performing activities of daily living and if impaired, may negatively impact a person"s quality of life. The current study used a novel passive hand function training (HFT) device, called the MyHand System, in chronic stroke patients with hemiparesis. This HFT device is designed to target neuroplasticity through a personalized exercise prescription focused on repetitive individual and multi-finger grasping exercises. The primary objective of this study was to compare the changes in motor function before and after a training program consisting of fifteen, 1-hour HFT sessions using the MyHand System over a three-week span. A total of 9 chronic stroke patients aged 56.22±18.71 (3.00±2.78 years post-stroke) participated in this study. The training sessions focused on improving active finger range-of-motion, strength, and fine motor skills, using an individualized exercise prescription involving gamified visual feedback. All training and assessment sessions took place at the same location. Changes in hand function pre- and post-intervention were tested using three assessments: Chedoke Arm and Hand Activity Inventory-9 (CAHAI-9), Box and Block Test, and Hand Dynamometry. The Wilcoxon Signed Ranks Test was used to determine the significance of within-subject changes of the CAHAI-9, Box and Block, and Dynamometry. Significant improvements pre/post were found for: CAHAI-9 (Z=-2.673, p=0.004), Box and Block (Z=-1.826, p=0.034), Tripod Pinch (Z=-1.892, p=0.029), and Lateral Pinch (Z=-2.254, p=0.012). Changes in grip strength were not significant (Z=-1.404, p=0.08). The CAHAI-9 score met the minimal clinically important difference criteria (MCID=7.2). Results from this study indicate that the MyHand System is a feasible method to increase manual dexterity of the hand and impact upper limb function in chronic stroke patients. To increase the statistical power and generalize findings, future studies should use a larger sample size.

P-146

A new hand rehabilitation robot: safety, accuracy and durability

M. Ochi¹, S. Saeki¹, Y. Matsushima¹, H. Ito¹, A. Hachisuka¹, T. Moriyama¹, M. Tokunaga¹, R. Hori¹

¹UOEH, Rehabilitation, Kitakyushu, Japan

Significant challenges remain in improving upper limb function after stroke and other neurologic disorders. Robotic upper limb functional training has made great strides in the last 10 years. Recently, many finger-type robots have been developed that can move the fingers directly, and devices that use soft exoskeletons such as gloves to perform not only passive finger movements but also assisted movements have been reported. In the acute phase, when time is scarce, ease of use is required in addition to safety. EsoGLOVE is a hand-shaped training support robot. A lightweight display with a touch screen is connected by a cable to a pneumatic glove, allowing passive and assisted movement of the hands. We have confirmed and will report on the safety, accuracy and durability of EsoGLOVE, which was introduced at our university.

P-147

Speed training improves motor performance of the paretic arm in chronic stroke survivors: the FAST randomized clinical trial

Y. Darmon¹, S. Kantak², H. Cone³, C. Winstein¹, E. Rosario³, N. Schweighofer¹

¹USC, Biokinesiology, Los Angeles, CA, United States

²Moss Rehabilitation, Research, Elkins Park, PA, United States

³Casa Colina, Research, Pomona, CA, United States

Despite the prevalence of upper extremity limitations after stroke, effective rehabilitation parameters are unknown. Upper extremity actions in stroke survivors are slow with multiple sub-movements, compatible with poor feedforward control. Theories of error-based learning predict that fast, but not slow, movements generate large errors that provide the necessary signal for retraining feedforward controllers.

Objectives: To compare the effects of an equivalent dose of speed vs accuracy training in chronic stroke and mild-to-moderate impairments who have no direct cerebellar damage.

Patients & methods: In this Phase-1 RCT (NCT05013762), we randomized 42 participants to either a speed or an accuracy arm-movement training condition. Participants moved their paretic hands through complex tracks, with 2080 trials over 4 consecutive days. Speed was manipulated by displaying either 5cm- (speed) or 1.25 cm-width (accuracy) tracks. We measured changes in kinematics and speed-accuracy trade-off of the paretic arm during goal-directed reaching at 3 days and 1 month post-practice.

Results: Compared to accuracy training, speed training led to significantly faster and smoother movements with better symmetry of reaching velocity profile at the 3-day test, consistent with better feedforward control. Movement time and velocity symmetry of the paretic arm in the speed group post-training were comparable to those of the nonparetic arm. Speed and accuracy training led to improvement and detriment of speed-accuracy tradeoff, respectively. At 1 month, however, some gains in the two tests were lost.

Conclusion: Speed training led to greater gains in kinematics of goal-directed actions than accuracy training, notably in a 3-day post-test. To maintain longer-term gains, future trials should increase the duration of training. Nonetheless, our results suggest that training programs that include high repetitions of fast movements can improve paretic arm reaching performance.

P-148

Measurement and rehabilitation of finger motor control after stroke

P. Lindberg¹, C. Van Ravestyn², E. Gerardin², M. Térémetz¹, M. Maier³, J. C. Baron¹, L. Dupin³, G. Turc¹

¹Insitute of Psychiatry and Neuroscience of Paris (Inserm U1266), Paris, France

²Université Catholique de Louvain, Brussels, Belgium

³Université Paris Cité, Paris, France

Introduction: We developed an interactive kinetic method for measurement and rehabilitation of finger force control, rhythm tapping and independent finger movements.

Objectives: The aims were to characterize multi-component dexterity recovery and to test the efficacy of targeted dexterity training post-stroke.

Materials & methods: The Dextrain Manipulandum ™ was used to quantify accuracy of visuomotor force-tracking, timing of finger tapping and individuation of finger movements. Corticospinal tract integrity was studied using anatomical MRI and transcranial magnetic stimulation. The contribution of dexterity impairments to upper limb activity capacity were assessed using multivariate linear regression models. A pilot randomized clinical trial was conducted in chronic stroke patients to study efficacy of targeted dexterity training.

Results: Corticospinal tract integrity and was a main determinant of force control and timing but not of independent finger movements. Force control and independent finger movements explained substantial variance in hand function recovery (Box and Block test and Motor Activity Log) not explained by conventional upper limb impairment measures. Multi-component dexterity training resulted in significantly improved Box and Block scores, comparable to conventional therapy. However, training significantly enhanced reported hand use at 3-month post-training follow-up. Benefits were greater in patients with more severe motor impairment at baseline.

Conclusion: Manual dexterity impairment post-stroke is multi-component and can explain unique variance in activity capacity not captured by conventional impairment measures. The pilot RCT results suggest that targeted dexterity training may enhance recovery of several dexterity components and reported hand-use, particularly when motor impairment is moderate (low initial grip force). Findings need to be confirmed in a larger trial.

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Intervention protocol to improve balance and gait in Miller Fisher syndrome – a case study

R. Brandão¹, M. Soares¹, I. Baleia Batista¹

¹Alcoitão School of Health Sciences, Physical Therapy, Alcabideche, Portugal

Introduction: Miller Fisher"s Syndrome is a rare variant of Guillain Barré"s Syndrome, being characterized as an acute or subacute inflammatory demyelinating polyradiculoneuropathy that is normally associated with a previous infection. It"s characterized by a symptomatic triad: ophthalmoparesis, ataxia and arreflexia, however, it can be associated with the loss or decrease of sensibility and muscle strength, dysarthria, diplopia, blurred vision, and it can be linked to the injury of the cranial nerves, leading to a functional limitation. However, there"s a reduced number of papers related to this syndrome and regarding physiotherapy intervention in its rehabilitation.

Objective: Describe and analyze the influence of a protocol focused on improving balance and gait in a patient with Miller Fisher Syndrome.

Patients & methods: 70 year old patient, retired and previously independent, was diagnosed with Miller Fisher Syndrome approximately one month ago, having been admitted to a hospital unit. The patient presented an overall decrease in strength, predominantly in the right side, ataxia, and lack of balance. The patient underwent a 10-day intervention focused on strength training, balance, and gait exercises, consisting of 7 physiotherapy sessions lasting appropriately 50 minutes each.

Results: A significant improvement was observed in lower limb strength, assessed through muscle testing; in ataxia, both in static and dynamic tasks, using the Scale for the Assessment and Rating of Ataxia (SARA); in balance, evaluated using the Mini-Balance Evaluation System Test (Mini BESTest); and gait, assessed using the Timed Up and Go (TUG) test.

Conclusion: After 10 days of intervention, a significant improvement was observed in the evaluated variables. However, further studies focusing on these variables are needed to determine the best intervention for this condition.

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A neuroplasticity based approach: updating traditional neurorehabilitation models to include evidence based neuroplasticity principles

S. Dos Anjos ¹

¹University of Alabama, Physical Therapy, Birmingham, AL, United States

Introduction: Since the beginning of neurorehabilitation, patient/client assessment and management principles have emerged and evolved as new scientific discoveries have been proposed and explored. Neurorehabilitation models described as muscle-reeducation, neurotherapeutic facilitation and task-oriented have been proposed with their underlying assumptions aligned with the reflex, hierarchical and systems models of motor control and recovery. Over the last few decades, neuroplasticity research has challenged many of the "tried and true" principles of physical rehabilitation following nervous system injury. A new neurorehabilitation model could better incorporate more recent theories of motor control and recovery and inspire new ways to examine, evaluate, diagnose and manage neurologic movement dysfunctions. This session explores our current understanding of neuroplasticity and the implications of these findings for assessment and management of neurologic movement dysfunction. Based on this emerging evidence, we propose and describe a fourth neurorehabilitation model, a Neuroplasticity Based Approach, that could guide patient/client clinical assessment and management. The model"s underlying assumptions and guiding principles will be discussed in detail with clinical examples provided for each.

Objectives: Describe models that have traditionally guided neurorehabilitation assessment and interventions. Discuss recent evidence concerning neuroplasticity and the rationale for the Neuroplasticity Based Approach (NBA). Explain the underlying assumptions, guiding principles, and clinical examples aligned with the NBR Model, and Discuss future directions for developing, researching and disseminating the NBA Model.

Conclusion: A 4th neurorehabilitation model will assist rehabilitation therapists to incorporate current concepts of neuroplasticity into neurorehabilitation assessment and intervention planning/implementation.

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Empowering patients with chronic stroke using the MindMotion GO: a real-world high-dose home-training program to improve rehabilitation access

S. Arbuckle¹, A. Knill^2,3, G. Rozanski⁴, J. Tosto-Mancuso⁴, A. Ford¹, L. Derungs¹, M. Chan-Cortés¹, D. Putrino⁴, M. Branscheidt^5,6

¹MindMaze, Lausanne, Switzerland

²ETH Zurich, Department of Rehabilitation and Human Performance, Zurich, Switzerland

³Lake Lucerne Institute, Vitznau, Switzerland

⁴Icahn School of Medicine at Mount Sinai, Department of Rehabilitation and Human Performance, New York, NY, United States

⁵cereneo Foundation, Neurorehabilitation, Weggis, Switzerland

⁶ETH Zurich, Health Sciences and Technology, Zurich, Switzerland

Introduction: While evidence indicates that long-term, high-dose therapy can prevent functional decline and even enhance functionality in chronic stroke survivors, the reality is that many of these patients lack access to such rehabilitation. Reasons vary, but the primary hurdles stem from resource limitations (e.g., therapist time and cost) and intrinsic patient factors (e.g., motivation and compatibility with daily life). This leads to a divide between evidence-based recommendations from clinical trials and what is eventually implemented in real-world settings.

Objectives: This study assessed the feasibility of a long-term (≥3 months) asynchronous therapy using digital devices. This program was designed to provide patients with outpatient treatment in the comfort of their homes and the flexibility to train on their own schedule.

Patients & methods: Chronic stroke patients (n=17) underwent a 12-18 week high-dose rehabilitation program. Therapy consisted of asynchronous self-training at home using the game-based digital therapy device MindMotion GO accompanied by synchronous telerehab with a therapist 1-3 times a week. Functional and physiological assessments were done in-person at the start and end of the program.

Results: Patients completed an average of 118 minutes of active training time (ATT) across ~3 days/week for 19.5 (±2.9) weeks, with an adherence of 74% (proportion of patients who completed ≥60 min ATT/week). Patients showed meaningful clinically important improvements on the Fugl-Meyer UE (+6.4±5.1; p<0.01) and the Berg Balance Scale (+6.1±4.4; p<0.01). Overall, patient satisfaction was high and 83% wanted to continue.

Conclusion: This predominantly asynchronous program highlights the feasibility of delivering long-term, high-dose training at home with minimal therapist involvement to improve clinical outcomes. Strong adherence and motivation scores highlight its effectiveness, expanding therapy access to a broader population.

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Altered basal ganglia network topology associated with auditory-motor synchronization in parkinson’s disease

S. Lavigne¹, J. Burdette², M. Bahrami², P. Laurienti², R. Lyday², C. Alain³, M. Thaut^1,4

¹University of Toronto, Music and Health Science Research Collaboratory, Toronto, Canada

²Wake Forest University School of Medicine, Department of Radiology, Winston-Salem, NC, United States

³University of Toronto, Baycrest, Toronto, Canada

⁴University of Toronto, Medicine, Toronto, Canada

Auditory-motor synchronization (AMS) effectively addresses gait, upper limbs, and speech motor rehabilitation in people with Parkinson’s disease (PD). Predictable auditory cues optimize movement patterns while reducing the brain’s reliance on dopaminergic (DA) responses in the ventral striatum of healthy young adults (HY), albeit exact mechanisms for the reduced DA uptake require further investigation.

AMS was investigated using network science methods applied to fMRI data from 14 HY (age 22-37, 7 F), and to EEG-fNIRS data from 15 HY, 15 adults with PD and 15 controls. Our finger-tapping tasks were, (1) self-paced (SP), starting with a <10 s presentation of 1 Hz or 2 Hz tones to allow subjects to self-pace their taps, and (2) Sync, in which subjects tapped in synchrony to 1 Hz or 2 Hz tones. With fMRI data around the basal ganglia network (BGN), we performed a community structure and connectivity analyses at the voxel-wise network resolution, and mixed-effects multivariate regression (MEMR) analyses at the regions-of-interest (ROIs) network resolution. With EEG-fNIRS data, brain networks generated using EEG intracranial source-space reconstruction will be analyzed using the MEMR framework to test our hypotheses within EEG frequency bands with integrated fNIRS features.

Our community structure and connectivity analyses resulted in the BGN having statistically higher spatial consistency (p = 0.017) and more functional connections with the sensorimotor network in Sync vs SP. Our MEMR analyses demonstrated within the BGN that the probability (p = 0.0112) and strength (p = 0.064) of connections between higher efficient regions were significantly greater in Sync vs SP. Our EEG-fNIRS results are underway.

Network science methods using fMRI with HY demonstrated that AMS altered the BGN topology in its whole-brain context. Our EEG-fNIRS findings will further advance our understanding of neural mechanisms underlying clinical applications of AMS in people with PD.

P-155

Evaluating the efficacy of pre and post epidural stimulation with the TYMO balance board on postural control and physiological function among chronic SCI patients: a case study

S. Kaura¹, P. Majumdar^1,2, S. Zafar²

¹Galgotias University, Physiotherapy, Delhi, India

²Galgotias University, Physiotherapy, Greater Noida, India

Spinal Cord Injury (SCI) is a debilitating condition characterized by impaired motor function, postural control, and physiological deficits. Emerging interventions, such as Epidural Stimulation (ES) and the TYMO Balance Board, have shown promise in enhancing the recovery prospects for individuals with chronic SCI. This case study investigates the efficacy of pre and post-ES in conjunction with the TYMO Balance Board as a therapeutic approach to improve postural control and physiological function in chronic SCI patients.

Several studies have shown that ESCS can be used to identify the functional distribution of the lumbosacral posterior roots.They found that the motor responses were topographically organized, with the proximal muscles of the lower limb being activated by stimulation of the rostral roots, and the distal muscles being activated by stimulation of the caudal roots. Hofstoetter et al(2021)

Methodology: A mixed-methods approach has been employed, combining quantitative and qualitative data collection techniques,Quantitative data has encompass assessments of postural control, physiological function.These measurements hasbe taken before, during, and after the intervention period. Participants has been divided into two groups: pre-ES and post-ES with the TYMO Balance Board.

Results: The study’s findings has been analyzed to assess the impact of pre and post-ES with the TYMO Balance Board on postural control and physiological function among chronic SCI patients.

Discussion: a comprehensive analysis of the results and their implications, offering insights into the efficacy of pre and post-ES with the TYMO Balance Board. that pre-ES patients had exhibit limited improvements, while post-ES participants has shown notable enhancements in these parameters due to the stimulation’s facilitation of neural reconnection.

Conclusion: This case study aims to evaluate the potential of pre and post-Epidural Stimulation in combination with the TYMO Balance Board to enhance postural control and physiological function in chronic SCI patients.The TYMO Balance Board further amplify the benefits by promoting proprioceptive feedback and postural stability.

P-156

Boostering motor imagery to improve gait in patients with Parkinson disease and freezing of gait

S. Mezzarobba^1,2, E. Ravizzotti¹, P. Bernardis³, M. Putzolu⁴, L. Iallorandro², C. Pollio², A. Botta², G. Bonassi¹, R. Marchese², L. Avanzino^2,4, E. Pelosin^1,2

¹University of Genoa, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health (DINOGMI), Genoa, Italy

²IRCCS Ospedale Policlinico San Martino, Genoa, Italy

³University of Trieste, Department of Life Sciences, Trieste, Italy

⁴University of Genoa, Department of Experimental Medicine (DIMES), Section of Human Physiology, Genoa, Italy

Background: Motor imagery (MI) is a promising cognitive approach in the field of neurorehabilitation. It is a self-generated, dynamic state during which a motor action is mentally activated without any motor output. Evidence suggests that imagined and executed actions share nearly identical neural structures recruiting overlapping brain regions. Although authors suggest a substantially normal efficiency of MI in Parkinson"s disease patients (pwPD), results on pwPD with freezing of gait (FoG) are not conclusive. Therefore, MI training in this population may be not effective in improving movement.

Objective: The aim of this study is to evaluate the priming effect of visual, auditory and attentional tasks in enhancing MI ability in pwPD with FoG.

Materials & methods: 19 pwPD were asked to attend to 4 single sessions of MI training (one a week). Sessions consist of MI combined with motor execution or "boosted" MI training where participants were required to perform one of the "booster" tasks (Attentional, Action observation, Auditory observation (AuO)) before MI and motor execution. The training was focused on 2 gait-related patterns gait initiation and turning. The order of each session was randomly assigned. Changes in motor performance was evaluated before and after each session by using inertial sensors. MI ability measures (MI questionnaire KVIQ, GIQ), FoG severity (NFOG-Q) - were taken before and after the 4 training sessions.

Results: Overall, participants improved their MI capability (KVIQ and GIQ score p<0.001) and reduced FoG symptoms (p<0.001). The results of 360°turning task showed an improvement in velocity (p=0,016) and turn angle (p=0.002). When differences among "booster" tasks were analysed, results showed that AuO was superior in improving turning.

Conclusion: Our preliminary results show that to booster MI is feasible for improving MI ability and FoG. AuO condition seems to better improve MI priming effect on motor performance.

P-157

Combined therapeutic effects of repetitive botulinum toxin a injections, tendon transfer surgery, and occupational therapy for severe upper limb spasticity

T. Hara^1,2, K. Hagiwara², Y. Miyazaki², D. Nishida², Y. Hara³, A. Matsui³, M. Abo¹

¹The Jikei University School of Medicine, Tokyo, Japan, Rehabilitation, MInatoku, Japan

²National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan, Department of Physical Rehabilitation, Kodairashi, Japan

³National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan, Department of Orthopedic Surgery, Kodairashi, Japan

We present a case where significant functional improvement was observed in severe upper limb spasticity following repetitive Botulinum toxin A therapy (BoNT-A), tendon transfer surgery, and occupational therapy for residual hand joint impairments.The patient was a 24-year-old male who developed left upper limb paralysis after surgery for intractable epilepsy, which later progressed to chronic spasticity, prior to intervention, spasticity was particularly pronounced in the hand joint, resulting in restricted dorsiflexion. A total of 4 BoNT-A injections and rehabilitation were performed, resulting in a 2-point improvement in spasticity and Fugl-Meyer assessment (FMA). Because wrist dorsiflexion limitation remained, tendon transfer surgery was performed, and her active dorsiflexion of the hand joint improved to 20 degrees. At 8 weeks post-surgery, the FMA score improved to 52 points. These results suggest the potential for improving upper limb function through a combination of treatment approaches for severe upper limb spasticity.

P-158

New ways of treatment for childhood autism: are we moving in correct direction?

T. Voloshyn ¹

¹KIRC, Neuro, lviv, Ukraine

Background: There is a huge amount of treatment approaches for treatment of children with ASD. Generally 2 main kinds of treatment for ASD exist: psychopharmaceutical and psychocorrectional. Because of insufficiency of current rehabilitation approaches’ effectiveness there is an urgent need to search for novel therapies to cure this disease.

Objectives: Autism Treatment Evaluation Checklist was used as a tool for unbiased measure of efficacy (filled in by parents). Patients divided in 4 groups: 1-control, 2-getting psychocorrectional approach, 3-psychopharmaceutical approach and 4-high-velocity low-amplitude chiropractic intervention.

Method: Double-blinded 1-year duration study. 209 ASD patients, mean age-6years7months.

All 3 groups (2,3,4) showed improvement in comparison to control. The most visible decrease in autistic traits happened in groups 2 (55.8 ATEC score before and 48.9 after), (p<0.01) and 4 (57.5 before and 49.6 after), (p<0.01). In group 3 autistic symptoms were less manifested as well but not statistically significant to control group data (p>0.05).

Results: Pharmaceutical approach is still widely used and the most commonly administered to ASD children. But its efficacy is lacking and even symptomatic intake to cure comorbidities or autistic symptoms itself doesn’t bring long-term benefit. There should be emphasis on psychocorrectional and physical interventions including chiropractice care. Using high-velocity low-amplitude chiropractic intervention may be more beneficial in comparison to using solely psychocorrectional techniques. Although translating insights from research data into daily clinical practice is not an easy task. It takes a huge effort in terms of medical staff’ education as well as clarifying the benefits of chiropractic care to patients and healthcare professionals.

P-159

Comparing the efficacy of digital upper-limb mirror therapy with unimanual versus bimanual training post-stroke: a preliminary study

Y. W. Hsieh¹, S. X. Peng¹, C. C. Chen²

¹Chang Gung University, Occupational Therapy, Taoyuan, Taiwan

²Linkou Chang Gung Memorial Hospital, Physical Therapy and Rehabilitation, Taoyuan, Taiwan

Introduction: Mirror therapy (MT) has been recognized as an effective intervention for restoring motor function of stroke patients. Recently, new forms of MT utilizing digital image processing or virtual reality technology have been developed and used to overcome certain limitations of classic MT.

Objectives: To investigate the treatment effects of a digital mirror therapy device that provided unimanual and bimanual upper-limb training on rehabilitation outcomes in stroke patients.

Methods: Eighteen patients participated in this study, receiving either unimanual digital mirror therapy (U-DMT) or bimanual digital mirror therapy (B-DMT) for 15 training sessions. Outcome measures included the upper-extremity subscale of Fugl-Meyer Assessment (FMA-UE), Chedoke Arm and Hand Activity Inventory (CAHAI), and Motor Activity Log (MAL). A blinded rater administered the outcomes at pretreatment (T0), posttreatment (T1), and 1-month follow-up after treatment (T2). The non-parametric Friedman test and Mann-Whitney U test were respectively used to analyze within-group and between-group differences.

Results: The U-DMT group had 9 patients, as did the B-DMT group, and there was no significant difference in baseline characteristics. Both groups demonstrated significant within-group gains on the FMA-UE from T0 to T1 and from T0 to T2 (all p < 0.05). Significant within-group improvements were shown on the CAHAI from T0 to T1 (p = 0.01) in the U-DMT group and from T0 to T2 (p = 0.01) in the B-DMT group. The B-DMT had significant within-group improvements on the MAL subscales from T0 to T1 and from T0 to T2 (p = 0.01 to 0.04). However, there were no significant between-group differences on any of the outcomes.

Discussion: The preliminary results indicate that both the U-DMT and B-DMT led to improvements in upper-limb motor function for stroke patients. Nevertheless, the B-DMT demonstrated favorable effects on enhancing patient"s functional performance in real-life activities.

P-160

Online GRASP (graded repetitive arm supplementary program) – a service evaluation

E. B. Lewis¹, L. Tremain¹

¹Aneurin Bevan University Health Board, Community Neurological Rehabilitation Service, Pontypool, United Kingdom

GRASP is an arm and hand exercise program that can supplement traditional therapy, completed independently at hospital or home.

GRASP has been shown to support the improvement in arm and hand functional outcomes in Stroke patients, however, has limited impact on social isolation and feelings of abandonment after stroke. Moreover, there is limited information regarding the effectiveness of this program when delivered in an online format.

The objectives of this study are to determine whether the formation of an online GRASP group is an effective approach to supporting functional arm recovery after Stroke and improve patient wellbeing. The overarching goal is to improve the Early Supported Discharge (ESD) pathway of stroke rehabilitation and the rehabilitative journey towards self-management.

Stroke survivors in the ESD and patients from the Acquired Brain Injury Team with arm impairments were invited to participate in the online group. Patients attended twice weekly for 8 weeks. 22 patients were recruited and 15 completed the course and consented for their data to be used. Data assessment focused on pre and post Arm Activity Measure A (ArmA) and Arm Activity Measure B (ArmB). 5 of 15 participants completed the post nine-hole peg tests (9HPT). No comparative study were undertaken.

92% of participants improved ArmA and ArmB scores and 33% showed significant improvement on the 9HPT. Focus group feedback showed very strong support for the continuation of the group beyond 8 weeks. Participants reported improved; peer support, social interaction, reduced isolation, and improved speech.

In addition to functional improvements, the online GRASP approach gave patients a sense of purpose and improved motivation to continue with their rehabilitation, optimising patient wellbeing. An added benefit is that this approach is cost and time effective for providers. Future directions will include expanding opportunities for referrals from inpatient and outpatient centres.

P-161

Increased cortical activity during sensory reweighting of postural control in Parkinson’s disease

H. Devos¹, S. Fakorede¹, A. Akinwuntan¹, M. Sadeghi¹

¹University of Kansas Medical Center, Physical Therapy and Rehabilitation, Kansas City, KS, United States

Introduction: Parkinson’s disease (PD) negatively affects balance. The individual contributions of the visual, sensory, and vestibular systems on cortical activity during postural control tasks are unclear.

Objectives: To compare the efect of sensory reweighting of postural control on cortical activity between older adults with PD and controls.

Patients & methods: Ten participants with PD (age: 72 ± 9; 3 women; Hoehn & Yahr: 2 [1.5 – 2.50]) and 11 controls (age: 70 ± 3; 4 women) completed a sensory organization test in virtual reality (VR-SOT) under 6 different conditions while cortical activity was recorded using electroencephalography (EEG). Linear mixed models were used to evaluate changes in EEG alpha and theta/beta power ratio between the two groups across the postural control conditions.

Results: Participants with PD exhibited greater alpha power when relying on visual input (condition 2; p = 0.003) and greater theta/beta power ratio when relying on somatosensory input (condition 4; p = 0.001) compared to condition 1.

Conclusion: The heightened cortical activity when relying on the visual and somatosensory systems may indicate compensatory central processes to maintain balance in PD.

P-162

From plaster to pixels: digitizing jules froment’s medical masterpieces, 3D scanning and printing of medical statuettes for education on neurological disorders

H. Ardaillon¹, M. Virely², P. Leplat-Bonnevialle², J. Honnorat², E. Broussolle², S. Thobois²

¹Lyon Civil Hospitals, Physical Therapy and Rehabilitation, Lyon, France

²Lyon Civil Hospitals, Lyon, France

Introduction: Prof. Jules Froment (1878-1946), the renowned neurologist from Lyon, France, is famous for his work on Parkinson disease (1926) and depiction of ’Froment’s sign’ and ’Froment’s manoeuvre’. In the 1920s, he oversaw the creation of plaster statuettes depicting various movement disorders: laterocollis, antecollis, Pisa syndrome, Todd’s hysterical dragging gait, camptocormia and cerebellar ataxia.

Objectives: Our primary goal was to digitally recreate these statuettes in 3D to aid medical and physiotherapy education as a valuable educational tool, catering not only to visually impaired students but to a broader audience as well. We aim to make these 3D files widely accessible to the medical community.

Methods: We meticulously scanned and rendered these statuettes with help of the CO’Lab 3D platform of the Hospices Civils de Lyon (HCL). Structured light technology, scanning software (EXScan S, Shining©), and volume editing software (MeshMixer) were employed. The figurines were 3D printed with a FDM (Fused Deposition Modelling) 3D-printer at 100% and 50% scale using PLA (polylactic acid, a biosourced polymer). We also conducted a semiological description of the depicted medical conditions.

Results: The digitization was challenging, with each statuette taking around one hour to scan. Post-processing involved dealing with the superposition of scans and artifacts elimination. Printing take 20 to 30 hours, with slicer software used to adjust printing characteristics for each statuette (i.e., 15% density, 0.2mm to 0.3mm layer thickness). The complex geometry required careful material and orientation selection to ensure a high-quality surface finish.

Conclusion: Our project successfully digitally reconstructed and printed these statuettes, bridging medical art and technology, as well as preserving the original statues. This initiative offers valuable educational and research opportunities in the field of movement disorders and physical therapy.

P-163

Application of respiratory rehabilitation in respiratory peripheral system diseases

T. Yu¹, J. Li¹

¹Nanjing Medical University, Rehabilitation, Nanjing City, China

Through comprehensive measures such as exercise training, nutritional intervention, psychological support and education, respiratory rehabilitation can improve the function of chronic respiratory diseases complicated by cardiovascular and blood diseases, muscle atrophy, osteoporosis, immune decline, psychological disorders and other respiratory peripheral system diseases, and then relieve the symptoms of dyspnea, improve cardiorespiratory endurance, and improve the quality of life. This paper reviews the mechanism of action and clinical application of respiratory rehabilitation in various respiratory peripheral diseases complicated by chronic respiratory diseases, expands the scope of application of respiratory rehabilitation, and provides more choices for both doctors and patients.

References

[1] Spruit MA, Singh SJ, Garvey C,et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15; 188(8):e13-64.

[2] Holland AE. Pulmonary rehabilitation for chronic obstructive pulmonary disease: has it peaked? [J]. Respir, 2019, 24(2) : 103-104.

[3] Jin L, An W, Li Z, Jiang L, Chen C. Pulmonary rehabilitation training for improving pulmonary function and exercise tolerance in patients with stable chronic obstructive pulmonary disease. Am J Transl Res. 2021; 13 (7) : 8330-8336.

[4] Figueiredo RIN, Azambuja AM, Cureau FV, Sbruzzi G. Inspiratory Muscle Training in COPD. Respir Care. 2020; 65 (8) : 1189-1201.

[5] Shen M, Li Y, Ding X, Xu L, Li F, Lin H. Effect of active cycle of breathing techniques in patients with chronic obstructive pulmonary disease: a systematic review of intervention. Eur J Phys Rehabil Med. 2020; 56 (5) : 625-632.

[6] Zheng Zeguang, Hu Jieying, Liu Ni. Research progress of respiratory rehabilitation therapy in 2017[J]. Chinese Journal of Practical Internal Medicine, 2018, 38(05): 393-396.

P-164

MSCanRehab: accelerating Multiple Sclerosis rehabilitation research and care through a multi-site multidisciplinary collaborative network

S. J. Donkers¹, M. Finlayson², K. Knox³, N. Mayo⁴, L. Pilutti⁵, L. Walker⁶, M. Ploughman⁷

¹University of Saskatchewan, Rehabilitation, Saskatoon, Canada

²Queen’s University, Rehabilitation, Kingston, Canada

³University of Saskatchewan, Physical Therapy and Rehabilitation, Saskatoon, Canada

⁴McGill University, Physical and Occupational Therapy, Montreal, Canada

⁵University of Ottawa, Interdisciplinary School of Health Sciences, Ottawa, Canada

⁶The Ottawa Hospital Research Institute, Cognitive Health in Multiple Sclerosis Research lab, Ottawa, Canada

⁷Memorial University of Newfoundland, Medicine, St. John’s, Canada

Introduction: Multiple Sclerosis (MS) remains the primary cause of neurological disability in young adulthood. With advances in our understanding of MS pathophysiology, high efficacy disease-modifying-therapies are now available that effectively address the autoimmune and inflammatory components of MS. However, MS remains a progressive neurodegenerative condition. The role of rehab in MS has never been more important. There remains a need for effective approaches which address the neurodegenerative processes and support repair/regeneration.

Objective: To accelerate MS rehab research to advance discovery and transform care.

Materials & methods: A multi-day meeting with MS rehab researchers committed to advancing this area was held in partnership with MS Canada. Brainstorming and discussions were had on the landscape of MS rehab research. Key strengths, gaps, challenges, and needs in clinical research and clinical trials in MS rehab were identified.

Results: A multi-site and multidisciplinary network of MS rehab researchers and clinicians "MSCanRehab" was established as a key output. MSCanRehab brings together leaders with expertise in physiatry, neuropsychology, physiotherapy, occupational therapy, exercise physiology, clinical epidemiology, and neuroscience. This network shares protocols and assessments across sites to accelerate conducting research studies. We collectively set our priorities and collaboratively conduct studies. MSCanRehab aims to test novel approaches, therapies, and technologies targeting restoring function in people living with MS, and processes of care that result in high quality healthcare and improved quality of life.

Conclusion: By undertaking clinical trials and related research together, the MSCanRehab network will determine more rapidly whether a treatment works, how it works, for whom it works best, and how to support implementation. MSCanRehab aims to advance rehab care of people with MS in Canada and worldwide.

P-165

Building bridges between evidence and practice: establishing a Canadian Multiple Sclerosis (MS) rehabilitation knowledge mobilization strategy

S. J. Donkers¹, M. Bayley², T. Bruno³, K. Knox⁴

¹University of Saskatchewan, Rehabilitation, Saskatoon, Canada

²University of Toronto, Medicine, Toronto, Canada

³University Health Network - Toronto Rehab Institute, Toronto, Canada

⁴University of Saskatchewan, Physical Therapy and Rehabilitation, Saskatoon, Canada

Introduction: Despite increasing evidence for MS rehab and symptomatic care, there is suboptimal uptake and access to evidence-based MS rehab. Effective knowledge mobilization (KMb) strategies which consider the local context are key for the translation of current evidence into practice.

Objective: Overarching purpose of the Canadian MS Rehab KMb initiative is to enhance equitable access to evidenced-based comprehensive care.

Materials & methods: To inform the development of a prioritized Canadian KMb "strategy" and corresponding action items, the MSBEST leadership team (msbest.ca) in partnership with MS Canada hosted a summit to engage key participants in identifying and discussing current rehab evidence, practice and needs. The multi-component event (workshops, presentations from KMb leaders in other neuro conditions, consensus surveys) ran Nov 2022 – Apr 2023.

Results: 43 stakeholders participated in at least one component of the summit. Participants included representation from across Canada, content experts in MS and/or KMb, early/mid/late-career MS multidisciplinary clinicians, and people with MS. Participants identified 18 KMb priorities, and subsequently rated priorities in terms of their importance and feasibility. Relationships between priorities, challenges, and impact were discussed. Developing a best-practice guideline for MS rehab was unanimously identified as the top priority. Support for healthcare providers (i.e. implementation tools) and sustaining a formal KMb network with partnerships were the next 2 top ranked priorities.

Conclusion: Consensus on top priorities and lessons-learned from the summit informed a Canadian KMb strategy to help bridge the research-to-practice gap. It will also inform advocacy efforts for improved access to evidence-based rehab and opportunities to support moving a sustainable MS KMb strategy forward. Our Canadian MS Rehab KMb Network will collaboratively support advancing and re-evaluating this strategy.

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IPAC-MS: individualized access to physiotherapists for behavioural coaching to support increased physical activity (PA) levels in previously inactive individuals living with multiple sclerosis (MS)

S. J. Donkers¹, K. Ives², C. Evans³, M. Levin⁴, J. Lim⁵, K. Knox⁶

¹University of Saskatchewan, Rehabilitation, Saskatoon, Canada

²University of British Columbia, Physical Therapy and Rehabilitation, Vancouver, Canada

³University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, Canada

⁴University of Saskatchewan, Neurology, Saskatoon, Canada

⁵University of Saskatchewan, Community Health and Epidemiology, Saskatoon, Canada

⁶University of Saskatchewan, Physical Therapy and Rehabilitation, Saskatoon, Canada

Introduction: Physical activity (PA) has substantial benefits for people with MS (PwMS), yet the majority of PwMS face barriers to PA and are insufficiently active. Lack of support from healthcare providers is a key modifiable barrier. Behavioural interventions may have the largest effect sizes for increasing PA.

Objective: To evaluate a novel intervention involving individualized behaviour change strategies delivered through on-going physiotherapist support for increasing PA levels in PwMS who were previously inactive.

Materials & method: A parallel-group study randomized participants 1:1 to the 12-month intervention or a wait-list control. Participants were recruited from a database targeting individuals not currently active. The primary outcome was change in PA level on the Godin Leisure Time Exercise Questionnaire (GLTEQ), a validated self-report measure in ambulatory PwMS. Secondary outcomes include change in MS symptoms (MSIS-29), confidence with managing MS (MSSE) and exercise self-efficacy (EXSE). Associations between demographics and change in activity were explored.

Results: 120 participants were enrolled and groups were similar at baseline. Three participants withdrew (unrelated reasons), 117 participants completed primary outcome. Based on mixed effect models the change in GLTEQ differed between groups at all post-baseline time points (3, 6, 9, and 12-months). Mean change at 12 months on the GLTEQ was 15.62 (intervention group) vs. -0.33 (control group) (p<0.001). Significant between group differences for improvement on the MSIS-29, MMSE and EXSE where observed at 12 months in favor of the intervention group (p<0.0001). Demographics were not associated with change in activity.

Conclusion: PA levels and exercise self-efficacy in the intervention group improved clinically and significantly. This improvement occurred regardless of age, sex, if on an MS drug, time since relapse, or co-morbidity history, supporting the wide applicability of the intervention.

P-167

NeuroSask: Active and Connected – virtual programming for people with a neurological condition

S. J. Donkers¹, S. Patrick², C. Evans³, M. Levin⁴, G. Linassi², I. Poliakov⁴, A. Rajput⁴, K. Knox²

¹University of Saskatchewan, Rehabilitation, Saskatoon, Canada

²University of Saskatchewan, Physical Therapy and Rehabilitation, Saskatoon, Canada

³University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, Canada

⁴University of Saskatchewan, Neurology, Saskatoon, Canada

Introduction: Neurological conditions account for more than half of Canadians requiring chronic care. Development of a self-management skillset is a critical component supporting those with chronic health conditions. NeuroSask is a virtual chronic disease management program offering physiotherapist led "active" exercise twice a week, and knowledge exchange "connect" sessions with guest specialists in neurological conditions and neurorehab. NeuroSask was launched in April 2020 in response to restricted services and supports for people with neurological conditions.

Objective: To evaluate the NeuroSask program from the participants" perspectives.

Materials & methods: All participants registered for the NeuroSask program at the time (2 years post launch, n=1989) were invited to complete an optional survey circulated by email. Questions were co-designed by multi-stakeholder team members. Surveys were analyzed using descriptive statistics and thematic analysis.

Results: 434 participants completed the survey. Majority of participants reported being in the age categories of 40-59 years. 70% reported a diagnosis of multiple sclerosis and 30% reported other neurological conditions. 75% of respondents were female. 45% reported living outside of a large city. 80% reported preferring online vs. in-person format for this type of programming. Connection, empowerment, leader characteristics, accessibility, program logistics, symptom benefit, and carry-over to everyday life were key themes identified, highlighting participant perceived impact and important components of NeuroSask that could inform other programming.

Conclusion: NeuroSask is an example of an accessible and meaningful approach to providing ongoing support for some individuals with neurological conditions. It was perceived as beneficial for fostering community and connection with perceived benefits extending beyond symptom management to participant reported improvements in function, daily life, and disease experience.

P-168

Results from a 6-month extension study for individualized physiotherapy and physical activity behavioural coaching in multiple sclerosis (IPAC-MS)

K. Ives¹, K. Knox², C. Evans³, M. Levin⁴, T. Le⁵, S. J. Donkers⁶

¹University of British Columbia, Physical Therapy and Rehabilitation, Vancouver, Canada

²University of Saskatchewan, Physical Therapy and Rehabilitation, Saskatoon, Canada

³University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, Canada

⁴University of Saskatchewan, Neurology, Saskatoon, Canada

⁵University of Saskatchewan, Community Health and Epidemiology, Saskatoon, Canada

⁶University of Saskatchewan, Rehabilitation, Saskatoon, Canada

Introduction: Follow-up research assessments post-intervention can provide important information on longer term efficacy. An extension study was conducted for IPAC-MS, a RCT investigating individualized behaviour change strategies delivered over 12 months of physiotherapist support for increasing physical activity (PA) levels. Individuals (n=120) with MS who were not substantially active for health benefits at baseline were randomized to a control or intervention group.

Objective: To determine if PA behavior in the IPAC-MS intervention group was maintained 6 months post IPAMC-MS study completion (now "follow-up" group). Secondary objective was to determine if the original control group (now "cross-over group") improved PA behavior when offered the IPAC intervention for only 6 months.

Materials & methods: Over the 6 months extension period, the follow-up group received no intervention, while the cross-over group received 6 months of intervention. PA levels were measured at 3 and 6 months using the Godin Leisure Time Exercise Questionnaire (GLTEQ).

Results: 117 participants completed IPAC-MS and 116 participants (58 in each group) completed the IPAC-MS extension study. There was a statistically (<0.0001) and clinically significant difference between groups on the GLTEQ at the start of the extension study. There was no difference between groups at the 3 and 6 month extension follow-up assessments (p= 0.414). Groups were equal on the GLTEQ at the 3-month extension. The cross-over group continued to increase PA levels between 3-6 months. The follow-up group however showed a trend towards decreasing PA levels between 3-6months post-intervention, but PA levels remained much higher than baseline. The 6 month cross-over group showed a similar increase in PA as the original IPAC 12-month intervention group.

Conclusion: Further research is needed to explore optimal length of PA behavioural coaching interventions and the timing and effectiveness of "booster" interventions.

P-169

Participants perspectives of the individualized physiotherapy and physical activity behaviour coaching in multiple sclerosis (IPAC-MS) intervention

K. Ives¹, K. Knox², R. Savard³, C. Evans⁴, S. J. Donkers⁵

¹University of British Columbia, Physical Therapy and Rehabilitation, Vancouver, Canada

²University of Saskatchewan, Physical Therapy and Rehabilitation, Saskatoon, Canada

³University of Saskatchewan, Neurology, Saskatoon, Canada

⁴University of Saskatchewan, College of Pharmacy and Nutrition, Saskatoon, Canada

⁵University of Saskatchewan, Rehabilitation, Saskatoon, Canada

Introduction: Physical activity (PA) has numerous benefits for persons with multiple sclerosis (PwMS), but most are not active enough to attain substantial health benefits. Effective ways to increase PA includes implementing behaviour change strategies (BCS). The IPAC-MS study combined 3 intervention components 1) access to a healthcare provider (neuro physiotherapist [neuro-PT])support, 2) a method of being physically active and 3) integration of BCS, in an individualized manner to increase PA.

Objectives: To explore PwMS experiences with participating in the IPAC-MS study and IPAC-MS extension study (an individualized behavioural coaching intervention delivered by physiotherapists (PTs) to increase PA levels).

Materials & methods: PwMS insufficiently active for health benefits were enrolled in the IPAC-MS twelve month RCT. At month 12, the control group then crossed over to receive 6-months of the intervention. All participants (n=120) were invited to participate in a post-intervention interview about their experience with the intervention. This qualitative study was ground in an Interpretive Description approach and thematic analysis was used.

Results: Eighty participants completed interviews (40 from the original IPAC-MS study and 40 from the extension cross over). 90% reported increased confidence and physical and mental wellbeing. 70% reported improvements in mood and symptom management. Three key themes about participants experience were identified: 1) the importance of specialized care, 2) the value of individualized care, and 3) the ability of connection to motivate.

Conclusion: PwMS accessing a neuro-PT trained in BCS reported an overall increase PA in an enjoyable manner. This was credited to the specialized and individualized nature of the program, and a connection with the neuro-PT prompted accountability and motivation to be physically active. Participants requested that this service be made available to other PwMS.

P-171

Tailored follow-up for persons with multiple sclerosis to optimize physical functions, health and employment: a prospective single-blinded randomized controlled trial. A protocol

B. Normann^1,2, M. Sivertsen¹, H. K. Fikke¹, E. C. Arntzen²

¹Nordland Hospital Trust, Physiotherapy, Bodø, Norway

²Nord University, Nursing and Health, Bodø, Norway

Introduction: Fatigue, physical and cognitive impairments are prevalent in individuals with multiple sclerosis (MS), leading to unemployment, reduced quality of life, personal hardships and societal costs. Combined personalized physiotherapy and work adaptation programs remain underutilized and unexplored.

Objectives: To examine the effects of an innovative, complex intervention spanning healthcare levels and sectors, in comparison to usual care, on physical function, physical activity, quality of life and employment for individuals with MS.

Materials & methods: Design: an assessor-blinded prospective, randomized controlled trial involving 114 employed individuals with MS with minor to moderate disability (0-4 on the Expanded Disability Status Scale). The new intervention includes:

1. Two informational videos for participants and employers covering MS and work adaptations as well as optimizing function and physical activity. A hospital-based physiotherapy session and a digital meeting with a public employment consultant to identify work-related barriers, to be followed up during the intervention period.

2. Six weeks of tailored group physiotherapy (indoor and outdoor exercises/physical activity) and self-training.

3. Six weeks of digital-supported physical activity.

Assessments at baseline, week 9, 16 and 52. Outcome measurements:MS Work Difficulties Questionnaire-23, ActiGraph wGT3x-BT monitors, European Quality of Life 5-Dimension, Fatigue Severity Scale, MS Walking Scale-12, Mini Balance Evaluation Systems Test, Trunk Impairment Scale, and AccuGait Optimized force platforms. Intention-to-treat analysis employing descriptive statistics, non-parametric tests, correlation, regression analyses, and mixed models to determine potential between-group differences over multiple measurements. Work-related data collected at baseline and week 52 will be obtained from the National Labor and Welfare Register for health economic analyses.

Results: preliminary, in 2024

P-172

The six spot step test is superior in detecting walking capacity impairments compared to short- and long-distance walk tests in persons with multiple sclerosis

A. G. Skjerbæk^1,2, U. Dalgas², E. Stenager³, F. Boesen¹, L. Hvid^1,2

¹MS Hospitals in Denmark, Ry and Haslev, Skanderborg, Denmark

²Aarhus University, Public Health, Aarhus, Denmark

³University of Southern Denmark, Department of Regional Health Research, Odense, Denmark

Background: Walking capacity is important not only to persons with multiple sclerosis (pwMS) but also to clinical practice and research. The present study aims to compare the extent of impairments (relative to healthy controls [HC]) across three commonly used walking capacity outcomes in pwMS.

Methods: In a two-hospital cross-sectional study, walking capacity was assessed using the timed-25-footwalk-test (T25FWT; "walking speed"), the six-minute-walk-test (6MWT; "walking endurance") and the six-spot-step-test (SSST; "walking balance and coordination"). Data were compared to normative reference data in HC.

Results: A total of 228 pwMS (68% females) were involved in the study: age 53.7±11.6 yrs (range 26–81 yrs); patient-determined-disease-steps 3 [IQR; 1; 4] (range 0–7); time since diagnosis 12.6±9.9 yrs (range 0–49 yrs); MS-phenotype (relapse remitting MS, secondary progressive MS, primary progressive MS) 146/39/41; and co-morbidity n=80 (35%). Compared to HC, deficits were observed across all walking capacity outcomes (p<0.001): T25FWT –26 [–30; –23]%, 6MWT –36 [–39; –32]% and SSST –44 [–47; –40]%. Deficits differed across walking capacity outcomes (p<0.001).

Conclusion: Altogether, pwMS performed substantially worse than HC across all three walking capacity outcomes. The results showed that the SSST was superior to T25FWT and 6MWT in detecting walking capacity impairments in pwMS.

P-173

Multiple sclerosis therapies rather than medications

A. Alsawareah¹, H. Bani Omar¹, Z. Abu Elkishik¹, M. Bassiony², A. Mouffokes³, A. Alzboon¹, M. Meshref⁴

¹Hashemite University, Neurology, Zarqa, Jordan

²Alexandria University, Neurology, Alexandria, Egypt

³University of Oran 1 Ahmed Ben Bella, Neurology, Oran, Algeria

⁴Al-Azhar University, Neurology, Cairo, Egypt

Background: Multiple sclerosis (MS) is a complex neurological disorder marked by significant symptom burden and reduced quality of life. Complementary to conventional pharmacotherapy, non-pharmacological interventions have gained interest for their potential to alleviate symptoms and enhance well-being in MS patients.

Objectives: This review assesses non-drug interventions for multiple sclerosis, highlighting their benefits and limitations, summarizing existing research on symptom relief, cognitive improvements, and quality of life enhancements. It also suggests directions for future research and clinical practice.

Methods: We conducted a structured review of non-drug interventions for MS from PubMed, Web of Science, and Scopus. We evaluated various interventions (diet, exercise, cognition, psychology, lifestyle) for their impact on MS symptoms and well-being.

Results: The results indicated that non-pharmacological interventions for multiple sclerosis (MS) offered several benefits, including symptom reduction and improved quality of life. These interventions encompassed dietary changes, polyunsaturated fatty acid (PUFA) supplementation, interventions like dance and music therapy, mindfulness, and cognitive behavioral therapy (CBT). Complementary therapies, such as electrical stimulation, also showed promise in alleviating specific MS symptoms. Additionally, physiotherapy, exercise, cognitive rehabilitation, and lifestyle modifications were found to enhance patients’ well-being.

Conclusion: Non-pharmacological interventions enhance MS symptom management and quality of life. Customizing their use is vital. Integrating them with conventional therapies provides a holistic approach. Further research is needed for validation, addressing literature gaps, and evidence-based guidelines. Combining conventional and complementary therapies improves care for individuals with MS.

P-174

Female issues faced by women with multiple sclerosis

A. Khandelwal¹, K. Ethans¹, R. A. Marrie¹, C. Brown¹, A. Toosy²

¹Health Sciences Centre, Winnipeg, Canada²UCL, London, United Kingdom

Introduction: Multiple sclerosis (MS) is the predominant cause of disabling neurological disease in young adults and is found to be 4 times more prevalent amongst women. Typical disease susceptibility and onset is greatest during childbearing years, and as such there is concern regarding the lack of research focus on personal topics such as menstruation, menopause, contraception, and sexual activity for women.

Objective: The aim was to become more knowledgeable and gain more insight into how these issues effect women with MS, their experiences, concerns, and solutions used to manage these issues.

Materials & methods: This was a two-part study. Part 1 was a semi-structured interview discussing the main topics. Part 2 was a 28-question survey developed to answer and focus on themes brought up during the interview. There were seven participants in the interview and thirty-six respondents for the survey.

Results: The sample included 7 interviewees, and 36 survey respondents. Changes in peri-menstrual symptoms (cramps, bloating, PMS (mood swings)) were significantly associated with changes in MS (pain, fatigue, and spasticity). Menopause, level of disability and duration were not associated with MS symptoms (pain, fatigue, spasticity, motor and sensory symptoms, sexual dysfunction, sphincter dysfunction, emotional challenges, exacerbation of symptoms, and cognitive symptoms). For sexual activity the following were all found to be significantly correlated with each another – motor and sensory symptoms, sexual and sphincter dysfunction, emotional challenges, symptom exacerbation, and cognitive symptoms.

Conclusion: This study found that change in peri-menstrual symptoms is significantly correlated with change in MS symptoms. It also shows the involvement of multiple symptom domains during sexual activity amongst women with MS is highly correlated. In bettering MS symptoms, physicians need to adopt interventions that are holistic and multi-faceted.

P-175

Optimizing ambulation in multiple sclerosis patients with hip flexor weakness: an interdisciplinary approach involving orthotics, physiatry, and biomedical engineering

C. Bhatla¹, C. Ganzert², R. Reebye^1,2

¹University of British Columbia, Medicine, Vancouver, Canada

²Canadian Association of Neuro-Orthopaedics for Spasticity Consortium, Vancouver, Canada

Introduction: Multiple Sclerosis (MS) is a demyelinating disorder that often impairs mobility and quality of life. In patients whose gait is impaired by hip flexor weakness, hip flexion assist orthoses can be beneficial. However, the commercially available options are bulky and cumbersome. Recognizing this challenge, our interdisciplinary team, including a physiatrist, an orthotist, and a medical student with biomedical engineering expertise, embarked on creating a novel orthosis. By approaching the problem from a non-commercial, research perspective, we hope to develop an effective yet affordable solution.

Objectives: Our primary objective is to design a lightweight, streamlined hip flexion assist orthosis tailored for MS patients, enhancing mobility and comfort. Additionally, we aim to analyze past prescribing patterns through a retrospective chart review, seeking insights to refine future prescribing practices and identify areas for device improvement.

Patients & methods: We developed a custom orthosis with a lightweight, ergonomic design. Concurrently, we are conducting a chart review of MS patients to understand historical prescribing patterns, patient utilization, and barriers to use. The chart review examines ambulatory MS patients followed in an academic clinic.

Results: A prototype of the novel orthosis design has been developed. Preliminary feedback from select patient trials suggests enhanced comfort and mobility. The retrospective chart review is ongoing, with detailed results pending.

Conclusion: This project marks a significant step towards improving ambulation for MS patients with hip flexion weakness, while highlighting the importance of interdisciplinary collaboration. The custom-designed hip flexion assist orthosis shows promise in enhancing mobility and patient compliance. Insights from the ongoing retrospective study will likely improve referral and prescribing patterns by identifying factors that predict successful orthosis use.

P-176

Understanding health challenges and rehabilitation practices in multiple sclerosis in a resource limited setting: cross-sectional study for development of a mobile health application for rehabilitation of relapsing multiple sclerosis

D. Khurana¹, S. Rajanchellappa², A. Sinha³, S. Kathirvel², A. Kumar²

¹Post Graduate Institute of Medical Education and Research, Neurology, Chandigarh, India

²Post Graduate Institute of Medical Education and Research, Chandigarh, India

³Punjabi University, Patiala, India

Background: Mobile health (m-health)applications provide accessible technology-based solution for telerehabilitation and monitoring. An understanding of specific health-related requirements and current rehabilitation practices of people with MS(pwMS)is essential to develop a patient centric app.

Objectives: To evaluate i.specific health related challenges faced by pwMS and ii. Current rehabilitation practices of North Indian pwMS.

Methodology: Cross sectional hospital based prospective study on 60 Relapsing MS patients(2017 Mc Donald’s criteria)attending our MS clinic. Major Inclusions were: Age between 18 and 50 years of both genders;Expanded Disability Status Scale (EDSS) 1.0 to 5.0;Clinically stable for at least one month prior to enrolment;Mini-Mental Status Examination (MMSE) score> 24;Major Exclusions were: Patients not on DMTs;Pregnancy and lactation;Progressive forms of MS.Patients’ socio-demographic characteristics, clinical profiles were recorded and data on health related challenges and rehabilitation practices was collected by interview. Descriptive statistics were employed to summarize the findings.

Results: 65% were females,Mean Age:35.63 ±9.604 years,Median EDSS:2.5 (1.5- 4.5).Amongst health related issues involvement of cerebral system(73.3%) was leading, followed by pyramidal system (58.3%), cerebellar system (53.3%), bladder-issues (41.7%), and visual system (30%). Regarding rehabilitation practices, majority(n=32)engaged in self-directed exercises at home. Common challenges associated with practicing exercises at home included other commitments preventing exercise (75%), feeling less confident about exercises (68.75%), and difficulty remembering exercise steps (53.12%).

Conclusion: North Indian pwMS have a high burden of health related neurological problems and significant gaps in rehabilitation practices related to adherence and accessibility. A mHealth app) can provide a personalized and patient centric rehabilitation solution in relapsing MS.

P-177

Effects of fatigue on motor skill acquisition in people with multiple sclerosis

E. A. Toledo-Aldana¹, Z. Moslemi¹, C. S. Mang¹

¹University of Regina, Faculty of Kinesiology and Health Studies, Regina, Canada

Introduction: Fatigue is a primary symptom of multiple sclerosis (MS), but its effects on motor skill acquisition in people with MS (PwMS) are not well known.

Objective: To examine the effects of motor system fatigue on motor skill acquisition in PwMS.

Materials & methods: PwMS completed study procedures under two experimental conditions delivered in a random order and separated by >1 week: Fatigue (FTG) and Control (CTL). In both conditions, participants practiced a continuous motor sequence tracking task on two consecutive days. Tracking was controlled by pinch grip force with the dominant hand. Pre- and post-practice tests each day determined task performance, maximal pinch grip force, ratings of perceived fatigue, and neurophysiological measures of corticospinal excitability and peripheral/central fatigue. Under the FTG condition, participants completed a fatigue protocol before practice on their first day. The protocol involved sustaining a maximal pinch grip until force dropped to ≤60% of baseline maximum. Under the CTL condition, participants held a pinch grip at 5% maximal force for a similar duration as the fatigue protocol. Under both conditions, there was no fatigue or control protocol conducted on the second day of practice.

Results: Initial trends (n = 5; 51(18) years; 2 female) suggest that task performance improved similarly under both conditions on the first day, despite a decline in maximal pinch grip force and reports of mental and physical fatigue following the fatigue protocol. On the second day, task performance improved to a greater extent under the fatigue than the control condition. Task practice on the second day appeared to elicit less perceived fatigue under the FTG condition. Further analyses, including neurophysiological data, are forthcoming.

Conclusion: Initial observations suggest that motor system fatigue did not impair motor performance or skill acquisition, but may have altered perceptions of fatigue, in PwMS.

P-178

Self-management skills following 2 weeks of multidisciplinary rehabilitation in persons with multiple sclerosis – preliminary findings from The Danish MS Hospitals Rehabilitation Study II

L. Hvid^1,2, F. Boesen¹, A. G. Skjerbæk^1,2

¹The Danish MS Hospitals, Research, Ry City, Denmark

²Aarhus University, Public Health, Aarhus, Denmark

Introduction: Health education is pivotal for rehabilitation programs in persons with multiple sclerosis (pwMS), aiming to promote self-management behavioral changes and skills. This can be comprehensively evaluated by the Health Education Impact Questionnaire (heiQ), yet few studies have done so following personalized multidisciplinary rehabilitation (MDR) in pwMS.

Objectives: Using a single-arm open-label study design, our objective was to evaluate the impact of 2 weeks of inpatient MDR on heiQ in pwMS.

Materials & methods: A total of n=47 pwMS (70% females, PDDS 3.6±2.1, age 56±11 years) admitted to the Danish MS Hospitals were enrolled. Assessments were carried out before and after the 2-week inpatient MDR. The heiQ (40 items) yield scores across 8 different constructs (1-4 point scale; higher is better, except for ED where lower is better): health-directed activities (HDA), positive and active engagement in life (PAEL), self-monitoring and insight (SMI), skill and technique acquisition (STA), social integration and support (SIS), health services navigation (HSN), constructive attitudes and approaches (CAA), and emotional distress (ED).

Results: Substantial and robust improvements (within-group mean diff. [95%CI]) + effect size (ES)) were observed for HDA (0.30 [0.08:0.53], ES=0.38), PAEL (0.17 [-0.04:0.37], ES=0.22), SMI (0.33 [0.12:0.54], ES=0.43), STA (0.36 [0.16:0.55], ES=0.50), and CAA (0.24 [0.04:0.43], ES=0.34); Improvements were observed for SIS (0.10 [-0.08:0.28], ES=0.16) and HSN (0.21 [-0.02:0.43], ES=0.26); no noticeable changes were observed for ED (-0.01 [-0.18:0.15], ES=-0.02).

Conclusion: Our preliminary data show that 2 weeks of personalized MDR leads to substantial and clinical improvements in certain self-management skills (especially HDA, PAEL, SMI, STA, CAA) in pwMS. We aim to explore whether these improvements are associated with / translates into potential improvements in health-related quality of life.

P-179

Fatigue moderates the relationship between fear of falling and physical functioning among persons with multiple sclerosis

L. Abou¹, K. R. Archer², A. Kratz¹

¹University of Michigan, Physical Therapy and Rehabilitation, Ann Arbor, MI, United States

²Vanderbilt University Medical Center, Department of Orthopaedic Surgery, Nashville, TN, United States

Introduction: Fear of falling (FOF) has been associated with decline in physical functioning, increased risk of falling, and social isolation among persons with multiple sclerosis (MS). Understanding the interplay of MS symptoms such as fatigue on the relationship between FOF and physical functioning may be important to develop targeted interventions to improve physical function in this population.

Objective: To investigate whether fatigue moderates the relationship between FOF and physical functioning among persons with MS.

Materials & methods: This survey-based study included 585 adults with MS. Participants completed surveys on demographics, MS clinical data, and symptom severity. Participants also completed the Falls Efficacy Scale International to assess FOF, the Patient Reported Outcome Measurement Information System (PROMIS) physical function, and the Fatigue Severity Scale. The association between FOF and PROMIS physical function was evaluated using a linear regression analysis. A moderation analysis using Hayes"s PROCESS analysis was conducted to examine the moderating effect of fatigue on the relationship between FOF and physical function. The analysis was adjusted for age, sex, type of MS, years since MS diagnosis, status of MS, and Patient Determined Disease Steps.

Results: Linear regression analysis indicated that lower FOF was associated with higher physical function (β = -1.22, 95% CI, -1.31 to -1.13, p < 0.01). The moderation analysis indicated that fatigue significantly moderated the relationship between FOF and physical function (β = 0.12, 95% CI, -0.06 to 0.18, p < 0.01). The conditional effect highlighted that as fatigue severity decreases, the magnitude of the effect of FOF on physical function increases.

Conclusion: Fatigue significantly affects the relationship between FOF and physical function. The findings suggest that the screening of fatigue is clinically relevant among persons with MS who experience any level of FOF.

P-180

Pulsed high-frequency stochastic color light stimulation improves visual acuity in patients with optic neuritis

P. Rieckmann¹, H. Vojta¹, M. Cetin¹, P. Gulde¹

¹University of Erlangen-Nuremberg, Clinical Neuroplasticity, Bischofswiesen, Germany

Introduction: Optic neuritis (ON) is an inflammatory, demyelinating disorder of the optic nerve that often occurs in PwMS. Symptoms like reduced visual acuity, color vision and periocular pain can be ameliorated with steroid treatment but visual contrast often remains impaired and impact on QoL. There is currently no treatment to improve visual dysfunction more than 6 months after an acute ON.

Objective: To evaluate the efficacy and safety of high frequency color light stimulation in patients with MS and long-term visual impairment after ON.

Patient & methods: 28 MS patients who had lasting monocular visual impairment of 6 months and more after an acute optic neuritis. All patients had relapsing MS, received standardized steroid treatment for ON and were on disease modifying medication. We offered pulsed high-frequency, stochastic color-light stimulation. Upon informed consent patients received a stochastic, trichromatic (RGB) visual signal at a frequency of 16 Hz delivered by smart phone directly in front of the affected eye for a duration of 80 seconds twice per day for 14 days. Visual acuity, colour vision contrast were quantified by standard tests at baseline, 5 minutes and 2 hours after the first stimulation as well as days 7 and 14.

Results: Compared with non-affected eye MS patients had increased vision contrast threshold (10% vs. 23% on the affected eye). After stimulation the values improved significantly at 5 minutes (15%; p=0.002), 2 hours (12%; p=0.001) and day 14 (8%; p=0,001). Patients reported improved QoL (25/28). All patients finished the study per protocol. Minor side effects included intermittent headache and nausea in 5/28 and 3/28 patient resp.

Conclusion: Pulsed high-frequency, stochastic, color light stimulation is an easy, effective and safe, non-invasive neuromodulation technique to improve contrast vision threshold and visual acuity and QoL in MS patient with lasting visual problems after uni-lateral ON.

P-181

Effects of trunk rehabilitation on balance, gait, fall and community mobility in patients with multiple sclerosis: a randomised clinical trial

S. Mukhtar¹, G. Aljohani¹, M. Bakkar¹, N. Almutairi¹, A. Maz¹, M. Albadi¹, F. Khaan¹

¹King Abdulaziz University, Dschidda, Saudi Arabia

Background: Multiple Sclerosis (MS) causes difficulties and impacts daily living and social life, which affects quality of life. Balance, gait, and risk of falls often associate with trunk impairment in MS patients. There is a need for interventions addressing these concerns and exploring potential effects of trunk rehabilitation.

Objective: To examine trunk rehabilitation effectiveness in individuals with MS and determine an optimal intervention strategy.

Patients & methods: 40 patients randomly assigned to Trunk Group and Core Group. Trunk Group received trunk exercises in multiplanar movements on unstable surfaces, alongside dual-task training. Core Group received standard core stability exercises. Both groups received conventional treatment with intervention. The primary outcome was Trunk Impairment Scale (TIS). Secondary outcomes were Berg Balance Scale (BBS), Timed Up and Go (TUG), Modified Falls Efficacy (FES), Modified Fatigue Impact Scale (MFIS), Hospital Anxiety and Depression Scale (HADS), and Reintegration to Normal Living Index (RNLI). For analysis, we performed two-way Mixed Model ANOVA.

Results: Results of two-way Anova time into condition interaction indicated significant improvements for the Trunk group in the Primary outcome TIS compared to the core group (MD=3.33, P≤0,001). In addition, BBS scores significantly increased (MD=5.42 , P≤ 0.001). TUG (MD= -10.3, p=0.06). Community mobility measured by RNLI also increased significantly for the trunk group (MD=0.15, P=0.003). Furthermore, trunk group had a significant reduction in depression and anxiety in HADS scores (MD= -3.7 , P=0.008) and Fatigue, measured by MFIS (MD= -9.63, P=0.007). Additionally, showed a higher scores in the MFES (MD=27.5, P≤0.001).

Conclusion: Trunk training suggested in this study shows promising evidence to effectively enhance trunk control, balance and gait in PwMS. Reducing their risk of falling and improves their mental well-being, confidence, and community mobility.

P-182

Procyanidin B2 protects astrocytes from H₂O₂-induced oxidative damage through Nrf2/HO-1 and Akt/Stat3 signaling pathways

S. Yuan ¹

¹Shanxi University of Chinese Medicine, Jinzhong, China

Background and Aims: Astrocytes (AS) are the main glial cells in the central nervous system (CNS) and play a key role in the pathology of CNS. High concentrations of oxidative free radicals have strong reactivity, which can lead to activated AS dysfunction. Proanthocyanidin B2 (PC-B2) is a member of the flavonoid family. It is considered to be an effective therapy for alleviating neurodegenerative diseases. Therefore, this study aims to explore the protective effect of PC-B2 on H₂O₂-induced oxidative damage in AS, and provide new insights into the neuroprotective effect of PC-B2.

Methods: The AS were randomly divided into control group, model group and treatment group. The content of MDA and the activity of SOD, CAT and GSH-Px were detected by ELISA kit. The mRNA and protein expression levels of Bax, Bcl-2, Caspase-3, Akt/Stat3, p-Akt, p-stat3 and Nrf2/HO-1 in AS were detected by RT-PCR and Western Blot, respectively.

Results: PC-B2 intervention could significantly reduce the content of MDA in AS, and increase the activity of SOD, CAT and GSH-Px. PC-B2 intervention could inhibit the mRNA and protein expression of Bax and caspase-3, and up-regulate the mRNA and protein expression of Akt/Stat3, Bcl-2, Nrf2/HO-1.

Conclusions: PC-B2 can significantly enhance cell viability and inhibit AS apoptosis. Compared with the H₂O₂ model group, PC-B2 intervention could significantly reduce the content of MDA in AS, and increase the activity of SOD, CAT and GSH-Px. PC-B2 intervention could inhibit the mRNA and protein expression of Bax and caspase-3, and up-regulate the mRNA and protein expression of Akt/Stat3, Bcl-2, Nrf2/HO-1.

P-183

Dynamics of visual-spatial search in patients with neglect syndrome after two types of group-based rehabilitation

G. Stepanov¹, D. Yurina¹, V. Propustina¹, M. Kovyazina^1,2,3, N. Varako^1,2,3, S. Vasilyeva⁴, V. Daminov⁴, Y. Zinchenko^1,3

¹Lomonosov Moscow State University, Psychology, Moscow, Russian Federation

²Research Centre of Neurology, Institute of Neurorehabilitation and Recovery Technologies, Moscow, Russian Federation

³Federal Scientific Center of Psychological and Multidisciplinary Research, Laboratory of Counseling Psychology and Psychotherapy, Moscow, Russian Federation

⁴Pirogov National Medical and Surgical Center, Moscow, Russian Federation

Introduction: Currently, there is a lack of focus on the rehabilitation methods for patients experiencing neglect syndrome (hereinafter referred to as NS). It is imperative to develop a successful approach to address this condition effectively.

Objective: A specialized rehabilitation program was created and evaluated for patients suffering from NS. It is anticipated that this training will yield favorable outcomes in terms of visuospatial search abilities, thereby reducing the symptoms associated with NS.

Patients & methods: The study consisted of two phases: 1) the creation and validation of the author’s task (83 patients with right hemisphere brain lesions); 2) the development and testing of a specific and non-specific rehabilitation training programs and the assessment of its effects on visuospatial search measures in patients diagnosed with left-sided visuospatial NS (37 patients).

Results: Data analysis using ANOVARM revealed statistically significant changes in the visuospatial search abilities of patients in the experimental group. Specifically, there was an increase in the number of head turns to the left (F=18.127, p<0.05) and a decrease in the proportion of missed stimuli on the left (F=18.367, p<0.05). Furthermore, total time spent performing the author’s technique increased after specialised rehabilitation training. This increase suggests that patients in the experimental group have a heightened awareness of the search process. Conversely, no significant differences were observed in the visuospatial search indicators of the patients in the two control groups.

Conclusion: Upon completion of a specific rehabilitation program targeting left-sided NS, patients exhibited significant improvements in visuospatial search indicators and increased overall visual activity. Non-specific effects include increased motivation, commitment to the rehabilitation process and willingness to attend additional individual and group sessions.

P-184

The colours of neglect

G. Rode¹, E. Chabanat¹, M. Lunven², J. Courtille³, P. Revol¹, L. Pisella¹, Y. Rode¹

¹Claude Bernard University, Centre de Recherche en Neurosciences de Lyon, Lyon, France

²ENS, PSL Research University, Département d’Etudes Cognitives, Paris, France

³Sorbonne Université,, Sciences, normes, démocratie (SND), UMR 8011,, Paris, France

Introduction: Neglect is defined as a lateralised attentional bias. It is a polymorphic disorder that can associate, in the same patient, deficient and / or productive symptoms depending on the topography of the right brain lesion. Complexity of neglect is better reflected in the drawings made from memory, and even in works by artists who suffered from left neglect.

Objectives: We report an exceptional and large series of 40 hand oil paintings made by patient F.B who developed intense pictorial activity for period of 3 years after a right subcortical lesion. To face the complexity of this material, we designed an original method borrowed from astrophysics.

Materials & methods: For each canvas, 3 parameters were measured and studied as a function of recovery time: the unpainted areas; the colour complexity (entropy) along the horizontal axis with a psychophysical approach using the HSV (Hue, Saturation, Value) human colour space model and the length of boundaries drawn in each side reflecting the monochromatic areas size.

Results: The early paintings showed unpainted areas on the left side lasting up to week 20. It was not the true end of the recovery but rather the beginning of a process of reappropriation of the left space by F.B. On this side, he produced large monochromatic dull areas whose colours and boundaries progressively gained in complexity. Initially the colours appeared colder (H more toward the blue), more dull (less S) and darker (less V). The follow-up analysis showed that HSV showed same recovery curves with a plateau and a slow progressive reduction of the entropy asymmetries.

Conclusion: Neglect cannot be simply interpreted as a combination of left sided deficit and right sided productive symptoms on the canvas. It associates other representational perturbations revealed by the choice of the colours and the size of the color patches. Free painting activity may have played a role in the recovery of neglect promoting a new relationship with space.

P-185

Development of an online visual scanning treatment for visuo-spatial neglect post-stroke: a single-case study series

N. Murphy¹, S. Horne¹, G. Eskes¹

¹Dalhousie University, Halifax, Canada

Introduction: Spatial neglect is a common attentional disorder after right hemisphere stroke characterized by difficulties with orienting, detecting or responding to information in the contralesional space on the body or in the environment. Evidence for effective rehabilitation is limited, but visual scanning treatment (VST) is an option and recommended in the 2020 Canadian Stroke Best Practices for Rehabilitation. Effective treatment often requires intensive practice with a therapist for at least 15 hours over 5 weeks, and thus it is difficult to implement with limited hospital resources.

Objectives: Our goals were to examine the feasibility and effectiveness of an online visual scanning program (SpyTrain) for visuo-spatial neglect post stroke.

Methods: Three patients with right hemisphere stroke and spatial neglect underwent visual scanning treatment using a non-concurrent multiple baseline single-case experimental design. Treatment included randomization to 3 different baseline lengths, followed by visual scanning treatment, 5 times/week for 5 weeks. Outcomes were collected repeatedly throughout the phases and analysed with Tau-U, a nonparametric test of non-overlap and trend in the intervention phase compared to baseline, with effect size (ES) values ranging between -1 and 1.

Results: In terms of feasibility, average training compliance was 94.7% (range = 84-100%) of sessions. Performance on our primary outcome, Landolt C cancellation task, showed a significant reduction in visual scanning omissions in all 3 participants. Tau-U values ranged from 0.61 to 0.84, with an average Tau-U value of 0.75 (large ES, p<.001). Subjective benefits were also reported by all 3 participants.

Conclusions: Data collection from additional patients continues. If this online method of VST continues to be feasible and effective, it would provide an accessible form of treatment for a common and chronic disorder, improving independence and quality of life after stroke.

P-186

Resting-state functional MRI and motion analysis characteristics in patients with isolated REM sleep behavior disorder

E. Sarasso^1,2,3, A. Gardoni¹, S. Marelli⁴, R. Balestrino^3,5,6, L. Zenere¹, S. Basaia¹, A. Castelnuovo⁴, A. Tettamanti⁷, L. Ferini-Strambi^3,4, M. Filippi^1,3,5,8,9, F. Agosta^1,3,8

¹IRCCS San Raffaele Scientific Institute, Neuroimaging Research Unit, Milan, Italy

²University of Genoa, Neuroscience, Genoa, Italy

³Vita-Salute San Raffaele University, Milan, Italy

⁴IRCCS San Raffaele Scientific Institute, Sleep Disorders Center, Milan, Italy

⁵IRCCS San Raffaele Scientific Institute, Neurorehabilitation, Milan, Italy

⁶IRCCS San Raffaele Scientific Institute, Neurosurgery and Gamma Knife Radiosurgery Unit, Milan, Italy

⁷IRCCS San Raffaele Scientific Institute, Department of Rehabilitation and Functional Recovery, Milan, Italy

⁸IRCCS San Raffaele Scientific Institute, Neurology, Milan, Italy

⁹IRCCS San Raffaele Scientific Institute, Neurophysiology Service, Milan, Italy

Introduction. Isolated REM sleep behavior disorder (iRBD) might represent an early manifestation of α-synucleinopathies.

Objectives. To assess clinical, motion analysis and resting-state functional MRI (RS-fMRI) functional connectivity (FC) alterations in iRBD patients relative to healthy subjects and the correlations between clinical features and RS-fMRI changes in iRBD.

Patients & methods: Thirty-eight patients with a polysomnography-confirmed iRBD and 28 age/sex-matched healthy controls underwent clinical, motion analysis, and RS-fMRI evaluations. Motion analysis was performed using a stereophotogrammetric system to assess spatio-temporal parameters during single and dual-task gait/mobility conditions. RS-fMRI images were analyzed using an Independent Component Analysis to study FC of RS networks.

Results: IRBD patients relative to healthy controls showed a worse manual dexterity at 9-hole peg test (9HPT), a higher asymmetry of arm swing amplitude during gait and a higher stride length variability while walking with cognitive dual-task relative to healthy subjects. Moreover, iRBD patients showed a decreased FC of pallidum within the basal ganglia network and of occipital and temporal areas within the visuo-associative network compared to healthy controls. The decreased FC in the basal ganglia network was correlated with a worse manual dexterity and with an increased asymmetry of arm swing amplitude during walking in iRBD subjects.

Conclusion: This study suggested that RS-fMRI, clinical and motion analysis features could help to identify early subtle movement disorders in a subclinical phase, being promising biomarkers for early alpha-synucleinopathy detection in iRBD. Longitudinal data will allow to test a multifactorial prediction model combining fMRI, clinical and motion analysis data to predict the conversion from iRBD to parkinsonian syndromes.

Funding: Italian Ministry of Health [grant number # RF-2018-12366746]

P-187

Neural correlates of bradykinesia in Parkinson’s disease: a kinematic and FMRI study

E. Sarasso^1,2,3, A. Gardoni¹, D. Corbetta⁴, D. Emedoli⁴, L. Zenere¹, A. Grassi^1,3, S. Basaia¹, D. Vidale⁵, M. Filippi^1,3,6,7,8, F. Agosta^1,3,6

¹IRCCS San Raffaele Scientific Institute, Neuroimaging Research Unit, Milan, Italy

²University of Genoa, Neuroscience, Genoa, Italy

³Vita-Salute San Raffaele University, Milan, Italy

⁴IRCCS San Raffaele Scientific Institute, Department of Rehabilitation Functional Recovery, Milan, Italy

⁵Khymeia S.R.L, Padua, Italy

⁶IRCCS San Raffaele Scientific Institute, Neurology, Milan, Italy

⁷IRCCS San Raffaele Scientific Institute, Neurorehabilitation, Milan, Italy

⁸IRCCS San Raffaele Scientific Institute, Neurophysiology Service, Milan, Italy

Introduction: Bradykinesia is one of the cardinal signs of Parkinson"s disease (PD) and is usually assessed during repetitive movements. The neural correlates of bradykinesia are still debated.

Objectives: The aim of the study was to investigate the neural correlates of hand tapping performance in patients with PD relative to healthy controls.

Patients & methods: Fifteen PD patients and 15 age- and gender-matched healthy controls were included. All the subjects underwent brain magnetic resonance imaging (MRI) including a hand tapping functional MRI (fMRI) task: subjects were asked to alternatively open and close (hand tapping) their right hand as fast and as ample as possible. Hand tapping speed and amplitude was measured during the fMRI task using an optical fiber data glove.

Results: During the fMRI hand tapping task, patients with PD showed reduced hand tapping amplitude and reduced activity of frontoparietal areas and sensorimotor regions including supplementary motor area (SMA), pre/postcentral gyri, pallidum and cerebellum compared to healthy controls. Decreased activity of SMA, cerebellum lobule VIII and caudate correlated with reduced hand tapping amplitude.

Conclusion: As expected, patients with PD showed a worse hand tapping performance in terms of reduced movement amplitude relative to healthy controls. Interestingly, we found a correlation between bradykinesia and brain activity. In particular, areas strongly involved in motor planning such as SMA and caudate correlated with reduced movement amplitude. This study has the major strength of collecting objective motor parameters and brain activity simultaneously, providing a unique opportunity to investigate the neural correlates of bradykinesia in PD. A reduced recruitment of cortical, cerebellar and basal ganglia areas implicated in motor programming is a hallmark of bradykinesia in patients with PD.

Funding: Italian Ministry of Health grant GR-2018-12366005

P-188

Non-invasive novel spinal cord functional evaluation using fNIRS: insights from complete traumatic injuries

J. P. Appelgren Gonzalez^1,2, R. Caulier Cisterna³, J. E. Oyarzún¹, L. Gonzalez¹, S. Uribe⁴, A. Eblen-Zajjur⁵

¹Catholic University of Chile, Biomedical Imaging Center, Santiago, Chile

²Trainfes, Translational Research Unit, Santiago, Chile

³Metropolitan University of Technology, Department of Informatics and Computing, Faculty of Engineering, Santiago, Chile

⁴Monash University, Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Australia

⁵Universidad Diego Portales, Facultad de Medicina, Lab. Neurociencia Traslacional, Santiago, Chile

Background: Despite great diagnostic advances in neuroimaging and electrophysiology, current medical care lacks an effective measurement of the functional status of the spinal cord. The link between neural activity and local blood flow, named as Neurovascular coupling, is a key element in the management of people with spinal cord injury (SCI).

Methods: In this study, near-infrared spectroscopy (fNIRS) was employed for the first time, to assess the functional status of the spinal cord in three traumatic SCI patients (PA, PB, PC), resulting from motorcycle accidents. This technique detected spinal functional lesions by monitoring the spinal neuro-vascular response (NVR), triggered by peripheral nerve stimulation of the left median nerve. Eight channels record real-time O2Hb, with stimuli applied every 4 minutes. Patient responses were compared to a healthy matched volunteer group (CG) (n=37)

Results: No EMG activity interference was observed during stimulation. Median nerve conduction velocity (NCV) was consistent with CG. NVR patterns in SCI patients were distinct compared to CG, with variations based on the injury level. PA showed thoracic NVR similar to CG, with a larger rise time and lower amplitude, while in Cervical zone, only one channel showed a clear response. PB and PC had lower Thoracic responses, characterized by shorter amplitude and larger rise time. Also, a correlation was observed between NVR patterns and the anatomical level of injury.

Discussion: Our results demonstrate the feasibility of using fNIRS to detect significant differences between healthy volunteers and patients with complete traumatic SCI. Importantly, these differences were not associated with abnormal NCV or EMG activity, eliminating potential artifacts and highlighting the specificity from this method. This suggests that fNIRS could serve as a valuable complementary tool in the diagnostic and follow up for people with SCI, providing a non-invasive and function-focused perspective.

P-189

Neuroimaging indicators of post-stroke spasticity

K. A. Scarlat^1,2, T. Wein^3,4,5, M. H. Boudrias^2,6, A. Thiel^3,7, A. G. Feldman^2,8, M. Levin^2,6

¹McGill University, Neuroscience, Montreal, Canada

²Jewish Rehabilitation Hospital, Centre for Interdisciplinary Research in Rehabilitation, Laval, Canada

³McGill University, Neurosurgery, Montreal, Canada

⁴McGill University, Montreal, Canada

⁵St Mary’s Hospital, Montreal, Canada

⁶McGill University, Physical and Occupational Therapy, Montreal, Canada

⁷Jewish General Hospital, Montreal, Canada

⁸University of Montreal, Neuroscience, Montreal, Canada

Stroke is a main cause of disability and post-stroke spasticity affects up to 60% of stroke survivors, limiting their recovery and functional independence. Accurate early detection of spasticity may be hampered by limitations in current clinical measures. Better detection of spasticity may help to decrease the impact of spasticity by the administration of earlier tailored treatments.

Our objective was to determine the relationship between stroke lesion location, descending tract integrity, and changes in spinal cord motoneuronal excitability using a novel measure, the Tonic Stretch Reflex Threshold (TSRT), on the development of spasticity in people with acute stroke. We hypothesized that greater stroke-related damage in the brain and descending cortico- and reticulospinal tracts would be associated with the development of a larger angular zone in which spasticity is present in the affected muscles.

Individuals were admitted into the study within one week of their stroke and assessed weekly for 12wk to evaluate sensorimotor deficits and spasticity in elbow flexors and/or ankle plantarflexors (TSRT; Modified Ashworth Scale [MAS]; etc.). Brain and spinal cord scans were done 6wk post stroke using anatomical and diffusion Magnetic Resonance Imaging (MRI). Manual lesion delineation of MRI scans was done with the FSL program, and diffusion data analysis of the reticulospinal and corticospinal tracts was done using the Spinal Cord Toolbox.

Preliminary results indicate that the TSRT is more sensitive for the early detection of spasticity than the MAS, and that there is a correlation between the reticulospinal tract radial diffusivity of the and the level of spasticity identified by the TSRT.

By improving accuracy in predicting who will develop spasticity after a stroke, more tailored treatments may be created to minimize the impact of spasticity on recovery and increase the functional independence in those living with stroke.

P-190

Menstrual cycle phase modulates causal connectivity in the resting-state brain: implications for clinicians and researchers

J. McLeod¹, A. Chavan², S. Damji³, L. Galea⁴, S. Babul^5,6, N. Virji-Babul^7,3

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²Sardar Patel Institute of Technology, Electronics and Telecommunication Engineering, Mumbai, India

³University of British Columbia, Physical Therapy, Vancouver, Canada

⁴Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada

⁵Centre for Addiction and Mental Health, Toronto, Canada

⁶University of British Columbia, Pediatrics, Vancouver, Canada

⁷University of British Columbia, Vancouver, Canada

Introduction: Ovarian hormones exert direct and indirect influences on the brain; however, little is known about how these hormones impact brain connectivity. Studying the female brain at a single time point may be confounded by distinct hormone phases. With studies often overlooking the menstrual cycle, studies of brain connectivity are important to the investigation of brain function in both healthy controls and in neuropathology.

Objective: To characterize resting-state causal connectivity during the follicular and luteal menstrual phases corresponding to low vs high estradiol and progesterone, respectively.

Methods: We used EEG to assess resting-state causal connectivity in a cohort of 40 healthy control females (mean age = 20.9 years, SD =1.8). Twenty participants were evaluated during their early follicular phase (M = 2.8 days after menses onset, SD =0.8) and twenty during their mid-luteal phase (M = 19.6 days after menses onset, SD =1.5). Causal connectivity was quantified using the information flow rate of EEG source data.

Results: A statistically significant difference in causal connectivity was observed between the follicular and luteal phases (p<.0001). During both phases, the brain regions driving activity were primarily (R) lateralized. Information flow during the follicular phase was widespread, with the (R) frontal, (R) central, (L) and (R) parietal, and (R) occipital regions driving activity and the (L) central region being the predominant receiver of activity. During the luteal phase, activity shifted posteriorly with information flowing primarily from the (R and L) parietal and occipital regions, with the main receiver of activity being the (L) occipital region.

Conclusion: The shift in causal connectivity demonstrates the flexibility of network dynamics as a function of menstrual phase, potentially impacting cognitive and emotional processing. These results emphasize the importance of considering the menstrual cycle during neurorehabilitation.

P-191

Enhancing our understanding of neural mechanisms underlying tool use performance: a comparative analysis of apraxia patients and healthy older adults

C. Seifert¹, E. Salazar-Lopez¹, T. Kampe¹, A. Wohlschlaeger², J. Hermsdoerfer¹

¹Technical University of Munich, Chair of Human Movement Science, Munich, Germany

²Technical University of Munich, Department of Neuroradiology, TUM-Neuroimaging Center, Munich, Germany

Introduction: Apraxia, a severe neurological health issue, may lead to impaired tool use performance. Addressing the neural complexities of this ability requires a methodological approach, combining fMRI and lesion data. This combination, however, remains challenging since the majority of fMRI studies involve young healthy individuals, while lesions predominantly affect older individuals.

Objectives: The present study employed a comparative analytical approach to assess the brain activation patterns in healthy older adults proficient in proper tool use and apraxia patients, experiencing impairments in performing tool-related tasks accurately.

Materials & methods: The study included 16 healthy individuals (Mage = 67.6 y) and 31 apraxia patients (M age = 56 y). Healthy adults engaged in tool-related tasks using MRI-compatible 3D tools in an event-related fMRI study, while apraxia patients underwent a VLSM approach linking damaged regions to error rates during similar tasks. The analysis compared activated brain areas in healthy adults with VLSM results in apraxia patients.

Results: The current study revealed that the left IPL, SMG, MOG and SPL were activated in healthy older individuals, and additionally linked to impaired tool use performance in the patient group. Frontal regions, such as the left IFG, and parietal regions, such as the AG, were revealed by VLSM, but not activated in healthy adults.

Conclusion: This comparative analysis stresses the importance of several areas, including the IFG, SPG, SMG, ITG and MTG, in their role in conducting tool-related tasks properly. Significantly, areas like the AG, damaged in patients but not activated in healthy individuals, imply the presence of ongoing plasticity mechanisms. This phenomenon could potentially indicate the broadening of the tool use network beyond the primary network engaged under healthy conditions.

P-192

Triadic and dyadic taxonomy of body representation: an analysis of brain mapping studies

H. Santos¹, I. Baleia¹, R. Brandão¹, G. Santos¹, I. Marques¹, J. Lamarão¹, J. Morais¹, L. Correia¹, J. Casaca¹

¹Alcoitão School of Health Sciences, Physiotherapy, Cascais, Portugal

Introduction: The 20th-century dyadic taxonomy (DT) of body schema (BS) and body image (BI) has long served as an interpretative tool for body representation (BR). However, since 2005, a triadic taxonomy (TT) proposing an additional BR: structural body description (SBD) and body semantics (BSem), has been suggested.

Objectives: Identify studies that assess the TT and DT as neuroscientific constructions of BR; identify conceptual and theoretical differences between TT and DT; examine the paradigms used in each of the BRs; compare the results and conclusions of studies.

Methodology: Out of a total of 1053 articles, 7 experimental studies were selected for analysis. The research was based on the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) methodology.

Results: The areas involved in the representation of BI according to the DT are the parietal cortex (left post-central sulcus and left intra-parietal sulcus) and the ventral pre-motor cortex; the areas activated during BSem are the left occipito-temporal lobe - fusiform gyrus and extra-striate body area (EBA), the left pre-cuneus, the right frontal lobe (pre-central gyrus), the right superior frontal gyrus, and the right cerebellum. There is an association of BS and SBD with differential neural substrates, suggesting that these BRs are independent, thus amplifying the functions of the secondary somatosensory cortex. The parietal and frontal cortex regions, namely the left inferior parietal lobe, left inferior frontal gyrus, bilateral, bilateral pre-motor cortex and anteromedial inferior parietal lobe, correspond to the areas responsible for SBD. The data related to the SBD showed bilateral activation in the superior parietal lobe (7A), posteroinferior temporal gyrus, middle frontal gyrus and left pre-central gyrus.

Conclusions: Through the selected brain mapping studies, TT and DT should not be considered neuroscientific constructions of BR, but rather conceptual.

P-193

Effects of musical mnemonics on the behavioural mechanisms and associated neural synchronization of memory performance in persons with amnestic mild cognitive impairment

L. Cole¹, M. Thaut¹

¹University of Toronto, Music and Health Sciences Research Collaboratory, Toronto, Canada

Amnestic Mild Cognitive Impairment (aMCI) is a neurological disease characterized as a pathological disorder of cognitive impairment, primarily in memory function, and the prodrome of Alzheimer"s Disease (AD). Cognitive rehabilitation has become a primary approach for intervention for this population, with a considerable number of studies demonstrating the older adult brain to be capable of plastic changes. Memory training which induces neuroplasticity demonstrates potential benefits. Specifically, studies find music-assisted learning to be an effective aid for verbal memory, though focusing primarily on AD, neglecting aMCI. The present study intends to determine whether this influence of musical mnemonics is apparent in this transitional stage between healthy aging and AD. The study protocol is reciprocal to that of Thaut et al., 2014, involving the administration of an ordered word-list task while participants simultaneously undergo electroencephalography (EEG) recording. This within-subject paradigm will measure behavioural differences in memory recall of an ordered word list, presented either sung as a musical mnemonic, rhythmically spoken, or spoken. EEG will be used for noninvasive task-related imaging, with high temporal resolution of the brainwave measures. Time-frequency analyses will determine the effects of musical mnemonics, as an aid in verbal memory, on neural synchronization. Anticipated results are that older adults with aMCI will exhibit improved verbal learning and short-term memory of an ordered word list using musical mnemonics, with significantly increased bilateral topography, and increased learning-related alpha band coherence for memory recall in the musical mnemonic conditions. A proactive approach to early interventions for aMCI is needed to prevent deterioration in cognition. Fewer AD cases will have a positive domino effect on our public health system, creating more space and availability for resources and clinicians.

P-194

Towards the future of neuroimaging: development of an ultra-low field MRI with a pump-probe-type optically pumped magnetometer

T. Kobayashi ¹

¹Kyoto University, Open Innovation Institute, Kyoto, Japan

Introduction: At present, MRI is one of the most useful imaging modalities, which enables visualization of the anatomy and function of the human brain. However, the conventional high magnetic field scanner has some limitations such as high cost and risk for patients with metal implants. To measure MR signals together magnetoencephalogram (MEG) without these limitations, ultra-low-filed (ULF) MRI attracted attention in recent years.

Objective: We have been developing optically pumped magnetometers (OPMs) with pump-probe arrangement. OPM is a sensor based on electron-spin polarization of alkali-metal atoms. Here, we introduce our newly developed miniaturized OPM to demonstrate its feasibility for both MRI and MEG measurements.

Materials & methods: In the OPM, a circularly polarized pump laser beam and a linearly polarized probe laser beam crossed orthogonally in the center of the glass cell including vaporized atoms. The strength of magnetic field can be measured based on the rotation angle of the linearly polarized plane of the probe beam. Sensitivity of OPMs do not depend on frequency, so that OPMs are suitable to be used as receiving sensors for ULF-MRI. Recently we developed a compact OPM module together with Hamamatsu Photonics K.K.

Results: We developed an OPM-based 7mT-MRI scanner operating at a Larmor frequency of 300 kHz. 3D imaging of a phantom was achieved with a resolution of 3×3×3 mm³ [J. of Magnetic Resonance, 343, 107280, 2022]. By using the same OPM, we successfully measured visual evoked responses and cortical activities associated with motor imagery of the wrists as well.

Conclusion: These results demonstrate the feasibility of the OPM as a common sensor both for MEG and ULF-MRI. We believe that the applicability of an affordable OPM-based MRI-MEG system might provide important advancements in neuroscience and improve the clinical diagnosis of neuropsychiatric disorders.

P-196

A systematic review of vestibular stimulation in post-stroke visual neglect

M. Sakel¹, L. Smith^1,2, C. Wheeler², D. Wilkinson²

¹East Kent University NHS Hospital, Neurorehabilitation, Canterburry, United Kingdom

²University of Kent, Psychology, Canterburry, United Kingdom

Introduction: Visual neglect adversely affects the lives of many stroke survivors. Studies have investigated different forms of vestibular stimulation as a potential therapy, but evidence is yet to be systematically reviewed.

Objectives: To determine whether people with post-stroke unilateral spatial neglect who receive vestibular stimulation ( Caloric Vestibular Stimulation CVS, Galvanic Vestibular Stimulation GVS ) show improvement in neglect symptomology and activities of daily living (ADL) relative to a comparator condition.

Materials & methods: The protocol for this review was registered on the Open Science Framework in May 2020 (https://doi.org/10.17605/OSF.IO/62SM5)

This systematic review used the Participants, Interventions, Comparisons, Outcomes (PICO) model[39] to design our research question and search strategies.

CENTRAL, PubMed, WHO ICTRP, PsychINFO, and CINAHL were searched. OpenGrey was used to search for grey literature, whilst Latin American and Caribbean Health Science Literature (LILACS) and the African Index Medicus (AIM) were searched for non-English sources.

Reviewer Manager 5.4 software was used to carry out statistical analyses to determine treatment effects

Results: PRISMA flow diagram showed 7244 initial records with 17 records were deemed eligible.

For meta-analyses, heterogeneity was visually assessed by looking at the forest plots and considering the extent to which the 95% CIs overlapped. The I2 statistic was also considered.

Forest plot displaying effect sizes and confidence intervals for individual studies which applied contra-lesional CVS showed improved Cancellation scores post-CVS.

Vestibular rehabilitation and motion-based stimulation resulted in increased scores post-stimulation in all studies assessed.

Conclusion: Vestibular stimulation, most notably CVS, shows promise as a potential treatment for post-stroke neglect, but conclusions are limited by clinical and methodological heterogeneity.

P-197

Correlation between cortical excitability and functional changes after combined bilateral neuromodulation therapies in stroke patients

F. J. Sánchez Cuesta¹, Y. González Zamorano², M. Moreno Verdú¹, A. Cerezo Zarzuelo³, B. Madroñero Miguel¹, J. P. Romero Muñoz^1,3

¹Universidad Francisco de Vitoria, Experimental Science, Madrid, Spain

²University, Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Madrid, Spain

³Hospital Beata María Ana, Madrid, Spain

Introduction: Bilateral repetitive transcranial magnetic stimulation (rTMS) and motor imagery (MI) with neurofeedback (NFB) have shown promise for enhancing post-stroke rehabilitation. Previous studies using unilateral rTMS demonstrated positive results for upper limb motor recovery in stroke patients by measuring Resting Motor Threshold (RMT), Action Motor Threshold (AMT), and Cortical Silent Period (CSP).

Objective: This study aimed to investigate the relationship between neurophysiological markers of corticospinal excitability and improvements in motor function (evaluated with FMA-UL) in stroke patients undergoing MI-based NFB along with bilateral rTMS.

Methods: In a crossover AB/BA clinical trial with 20 participants, Therapy A involved only bilateral rTMS (10 daily sessions over two weeks), while Therapy B combined bilateral rTMS with MI-NFB training. All patients also received physical therapy and occupational therapy. We assessed corticospinal excitability (RMT, AMT, and CSP) before and after the intervention, and again after 15 days.

Results: AMT and RMT in the unaffected hemisphere remained stable over time with a significant time-sequence interaction (p < 0.05). CSP increased significantly with both therapies (F (1, 19) = 4.03; p < 0.05)(Tab. 1-2, fig. 1–3). FMA-UL showed significant improvement with the therapy factor (F (1, 64) = 27.096; p < 0.001). However, no significant correlation (p > 0.05) was found between changes in neurophysiological variables and FMA-UL scores.

Conclusion: This research highlights the lack of a significant correlation between basic neurophysiological measurements like AMT and RMT and the clinical effectiveness of neuromodulation therapy. CSP suggests that inhibiting the healthy hemisphere was effective and likely contributed to clinical improvements, but it may not be the sole factor driving functional changes.

P-198

Transcutaneous spinal cord stimulation (ARC^EX therapy) is safe and effective at improving upper extremity function following spinal cord injury – presented on behalf of the Up-LIFT and LIFT Home Principal Investigators

J. D’Amico ^1,2

¹University of Alberta, Edmonton, Canada

²Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Canada

Introduction: Upper extremity (UE) impairment following cervical SCI significantly alters quality of life. ARC^EX Therapy, which combines transcutaneous spinal cord stimulation with functional task practice (FTP), may facilitate functional recovery in the chronic SCI population.

Objective: Safety and effectiveness evaluation of ARC^EX Therapy delivered in the clinic and home setting.

Methods: Sixty-five participants enrolled in a prospective, single-arm, multicenter trial (Up-LIFT, NCT04697472) that included a two-month run-in period of UE FTP followed by an equivalent period of ARC^EX Therapy, with stimulation delivered over the cervical spinal cord. Within 12 months of completing in-clinic ARC^EX Therapy, seventeen individuals subsequently enrolled in one month of therapy delivered at home with the aid of a caregiver (LIFT Home, NCT05284201). The primary safety endpoint for both trials reported device-related serious adverse events (SAEs). Effectiveness was evaluated utilizing a composite responder score to assess whether the majority of participants achieved clinically significant improvements in at least one strength (ISNCSCI-UEMS, GRASSP Strength, pinch and grasp force) and at least one function metric (CUE-T and GRASSP Prehension) during the ARC^EX Therapy phase of the Up-LIFT Trial. Similar outcomes assessed effectiveness during the LIFT Home Trial.

Results: No SAEs related to ARC^EX Therapy were reported during clinic or home-based therapy. Of sixty participants who completed the in-clinic ARC^EX Therapy phase, 72% met the predefined responder criteria. Compliance with the prescribed home therapy was high and mirrored in-clinic therapy dosages (12.3 ± 2.9 sessions/month). One month of home-based therapy improved CUE-T scores and pinch forces (Δ 2.2 ± 4.1, p = 0.025 and Δ 6.9N± 15.5, p = 0.020, respectively).

Conclusions: Clinic and home-based ARC^EX Therapy is safe and effectively improves UE strength and function in people living with chronic, cervical SCI.

P-199

Observational practice enhances learning of a novel bimanual action when compared with tDCS over primary motor cortex: new evidence from brain causal connectivity and behaviour

J. McLeod¹, A. Chavan², S. Kurry³, S. Sattari⁴, Z. Janmohamed⁵, M. Wake³, H. Lee⁶, N. Hodges⁷, N. Virji-Babul^8,9

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²Sardar Patel Institute of Technology, Electronics and Telecommunication Engineering, Mumbai, India

³University of British Columbia, Neuroscience, Vancouver, Canada

⁴University of British Columbia, Biomedical Engineering, Vancouver, Canada

⁵McGill University, Neuroscience, Montreal, Canada

⁶Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada

⁷University of British Columbia, Kinesiology, Vancouver, Canada

⁸University of British Columbia, Vancouver, Canada

⁹University of British Columbia, Physical Therapy, Vancouver, Canada

Introduction: The human ability to learn a motor skill through observation of others (AO) is a fundamental process established in early infancy and maintained throughout life. While non-invasive brain stimulation (tDCS) has been shown to impact motor learning, there is no information comparing the underlying causal brain connectivity between AO and tDCS.

Objectives: (1) to compare primary motor cortex tDCS (M1-tDCS) to action-observation (AO) for learning a novel bimanual juggling skill. (2) to characterize the brain causal connectivity patterns underlying motor learning.

Methods: Learning was investigated using a two-hand juggling task with two balls. Twenty participants with no juggling experience were recruited (mn =23.4 yrs, SD =3.0; 13 =F, 7=M). Participants were randomly assigned to either video observation of a skilled juggler or anodal M1-tDCS only. 30-trials of juggling were scored after intervention. Resting-state EEG data were collected before and after intervention. We applied information flow rate to EEG source data to measure causal connectivity.

Results: The AO group had significantly higher juggling accuracy scores than the M1-tDCS group (p =.03). Higher power in alpha/beta frequency bands was observed in the AO compared with M1-tDCS (p <.03). Information flow in the M1-tDCS group was primarily (R) lateralized with occipital, parietal, and motor regions driving brain activity. Information flow in the AO group was (L) lateralized with motor and parietal regions driving brain activity in the (R) motor and parietal brain regions and the (L) temporal region. The statistical distribution of the normalized information flow rates in each group was significantly different (p<.008).

Conclusion: We show that observational practice enhanced learning of a novel skill via a distinct pattern of information flow. One session of M1-tDCS without observation did not facilitate learning. Results from this study provide important insights for motor rehabilitation.

P-200

Phobiomodulation therapy on Alzheimer’s: multifaceted impact beyond beta-amyloid mitigation

L. Lim ¹

¹Vielight Inc., Toronto, Canada

Introduction: Photobiomodulation (PBM) therapy, using near-infrared (NIR) light to modulate the brain and body functions, shows promise in treating various conditions like traumatic brain injury, depression, Parkinson"s Disease, chronic pain, and COVID-19. In Alzheimer"s disease (AD) treatment, PBM goes beyond targeting just beta-amyloid deposits, affecting neurofibrillary tangles, inflammation, and mitochondrial functions. Its impact on brain gamma oscillations, a factor in AD pathology, is also gaining therapeutic interest.

Objective: This presentation highlights PBM’s effectiveness in treating AD through cellular, animal, and human studies, comparing it with standard AD drugs in terms of mechanisms and clinical outcomes.

Materials & methods: We reviewed studies on PBM in AD, including unpublished ongoing research from our team and collaborators.

Results: PBM potentially enhances recovery by improving mitochondrial function, cellular energy, growth factors and inflammation. It is promising in restoring gamma oscillations, associated with memory encoding, and reducing beta-amyloid aggregation. The efficacy depends on the light delivery method and device specifications, covering pulse frequencies, power density, wavelength, and length of exposure, among others. Our work suggests that a combination of NIR wavelength, up to 100 mW/cm2 in power density on key locations of the head, pulse frequencies alternating between 10 Hz and 40 Hz over 20 minutes on alternate days could produce efficacious outcomes.

Recent developments: MRI and EEG have revealed significant brain changes post-PBM, indicating its potency. These insights may lead to personalized treatments, possibly integrated with artificial intelligence.

Conclusion: PBM emerges as a promising, cost-effective intervention for AD, impacting various aspects of disease pathology. Its full potential and public availability for AD treatment require well-powered randomized controlled trials, currently underway.

P-201

Neurorehabilitation with photobiomodulation, focusing on traumatic brain injury

L. Lim ¹

¹Vielight Inc., Toronto, Canada

Introduction: Photobiomodulation (PBM) involves delivering light energy to tissues for therapeutic effects. It has shown promise in treating a range of conditions, including chronic pain, diabetic wounds, and cancer therapy side effects. Recent evidence highlights its potential in neurorehabilitation, particularly for conditions like traumatic brain injury (TBI), dementia, Parkinson"s Disease, depression, and stroke. Despite accumulating evidence, awareness of PBM in neurorehabilitation remains limited.

Objective: This presentation aims to showcase evidence from cellular, animal, and human clinical studies demonstrating the efficacy of PBM in neurorehabilitation, with a focus on traumatic brain injury.

Materials & methods: We reviewed both published and unpublished research related to PBM in neurorehabilitation. This presentation focuses on TBI.

Results: PBM’s recovery effects stem from its fundamental mechanism of revitalizing stressed mitochondria, thereby enhancing cellular energy, growth factors, and inflammatory balance. These cellular improvements translate into broader tissue recovery, evident in TBI. Additionally, PBM may stimulate neurogenesis, contributing to recovery from neurodegenerative conditions like chronic traumatic encephalopathy (CTE) and dementia. For TBI, PBM offers a promising treatment option, either as a standalone therapy or in conjunction with other treatments like neurofeedback. It is user-friendly, affordable, and recognized as low risk under FDA guidelines. However, more extensive clinical trials are necessary to fully establish its efficacy and safety.

Recent developments: Advanced imaging techniques, including MRI and EEG, have revealed significant changes in brain networks and structures following PBM treatment. Imaging could be the tool to support personalized treatment in the future.

Conclusion: While research is ongoing, PBM is rapidly emerging as a significant tool in neurorehabilitation, backed by increasingly comprehensive data.

P-202

TDCS neuromodulation to enhance cognitive and lower limb rehabilitation in corticobasal degeneration: a case report

A. Hurtado Martínez¹, Y. González Zamorano², M. Moreno Verdú¹, D. De Noreña Martínez³, F. J. Sánchez Cuesta¹, A. Martínez Benito⁴, J. P. Romero Muñoz^1,3

¹Universidad Francisco de Vitoria, Experimental Science, Madrid, Spain

²Universidad Rey Juan Carlos, FIsioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Madrid, Spain

³Hospital Beata María Ana, Unidad de Daño Cerebral, Madrid, Spain

⁴Universidad Autónoma de Madrid, CSEU La Salle, Madrid, Spain

Introduction: Corticobasal Degeneration (CBD) is a rare progressive neurodegenerative tauopathy, presenting marked asymmetry, dystonia, myoclonus, alien limb syndrome, and neuropsychological alterations. We describe a 71-year-old female patient without prior neurological history, with a 2-year history of progressive postural instability and left leg clumsiness, leading to wheelchair dependency. A PET-CT at onset revealed right frontal hypoactivity worsening over a year. Physical examination showed normal muscle strength, predominant lower limb hyperreflexia, and apraxic gait. Neuropsychological assessment indicated executive, attentional, and mnesic impairments. L-dopa treatment proved ineffective.

Objective: Assess the effectiveness of a non-invasive neuromodulation protocol using tDCS, Action Observation (AO), and Motor Imagery (MI) to enhance motor and cognitive performance.

Method: 20 sessions of 20-minute 2mA anodal tDCS stimulation over the right M1, combined with 30-minute AO+MI (fig 1). Treatment was administered daily for 4 weeks. Training involved different movements each weekday, with a gradual shift from AO to a more active approach as weeks progressed.

Results: Significant improvements occurred in Berg Balance Scale (BBS), 5-Times Sit to Stand (5TSTS), and weight distribution (WD) after treatment (all scores, d>0.61). These gains persisted in a one-month follow-up for 5TSTS and WD (d>0.61), but not for BBS. Inverse digit scores significantly improved post-treatment and during follow-up (d>0.61). Improvement in Direct digits, Trail making test-B, STROOPs C, and WC was only significant in follow-up (d>0.61). In terms of functional domains, only emotional well-being in SF-36 showed significance (d>0.61) (table 1).

Conclusions: The combined tDCS+AO+MI protocol maintained or improved balance, motor control, attentional, mnesic, and executive functions in a CBD patient, highlighting the potential of this technology in CBD rehabilitation and treatment

P-203

Repetitive transcranial magnetic stimulation improves cognitive outcomes in patients with persistent post-concussion symptoms

A. Wilson¹, C. Campbell¹, S. du Plessis², M. Vergeer¹, K. Jobin¹, F. MacMaster³, A. Harris², C. Debert¹

¹University of Calgary, Neuroscience, Calgary, Canada

²University of Calgary, Radiology, Calgary, Canada

³Dalhousie University, Halifax, Canada

Introduction: Roughly one third of individuals who sustain a concussion will meet criteria for persistent post-concussion symptoms (PPCS) one-month post-injury. Cognitive dysfunction is experienced chronically by up to half of individuals after a single concussion. Unfortunately, there are few evidence-based treatments for PPCS and as such, neuromodulation approaches including repetitive transcranial magnetic stimulation (rTMS) are being investigated.

Objectives: To determine whether an rTMS protocol improves cognitive dysfunction (measured by the Saint Louis University Mental Status Examination (SLUMS)) associated with PPCS.

Patients & methods: In an ongoing randomized double-blind sham-controlled clinical trial, 64 participants were randomized to 20 sessions over four weeks of high frequency (10Hz) rTMS (n=32) or sham rTMS (n=32). The rTMS protocol consisted of 10 trains of 60 pulses per session delivered to the left dorsolateral prefrontal cortex at 100-120% of resting motor threshold. The SLUMS was administered at pre-treatment, post-treatment, 1-month and 3-month follow-up. A linear mixed effects model was used to examine the effects of time and condition on total SLUMS score.

Results: Total SLUMS scores indicate 18/64 participants presented with mild cognitive dysfunction (score of ≤ 26) at pre-treatment. A significant main effect of time (β=-1.38,95%CI[-2.18,-0.57],p<.001) was observed over the intervention. Pairwise comparisons revealed significant improvement in SLUMS score compared to pre-treatment for all timepoints. A significant main effect of condition (β=-0.66,95%CI[-1.17,-0.15],p=.012) was observed favoring rTMS compared to sham rTMS. There was no significant interaction effect between timepoint and condition.

Conclusion: rTMS may be a promising treatment for cognitive dysfunction in PPCS. However, given the SLUMS is a screening tool, future research should replicate the study design using a more comprehensive cognitive assessment.

P-204

Moderate intensity exercise to increase neuroplasticity in chronic stroke

B. Hordacre¹, F. Johnson¹, G. Hill², J. Uy¹, I. Serrada¹, B. Benyamin¹, M. van den Berg²

¹University of South Australia, Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Adelaide, Australia

²Flinders University, Adelaide, Australia

Introduction: Early recovery from stroke appears rapid and is at least partially underpinned by a time-limited period of heightened neuroplasticity. However, recovery often remains incomplete, with behavioural gains slowing in chronic stroke. Upregulation of neuroplasticity might help accelerate ongoing recovery in people with chronic stroke.

Objectives: Investigate whether moderate intensity cardiovascular exercise could increase neuroplasticity in people with chronic stroke.

Patients & methods: Thirty-three people with chronic stroke (aged 63.87 ± 10.30 years) participated in a randomised controlled trial. Participants were randomly allocated (1:1) to exercise or control. Those allocated to exercise completed 20 minutes of cycling at 60-80% heart rate max. The control group remained sedentary and watched a 20 minute animal documentary. Transcranial magnetic stimulation measured corticospinal excitability of the contralesional hemisphere by recording motor evoked potentials. Intermittent theta burst stimulation repetitively activate synapses in the contralesional primary motor cortex, initiating the early stages of neuroplasticity and increasing excitability. The hypothesis was that if exercise increased neuroplasticity, there would be a greater facilitation of corticospinal excitability following intermittent theta burst stimulation.

Results: Participants allocated to exercise had a stronger response to intermittent theta burst stimulation (Time*Group interaction P = 0.009). A non-significant trend indicated time since stroke might moderate this relationship (P = 0.055). Participants who were 2–7.5 years post stroke exhibited a much stronger intermittent theta burst stimulation response (P < 0.001). There was no effect of age, sex, lesion volume or weighted lesion load.

Conclusion: Moderate intensity cycling appears to enhance neuroplasticity in people with stroke. This therapy adjuvant could provide opportunities to maximize stroke recovery.

P-205

Effect of transcranial direct current stimulation and pharyngeal electrical stimulation on postacute dysphagia: the randomized controlled, double blinded pes-norest trial

C. Ledl¹, K. Simmet¹, D. Jungbluth¹, C. Krewer¹, W. Klein¹, S. Mudungaze¹, R. Oldenburg¹, M. Schumacher¹, K. Jahn¹, F. Müller¹

¹Schoen Clinik Bad Aibling, Dysphagia, Speech and Language Departement, Bad Aibling, Germany

Introduction: Pharyngeal electrical stimulation (PES) and transcranial direct current stimulation (TDCS) are discussed as adjuncts to dysphagia therapy (DT). Outcome studies are inconsistent and depend on etiology, severity of dysphagia, presence of a tracheostomy and study procedure. Although proof of principle studies show that highest cortical excitability is reached 60 to 90 minutes post stimulation, a corresponding therapeutic paradigm has not yet been tested. The main goal of this randomized controlled trial (RCT) is to investigate effects of electrical stimulation combined with swallowing therapy on improvement of dysphagia.

Method(s): A total of 82 postacute stroke patients were randomly assigned to a TDCS group (n=27), a PES group (n=27) and a sham stimulation group (n=28: sham TDCS=14, sham PES=14). Inclusion criteria were persistent dysphagia after a 2 week period of DT and aspiration during FEES. Participants received 5 times 10 minutes of real or sham stimulation and DT one hour afterwards. Patients and raters were blinded to group adherence. Primary outcome was change in Penetration/ Aspiration (PA) for saliva, fluids and puree. FEES was done at baseline and one week post stimulation (FU).

Result(s): PA-values of all tested consistencies improved significantly from baseline to FU by 1.0 point (p=.000) for all participants (TDCS 0.67; PES .91; sham 1.4) but showed no significant effect of stimulation group (p=.326). Subanalysis of tracheotomized and non-tracheotomized patients showed significant improvements (p=.028; p=.000) but again no significant group effects (p=.588; p=.531).

Conclusions: The results of this RCT show no influence of electrical stimulation neither by TDCS nor by PES on PA-grades in tracheotomized or non-tracheotomized stroke patients. However, given the relevant improvements observed in the entire study population, potential benefits of a combined therapy scheme (prestimulation to increase arousal - pause - DT) should be considered.

P-206

Translation of transcranial magnetic stimulation into speech-language pathology practice: a survey

E. Williams^1,2, C. Brocksopp¹, M. Goldsworthy^1,2,3, B. Hordacre³, S. Attrill¹

¹University of Adelaide, Adelaide, Australia

²South Australian Health and Medical Research Institute, Adelaide, Australia

³University of South Australia, Adelaide, Australia

Introduction: Transcranial magnetic stimulation (TMS) has a range of potential applications in the rehabilitation of communication and swallowing disorders. These emerging treatments are still under development, however once they are suitable for use in clinical practice, speech-language pathologists (SLPs) will likely be responsible for their delivery.

Objectives: To identify barriers and facilitators that might influence translation of TMS into speech-language pathology practice from the perspective of SLPs globally.

Materials & methods: An online, international survey of 184 SLPs was conducted to collect both quantitative and qualitative data in a convergent parallel design. The refined Theoretical Domains Framework (rTDF) was used to guide survey design, analysis and interpretation of data, and reporting of findings.

Results: Surveyed SLPs had limited familiarity and experience with TMS. Approximately half of currently practising respondents did not believe TMS would fit within their role. Very few respondents perceived themselves capable of administering TMS at the time of the survey, however 62.5% believed they would be capable following standard training (e.g., professional development course, on-the-job training). Many respondents were optimistic about TMS, whereas others described potential consequences of using TMS in practice. Finally, respondents reported environmental barriers such as cost and training requirements/availability.

Conclusion: Future research and translation efforts should not only increase SLP knowledge and skills through traditional education and training, but should also address SLP beliefs in relation to role and identity, capabilities, optimism, and consequences. Environmental barriers should be investigated further.

P-207

Impact of electric field magnitude in the left DLPFC to changes in intrinsic functional connectivity by transcranial direct current stimulation

E. Kim¹, S. J. Yun¹, B. M. Oh¹, H. G. Seo¹

¹Seoul National University Hospital, Rehabilitation, Seoul, South Korea

Introduction: Although transcranial direct current stimulation (tDCS) is known to be effective for modulating cortical activity, there is considerable variability in response and lack of understanding how resting state functional connectivity (rsFC) changes.

Objectives: To investigate whether rsFC of the left dorsolateral prefrontal cortex (L-DLPFC) changes are associated with electric field magnitude (E-field) delivered to target area.

Methods: A double-blind, sham-controlled, counterbalanced cross-over design was applied on 21 healthy individuals (37.6±8.6y). Participants received either constant 2 mA anodal or sham tDCS targeting L-DLPFC during 10 min (wash-out period; at least 3 d). The resting-state fMRI was acquired before and after stimulation. The L-DLPFC was localized in each individual and E-field (V/m) was estimated. A spherical region of interest (ROI) surrounding individual peak of the L-DLPFC (radius 10 mm) was generated to construct seed-based rsFC. Mean beta-estimates of rsFC were estimated from each condition based on rsFC of all pre-conditions (cluster |z|>3.1, p<.05).

Results: There was a significant decrease in rsFC after sham whereas the change was modest and not significant after real tDCS (one-sample t-test, p<.05). In addition, real tDCS weakened negative connectivity to the left superior temporal areas, while the sham induced no changes (FSL FEAT, corrected p<.05). We generated 23 ROI masks extracted from rsFC (real pre condition, cluster|z|>3.1) and obtained significant positive correlations between E-field and connectivity changes (post-pre beta-estimates) in the right lateral occipital and left supramarginal areas (adjusted p<.05). There was a marginal trend of positive correlation within the left lateral occipital and frontal areas (adjusted p=.06, p=.09).

Conclusion: TDCS may help to maintain overall rsFC and induce local rsFC changes. E-field applied on the target area is associated with changes in rsFC.

Fund: NRF-2020R1C1C1012785

P-208

Neuromodulation treatment on target sites improves social cognition in mild cognitive impairment patients: a randomized clinical trial

G. C. Riccitelli^1,2, M. Villa¹, L. Varriano¹, S. Rossi¹, L. Sacco¹, A. Kaelin-Lang^1,2

¹Civic Hospital, Istituite of Clinical Neuroscience of Southern of Switzerland, Lugano, Switzerland

²University of Lugano, Biomedical Sciences, Lugano, Switzerland

Introduction: In patients with mild cognitive impairment (MCI), deficits in social cognition (SC) contribute to the risk of progressing to dementia. However, there are few pharmacological treatments to mitigate these abnormalities; therefore, alternative therapeutic approaches should be explored.

Objectives: To assess short-/long-term effects of repetitive transcranial magnetic stimulation (rTMS) on SC abilities in MCI patients by stimulating two sites belonging to the social brain and investigate whether the effect extends to other cognitive abilities supported by the stimulated network.

Patients & methods: Eighteen MCI patients were randomized in two study groups. A multiple-baseline design was used; 4-weeks of real rTMS stimulation protocol was carried out by one group (RR_Gr), while 2-weeks of placebo treatment and 2 weeks of real rTMS stimulation by the other group (SR_Gr). High-frequency neuronavigation-guided rTMS over medial prefrontal cortex (mPFC) and right temporoparietal junction (rTPJ) took place daily, 5 times a week. Improvement in SC performance was assessed at 2 (T2) and 4 (T4) weeks after rTMS, and 8 (T12) weeks after the end of rTMS. The following effects were investigated: short (baseline vs T2), long-lasting (baseline vs T4), maintenance (T12 vs T4), and overall treatment effects.

Results: RR_Gr, compared to SR_Gr, showed improvements in theory of mind and empathy performances (p=0.01; p=0.03) at T2; in empathy performance (p=0.04) at T4; and in face emotion recognition (p=0.01) at T12. They also exhibited a positive overall treatment effect on complex mental representation (p=0.03) and social behaviour (p=0.01) over time. In both groups, rTMS had short and long-lasting effects on global cognitive abilities (p=0.02), mainly on fronto-executive function (p=0.03).

Conclusions: Long-term rTMS treatment on two social brain areas contributes to improve and maintain complex SC abilities in MCI patients.

P-209

Effects of posterior parietal cortex and cerebellum anodal transcranial direct current stimulation on ankle tracking visuomotor adaptation in healthy young adults

I. F. Cho¹, P. F. Tang^1,2,3,4,5, C. C. Chao⁶, T. T. Lin^2,4,5,7

¹National Taiwan University, Physical Therapy, Taipei, Taiwan

²National Taiwan University, Graduate Institute of Brain and Mind Sciences, College of Medicine, Taipei, Taiwan

³National Taiwan University Hospital, Physical Therapy and Rehabilitation, Taipei, Taiwan

⁴National Taiwan University, Center for Artificial Intelligence and Robotics, Taipei, Taiwan

⁵National Taiwan University, Neurobiology and Cognitive Science Center, Taipei, Taiwan

⁶National Taiwan University Hospital, Neurology, Taipei, Taiwan

⁷National Taiwan University, Department of Biomechatronics Engineering, College of Bio-Resources and Agriculture, Taipei, Taiwan

Background & objectives: The posterior parietal cortex (PPC) and cerebellum are both implicated in state estimation functions, a crucial neurocomputation processing for successful sensorimotor adaptation. However, their roles in sensorimotor adaptation are seldom compared. We compared the effects of anodal transcranial direct current stimulation (atDCS) applied to the PPC and cerebellum on ankle tracking visuomotor adaptation.

Methods: In this single-blind, sham-controlled study, 57 healthy young adults (mean age = 22.8 ± 1.2 years) were randomly assigned to the PPC, cerebellum, or sham stimulation groups. Participants completed an ankle tracking experiment with learning, adaptation, and re-adaptation phases, each comprising 40 twenty-second trials. During adaptation, the online visual feedback ratio was altered to prompt visuomotor adaptation. The PPC and cerebellum groups concurrently received 2 mA atDCS for 20 minutes. Tracking accuracy was assessed by averaging normalized RMSE over every 5 trials to calculate block RMSE. Adaptation rates were determined as the reduction in RMSE between adjacent blocks.

Results: During motor adaptation, a significant Group x Adjacent Block interaction effect was observed in adaptation. Both the PPC (11%, p = 0.006) and cerebellum (9%, p = 0.048) groups showed significantly greater adaptation rates from the first to the second block compared to the sham group (1%), indicating enhanced early visuomotor adaptation.

Conclusions: This study supports the involvement of the PPC and cerebellum in motor adaptation. Stimulation of these regions via atDCS amplifies early visuomotor adaptation, suggesting promising potential for brain modulation techniques targeting these regions to improve visuomotor adaptation.

Acknowledgements

This research was supported by Grant # NSTC 111-2813-C-002-265-B, ROC.

P-211

Effects of low intensity focused ultrasound stimulation combined with functional electrical stimulation on upper extremity motor symptoms in Parkinson disease

N. Desai¹, M. Callister¹, R. X. Chang¹, T. Cortez¹, C. Sarica¹, R. Chen¹

¹Krembil Research Institute, University Health Network, Toronto, Canada

Introduction: Low-intensity focused transcranial ultrasound stimulation (TUS) is a novel form of non-invasive brain stimulation. TUS delivered at theta frequency (tbTUS) has shown to increase cortical excitability in Parkinson disease (PD) patients in the on-medication state, suggesting that tbTUS can induce plasticity in PD.

Objective: To examine the effects of combining tbTUS of bilateral motor cortex (M1) with functional electrical stimulation (FES) of the hand muscles on corticospinal excitability and PD motor signs.

Patients & methods: 15 individuals with PD will attend 3 study visits in a random order. The visits consist of 1) Real tbTUS (120s train of 20ms ultrasound bursts, repeated every 200ms) followed by Real FES (bilateral stimulation of the opponens pollicis brevis (OP) and first dorsal interossei (FDI) muscles during execution of functional tasks involving a pinch grip), 2) Real tbTUS+ Sham FES or 3) Sham tbTUS+ Real FES. Corticospinal excitability is measured using transcranial magnetic stimulation with motor-evoked potentials (MEP) recorded from bilateral FDI, OP and abductor digiti minimi (ADM) muscles at baseline (BL), immediately after tbTUS (T0), after 30 min of FES training (T30) and at 30 mins (T60) post FES. PD motor signs are measured using MDS-UPDRS-III scores and finger accelerometry. This study is ongoing and 4 participants have completed the study.

Results: The participants showed increased MEP amplitude in the FDI and OP muscles at T30 compared to BL in both arms in all study conditions, except the OP muscle in the less affected arm which showed no change in MEP amplitude in the Real tbTUS +Sham FES condition. Changes in MDS-UPDRS-III scores were not significant.

Conclusion: Real tbTUS, real FES and their combination resulted in an immediate increase in corticospinal excitability, suggesting that all three excitatory protocols may produce LTP-like changes in PD. More participants are being recruited and the results will be updated.

P-212

Intermittent theta-burst stimulation of left superior parietal cortex enhances motor retention of new skills in healthy subjects

P. Nicolo¹, S. Blanche², S. Habiby Alaoui³, A. Nguyen-Danse⁴, F. Turri⁵, N. Nicastro⁵

¹Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western, Physiotherapy, Geneva, Switzerland

²La Tour Hospital, Physiotherapy Department and Motion AnalySwiss Olympic Medical Center, Meyrin, Switzerland

³University Hospital of Geneva, Neurosurgery, Geneva, Switzerland

⁴University of Geneva, Faculty of Psychology and Educational Sciences, Geneva, Switzerland

⁵University Hospital of Geneva, Neurorehabilitation, Geneva, Switzerland

Background: Motor learning involve complex brain networks. The induction of plasticity via intermittent theta burst stimulation (iTBS) has shown to improve motor function. Studies showing these effects are, however, mostly restricted to stimulation of the primary motor cortex (M1), whereas, motor retention requires the key implication of the parietal cortex. We aimed to explore the efficacy of iTBS applied over the left superior parietal cortex (left-SPC).

Objective/Hypothesis: We investigated the effects of iTBS on neural functional connectivity (FC) and motor evoked potential (MEP) in healthy individuals. We hypothesize that iTBS over left-SPC but not sham iTBS would facilitate visuomotor retention and consolidation.

Methods: In a cohort of 20 healthy adults, we applied one session of iTBS over left-SPC before a visuomotor learning task. With the use of a randomized, placebo-controlled, parallel-group study design, we tested the efficacy of real iTBS compared to sham stimulation (n=10 in each group). We compared motor performance (for errors and time) during retention (10 minutes after learning) and consolidation (24 hours after) between the two groups. Electroencephalography and MEP were recorded before and after learning session. We ran correlations between neurophysiological variables and motor performance.

Results: We showed that real iTBS over left-SPC, but not sham stimulation, promotes short-term improvements only for errors 10 minutes after learning (p=0.03). The participants who exhibited higher beta-band FC between the stimulated left-SPC and the rest of the brain before stimulation (r=-0.61, p=0.005), and a subsequent decrease in the same brain area after learning (r=0.71, p<0.001), were associated with greater retention performance.

Conclusions: The application of real iTBS over left-SPC improved motor retention. These findings open exciting new possibilities in developing hypothesis-driven clinical studies in neurorehabilitation.

P-213

The effect of sensory-based priming technique using repetitive peripheral magnetic stimulation on corticomotor excitability in neurologically healthy individuals

R. Aljuhni^1,2, S. Kumar², C. Sawa², S. Madhavan²

¹Al Majma’ah University, Physical Therapy, Majma’ah, Saudi Arabia

²University of Illinois, Physical Therapy, Chicago, IL, United States

Background: Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive sensory stimulation technique applied to peripheral nerves and muscles. It depolarizes the conductive structures within the peripheral nervous system, enhancing corticomotor excitability (CME). The underlying therapeutic idea of rPMS is that it induces local improvements in muscle and nerve function, while also leading to broader effects on the fronto-parietal circuit, sensory and motor cortices. Previous research has investigated the impact of rPMS on CME in the upper limbs of neurologically healthy individuals. These studies have shown that a single session of rPMS can effectively enhance CME. However, there is a gap in the research when it comes to assessing the time-dependent effectiveness of rPMS on CME in the lower limbs of neurologically healthy individuals.

Objective: The overall objective of this study was to determine the time-course effectiveness of rPMS on CME of the tibialis anterior (TA) muscle in healthy individuals.

Methods: 20 healthy subjects were recruited; we tested the effectiveness of rPMS on the non-dominant TA muscle and compared it with the dominant TA muscle. rPMS was applied on the TA muscle belly at 10% above MT. Participants received ~2400 pulses at 20 Hz for 3 seconds on, 19 seconds off. We used transcranial magnetic stimulation to measure CME from both sides. We assessed MEP amplitude, MEP latency, and MEP duration at baseline, 0, 30, and 60 minutes after the stimulation.

Results: We found a significant main effect of side for MEP amplitude (p=0.003), with a 12% increase in MEP amplitude at 30 minutes after the stimulation, compared to 9% immediately after and 7% at 60 minutes after the stimulation. We did not see an effect of rPMS on other MEP parameters.

Conclusion: rPMS has the potential to facilitate lower limbs CME represented by an increase in MEP amplitude in the motor cortex.

P-214

Transcranial direct current stimulation for post-stroke upper extremity motor recovery: an updated meta-analysis

S. Ikramuddin¹, S. Liu², W. Feng³

¹University of Minnesota, Neurology, Minneapolis, MN, United States

²Capital Medical University, Neurology, Beijing, China

³Duke University, Neurology, Durham, NC, United States

Transcranial direct current stimulation (tDCS) has been emerging as a promising adjunctive tool to reduce post-stroke upper extremity motor impairment. However, trial results have been inconsistent. Chhatbar et al. (2016) conducted a meta-analysis of randomized sham-stimulation-controlled clinical trials between 1980-2014 that only included Fugl-Meyer Upper Extremity Scale (FM-UE) as the measurement of motor impairment. We aimed to conduct an updated meta-analysis by including additional trials since 2014 using the same criteria to test whether positive results still hold. We conducted a PubMed and Embase search using the terms "(tDCS) AND (stroke)) AND (sham)) AND (motor)) AND (improvement) AND (Fugl)" from January 1, 2014- October 1st 2023. There were 61 initial records. After screening for randomized, double blinded, sham-controlled trials using the FM-UE with >5 stimulation sessions, 16 studies remained. Seven additional studies were included from the meta-analysis Chhatbar et al. resulting in a total of 23 studies. The primary outcome was the mean change in the FM-UE (baseline to post-intervention). PEDro and JADED scores were collected to assess the quality of included trials. 14 out of 23 studies had sufficient extractable data from the manuscript to be included in the meta-analysis. 228 subjects underwent tDCS. 230 underwent sham stimulation. Meta-analysis favored the active stimulation group by a standard mean difference [95% CI] of 0.50 [0.13-0.86], z=2.67, p=0.008. Heterogeneity was measured as I2=68% with P<0.001. The mean (SD) PEDro and JADED scores for the included studies was 9.9 (1.2) and 4.5 (0.7) respectively. In this updated meta-analysis, there is evidence to support the positive effect of tDCS in reducing post-stroke motor impairment. The presence of statistical heterogeneity is indicative of variation between trials in the magnitude of sample estimates or the relative benefit of active stimulation group.

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Electric field simulation and appropriate electrode positioning for optimized transcranial direct current stimulation of stroke patients: an In Silico model

S. Lim^1,2, M. J. Yoon³, Y. J. Yoo³, H. J. Park¹, T. W. Kim⁴, H. M. Oh⁴, S. Im⁵

¹Seoul St.Mary’s Hospital College of Medicine, The Catholic University of Korea, Rehabilitation, Seoul, South Korea

²Institute for Basic Medical Science, Catholic Medical Center, The Catholic University of Korea, Seoul, Republic of Korea, Seoul, South Korea

³St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea, Rehabilitation, Suwon, South Korea

⁴National Traffic Injury Rehabilitation Hospital, Gyeongki-do, Republic of Korea, Rehabilitation, Gyeongki-do, South Korea

⁵Catholic University of Korea, Rehabilitation, Bucheon, South Korea

Transcranial Direct Current Stimulation (tDCS) has benefits for motor rehabilitation in stroke patients, but its clinical application is limited due to inter-individual heterogeneous effects. Recently, optimized tDCS that considers individual brain structure has been proposed, but the utility thereof has not been studied in detail. We explored whether optimized tDCS provides unique electrode positions for each patient and creates a higher target electric field than the conventional approach. A comparative within-subject simulation study was conducted using data collected for a randomized controlled study evaluating the effect of optimized tDCS on upper extremity function in stroke patients. Using Neurophet tES LAB 3.0 software, individual brain models were created based on magnetic resonance images and tDCS simulations were performed for each of the conventional and optimized configurations. A comparison of electrode positions between conventional tDCS and optimized tDCS was quantified by calculation of Euclidean distances. A total of 21 stroke patients were studied. Optimized tDCS produced a higher electric field in the hand motor region than conventional tDCS, with an average improvement of 20%. The electrode montage for optimized tDCS was unique to each patient and exhibited various configurations that differed from electrode placement of conventional tDCS. Optimized tDCS afforded a higher electric field in the target of a stroke patient compared to conventional tDCS, which was made possible by appropriately positioning the electrodes. Our findings may encourage further trials on optimized tDCS for motor rehabilitation after stroke.

P-216

Additional effects of sequential cerebellar rTMS on inhibitory rTMS over M1 in stroke patients

S. Kim¹, H. S. Lee¹, D. H. Kim¹, W. H. Chang^1,2

¹Samsung Medical Center, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Seoul, South Korea

²Sungkyunkwan University, Health Sciences and Technology, Seoul, South Korea

Background: The most common strategy with repetitive transcranial magnetic stimulation (rTMS) to improve motor function in stroke patients is inhibiting unaffected primary motor cortex (M1). Cerebellum (Cbll) might be one of target of rTMS in stroke patients.

Objectives: To investigate the enhancing effects of Cbll rTMS on inhibitory rTMS for motor recovery in subacute stroke patients.

Patients & methods: Twenty-nine subacute hemiplegic stroke patients with no response in TMS-induced MEPs of affected M1 were recruited in this single-blind randomized controlled study. Cr-Cbll group was received the Cr-Cbll rTMS stimulation consisted with the continuous theta burst stimulation (cTBS) over the contralesional M1 (40 secs), shoulder mobilization exercise (10 min), and high-frequency rTMS over the contralesional Cbll (10 min). In addition, Cr-sham group was received the Cr-sham rTMS stimulation consisted with sham rTMS over Cbll instead of high-frequency rTMS over Cbll. Ten daily sessions were conducted for 2 weeks. Fugl-Meyer Assessment (FMA) were measured before (T0), immediately after (T1) and 2 months after the intervention (T2).

Results: Total 23 participants (10 in Cr-Cbll group and 13 in Cr-sham group) performed the Cr-Cbll rTMS intervention for 2 weeks and were assessed at T2. There was no significant difference in the general and clinical characteristics at T0 between the two groups. At T1 and T2, there were significant difference in both total and upper FMA between the two groups (p<0.05).

Conclusion: These results demonstrated that the Cbll rTMS might have additional effects on inhibitory rTMS over contralesional M1 for improving motor function in subacute stroke patients.

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Preliminary impact of activity-based therapy and transcutaneous cervical spinal cord stimulation on tactile touch sensations in cervical spinal cord injury: three case reports

U. Gopaul¹, G. Gholamrezaei², M. Bayley¹, S. Kalsi-Ryan¹

¹Toronto Rehabilitation Institute, The KITE Research Institute, Toronto, Canada

²Toronto Rehabilitation Institute, KITE Innovations and Rehabilitation Clinics, Toronto, Canada

Background: Restoring tactile touch sensations after cervical spinal cord injury (cSCI) has been poorly investigated. Activity Based Therapy (ABT) incorporates high intensity and long-duration exercises to enhance improvements in sensory and motor function¹. Transcutaneous cervical spinal cord stimulation (TCSCS) is a neuromodulation technique to improve spinal network excitability and thus motor function². To date, the impact of ABT and TCSCS on the tactile touch sensations in the hands after traumatic cSCI is poorly understood.

Objective: To determine the preliminary impact of ABT and TCSCS on tactile touch sensations after traumatic cSCI.

Methods: Three individuals with traumatic cSCI were evaluated (Case 1: Male,30 years,17 years post-cSCI, Neurological level injury: C2; AIS:C; Case 2: Male,74 years,5 years post-cSCI, Neurological level injury:C3; AIS: C; Case 3: Female,36 years,10 years post-cSCI, Neurological level injury:C3; AIS:C). The ABT program included: arm cranking, strengthening, postural, and functional exercises. TCSCS was delivered between C3 and C7 vertebrae at 30-50 Hz and 500-1000 µs. 12 sessions of ABT only were delivered, followed by 28 sessions of combined ABT-TCSCS, delivered three times a week (1 hour/session). Changes in tactile touch sensations were assessed using the Tactile Discrimination Test³, tested with and without TCSCS at post-ABT only and post- combined ABT-TCSCS program.

Results: Case 1 improved in both hands post-ABT only and in the left hand between post-ABT only and post-ABT-TCSCS, tested without TCSCS. Case 2 improved in both hands, after ABT only and post- ABT-TCSCS, tested with and without TCSCS. Case 3 improved in the left hand between post-ABT only and post-ABT-TCSCS without TCSCS.

Conclusion: The impact of ABT and tCSCS on touch sensations in traumatic cSCI varies and requires further investigation.

References

1. doi: 10.14336/AD.2014.1105

2. doi: 10.1109/TNSRE.2018.2834339

3. doi: 10.1177/1545968397011004

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Effects of sequential cerebral and cerebellar rTMS in stroke patients

H. S. Lee¹, S. Kim¹, D. H. Kim¹, W. H. Chang¹

¹Samsung Medical Center, Sungkyunkwan University School of Medicine, Physical Therapy and Rehabilitation, Seoul, South Korea

Background: The facilitating affected primary motor cortex (M1) with repetitive transcranial magnetic stimulation (rTMS) could improve motor function in stroke patients. Recently, many articles have reported that that plasticity at synapses in the cerebellum (Cbll) mediates motor learning.

Objectives: To investigate the additional effects of Cbll rTMS on motor recovery of facilitatory rTMS in subacute stroke patients.

Methods: Twenty-eight subacute stroke patients with the response in TMS-induced MEPs of affected M1 were recruited in this single-blind randomized controlled study. Cr-Cbll group was received the Cr-Cbll rTMS stimulation consisted with the high-frequency rTMS over the ipsilesional M1 (10 min), fine motor training (10 min), and high-frequency rTMS over the contralesional Cbll (10 min). Cr-sham group was received the sham rTMS instead of high-frequency rTMS over Cbll. Ten daily sessions were conducted for 2 weeks. Fugl-Meyer Assessment (FMA) were measured before (T0), immediately (T1), and 2 months after the intervention (T2).

Results: Total 19 participants (10 in Cr-Cbll group and 9 in Cr-sham group) completed follow-up assessments. There was no significant difference in the general and clinical characteristics at T0 between the two groups. The scores of FMA were significantly improved after the intervention in each Cr-Cbll and Cr-sham group (p<0.05). At T1 and T2, the improvements of upper limb score of FMA in the Cr-Cbll group were significantly higher than in the Cr-sham group (p<0.05).

Conclusion: These results revealed the potentials of the Cbll rTMS for enhancing facilitatory rTMS for improving motor function in subacute stroke patients (This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP)(NRF-2018R1D1A1A02086038) and the Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning(RS-2023-00265824)).

P-219

Microvascular decompression to ditch the twitch: a case report of hemifacial spasm in acute rehabilitation

A. Roldan¹, S. Bahrami Tabar², M. Elashvili³, A. Abdou³

¹Montefiore Medical Center, Physical Therapy and Rehabilitation, New York, NY, United States

²New York Institute of Technology College of Osteopathic Medicine, New York, NY, United States

³Burke Rehabilitation Hospital, White Plains, NY, United States

Introduction: Hemifacial spasm (HFS) is a rare, often disabling, peripheral neuromuscular disorder characterized by involuntary, paroxysmal tonic/clonic contractions of unilateral facial muscles innervated by the ipsilateral facial nerve (CN VII). Symptom management includes serial botulinum toxin injections & oral medication. Most commonly caused by aberrant cerebellar or vertebral arteries in the posterior cranial fossa compressing CN VII, microvascular decompression (MVD) is the only permanent treatment.

Objective: To present a neurosurgically managed neuromuscular disorder requiring neurorehabilitation

Patients & methods: Two female patients aged 59 (Patient A) and 70 (Patient B) years old, each with 5 years of intractable HFS refractory to medical management including botox injections. Both patients with MRI findings of neurovascular conflict affecting the facial vestibulocochlear nerve complex presented for multidisciplinary acute inpatient rehabilitation (AR) following elective craniotomy with MVD of involved CN VII. Each received occupational & physical therapy targeting postoperative dizziness & imbalance limiting gait & activities of daily living. Patient B also required speech therapy for dysarthria & dysphagia secondary to postsurgical hemifacial paresis.

Results: Rehabilitation course for Patient A was initially limited by severe vertigo which improved after a prolonged course of methylprednisolone. At discharge home on post operative day (POD) 14, her facial spasms persisted. Patient B underwent EMG revealing partial facial nerve injury. Some improvement in facial asymmetry was attained by discharge home on POD 19.

Conclusion: MVD has 80-88% success rate in treating HFS. The most common post surgical complication is transient or permanent facial nerve palsy which may require neuromuscular retraining for speech & swallow. Involvement of the vestibular nerve can often cause vertigo & ataxia which may warrant AR to ensure a safe discharge home.

P-220

Growing into adulthood with Duchenne Muscular Dystrophy: the process of transition

B. Brigliadori¹, A. Marcassoli², E. Guastafierro², N. Nardocci¹, T. Langer³, S. Friedrich³, G. Reeskau⁴, S. Rodger³, J. Willems³, F. De Angelis⁵, A. Fournier⁶, J. Frei⁷, J. W. Gorter⁷, R. Guiterrez Rojas⁶, O. K. De Camargo⁷, D. McCauley⁷, H. Osman⁸, K. Pozniak⁷, N. Rajapakse⁷, A. Swain⁷, I. Moroni¹, M. Leonardi²

¹IRCCS Carlo Besta Neurology Institute, Dipartimento di Neuroscienze Pediatriche, Milan, Italy

²IRCCS Carlo Besta Neurology Institute, U.O Neurologia, Salute pubblica e Disabiltà, Milan, Italy

³Universitätsklinikum Freiburg, Freiburg, i.Br., Germany

⁴Deutsche Gesellschaft für Muskelkranke, Freiburg, i.Br., Germany

⁵Parent Project APS, Rome, Italy

⁶CHU Sainte-Justine Montréal, Montreal, Canada

⁷CanChild – McMaster University, Hamilton, Canada

⁸Muscular Dystrophy, Toronto, Canada

Introduction: Duchenne Muscular Dystrophy (DMD) is a rare X-linked disease characterized by progressive muscle degeneration resulting in loss of ambulation and severe multisystem complications. In recent years the life expectancy of DMD patients has increased, leading to the need of a transition process from the pediatric to the adult care system. This process is particularly challenging in patients with DMD, involving various factors such as health, social and family contexts.

Objectives: The EU-funded project "Growing into adulthood with Duchenne Muscular Dystrophy – comparing patient experiences and systems to optimize care" focuses on: i) investigating the experience of patients, families, and clinicians, ii) identifying the obstacles and facilitators that can arise during the transition process, iii) finding how to improve the rehabilitation system, and iv) developing guidelines to improve the transition process.

Materials & methods: The study is being conducted in three countries (Germany, Italy, and Canada) and four languages (German, Italian, English, and French) with the support of Patient Organisations for each country who are full partners in the project. The sample will include patients aged between 15-25 years, as well as caregivers and healthcare providers. Semi-structured interviews and online questionnaires will be administered.

Results: We established two specific Interviews for patients and caregivers divided into different thematic sections: socio-demographic information, transition process and, everyday life. A third Interview was constructed for professionals involved in DMD care: doctors, nurses, psychologists, social workers, therapists. A forth part will be administrated by online questionnaires.

Conclusion: The experience by young people with DMD, their families and healthcare providers in different countries will provide recommendations for improving the transition process from pediatric to adult care system.

P-221

The role of intensive neurorehabilitation in Friedreich Ataxia

A. Martinuzzi¹, G. Paparella¹, C. Straga’¹, V. Merotto¹

¹IRCCS Medea, Neurorehabilitation, Conegliano, Italy

Background: The relevance of rehabilitation in progressive neurological disorders, such as Friedreich"s Ataxia (FRDA), has yet to be convincingly proven. FRDA is characterized by ataxia, loss of gait, scoliosis, cardiomyopathy, dysarthria and dysphagia, with reduced life expectancy. The disease onset is usually in adolescence, leading to progressive disability. Intensive rehabilitation (IR) can be of help in maintaining the residual functioning.

Methods: All study participants underwent FRDA multidisciplinary rehabilitation treatment in an inpatient setting. 42 individuals (29 adults and 13 children) with FRDA were recruited. There were 27 deambulant participants and 15 non-deambulant. The patients underwent IR of 3 and 4 weeks in children and adults, respectively. The IR was designed to be applied within a multidisciplinary setting, therefore FRDA patients also underwent occupational therapy, practical manual activities and psychological support aiming to enhance transferable skills useful in the activities of daily living. The primary outcome was the Scale for the Assessment and Rating of Ataxia (SARA). Other measures included: Friedreich Ataxia Rating Scale (FARS) and Nine Hole Peg Test (NHPT). Furthermore, we used the 6 Minute Walk Test (6MWT), the Timed Up and Go (TUG) and the Berg Balance Scale (BBS) only on ambulant subjects. Measures were administered at baseline and at the end of the treatment.

Results: We show that the inpatient IR significantly improves motor performance and ataxia symptoms in patients with FRDA. Our study showed significant functional improvement in all the outcome measures used, except for NHPT bilaterally. FARS and SARA scores post-IPR are significatively reduced when compared (p.value <0.001).

Conclusions: We show that IR programs in FRDA can provide a meaningful clinical improvement in terms of outcome measurements. These findings could be useful when approaching progressive neurological disorders.

P-222

Predicting rehabilitation outcomes in patients with Guillain-Barré syndrome (GBS) using the Early Rehabilitation Barthel Index (ERBI) – results from a German retrospective study

A. Schmidt^1,2, B. Neukirch², K. Gerbershagen^1,3, M. Weyermann²

¹University of Witten/Herdecke, Neurology, Witten, Germany

²Niederrhein University of Applied Science, Health Science, Krefeld, Germany

³RehaNova Neurological Rehabilitation Clinic Cologne, Neurorehabilitation, Cologne, Germany

Introduction: GBS is an inflammatory polyradiculoneuropathy with wide heterogeneity in terms of disease course and long-term outcome. Therefore, early prognosis of expected outcome is important. In German rehabilitation clinics, the ERBI and its two components Early Rehabilitation Index (ERI) as well as Barthel Index (BI) were routinely used to determine patient status. The outcome values are used in the German ICD-10 catalogue for severity assessment.

Objective: We analyse potential determinants that can predict the functional outcome already at the beginning of rehabilitation.

Methods: We performed logistic regressions to analyse good outcome among 127 GBS patients. Good outcome (GO) at the end of rehabilitation was defined as an ERBI score >30, a BI score of at least 60 and an ERI score of 0 points. We considered the functional status at onset of rehabilitation, early symptoms and corresponding medical devices (artificial ventilation, dysphagia, cranial nerve and bladder paralysis, autonomic dysfunction), age, sex and duration of illness until rehabilitation onset as potential determinants.

Results: Among 123 patients (4 died during rehabilitation) the proportion with GO ranged between 65.0% (BI ≥ 60) and 87.8% (ERI =0). In bivariate analyses, all determinants except age and sex were associated with GO at the end of rehabilitation. Due to limited statistical power, we only include two determinants simultaneously in the multivariate models. Highest values of c-statistic could be achieved with simultaneous consideration of the scores of functional status at onset of rehabilitation and duration of illness (range of c-statistic: 0.86 to 0.93).

Conclusion: For GBS patients in Germany, good functional status at the end of rehabilitation can be well predicted by scores of the ERBI and its components BI and FRI collected at baseline in combination with disease duration. The extent to which taking early symptoms into account further improves prediction needs to be investigated in larger studies.

P-223

Effect of proprioceptive neuromuscular facilitation (PNF) on muscle function: a systematic review

G. Campos Santana¹, A. Paiva de Castro Vidal¹, I. Manhoni Baiense¹, M. Barçante¹, Y. Rodrigues Antunes¹, J. C. Souza Alves¹, F. Zanela da Silva Arêas¹

¹Universidade Federal do Espírito Santo, Serra, Brazil

Cardiovascular diseases account for approximately 40% of age-related conditions, and their prevalence increases with age1. Aging and the decline in cardiorespiratory fitness, leading to physical inactivity, contribute to the dysfunction of skeletal muscle2. The progressive loss of muscle mass and strength with age plays a considerable role in limiting exercise capacity3. The objective of this study was to evaluate the effects of Proprioceptive Neuromuscular Facilitation (PNF) on muscle function (MF). Searches were conducted at SPORTDiscus, PUBMED, Cinahl, Embase, PEDro, and Central databases. Two independent reviewers extracted data to investigate the effect of PNF on MF. The inclusion criteria for studies were: randomized controlled trials (RCTs) in any population; studies where the primary treatment was PNF compared to another intervention, placebo, or no intervention; studies that assessed the immediate, short, medium, or long-term effects of the intervention on muscle function, whether measured by strength, electromyographic activity, hypertrophy, or muscle power; and complete studies published in scientific journals in any year and any language. This review included 66 studies involving 2,511 participants, and the results indicate that PNF can be used in clinical practice when the goal is medium-term strength gain. However, there was no significant effect on power, endurance, and electromyographic activity. Future RCTs could compare PNF techniques to establish the most effective method for motor control and muscle activation in patients with a loss of these abilities. References: ¹FRANCESCHI C, et al. The continuum of aging and age-related diseases: common mechanisms but different rates. Front Med, 2018; ²FAJEMIROYE JO, et al. Aging-induced biological changes and cardiovascular diseases.2018; ³CRUZ-JENTOFT AJ, et al. Sarcopenia: European consensus on definition and diagnosis: report of the European Working Group on Sarcopenia in Older People. Age Ageing, 2010.

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Psychosocial interventions for people with amyotrophic lateral sclerosis and motor neuron disease and their caregivers: a scoping review

J. Oh ¹

¹Dankook University, Cheonan-si, South Korea

Introduction: As amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) is a fatal progressive neurodegenerative disorder, patients experience severe impairments, with patients and family caregivers facing emotional distress and exhaustion. Several psychosocial interventions are aimed at providing tailored support for ALS patients and caregivers. The aim of this study was to conduct a scoping review and present a comprehensive overview of psychosocial interventions designed for individuals and families affected by ALS/MND, while also pinpointing research gaps.

Methods: This scoping review utilized Arksey and O’Malley’s methodological framework to investigate psychosocial interventions designed for individuals with ALS/MND and their families. The study adhered to the PRISMA-ScR checklist for reporting.

Results: A total of 27 articles describing 25 interventions met the inclusion criteria. The predominant interventions observed in the research encompassed education-related strategies, closely followed by behavior therapy, counseling, social support interventions, and psychotherapy interventions. Across the majority of the studies, findings indicated promising feasibility and acceptability of these interventions. Notably, a significant proportion of quantitative investigations yielded one or more statistically significant effects, while qualitative studies consistently reported favorable outcomes, including enhancements in well-being and heightened awareness of individual circumstances.

Conclusions: Given the progressive and debilitating nature of this condition, coupled with the absence of a cure, the adoption of a psychosocial approach can prove beneficial for both ALS/MND patients and their families. However, high-quality RCTs with a large sample size are recommended to examine and confirm the effectiveness.

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Objective assessment of muscle fatigue in the back and lower extremities in adult spinal deformity patients before and after spinal correction surgery

M. Muraoka¹, K. Hasegawa², M. Sakai³, S. Hatsushikano⁴, K. Watanabe²

¹Kameda-Daiichi Hospital, Rehabilitation, Niigata, Japan

²Kameda-Daiichi Hospital, Niigata spine surgery center, Niigata, Japan

³Kameda-Daiichi Hospital, Devision of Neurophysiology, Niigata, Japan

⁴Kameda-Daiichi Hospital, Devision of Radiology, Niigata, Japan

Background & aims: Pain and muscle fatigue in the low back and lower extremities associated with adult spinal deformity (ASD) markedly limit daily activities and affect quality of life. This study aimed to clarify if spinal correction surgery decreases the muscle activity requirements in relation to alignment and balance parameters using an integrated electromyogram (I-EMG) and body sway.

Methods: Integrated electromyogram studies of the low back and lower extremities in addition to whole body alignment, body sway, and health-related quality of life (HRQOL) were evaluated in 16 patients with ASD before and after surgery. Sixteen healthy volunteers were included as control subjects. Muscle activities of the bilateral lumbar paravertebral, biceps femoris, rectus femoris, gastrocnemius, and tibialis anterior were measured using surface electromyogram in the standing position for 20 seconds. Surgical outcomes were based on improvements in muscle fatigue using the sum of the whole muscle I-EMGs and body sway. HRQOL was evaluated by Scoliosis Research Society-22 questionnaire revised (SRS-22r).

Results: In controls, the sum of the 10 whole I-EMGs (mVms; mean±SD) was 3316±1247. The I-EMG values were higher in ASD patients than in healthy subjects; the sum of the whole 10 I-EMGs significantly decreased from baseline (9125±3529) to 3 (6088±1793) and 6 (6381±1776) months postoperatively (p<0.01). Body sway was also improved postoperatively at 3months and maintained at 6 months. Those findings were shown along with the amelioration of whole-body sagittal alignment, and four SRS-22r scores significantly increased postoperatively.

Conclusion: Following spinal correction surgery, whole-body sagittal alignment was improved, and muscle activity based on I-EMG and body sway were significantly decreased. The SRS-22r scores after surgery also indicated significant improvement, suggesting that muscle fatigue in the standing position was ameliorated.

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Neurophysiological dysfunctions in polio patients with post-polio syndrome: a descriptive study

N. Suhak¹, S. Birk¹, N. M. Nielsen², L. Kay³, M. Almer⁴, S. L. Ravn^4,5, B. Wanscher⁶, P. J. Jennum¹

¹Rigshospitalet (National Hospital), Department of Clinical Neurophysiology, Copenhagen, Denmark

²Statens Serum Institut, Department of Epidemiology Research, Copenhagen, Denmark

³Specialized Hospital for Polio and Accident Victims & Accident Victims Denmark, Retired, Roedovre, Denmark

⁴Specialized Hospital for Polio and Accident Victim, Roedovre, Denmark

⁵University of Southern Denmark, Psychology, Odense, Denmark

⁶Næstved-Slagelse-Ringsted Hospitals, Neurology, Slagelse, Denmark

Introduction: More than 50% of polio patients are affected by Post-Polio Syndrome (PPS) after they have experienced a period with neurological and functional stability following the acute poliomyelitis. PPS can, beside diminished muscle strength, result in fatigue or sleep disturbances. This leaves some polio patients to need medical attention later in life. The specific mechanism behind the development of PPS is however still unknown. In the present study we want to investigate whether neurophysiological and sleep dysfunction somehow should contribute to the PPS symptomatology. New knowledge is essential for optimizing the treatment of PPS.

Methods: We included 42 PPS patients (52% women, <75 years of age) recruited among Danish polio survivors formerly treated for acute paralytic poliomyelitis. Data collection included 1) self-report questionnaires on, among others, sleep disturbances and fatigue, 2) a clinical somatic and neurological examination, 3) nerve conduction study (NCS), 4) electromyography (EMG), 5) ambulant polysomnography, 6) long-term blood pressure measurement.

Results: Epworth Sleepiness Scale was between 0-16 and The Self-Reported Impairments in Persons with Late Effects of Polio Rating Scale was between 4-27 (mean 12±5,62), which indicates a considerable variability of the subjective symptoms. NCS was normal in 15 (35,7%) and abnormal in 27 patients (64,3%). EMG-abnormalities typical for previous poliomyelitis, in clinically affected muscles, were seen in all patients. 37 patients (88,1%) had obstructive sleep apnea. 12 patients (29%) had abnormal Periodic Limb movements in sleep. Long-term blood pressure measurement during polysomnography was available in 31 participants and demonstrated elevated blood pressure in 16 (51,5%).

Conclusions: The results of the study showed different neurophysiological dysfunctions in PPS patients and thereby contribute to improved possibilities for proper assessment and intervention for the symptoms of these.

P-228

Relationship between laboratory findings and polyneuropathy in haemodialysis patients

B. Leblebici¹, P. Doruk Analan², R. Kozanoglu³, Y. K. Emine Ece⁴

¹Baskent University, Physical Therapy and Rehabilitation, Istanbul, Turkey

²Baskent University, Physical Therapy and Rehabilitation, Adana, Turkey

³Baskent University, NEPHROLOGY, Adana, Turkey

⁴NHS, NHS, United Kingdom

Introduction: Polyneuropathy (PNP) is a common complication in haemodialysis (HD) patients. Some evidence suggests that the presence of a variety of toxins contribute to its development.

Objectives: The aim of this retrospective study was to determine whether there is an association between pathologic electrophysiological parameters and HD adequacy, duration of HD treatment, and laboratory findings.

Materials & methods: The study included 60 HD patients (30 males and 30 females; average age 61.5±11.73 years). Electrophysiological parameters on nerve conduction studies (NCS) and needle electromyography (EMG) were used for the evaluation of motor and sensory nerve functions. Age, gender, causes of kidney failure, laboratory parameters, haemodialysis duration, and HD adequacy were recorded.

Results: There was an association between the number of pathologic electrophysiological parameters of NCS and EMG and age. The number of pathologic electrophysiological parameters of NCS and EMG was not correlated with duration of HD treatment and HD adequacy. There was an association between the number of pathologic electrophysiological parameters of NCS and glucose. Serum sodium level was negatively correlated with the number of pathologic electrophysiological parameters of both NCS and EMG. There was a negative correlation between the number of pathologic electrophysiological parameters of NCS and serum level of albumin. Other biochemical parameters were not correlated with the number of pathologic electrophysiological parameters of NCS and EMG.

Conclusion: Several factors such as dialysable neurotoxins appear to affect nerve conduction. However, there were no associations between PNP and laboratory parameters with the exception of serum level of glucose, albumin, and sodium.

Key words: haemodialysis, electrophysio-logical parameters, polyneuropathy, laboratory parameters

P-229

Innovation to communicate using low cost technology for ALS patients

S. Kaur¹, H. Rawat¹

¹ALS Care & Support Foundation, New Delhi, India

Objectives: This study aimed to develop and assess innovative, cost-effective methods to facilitate communication for patients with Amyotrophic Lateral Sclerosis (ALS). ALS often leads to severe motor function loss, rendering patients unable to communicate effectively as their speech becomes slurred.

Materials and Methods: The study employed two distinct approaches. The first, the Audible Alert Technique, involved the use of a stone ring or a coin attached to a patient"s functional finger, and a steel plate positioned under the patient’s hand. The second approach, the Laser Pointer Communication Technique, employed glasses adapted with a laser light, used in conjunction with an alphabet board and a picture board.

Results: The Non-digital Audible Alert Technique enabled patients to create an audible signal by striking the steel plate with the stone ring or coin attached to a patient"s functional finger . This simple, yet effective method allowed patients to efficiently capture the attention of caregivers. The Laser Pointer Communication Technique was designed for patients who retain head movement. By wearing the adapted glasses, patients could use the attached laser light to point to letters on the alphabet board or images on the picture board.

Conclusion: The study demonstrates simple yet innovative neurorehabilitation tools in ameliorating communication for ALS patients. The non-digital audible call tool provides a practical means for patients to alert caregivers. The laser-pointer tool allows for more elaborate communication, crucial in maintaining the quality of life such patients. These tools are cost- effective, and can be readily integrated into the care regimen, thus offering promise in addressing communication challenges. Implications for improving the quality of life and care for patients through simple, innovative communication methods.

P-231

The use of alcohol neurolysis for management of upper limb spasticity in patient with amyotrophic lateral sclerosis

Y. E. Ooi¹, T. Lau¹, S. T. Kong¹

¹Sengkang General Hospital, Rehabilitation, Singapore, Singapore

Amyotrophic lateral sclerosis (ALS) is a fatal motor neurone disease. The mainstay of management involves maximising the quality of life including management of spasticity and spasticity-related pain. The prevalence of spasticity in ALS is variable across different studies but may be reported up to 80% of patients. Currently there is no clear guidelines for management of spasticity in ALS. Treatment options usually include oral agents such as tizanidine or baclofen, or use of botulinum toxin injection for focal spasticity. This case report shares the use of alcohol neurolysis in management of upper limb spasticity in a patient with ALS.

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Neuroscience at the crossroads of pathogenesis and salutogenesis: unveiling epistemic opportunities in sleep medicine research

L. Litvin ¹

¹TU Berlin, MTEC / Charité Berlin, Berlin, Germany

Within the contemporary medical research landscape, there is a pronounced emphasis on investigating disease genesis, diagnosis, and treatment—the pathogenetic approach. In contrast, research on promoting and maintaining health, termed by Aaron Antonovsky as salutogenesis, receives comparatively less attention [Lindström 2005].

The tension between patho- and salutogenesis as research paradigms in medical research subject of scientific theoretical reflections within medical philosophy [Hucklenbroich 2021].

A comprehensive literature review unveils sleep research as a fruitful philosophical case study with direct practical relevance to sleep research and, thus, for neurorehabilitation.

On the one hand, sleep deprivation and disorders contribute to pathological changes, inducing an allostatic overload on the nervous system. This, in turn, hampers brain neuroplasticity and may lead to mental disorders. Additionally, insufficient sleep is linked to a compromised immune system [Palagini 2022]. On the other hand, recent studies demonstrate that removing toxic substances, such as beta-amyloids (Aβ), occurs during sleep—a process crucial for maintaining nervous system health [Semyachkina-Glushkovskaya 2023].

This study conveys a conceptual framework for the multi-layered epistemic potential of promoting patho- as well as salutogenetic research in sleep and general neuroscientific research. For research practice, this entails the necessity to cultivate a profound self-understanding and actively position each research project within the dynamic interplay between patho- and salutogenesis.

Hucklenbroich, P. (2021). Die Begriffe von Krankheit und Gesundheit [. . .]. In Philosophie der Medizin (pp. 137-179). Brill mentis.

Lindström, B., & Eriksson, M. (2005). Salutogenesis. J of Epidemiology & Community Health, 59(6), 440-442.

Palagini L. et al. Sleep, insomnia and mental health. J Sleep Res 2022;31:e13628.

Semyachkina-Glushkovskaya, O et al. (2023). Brain Waste Removal System and Sleep [. . .]. International Journal of Molecular Sciences, 24(4), 3221.

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Acute arm cycling effects on response to lower limb spinal paired associative stimulation

H. C. M. Foy¹, N. D. Bye¹, A. Y. Rajaei¹, E. A. Toledo-Aldana¹, J. Savage¹, C. S. Mang¹

¹University of Regina, Faculty of Kinesiology and Health Studies, Regina, Canada

Introduction: The excitatory effect of paired associative stimulation (PAS) targeting upper limb motor cortex circuits is facilitated by acute high-intensity leg cycling. Whether similar acute exercise effects on plasticity occur in spinal circuits projecting to the lower limbs is not known.

Objective: To determine whether response to PAS targeting spinal circuits for the soleus muscle is influenced by acute high-intensity arm cycling.

Materials & methods: 12 young healthy adults (4 females; age: 24.2±4.0 years) underwent excitatory PAS that targets spinal cord circuits for the soleus muscle in two sessions. In these sessions, PAS was preceded by either seated rest or high-intensity interval arm cycling. Spinal and corticospinal excitability were assessed pre- and post-PAS. Measurements of spinal excitability included the stimulus intensity (SI) to elicit, and the amplitude of, the maximal H-reflex (Hmax) in the soleus. Corticospinal excitability was assessed by amplitude of soleus motor evoked potentials (MEPs) elicited by transcranial magnetic stimulation at 120% resting motor threshold. Hmax and MEP values were normalized to the maximal M-wave. In preliminary analyses, paired t-tests were conducted to determine PAS-induced changes within and across conditions.

Results: SI-Hmax did not change from pre- to post-PAS in either condition (p>0.84). There was a trend for a PAS-induced decrease in Hmax under the exercise condition (p=0.07) with no change under the rest condition (p=0.34). The pre-to-post PAS difference in Hmax under the exercise condition was less than under the rest condition (p=0.05). In contrast, there was a PAS-induced increase in MEP amplitude under the exercise condition (p=0.05) with no change under the rest condition (p=0.25). The pre-to-post PAS change in MEP amplitude was not different across conditions (p=0.30).

Conclusion: Acute exercise may have differential effects on excitability and plasticity across spinal and supraspinal circuitry.

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Characterizing the relationship between inter-neuronal activation in the primary motor cortex (M1) and clinical motor outcome measures after stroke

A. Rajendran¹, R. Denyer¹, C. Rubino², L. A. Boyd^1,2,3

¹University of British Columbia, Neuroscience, Vancouver, Canada

²University of British Columbia, Rehabilitation, Vancouver, Canada

³University of British Columbia, Physical Therapy, Vancouver, Canada

Introduction: Inter-neuronal networks in M1 contribute to motor planning, preparation, and execution which can be evaluated by indexing motor evoked potentials (MEP) from directional transcranial magnetic stimulation (TMS) (Mirdami et al., 2017; Hannah et al., 2018). Pulses in the anterior-posterior (AP) direction result in longer latency than those from the posterior-anterior (PA) direction; these differences are attributed to increased stimulation of interneurons with a multi-synaptic distance from corticospinal neurons, whose activation is measured through pulses in the lateral-medial (LM) direction (Hamada et al., 2012). How these networks change after stroke and what implications they may have on motor function is not known.

Objectives: Explore the relationship between inter-neuronal and network activation to motor function after stroke.

Methods: Data from 22 (of a planned 30) chronic stroke participants, ranging from with mild to severe motor impairment were recruited (6 females, mean age = 68.36, SD=13.00). Single pulse TMS was delivered over the primary motor cortex on both hemispheres, in the AP, PA, and LM directions. Network onset times were indexed by subtracting the mean MEP onset time in the LM direction from the AP and PA directions respectively. Wolf-Motor Function Test (WMFT) scores were collected for the affected and unaffected stroke arms. Results: A trend for a positive relationship between PA onset times in the ipsi- (Pearson’s r = 0.44, p=0.10) and contralesional (Pearson’s r= 0.28, p= 0.20) motor cortices and WMFT was found. The AP onset times did not exhibit the same pattern.

Conclusion: Though preliminary, the exhibited pattern suggests that longer onset time differences in the PA mediated interneuron networks may be related to an increase in clinical motor function scores. Findings motivate ongoing and future work exploring these networks as a way to understand motor function after stroke.

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The night time movement index measured by the under-mattress sensor can be a useful index that reflects the effectiveness of inpatient rehabilitation

K. Ota¹, T. Nishiwaki¹, Y. Ootaka¹

¹Fujita Health University, Community-Based Rehabilitation with Robotic Technology, Toyoake, Japan

Background: The under-mattress sensor for objective sleep measurement; the Nemuri SCAN (NSCAN; Paramount Bed Co., Ltd., Tokyo, Japan) has been getting popular in rehabilitation hospital to monitor the sleeping time of inpatients. We try to use the movement index and resting heart rate measured with the automatic NSCAN while the patient is sleeping as a useful index of rehabilitation effects.

Methods: Study design: Retrospective observational study. Subjects: 17 patients (age 70.3±4.8, 10 male and 7 female, 7 CVA and 10 orthopedics) who underwent inpatient rehabilitation (hospital stay 52.4±8.4 days)

Methods: We extracted the CSV-data on the movement index and heart rate from the NSCAN and calculated the average movement index and resting heart rate (showed movement index zero by NSCAN ) during night time from 9 pm. to 6 am. for seven days both after admission and before discharge. We compared the average of movement index and resting heart rate to ADL(Functional Independent Measure; FIM) on both admission and discharge. We also divided into two groups based on ADL improvement level; ADL improvement group (FIM gain more than 20, 10people), ADL non-improvement group (FIM gain less than 10, 7 people). We compared the changes of movement index, resting heart rate and FIM gain between the two groups.

Results: 1) The change of indexes at admis sion and discharge were as follows: admission / discharge. Movement index: 93.9±46.4/ 86.8±74.0 Resting heart rate: 71.2±11.1 / 67.0±12.0, FIM: 42.1±13.8 / 60.6±27.2. 2) In the ADL improvement group, movement index decreased (82.6±27.7 /49.6±3) significantly during hospitalization (p=0.01 paired t-test). The resting heart rate also decreased (71.2±11.1/67.3±12.5) but not significantly. However, in the ADL non-improvement group, those indexes had no significant changes.

Conclusion: Night time movement index measured by NSCAN might be considered as an index of the effectiveness of inpatient rehabilitation.

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Determining the corticospinal, intracortical and motor function responses to transcranial alternating current stimulation of the motor cortex in healthy adults: a systematic review and meta-analysis

M. Rostami¹, A. Lee¹, A. K. Frazer¹, Y. Akalu¹, U. Siddique¹, A. J. Pearce¹, J. Tallent¹

¹Exercise Neuroplasticity Research Unit, Monash University, Physiotherapy, Melbourne, Australia

Background: Transcranial Alternating Current Stimulation (tACS) employs low-intensity sinusoidal currents to influence cortical plasticity and motor function. Despite extensive research, inconsistent results require a comprehensive review of tACS efficacy.

Objective: This study systematically assesses tACS effects on corticospinal and intracortical excitability, and motor function over the motor cortex (M1), focusing on alpha, beta, and gamma frequencies.

Methods: Relevant studies were identified through database searches and citations were tracked until July 10, 2023. The methodological quality of the included studies (29) was evaluated by Downs and Black. Data synthesis involved meta-analysis (n = 25) and best evidence synthesis (n = 5).

Results: Meta-analysis revealed that alpha and beta tACS with intensities > 1 mA and tACS with individualised alpha frequency (IAF) increased corticospinal excitability (CSE). tACS over M1 improved motor function, irrespective of stimulation frequency and intensity. Sub-analysis showed that alpha and beta tACS with an intensity ≤ 1 mA led to improved motor function, while gamma tACS at 2 mA enhanced motor function. Additionally, beta tACS at a fixed frequency of 20 Hz, as well as both low gamma (30–55) and high gamma (55–80) tACS, resulted in improved motor function. A stimulation duration of 20 min led to improvements in both CSE and motor function, and tACS with electrode sizes smaller than 35 cm2 and an electrode montage over M1-supraorbital region (SOR) were found to enhance motor function. Notably, both online and offline tACS improved motor function, regardless of stimulation factors.

Conclusion: tACS modulates CSE and improves motor function, with outcomes dependent on stimulation parameters and timing.

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Exploring brain activity during a buttoning task in healthy young adults: a functional near infrared spectroscopy investigation

N. Benam^1,2, C. L. Pollock^2,3, J. Zwicker^4,5, S. Lim^2,3, K. Yoshida^1,2, J. Schmidt^2,4

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²Centre for Aging Smart, Rehabilitation, Vancouver, Canada

³University of British Columbia, Physical Therapy, Vancouver, Canada

⁴University of British Columbia, Occupational Therapy, Vancouver, Canada

⁵BC Children’s Hospital Research Institute, Vancouver, Canada

Introduction: The ability to complete activities of daily living (ADLs) is an important part of daily life and can promote well-being and independence. Occupational therapists facilitate independence in ADLs, such as dressing. However, there is currently limited knowledge of brain activity during dressing tasks. Previous studies explored brain activity during dressing using fMRI, however, the supine position during fMRI neuroimaging is not a natural dressing posture and may impact findings. Functional near-infrared spectroscopy (fNIRS) is a promising method of data collection as it can investigate brain activity in a natural state (sitting) during dressing.

Objectives: To understand brain activity during buttoning in healthy adults using fNIRS.

Methods: Participants completed an upper extremity task of buttoning in three 20-second repetitions with 15 seconds rest in between each activity block. Brain activation patterns were recorded using fNIRS over the prefrontal cortex, premotor cortex, supplementary motor area, sensorimotor cortex, and posterior parietal cortex.

Results: Twenty healthy participants (25-65 years) were recruited from the community. Significantly higher activation in the prefrontal cortex, premotor cortex, supplementary motor area, and sensorimotor cortex was observed for healthy control participants during the activity block when compared to the resting state. No statistically significant change in brain activity was observed in the posterior parietal cortex during the buttoning task compared to the rest period.

Conclusions: Knowledge of brain activity in healthy adults during the performance of activities of daily living such as dressing is a critical first-step for investigating brain activation in different clinical populations, such as clients with brain injury. This knowledge has the potential to inform future occupational therapy interventions.

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Characteristics of limb position senses with different measurement methods in healthy adults

S. J. Yun^1,2,3, S. Park^4,5, B. M. Oh^1,2, H. G. Seo^1,2

¹Seoul National University Hospital, Rehabilitation, Seoul, South Korea

²Seoul National University College of Medicine, Rehabilitation, Seoul, South Korea

³Seoul National University College of Medicine, Department of Human Systems Medicine, Seoul, South Korea

⁴Seoul National University, Interdisciplinary Program in Bioengineering, Seoul, South Korea

⁵Seoul National University Hospital Biomedical Research Institute, Institute of Innovative Medical Technology, Seoul, South Korea

Introduction: Proprioception is a component of somatosensory that involves perceiving one’s body position and movement in response to internal changes. Recent studies suggested that there are two different senses of human limb position.

Objectives: This study aimed to investigate and compare the characteristics of proprioception according to different measurement methods in healthy adults.

Materials & methods: Participants engaged in three tasks using the device we developed to assess elbow joint proprioception: an ipsilateral matching task (IMT), a contralateral matching task (CMT), and a pointing task (PT). Each task was performed three times at three different angles (30, 50, and 70 degrees) in a randomized order for nine trials and tested for both the right and left hand. Activity level was measured by the International Physical Activity Questionnaire-Short form (IPAQ).

Results: Twenty healthy adults (10 males, mean age: 39.80 ± 12.19 years) were enrolled. The absolute error of IMT was significantly lower than CMT and PT (Bonf. p=.029, and .016, respectively). PT showed higher variable error compared IMT and CMT (Bonf. p=.000, and .040, respectively). On the other hand, the constant error of PT was the lowest among the three measurements. There were no significant differences in errors across tasks based on gender or age groups. The total IPAQ score showed statistically significant correlations with the absolute error (r=-.460, p=.041) and the constant error (r=-.478, p=.033) of the CMT, and variable error of the PT (r=-.469, p=.037).

Conclusions: The PT showed a higher variable error and a lower constant error than the matching tasks, suggesting noticeable variability in the PT. These differences may be due to distinct mechanisms underlying PT compared to the matching tasks, which warrants further investigation.

Funding: Grant no "NTRH RF-2023004" from the MOLIT Research Fund.

P-240

Vestibular-evoked balance responses adapt with repeated exposure to height-related postural threat

S. Villemer¹, M. Zaback^2,3, K. J. Missen¹, J. T. Inglis¹, M. Carpenter¹

¹University of British Columbia, Kinesiology, Vancouver, Canada

²Temple University, Department of Bioengineering, Philadelphia, PA, United States

³Temple University, Department of Health and Rehabilitation Sciences, Philadelphia, PA, United States

The intricate link between anxiety, vestibular function and postural control can be investigated in disorders like postural dizziness (Balaban 2013) or in healthy young adults through exposure to threatening conditions. Standing at the edge of an elevated surface elicits a fear of falling as well as changes in standing balance (Adkin & Carpenter 2018) and facilitation of vestibular responses (Horslen et al. 2014). Subjects show reduced anxiety and standing balance adaptations with repeated exposure to height (Zaback et al. 2021), but it is unknown whether vestibular responses also adapt. This study investigated how vestibular-evoked balance responses vary following repeated exposure to height-related postural threat. 23 healthy young adults completed a series of 90s standing trials at LOW (0.8m) and HIGH (3.2m) heights while receiving stochastic vestibular stimulation (SVS; 2–25 Hz, ±4.5 mA). Emotional and arousal state was assessed using self-report questionnaires and electrodermal measures. Medial gastrocnemius (MG) and soleus (SOL) electromyographic activity and horizontal ground reaction forces (GRF) were recorded to assess vestibular-motor coupling (quantified by coherence and cumulant density) and gain between SVS-SOL, SVS-MG and SVS-GRF. Results show an increase in all dependent measures at first exposure to height. Following a block of 10 consecutive HIGH trials, emotional and arousal state reduced back to near baseline levels and significant adaptation of the SVS-MG and SVS-GRF coherence and gain was observed. For cumulant density, only the MG medium latency peak and GRF short latency peak showed significant adaptation. Limited adaptation was seen in SVS-SOL, suggesting a muscle-specific response. The observation of vestibular-evoked balance response adaptation to repeated height exposures provides insight into how the vestibular system contributes to threat-related changes in standing behavior and the potential benefits of exposure therapy interventions.

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Cog-First: a new tablet-based cognitive assessment tool for brain injured patients. A pilot study on Canadian population

C. Heslot^1,2, A. Schnitzler^3,4, F. Tarpin-Bernard⁵, V. Facque⁵,J. Yao², E. Mandonnet^1,6, R. Reebye²

¹Frontlab, Paris Brain Institute (ICM), CNRS UMR 7225, INSERM U1127, Paris, France

²University of British Columbia, Vancouver, Canada

³PRM Department, GH St Louis Lariboisière F. Widal, Paris, France

⁴Paris University, Paris, France

⁵SBT Group, Paris, France

⁶Lariboisière Hospital, Neurosurgery, Paris, France

Introduction: Acquired brain injuries (ABI) frequently lead to cognitive impairments, necessitating accurate cognitive assessment tools for relevant clinical management. Although the Montreal Cognitive Assessment (MoCA) is widely used, Cog-First, an innovative tablet-based assessment, designed by a French academic collaboration, evaluating executive functions, episodic memory, and attention, provides a promising alternative. This pilot study compares Cog-First and MoCA in assessing cognitive functions in chronic-phase brain injury patients.

Methods: ABI patients were prospectively and sequentially recruited in an outpatient setting at the Gf Strong Rehabilitation Centre, Vancouver, Canada. Participants underwent cognitive assessments using both Cog-First and MoCA version 8.3 in a randomized order and Pearson"s correlation coefficient was used to assess score and sub-score correlations.

Results: Twenty-one brain injured patients (52% male, median age 61 years) were recruited, with a median time of 3.9 years post-injury. Injury types included 8 stroke patients, 6 traumatic brain injuries, 4 multiple sclerosis cases, 2 cerebral tumor surgery patients, and 1 with cerebral tuberculosis. All participants completed assessments and Cog-First median time was 25 minutes. Statistical analysis revealed a significant correlation between Cog-First and MoCA scores (p=0,027). Preliminary findings from this pilot study suggest that Cog-First and MoCA exhibit differences in performance and potential utility.

Conclusion: This pilot study highlights the potential of Cog-First as a promising alternative cognitive assessment tool for ABI patients in the chronic phase. Further research is warranted to validate these initial findings and determine the clinical implications of choosing between Cog-First and MoCA in acquired brain injury management. This study represents a significant step toward optimizing cognitive assessment strategies for acquired brain injury individuals.

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English translation and cultural adaptation of Cog-First: validation of a French tablet-based tool into the English clinical setting

C. Heslot^1,2, A. Schnitzler^3,4, F. Tarpin-Bernard⁵, V. Facque⁵, E. Nathoo⁶, J. Yao², E. Mandonnet^1,4,7, R. Reebye²

¹Frontlab, Paris Brain Institute (ICM), CNRS UMR 7225, INSERM U1127, Paris, France

²University of British Columbia, Vancouver, Canada

³PRM Department, GH St Louis Lariboisière F. Widal, Paris, France

⁴Paris University, Paris, France

⁵SBT Group, Paris, France

⁶University of British Columbia, Vancouver, Canada

⁷Lariboisière Hospital, Neurosurgery, Paris, France

Introduction: Acquired brain injuries often lead to persistent cognitive deficits, which can be challenging to detect and impact patient outcomes. Early and specific screening are crucial for proper management. Cog-First, a tablet-based promising tool, is performed independently and briefly evaluates executive functions, memory, and attention in approximately 20 minutes. This study aimed to translate and culturally adapt Cog-First into English, enabling its use for English-speaking patients.

Methods: Our translation process followed International Society for Pharmacoeconomics and Outcome Research guidelines. Two professional translators independently translated Cog-First into English and combined into a consensus version. Two translators back-translated the consensus version into French, which was compared to the original version. The resulting English version was assessed by ten healthcare practitioners experienced in cognitive testing to ensure its suitability. Ten English-speaking brain injured patients tested the version for relevance and comprehensibility.

Results: Practitioners highly rated the relevance and applicability of sub-tests. Strong agreement (90%) was observed for sub-test assessing memory, attention and inhibition. 90% of practitioners expressed a clear need for Cog-First and indicated they would "very likely" use it in cognitive screening. All patients completed the study, with 90% reporting high satisfaction with Cog-First. Instructions received a positive rating of 96.3% for relevance and comprehensibility.

Conclusion: Our study supports the quality of the English version of Cog-First, and enables its integration into clinical and research practice. Cog-First is a promising tool for detecting and screening cognitive deficits in individuals with acquired brain injury. While further research is required to explore its performance comprehensively, Cog-First may have the potential to enhance patient treatment outcomes.

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Adding cognitive and psychological assessment for patients with Cerebral Amyloid Angiopathy

M. Leonardi¹, G. Camarda¹, R. Terragni¹, A. Mazzucchelli¹, S. Schiavolin¹, P. Sismondo¹, F. Barbadoro¹, C. Ippoliti¹, M. Cacciatore¹, A. Marcassoli¹, A. Bersano², I. Canavero², B. Storti²

¹IRCCS Carlo Besta Neurology Institute, Neurology, Public Health and Disability Unit, Milan, Italy

²IRCCS Carlo Besta Neurology Institute, Cerebrovascular Unit, Milan, Italy

Background: Cerebral amyloid angiopathy (CAA) is a type of cerebral small vessel disease (CSVD) marked by the gradual accumulation of β-amyloid, which can result in spontaneous intracerebral bleeding and dementia among elderly patients, leading to significant disability and societal challenges. Recent research has brought to light the existence of mild cognitive impairment (MCI) in individuals with CAA, and CAA appears to be linked to cognitive impairment regardless of Alzheimer’s disease or other neurodegenerative conditions.The study’s objective is to establish a neuropsychological assessment specifically tailored for individuals with CAA and incorporate this evaluation into the clinical diagnostic process, thus enhancing the comprehensive clinical understanding of CAA patients.

Methods: The neuropsychological assessment encompasses the appraisal of overall cognitive impairment, cognitive functions, the emotional well-being, patients" subjective perception of their illness and clinical condition. These evaluations will be conducted both at the initial assessment and during subsequent follow-up examinations.

Results: Anticipated outcomes are likely to reveal compromised cognitive functions, particularly in executive function and processing speed, mirroring a cognitive profile akin to individuals with vascular cognitive impairment. Additionally, the results may also point to psychiatric symptoms such as behavioral issues, personality alterations, and symptoms of depression.

Conclusions: Identifying cognitive and psychological factors that predict CAA progression is crucial for establishing disease prognosis and enhancing patient recovery through the development of tailored psychiatric and psychological interventions, supportive care, and cognitive rehabilitation strategies. This underscores the significance of incorporating a neuropsychological assessment into the clinical practice for individuals with CAA.

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Anxiety and depression predict the overall disability, independently from the Expanded Disability Status Scale, in patients with Multiple Sclerosis

M. Leonardi¹, C. Curatoli¹, A. Marcassoli¹, M. Lanza¹, S. Schiavolin¹, R. Terragni¹, P. Confalonieri², V. Torri Clerici², L. Brambilla², C. Antozzi², R. Mantegazza², A. Raggi¹

¹IRCCS Carlo Besta Neurology Institute, Neurology, Public Health and Disability Unit, Milan, Italy

²IRCCS Carlo Besta Neurology Institute, Neuroimmunology and Neuromuscular Diseases Unit, Milan, Italy

Introduction: Multiple Sclerosis (MS) is the most common cause of neurological disability in young people thus leading to several motor, sensory, and cognitive symptoms. However, little is still known about how psychological, cognitive, and social-support variables could impact on MS patients" level of comprehensive disability.

Objectives: This study aimed to explore the role of psychological, cognitive, and social-support variables, along with clinical disability measured throuht the Expanded Disability Status Scale (EDSS), in predicting MS patients’ level of global disability.

Materials & methods: The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the EDSS scores were collected as subjective and objective measures of disability, respectively. State-Trait Anxiety Inventory and Beck Depression Inventory-II were used as psychological variables; whereas 19-item Medical Outcome Study-Social Support Survey was used to assess the perceived social support. Finally, Rao"s Brief Repeatable Battery was administered to assess patients" cognitive functioning. A multivariable regression analysis with a forward procedure was applied using WHODAS 2.0 as outcome and variables as predictors. We targeted P < 0.05 for variable retention so that only significant predictors were included in the final model.

Results: EDSS (β = 7,190), state anxiety (β = 0,265) and symptoms of depression (β = 0,835) independently predicted disability variation (Adj. R2 = 0,705) in a sample of 151 MS patients admitted to the "Carlo Besta" Neurological Institute (58 males, 130 with relapsing-remitting MS phenotype; mean age ±ds: 51.64±5.83, mean disease duration ±ds : 11.96±8.75).

Conclusion: We found that state anxiety, depression and the EDSS could indipendenctly impact on around the 70.5% of MS patients" disability. Thus, our results are of interest in rehabilitation practices considering this psychological modifiable factors as possible targets for interventions, providing suggestions to reduce overall disability and restoring functioning in MS patients, in a biopsychosocial perspective.

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Solution focused hypnotherapy and memory retrieval in post-traumatic retrograde amnesia: a case study

J. Sheppy¹, A. Hartley¹

¹STEPS Rehabilitation Ltd, Research and Development, Sheffield, United Kingdom

Introduction: Despite post-traumatic amnesia being known as a common problem following traumatic brain injury (TBI) there is limited evidence to guide treatment. In the case of retrograde autobiographical amnesia any evidence around prognosis or treatment is very limited. The available evidence suggests cognitive therapy incorporating photographs, story boards, personal objects and music to help the memories return.

Objective: This case report aims to describe the treatment of a patient who unexpectedly retrieved autobiographical memories during Solution Focused Hypnotherapy (SFH) sessions.

Patients & methods: A gentleman 16 months post-TBI with almost total retrograde amnesia had SFH sessions as part of his residential rehabilitation. A range of SFH techniques were used to aid relaxation and provide education around emotional regulation. The memory retrieval process was unexpected, and once identified the methodology changed to include bespoke scripts aimed at developing this in a trauma informed way. Corroborations of accuracy were confirmed by family members.

Results: Alongside improvement in the patient"s ability to emotionally regulate, the patient started to access lost autobiographical memories during trance. Subjectively the patient reported how important this process was stating it was like having "a window into his old life". Prior to the therapy he said he felt "empty" but these sessions helped to recreate the "missing pieces of the jigsaw". Overall, this allowed him to feel a greater connection to himself and family and more confident and positive about his future.

Conclusion: SFH successfully and safely enabled an individual patient with post-traumatic retrograde amnesia to retrieve autobiographical memories. Further research is required to understand the underlying processes and if these results could be replicated in further cases.

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Exploring music as mnemonics and brain plasticity in individuals at risk of developing Alzheimer’s disease

A. Chu¹, C. Wu², M. Thaut¹

¹University of Toronto, Music and Health Research Collaboratory (MaHRC), Toronto, Canada

²Taipei Medical University, Brain and Consciousness Research Center, Taipei, Taiwan

Introduction: Mild cognitive impairment (MCI), characterized by cognitive decline without hindering daily functioning, may increase the risk of Alzheimer’s Disease (AD). Music, utilized as mnemonics (i.e., sung information presentation), finds application in educational and therapeutic settings. Its efficacy in establishing temporal and structural frameworks for information encoding extends to individuals with neurological disorders. However, the neural mechanisms underpinning the impact of musical mnemonics on verbal learning, particularly in MCI, remain unclear.

Objectives: This study aims to: 1) assess the impact of rhythm and melody-assisted verbal learning on memory encoding and retrieval, and 2) investigate the neural networks, functional connectivity patterns, and neuroplastic changes associated with memory encoding during music-assisted verbal learning in individuals with MCI and healthy adults.

Methods: The cohort (n=28) was determined through G power analysis with 80% power and 5% Type I error rate for ANOVA analysis. Participants, native Mandarin-Chinese speakers aged 40-90 years, are stratified based on the presence of MCI or probable AD. The within-subject design encompasses three conditions: "spoken," "rhythm," and "melody," denoting the presence of rhythmic/musical templates. Six sessions, with one-week intervals for washout, include 3 fMRI and 3 EEG sessions, utilizing the Chinese Verbal Learning Test.

Hypothesis: If musical mnemonics enhance memory encoding and retrieval, we expect improved word recollection and accurate sequencing under "rhythm" or "melody" conditions, accompanied by observable indications of heightened neuroplasticity in individuals with MCI.

Conclusion: This study aims to validate musical mnemonics as a valuable strategy for mitigating daily challenges in individuals with MCI, potentially reducing the risk of AD. The findings may have broader implications for tonal language speakers beyond English-speaking populations.

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Take Charge After Stroke (TACAS): a process evaluation of implementation in a stroke support service

F. Bright¹, C. Cummins¹

¹University of Auckland, Auckland, New Zealand

Background: Take Charge After Stroke (TACAS) is an evidence-based intervention that supports people to identify what is meaningful and "take charge" of their recovery. While shown to be effective in improving independence, and acceptable to people with stroke, it is not embedded in usual care in stroke services in New Zealand.

Objective: This study sought to understand the process of implementing TACAS in routine practice in a non-governmental community-based stroke support organisation, and to provide guidance to other services seeking to implement TACAS.

Material & methods: Process evaluation was undertaken. Data were collected through multiple means: qualitative surveys with people with stroke (clients) and service providers; fidelity data from providers; and interviews and focus groups with clients, service providers, managers. Data were analysed using conventional content analysis and normalisation process theory (NPT).

Results: People were generally positive about TACAS. Clients predominantly found TACAS empowering, helping them review their life and priorities and envision how to move toward after stroke. For some, it helped them feel they had permission to take charge of their recovery. Some providers found it challenging to see how TACAS differed from usual practice, while some struggled with role shifts from problem-solver to facilitator. Providers appeared less likely to offer TACAS when there were language and cultural differences, and there were challenges when clients had visual, communication or cognitive difficulties. Extensive training and coaching supported implementation.

Conclusion: TACAS was valued as an evidence-based intervention; this gave it legitimacy. However, implementation in usual practice was not straight forward. NPT provides useful insight into supports and shifts needed to help providers embed TACAS as part of usual practice. This evaluation will provide useful insights for services seeking to implement TACAS.

P-249

Cognitive function and fatigue before and after transsphenoidal surgery in pituitary adenoma patients: a prospective longitudinal study

D. Krabbe^1,2, G. Johannsson^3,4, T. Skoglund^1,5, T. Hallén^1,5, D. S. Olsson^3,4,6, V. Hantelius^3,4, O. Ragnarsson^3,4,7, S. Jakobsson^8,9, K. Stibrant Sunnerhagen^1,2

¹University of Gothenburg, Neuroscience, Gothenburg, Sweden

²Sahlgrenska University Hospital, Rehabilitation, Gothenburg, Sweden

³University of Gothenburg, Department of Internal Medicine and Clinical Nutrition, Gothenburg, Sweden

⁴Sahlgrenska University Hospital, Medicine, Gothenburg, Sweden

⁵Sahlgrenska University Hospital, Neurosurgery, Gothenburg, Sweden

⁶AstraZeneca, Late-stage Clinical Development, Cardiovascular, Renal and Metabolism (CVRM), BioPharmaceuticals R&D, Mölndal, Sweden

⁷University of Gothenburg, Wallenberg Centre for Molecular and Translational Medicine, Gothenburg, Sweden

⁸University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden

⁹University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden

Introduction: Pituitary adenomas and their treatment can affect patients´ wellbeing and general health. Cognitive problems and fatigue are among the most frequently reported symptoms. These symptoms can have several causes, including transsphenoidal surgery (TSS), the primary treatment of choice for most pituitary adenomas.

Objectives: The aim of this longitudinal study was to evaluate cognitive function and fatigue before and 12 months after TSS using a within-subject design with comparisons at group and individual level.

Patients & methods: Fifty-nine patients were recruited. Cognitive function and fatigue were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Multidimensional Fatigue Inventory (MFI-20). Paired group-level comparisons were made for total and subscale scores. The symptoms were graded into different levels; normal or either of two clinical levels. This classification was based on normative data and combination of index scores for RBANS and on normative data for the general fatigue subscale of MFI-20.

Results: No difference in total or subscale RBANS score before and after surgery, except for the attention index which improved. MFI-20 total and all subscale scores improved with small effect sizes (r=-.20 to r=-.29). This improvement was more pronounced in patients with functioning pituitary adenoma, who reported worse fatigue before surgery. For cognition and fatigue respectively, just over a third of the patients had score differences that entailed classification into different levels of symptoms between evaluations, with change to a lower level being more common than vice versa in absolute numbers.

Conclusion: The results suggest that TSS has minor if any effects on cognitive function and that fatigue improves 12 months after surgery at group level. For subgroups of patients, symptoms were classified into different levels between evaluations, and such change was seen in either direction.

P-250

The screening visual complaints-acquired brain injury questionnaire (SVC-ABI): confirmatory factor analysis and clinical utility

V. L. Dol^1,2, A. Van Sorge², E. Will², A. Füermaier¹, J. Heutink^1,2

¹University of Groningen, Clinical and Developmental Neuropsychology, Groningen, Netherlands

²Royal Dutch Visio, Centre of expertise for blind and partially sighted people, Huizen, Netherlands

Introduction: Individuals with acquired brain injury (ABI) may experience impairments in visual functioning. Yet, visual complaints are often underestimated or overlooked in clinical practice of rehabilitation settings. Therefore, we constructed the Screening Visual Complaints-Acquired Brain Injury questionnaire (SVC-ABI), a screening instrument for assessing visual complaints following acquired brain injury.

Objectives: Aim of the present study was to determine the factor structure of the SVC-ABI in a sample of individuals with ABI and assess its utility for clinical practice.

Materials & methods: The SVC-ABI is a 23-item questionnaire that showed good psychometric properties in a community sample. Healthcare providers at four rehabilitation centers in the Netherlands administered the SVC-ABI to individuals following an inpatient or outpatient ABI rehabilitation program. A total of 156 individuals with ABI completed the questionnaire (Mean [SD] age, 59 [13] years). Confirmatory factor analyses were performed to determine the fit of a correlated 3-factor and 5-factor model.

Results: Both the 3-factor and 5-factor model demonstrated a good model of fit in our ABI sample, with the 5-factor model outperforming the 3-factor model. The factors of the 5-factor structure were interpreted as follows: diminished visual perception-function related, diminished visual perception-luminance related, diminished visual perception-task related, altered visual perception, and ocular discomfort

Conclusion: Factor analysis determined a robust 5-factor structure of the SVC-ABI in individuals with ABI. In clinical practice, the SVC-ABI may be best interpreted by five subscales to evaluate the nature and extent of visual complaints, and to guide further care and rehabilitation.

P-251

Signaling visual complaints following acquired brain injury: development and validation of a screening instrument

V. L. Dol^1,2, A. Füermaier¹, A. Van Sorge², E. Will², J. Heutink^1,2

¹University of Groningen, Clinical and Developmental Neuropsychology, Groningen, Netherlands

²Royal Dutch Visio, Centre of expertise for blind and partially sighted people, Huizen, Netherlands

Introduction: Acquired brain injury can cause a range of visual impairments and related complaints. Although these complaints can significantly affect daily functioning and rehabilitation progress, they are often overlooked in clinical practice of rehabilitation centers.

Objectives: The current study aims to develop a screening instrument for assessing visual complaints following acquired brain injury and evaluate its psychometrics properties in a community sample.

Materials & methods: We constructed the Screening Visual Complaints-Acquired Brain Injury questionnaire (SVC-ABI), a self-report 23-item questionnaire. The SVC-ABI is an adaptation of the Screening Visual Complaints questionnaire, a validated measure originally developed for individuals with neurodegenerative diseases. A Dutch community sample of 1159 participants (Mean [SD], 60 [16] years) completed the SVC-ABI and other questionnaires on visual disturbances, executive functioning, mental health, and autistic traits. We evaluated the factor structure, internal consistency, test-retest reliability, and convergent and divergent validity.

Results: Confirmatory factor analysis showed a good fit for a correlated 3-factor model and 5-factor model. The 5-factor model outperformed the 3-factor model. The SVC-ABI demonstrated good internal consistency (ICC = 0.79) and test-retest reliability (ICC = 0.79), along with sufficient convergent (r2 = 40%) and divergent validity (r2 = 0.0% to 18%).

Conclusion: The SVC-ABI proves to be a valid and reliable tool for assessing visual complaints in a community sample, showing promise for use in clinical practice of rehabilitation settings in individuals with acquired brain injury.

P-252

A good "old" paper puzzle – an important part of cognitive rehabilitation therapy

D. Maslarov^1,2, D. Drenska¹, J. Maslarova-Gelov³, I. Gelov⁴

¹University First MHAT “St. Joan Krastitel”, Neurology Clinic, Sofia, Bulgaria

²Medical University of Sofia, Medical College ”Y. Filaretova”, Sofia, Bulgaria

³Barchester Healthcare Ltd, Senior Social Media Executive, Barchester, Bulgaria

⁴Lifecycle & Shadow IT Assurance Manager – Vodafone Group, ___, United Kingdom

Background: An application of cognitive rehabilitation therapy (CRT) is a multifunctional and innovative intervention.

Objectives: We present a comparative study of 40 patients with acute ischemic stroke and various types of CRT during the period 2022-2023.

Materials & methods: Inclusion criteria were: age up to 85 years, mild cognitive impairment, and NIHSS score ≤6 p. Stroke patients were divided into two groups: Group-1 included 12 females and 8 males versus 11 females and 9 males in Group-2. The mean age was 73.1 (±8.1) years. Neuropsychological assessments such as MMSE (M.F. Folstein et al., 1975), MoCA (Z.S. Nasreddine et al., 2005) and CDT with a 10-point scoring system (I. Rouleau et al., 1992) were implemented.

In Group-1 a neurorehabilitation program was consisted of standard and CRT of emotion recognition, problem-solving training, mnemonic strategies and arrangement of puzzles between 50 and 500 pieces. In Group-2 cognitive training was represented only by activities with paper puzzles (50-1000 pieces). All participants completed an average of 90 hours" cognitive rehabilitation exercises. Outcomes were evaluated at discharge and 6 months later.

Results: The 6-month follow-up observations demonstrate an improvement at MoCA and CDT in comparison to baseline without changes in MMSE scores in both groups. The final results indicate that regardless of the different content of cognitive rehabilitation, no statistically significant differences were identified between Groups - 1 and - 2 in terms of independent functioning.

Conclusion: Paper puzzle exercises based on increasing complexity stimulate different cognitive domains and are an important part of therapy for post-stroke cognitive impairment.

P-253

Acuhypno: a new therapeutic approach in rehabilitation

J. Sheppy¹, J. Warden¹, A. Hartley¹

¹STEPS Rehabilitation Ltd, Research and Development, Sheffield, United Kingdom

Introduction: Traditional Chinese acupuncture and Solution Focused Hypnotherapy has been integrated into the rehabilitation of patients with neurological and complex injuries at a UK residential rehabilitation unit. It was identified by these therapists that combining their approaches to create Acuhypno could be beneficial to help manage pain, promote sleep and reduce stress and anxiety for patients.

Objectives: This case series introduces the audience to the clinical application of the new therapeutic practice of Acuhypno in neurological and complex injury rehabilitation.

Patients & methods: Ten patients received Acuhypno as part of their Amputee (3), Incomplete Spinal Cord Injury (3), complex pain (3) and Functional Neurological Disorder (1) rehabilitation. Total number, frequency and content of sessions were tailored to each patients" needs and goals. Outcome data was collected relevant to each patient"s goals and included participant-rated scales (0-10), the Subjective Unit of Distress (0-10), clinically relevant subjective feedback and session frequency. Data was compared from baseline to conclusion of individual sessions and from admission to discharge.

Results: All patients received weekly sessions for a minimum of six weeks. Improvement was found across pain, relaxation, and sleep for all participants, with a reported greater sense of connection to their bodies in amputee patients. A gradual improved perception of stiffness in hand function occurred with one patient, whilst another patient experienced a perception of increased strength.

Conclusion: Acuhypno is a new therapeutic approach which provided benefits for the patients involved. Further research is needed to fully understand the potential of this approach and what is best practice within neurological and complex injury rehabilitation.

P-254

The dynamic balance control of older adults with cognitive impairment under dual-task walking: a cross-sectional study

Q. Zhong¹, R. Xu¹, H. Li², X. Yang², Y. Shen³, C. Guo³, X. Xiong¹, Y. Zhu³, X. Wu⁴, T. Wang³

¹Nanjing Medical University, Rehabilitation, Nanjing City, China

²Nanjing Medical University, Rehabilitation, Nanjing City, China

³Nanjing Medical University, Rehabilitation, Nanjing City, China

⁴Nanjing Medical University, Zhongshan Rehabilitation Branch, Nanjing City, China

Introduction: Older adults with cognitive impairment have worse performance during dual-task walking compared to normal elderly. The movement of the center of mass (COM) and its coordination with the center of pressure (COP) has been used for describing the body"s dynamic stability during walking. However, the dynamic balance control remains unknown in elderly with impaired cognition.

Objectives: To explore the difference in gait imbalance under dual-task walking among patients with cognitive impairment (MCI), subjective cognitive impairment (SCD) and normal cognition (NC).

Materials & methods: This cross-sectional study recruited 181 participants from July to December 2019, only 82 met the inclusion criteria and consented to participate and only 79 completed gait analysis. Data were obtained using three-dimensional motion capture system during single and dual-task walking with naming animals, and the COM-COP inclination angle (IA) and its rate of change (RCIA), COM–COP angular velocity, COM-Ankle inclination angles and COM velocity were analyzed by Visual 3D software. Differences in gait imbalance among the groups were analyzed using Kruskal-Wallis test or one-way ANOVA. The significance level was P < 0.05.

Results: Thirty-three SCD patients, 25 MCI patients and 21 NC older adults completed the trials.

Under dual-task walking, significant differences between the NC and SCD groups were found for the COM-COP IA (P = 0.014), COM–COP angular velocity (P = 0.019), RCIA (P = 0.043), COM velocity(P = 0.024).Meanwhile, significant differences between SCD and MCI groups were found for COM-Ankle inclination angles (P = 0.043). However, there were no differences in those parameters under single task walking.

Conclusion: The parameters of COM, COP and its variation under dual-task walking may be used in balance control assessment in patients with cognitive impairment.

P-255

’Talk and Chalk’: initial efficacy of a virtually administered emotion regulation intervention for anger after brain injury

J. Witten^1,2, R. Coetzer^2,3,4, L. Rowlands⁵, O. Turnbull²

¹University of British Columbia, Occupational Therapy, Vancouver, Canada

²Bangor University, School of Psychology and Sport Science, Bangor, United Kingdom

³Brainkind, UK, Burgess Hill, United Kingdom

⁴Swansea University, Faculty of Medical, Life and Health Science, Swansea, United Kingdom

⁵Arden University, Psychology, Coventry, United Kingdom

Background: Of the basic emotions, anger is arguably the most detrimental to personal relationships with family members and loved ones. Uncontrollable anger is especially prevalent in populations with acquired brain injury (ABI) and is likely due to post-injury difficulties with emotion regulation (ER). Existing interventions to manage post-ABI anger appear to be effective but have several theoretical and practical challenges.

Objectives: This proof-of-concept study attempted to address these challenges, by investigating the preliminary efficacy of an ER-based intervention for post-ABI anger (i.e., ’Talk and Chalk’). A secondary objective was to determine which participant characteristics were associated with intervention gains.

Patients & methods: 24 adult survivors of an ABI were enrolled. This pre-post intervention design, which included a 3-month follow-up (3MFU), had 5 individually administered, 1-hour meetings on Zoom over 4 months. In addition to the intervention techniques, meeting content included the primary outcome measures of anger, which were administered across three time points (i.e., baseline, post-treatment, and 3MFU). Participants also completed several cognitive tests, and measures relating to anger awareness, mental health, and the use of ER techniques.

Results: Significant differences were observed on measures of external anger (e.g., experience, outward expression, and control) from baseline to post-treatment, which were maintained at 3MFU. In terms of participant characteristics, only readiness to change anger, and symptoms of anxiety, were significantly associated with gains.

Conclusion: ’Talk and Chalk’ presents an initially efficacious, virtually administered, ER-based intervention for post-ABI anger. Certain participant characteristics may optimize gains, with important implications for clinical delivery. These findings encourage a randomised control trial and are beneficial to clinicians who are providing services to survivors of ABI.

P-256

A systematic review of rehabilitation programs for cancer related cognitive impairment: different programs at different times?

M. Merceur¹, K. T. Reilly², M. Cogne¹

¹University Hospital Rennes, Rennes, France; ²Claude Bernard University, Lyon, France

Background: "Cancer Related Cognitive Impairment" (CRCI) defines cognitive disorders related to cancer and its treatments. Many breast cancer participants experience signs of CRCI (between 20 and 30%). Our main objective was to provide a detailed description of the methods and results of randomized controlled trials of interventions for CRCI in breast cancer survivors, paying particular attention to the timing of the interventions within the participant care pathway.

Methods: We conducted a systematic literature review following the PRISMA guidelines from 01-01-2019 to 16-07-2023 and included randomized controlled trials of interventions for CRCI after breast cancer with at least one objective cognitive assessment as a primary or secondary outcome.

Results: Among 228 identified studies, 35 (including 2821 participants) were retained for inclusion. The interventions were classified into 4 categories: cognitive rehabilitation, physical activity, complementary therapy and pharmacological treatment. Our analysis revealed that pharmacological interventions have no effect, whereas Physical Activity interventions proposed in the months following initial cancer treatment improve Quality of Life and Speed of Information Processing while interventions proposed later improve Memory and Attention (Cognitive Rehabilitation) and Perceived Cognitive Function and Depression/Anxiety/Mood (Complementary Therapies).

Conclusion: Since CRCI is affected by numerous factors, with participants frequently suffering from high levels of fatigue, pain, anxiety and depression, participants are most likely to benefit from holistic approaches that include cognition, physical activity, relaxation, psychoeducation, group support and/or psychological counselling.

P-257

EURECA study: evaluation of remediation programs for patients with CRCI (Cancer Related Cognitive Impairment) in the aftermath of breast cancer

M. Merceur¹, K. T. Reilly², M. Cogne¹

¹University Hospital Rennes, Rennes, France; ²Claude Bernard University, Lyon, France

Background: "Cancer Related Cognitive Impairment" (CRCI) represents cognitive disorders linked to cancer and its treatments. The effectiveness of physical activity and cognitive rehabilitation on these CRCIs has been proven, but the question of combined rehabilitation has never been addressed and its exact modalities are still to be defined.

Objectives: We conducted a study aimed at evaluating the effectiveness of combined rehabilitation on the symptoms of CRCI in 26 patients affected after breast cancer, in 2 university hospitals, Lyon and Rennes.

Method: This prospective, interventional, two-center study is carried out according to the SCED methodology, in 3 phases, with 4 to 6 weekly evaluations per phase. The patients included present symptoms of CRCI after breast cancer. The primary endpoint is the score on the FACT-Cog (Functional Assessment of Cancer Therapy – Cognitive Function) self-questionnaire and the secondary endpoints are the results of cognitive tests (MOCA, TAP and SDMT).

Results: The results seem to show an improvement in the FACT-Cog score in the non-intervention phase, continued in the intervention phase (on average gain of 7 points) and stable in the follow-up phase. Concerning the secondary endpoints, the impact on anxiety, depression, fatigue and self-esteem is positive. This suggests that a combined rehabilitation program improves CRCI symptoms. The continuation of this study will make it possible to assess its replicability in other centers. Ultimately, the challenge is to identify the mechanism(s) involved.

P-258

Taking control of your functional cognitive disorders workbook: novel neuro-behavioral therapy treatment introduction & pilot data presentation

E. Cotton¹, K. Mordecai², R. Van Patten^3,4, V. Cabreira⁵, L. McWhirter⁵, W. C. LaFrance^3,4

¹Northwestern University, Psychiatry & Behavioral Sciences

Ken & Ruth Davee Dept of Neurology, Chicago, IL, United States

²VA Maryland Healthcare System, Baltimore, MD, United States

³VA Providence, Providence, RI, United States

⁴Brown University, Providence, RI, United States

⁵University of Edinburgh, Psychiatry, Edinburgh, United Kingdom

Background: Functional Cognitive Disorder (FCD) is a subset of Functional Neurological Disorder (FND), marked by distressing cognitive symptoms causing disability. FCD often co-occurs with pain, fatigue, and low activity tolerance, hypothesized to result from disrupted attention, anxiety, and unhelpful responses to cognitive errors. Despite its prevalence, established behavioral health treatments for FCD are lacking.

Objectives: To address this gap, we developed the "Taking Control of Your Functional Cognitive Symptoms Workbook," an intensive neurobehavioral therapy (NBT) intervention. Our goal is to introduce this treatment and present promising pilot study results.

Methods: Our FCD workbook intervention includes 14 one-hour weekly neuro-behavioral therapy (NBT) sessions. Working with a counselor, patients also complete homework, learn and practice skills, and actively use the workbook to target FCD symptoms. Experts adapted this NBT approach from the "Taking Control of Your Seizures Workbook." The FCD workbook addresses cognitive, somatic, emotional, and behavioral issues impacting daily life. Findings from a pilot study with five subjects will be presented.

Results: Treatment Credibility & Expectancy Questionnaire (CEQ), post-treatment qualitative interviews, and pre/post measures such as MoCA, Rey-15, NIHTB-CB, PROMIS (Cognition, Anxiety, Depression, Pain, Fatigue, Self-Efficacy for Managing Emotions), and WHODAS. Additional pre/post data from the Fear and Avoidance of Memory Loss Scale, Multifactorial Memory Questionnaire, and Metamemory in Adulthood will also be discussed.

Conclusions: The "Taking Control of Your Functional Cognitive Symptoms Workbook" is a well-received treatment, supported by pre/post data suggesting its efficacy. It is currently under evaluation for a larger randomized controlled trial (RCT). We are also happy to present this approach in a Round Table format, featuring speakers E. Cotton, W.C. LaFrance, and L. McWhirter.

P-259

Interplay of motor learning and spatial memory: a cognitive perspective

E. Soto Espinoza^1,2, F. Farrán Iturra¹, E. Poblete Alcantara¹, J. L. Valdés³

¹Universidad de Santiago, Kinesiology, Santiago, Chile

²University of Chile, Servicio de Medicina Física y Rehabilitación, Santiago, Chile

³University of Chile, Departamento de Neurociencias, Facultad de Medicina, Santiago, Chile

Introduction: Motor learning is relevant for enhancing performance and facilitating daily activities. In recent years, evidence has accumulated supporting the relevance of cognitive processes for motor learning. Among these processes, spatial memory possesses critical characteristics for proper motor learning; however, the relationship between the two remains unknown.

Objective: Our research aims to determine if motor learning is related to spatial memory.

Method: We recruited 33 young and healthy participants who underwent a motor learning test based on the center-periphery paradigm, evaluating variables such as reaction time, execution time, and performance. Subsequently, participants completed a spatial learning test based on the Morris virtual maze, assessing variables such as latency, distance traveled, and performance.

Results: A significant correlation was observed between performance in the motor learning task and aspects of the spatial memory test, such as distance (r=0.362; p=0.049) and latency (r=−0.372; p=0.043). No other correlations were found.

Conclusion: These results suggest that motor learning is enhanced when execution time is reduced and active search strategies are employed, leading to increased distance traveled. This implies a potential relationship between the ability to improve motor task performance and the capacity to remember and navigate spatial environments. Our next steps involve conducting clinical studies with the target population to validate and replicate these findings.

P-260

Enhancing motor learning through cognitive training

E. Soto Espinoza^1,2, C. Abarca Calderón¹, K. Astete San Martín¹, C. Araya Lillo¹

¹Universidad de Santiago, Kinesiology, Santiago, Chile

²University of Chile, Servicio de Medicina Física y Rehabilitación, Santiago, Chile

Introduction: Injuries to the central nervous system often result in physically debilitating conditions that pose challenges for rehabilitation, emphasizing the importance of identifying approaches that promote motor recovery. Recent years have seen an accumulation of evidence underscoring the bidirectional relationship between cognitive and motor skills.

Objective: Our research focuses on determining whether exclusive cognitive training can improve performance in motor learning tasks.

Method: We recruited 22 young, healthy participants and divided them into two groups: control and experimental. The experimental group underwent a three-week cognitive training regimen, while the control group had a resting period. Both groups engaged in a motor learning task based on the center-periphery paradigm, assessing variables such as reaction time (RT), execution time (ET), and performance (P) before (pre) and after (post) the training period.

Results: The experimental group demonstrated significant improvement in multiple parameters, reducing reaction time (pre-RT: 197.39ms - post-RT: 159.2ms; p=0.003), execution time (pre-ET: 1445.40ms - post-ET: 1266.71ms; p<0.001), and increasing performance (pre-P: 66.5% - post-P: 72.1%; p<0.001). In contrast, the control group improved their reaction time (pre-RT: 203.54ms - post-RT: 160.21ms; p<0.001) but exhibited an increase in execution time (pre-ET: 1205.32ms - post-ET: 1299.23ms; p<0.001) and a decrease in performance (pre-P: 78.5% - post-P: 69.8%; p<0.001).

Conclusion: These findings suggest that cognitive training may be an effective approach for enhancing performance in motor learning tasks. Our future endeavors involve conducting clinical studies with the target population to validate and replicate these results.

P-261

The effect of dance on brain structure and function in elderly patients with mild cognitive impairment: a systematic review

H. Tian¹, S. Tian², H. Wu³, Y. Zhu⁴, Y. Shen⁴, C. Guo⁵, T. Wang⁴

¹Suzhou University, Affiliated Dushu Lake Hospital, Suzhou City, China

²Nanjing Medical University, Department of Radiology, Nanjing City, China

³Nanjing Medical University, Department of Rehabilitation, Nanjing Drum Tower Hospital Clinical, Nanjing City, China

⁴Nanjing Medical University, Rehabilitation, Nanjing City, China

⁵Nanjing Medical University, Rehabilitation, Nanjing City, China

Objective: This systematic review aims to evaluate the effect of dance intervention on brain function or structure in patients with mild cognitive impairment (MCI) from the perspective of imaging, and provide imaging evidences for the clinical application of dance in patients with MCI.

Methods: Literature searches were performed in four databases including Cochrane Library, EMBASE, PubMed and Web Of Science to identify articles written in English or Chinese and published until August 2022. Randomized controlled trials were included . We extracted coordinate points corresponding to the changes functional connections, gray matter volume, and amplitude of low frequency fluctuation (ALFF) . Metlab software marked the brain regions with changes on the 3D whole brain stereogram.

Results: A total of 371 studies were screened, 8 studies were included in the review. In which, we extracted 51 coordinate points with changes in functional connectivity, 14 coordinate points with changes in ALFF, and 8 coordinate points with changes in gray matter volume. Almost all studies showed that dance could improve brain structure and/or brain function in elderly people with MCI. The structural changes include increased gray matter volume in hippocampus, bilateral anterior cingulate gyrus, frontotemporal occipital region.While the functional connections changes include the default mode network, dorsal attention network, locus coeruleus and ventral tegmental area of the midbrain. Increased ALFF in frontotemporal lobe, anterior cingulate gyrus, hippocampus and medial prefrontal lobe, and P300 latency was shortened.

Conclusion: Multi-component dance training has positive effects on brain structure and function in patients with MCI, thereby improving their cognitive function. Regular dance training with certain intensity may be essential to stimulate brain plasticity.

Key words: dance, mild cognitive impairment, gray matter volume, systematic review

P-262

Experiences of cognitive behavioral therapy for functional cognitive disorder after concussion

R. Mamman^1,2, M. Rioux³, A. Somani³, W. J. Panenka⁴, A. K. Howard⁴, D. L. Perez⁵, M. T. Byworth⁴, J. Schmidt^2,6, J. Lemoult³, N. Silverberg^2,3

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²Rehabilitation Research Program, GF Strong Rehabilitation Centre, Centre for Aging SMART, Vancouver, Canada

³University of British Columbia, Psychology, Vancouver, Canada

⁴University of British Columbia, Psychiatry, Vancouver, Canada

⁵Massachusetts General Hospital, Harvard Medical School, Neurology and Psychiatry, Boston, MA, United States

⁶University of British Columbia, Occupational Therapy, Vancouver, Canada

Introduction: After a concussion, certain individuals develop functional cognitive disorder (FCD). FCD is characterized by persistent memory symptoms not attributable to structural brain injury or disease. There are no known effective rehabilitation therapies for this condition, however, cognitive behavioral therapy (CBT) is an effective intervention for health conditions with phenotypical similarities to FCD. Importantly, there is limited understanding of the experiences of receiving CBT for people with FCD.

Objectives: To understand the experiences of individuals with FCD after concussion when receiving a novel CBT intervention.

Materials & methods: Qualitative methods using interpretive phenomenology was used. Five participants (3 females, mean age = 31 years, mean time post-injury = 618 days) were recruited from a feasibility randomized controlled trial (Clinicaltrials.gov #NCT05581810) where participants completed a manualized 11-session CBT protocol tailored to FCD. Data was collected during semi-structured interviews after the intervention. Reflexive thematic analysis was used to analyze data.

Results: Our analysis identified two themes: 1) ’reframing the monologue’ examined changes in participant beliefs about themselves and their memory. For example, after the intervention, participants perceived themselves as being similar to those without memory problems, and being more open about their memory failure as participants recognized it as a normal experience, and 2) ’I was in a safe space to deal with it’ described the positive therapist relationships and effective CBT strategies that participants integrated in their daily living.

Conclusion: Findings describe experiences of participants undergoing a novel intervention for FCD after concussion. Incorporating participant perspectives of interventions provides key information for future research studies and clinical practices to tailor their interventions and improve participant experience.

P-263

The detection of mild cognitive impairment based on the natural language processing

R. Wang¹, Y. Tang¹

¹The Second Xiangya Hospital, Rehabilitation, Changsha, China

Background: There is no widely accessible tool for the early detection of mild cognitive impairment (MCI) in China. This study aimed to screen individuals with high risk of developing MCI automatically and objectively by the development of a natural language processing (NLP)-based predictive model by acoustic data in mandarin-speaking Chinese individuals.

Methods: 215 individuals aged 50-80 were recruited to this study. The corresponding acoustic data and cognitive functions were collected by specific reading tasks and mini mental state examination (MMSE), respectively. Furthermore, participants were divided into the normal cognition group and the MCI group according to their MMSE scores. After 162 acoustic features were extracted, predictive models for cognitive function of individuals were constructed for both male and female subjects using multiple regression, respectively.

Results: Compared with the normal cognitive function, the MCI group showed significant differences 50 phonological features reflecting the pronunciation rhythms and pronunciation accuracy. The sensitivity, specificity and accuracy of the prediction model we constructed were 0.54, 0.80 and 0.69 for males and 0, 0.86 and 0.63 for females, respectively.

Conclusion: Speech features of patients with MCI were significantly altered. Speech analysis based on NLP can automatically and objectively detect MCI.

P-264

Prior exposure to environmental enrichment protects against learning and memory deficits caused by sepsis-associated encephalopathy

S. Jiang¹, X. Lu¹, B. Y. Gao¹

¹China-Japan Friendship Hospital, Rehabilitation, Beijing, China

Sepsis-associated encephalopathy (SAE) is one of the most serious complications of sepsis and obviously impairs the learning and memory ability. Our previous studies have shown that environmental enrichment (EE) is capable of increasing the learning and memory ability of SAE rats. However, this positive effect is palliative rather than preventive. Therefore, the present study aimed to investigate the possibly positive effect of prior exposure to EE on learning and memory ability of SAE rats and its related mechanisms. Our results showed that the SAE-induced impairment of learning and memory could be alleviated by prior to EE. In addition, prior exposure to EE decreased the levels of pro-inflammatory cytokines and oxidative stress, while increased the levels of anti-inflammatory cytokines and antioxidant properties in the hippocampus. Moreover, pre-exposure to EE also showed the ability to downregulate the pro-brain-derived neurotrophic factor (proBDNF) level, while upregulate the mature BDNF (mBDNF) level in the hippocampus. In conclusion, these results indicated that EE is neuroprotective when applied prior to SAE, resulting in an alleviated learning and memory impairment caused by SAE through enhancing antioxidant and anti-inflammatory capacities, and mature BDNF level.

P-265

The CAREPa-Re^® framework for rebooting the brain^® – clinical reasoning and management in functional neurosciences

S. Sharan¹, V. Siddharth¹, S. Prathiba¹

¹PRS Neurosciences & Mechatronics Research Institute (PNMRI), Functional Neurosciences - neuromodulation & neuro rehabilitation, Bengaluru, India

Introduction: Goal is helping neurologically disabled achieve their best functional outcomes in shortest time with least effort @affordable costs. This robust clinician-testedclini-tech process is leading the DIGITAL TRANSFORMATION & involves BIG DATA analytics. It is impossible to decide best possible patient-specific practical plan based on the complaints given by the patientand the clinical findingswe elicit examination. The progress and prognosis of the patients disease condition and possible future recovery is not simple 1+1=2 formula but dynamic complex multi-layered process. To be able to generalize it MASS CUSTOMISATION. clinicians across the world have successfully written a complex "reasoning and management" software in their brains helping them to effectively manage their patients and achieve outcomesWe amalgamate it distill it into specific categories make it a framework that can be generalized. This CAREPa-Re Principle with implemention on ground and constant refinements evolved into a mature clinical framework.

Materials & methods: We conducted descriptive analysis using ICF model which has universal acceptance. ICF has its limitations for a neuro-specialty set up where functional recovery is the only deliverable outcome rather than data collection. We conducted open-ended interviews with our healthcare team including physi therapist, occupational therapist, speech, neuropsychologist, neurologist neurosurgeon.We focused on challenges faced while communicating amongst themselves about the patients status and recovery.

Results: Disease determines rehabilitation protocols of patients in neurorehabilitation. Rehabilitation strategies need to be specific yet mass customizable. CAREPa-Re® Framework (Clinical Anatomical, Radiological, Etio-Pathology and Rehabilitation) across function-structure continuum.

Conclusion: The Framework is effective for communicating, planning and implementing neurorehabilitation across brain and spinal cord related disorders.

P-266

Introducing the REHABABILITY INDEX (RI) – the neurorehabilitation astrologer

S. Sharan¹, V. Siddharth¹

¹PRS Neurosciences & Mechatronics Research Institute (PNMRI), Functional Neurosciences - neuromodulation & neuro rehabilitation, Bengaluru, India

Introduction: Every neurologically disabled patient/ caregiver has same questions: Is he REHAHABLE? how long will it take? How much will it cost? Is it worth it? In India & developing world most patients still make out-of-pocket payments of their hospital bills. It is also useful even the developed world, wherein such accurate and evidence-based information can be a additional tool to convince the patient and family to engage in rehabilitation with confidence. RI is a progress & prognosis predictor. Features of this Predictive tool: 1. helps predict the best possible "functional" outcome – as per our C2C levels, 2. we can reassess the RI, 3. It predicts max possible C2C level, 4. Prudent money spend by family.

Materials & methods: We did online review of literature of Predictive tools for neurorehab. We got only one paper which clearly defined qualities a predictive tool must have to deliver the necessary need on ground. We saw that the eventual functional outcomes for neuro disabled patients depended mainly on the following: 1. Severity of the deficits > severity of disease, 2. Additional CAREPa complexities during treatment 3. Ictus rehab duration IRD 4. good neurorehab daily by group of experts 5. Duration of rehab, usually for long time.

Results: Our initial experience of using RI on patients with brain & SCI, we realized that RI can be used as a predictive tool to explain the rehab potential to patient/caregiver and professionals. We successfully predicted outcome for timeline -1 mnth to 2 yrs IRD with 70 –80% accuracy. RI initially was focused on acute insults (like TBI, stroke, brain tumor, SCI) that happened to normal adults, we use for pats with degen probs. We found predictions not as accurate. When use for dementia had limitations.

Conclusion: The RI is promising tool can be used in patients with acute insults. We need further validate RI against other similar indices. We also intend to add the CAREPa influence on outcomes in RIv2.0.

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Latin American survey for therapists and neurologists who care for patients with multiple sclerosis

M. Maldonado^1,2, L. Galleguillos¹, R. Alonso³

¹Clinica Alemana, Physical Therapy and Rehabilitation, Santiago, Chile

²Universidad del Desarrollo, Physical Therapy, Santiago, Chile

³Hospital Ramos Mejía, Buenos Aires, Argentina

Background: This disabling and poorly attended disease is becoming increasingly visible to health organizations and professionals and thanks to the Latin American Network of Multiple Sclerosis Associations (LATAM).

Objectives: To recognize the context of physical rehabilitation in Multiple Sclerosis in Latin American countries.

Methods: Cross-sectional study that investigated the opinion of a rehabilitation team (neurologists, physiatrists, physiotherapists, occupational therapists, psychologists) from Latin America on the comprehensive management of multiple sclerosis in their countries. The application of the information collection instrument was virtual, so the type of sampling was non-probabilistic.

Results: A total of 93 people constituted the sample, two groups of professionals were identified, the first were 78 neurologists with an average age of 51 ± 12 years, 53% (n = 41) worked in the private sector; 40% (n = 31) stated that research on physical rehabilitation in MS is carried out in their country. The majority (71% - n = 55) considered that the type of intervention most used for rehabilitation was outpatient and that the most used approach was multidisciplinary (51% - n = 40). The second group was 15 therapists, with an average age of 39 ± 6 years and 93% (14 people) worked in the private sector. 67% (10) stated that they did not know if research was carried out in their country on physical rehabilitation in Multiple Sclerosis. The majority (60% - n = 9) considered that the type of intervention most used for rehabilitation was also outpatient and that the most used approach, unlike what was expressed by neurologists, was interdisciplinary. The people surveyed recognized health care professionals or teams as the main barriers. While more than 60% did not consider costs or the conditions of patients with MS as barriers.

Conclusion: The education, promotion of a healthy lifestyle and facilitation of self-treatment are key of the therapeutic focus.

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Adaptive gait stimulation algorithm for central neurological conditions. Steps towards a more ecological adoption

J. P. Appelgren Gonzalez^1,2, F. Covarrubias Escudero^1,3, M. Campos¹, M. Hosiasson¹

¹Trainfes, Translational Research Unit, Santiago, Chile

²Catholic University of Chile, Biomedical Imaging Center, Santiago, Chile

³Metropolitan University of Science Education, Kinesiology, Santiago, Chile

One of the key elements of a succesful neuromotor therapy is about the question of what is the appropiate dosage for a specific objective. Of course this depends on several things, mostly due to the pathology and the systemic impairments that the person faces. In general, the most repeated factor is the intensity, how many repetitions can the patient do in order to achieve a functional goal. Sometimes, achieving that number is not possible in face-to-face sessions alone, so the therapist must find ways to keep the patient exercising with as few compensation as possible to relearn that movement.

Home-based rehabilitation is a powerful option to increase frequency of exercises, therapy adherence, amount of training per week, and self-confidence. Home-exercise using FES is an option which can help reduce the sequelae of sensorimotor disorders and lends itself as an exciting way for people suffering from various conditions to exercise their muscles. Nevertheless, how FES systems deliver activation of different muscles is critical. In this closed loop algorithm can be facilitated up to six different muscles in different and concurrent patterns.

For sagital and frontal planes, the inertial unit compare the actual movement with a reference. The farther away from the reference, the greater the intensity of the stimulus, reaching only the pre-configured parameters on each muscle by demand of each step. In order to do this in an efficient way, the algorithm process the previous steps and calculates the activation timing for the first stage of the next step. Also based on the previous steps, it adapts in speed and ground slope.

In this work we demonstrate changes in different clinical test for stroke population using the systems in ecological enviroments. What helps in stroke may not suits the demand in other conditions such as SCI or CP, so we proposed changes on this adaptative systems to learn about this behivors and facilitate them in a more organic way.

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From knowledge to practice: a nationwide study on spinal cord injury rehabilitation views among Indian physiotherapists

J. V. A. Dsouza¹, G. M. John¹

¹St. John’s Medical College Hospital, Bangalore, India, Physiotherapy, Bangalore, India

Introduction: This study explores the knowledge and perspectives of Indian physiotherapists regarding spinal cord injury (SCI) rehabilitation, emphasizing the need to address rehabilitation needs within resource-limited settings. Understanding their practices and challenges is crucial for enhancing SCI rehabilitation.

Objectives: Primary Objective: Assess current practices and perspectives of Indian physiotherapists in SCI rehabilitation. Secondary Objective: Highlight the need for India-specific Clinical Practice Guidelines (CPGs) for SCI rehabilitation.

Methodology: We employed a cross-sectional survey, distributing it via Google Forms. Eligible participants held qualifications like BPT, MPT, MSc, or PhD and had ≥2 years of rehabilitation experience, treating SCI patients. Our survey instrument, developed with expert input, captured their knowledge, perspectives, and practices.

Results: 385 physiotherapists participated (91% response rate). Findings revealed disparities. While many involve patients in planning (n=356) and consider their goals (n=376), clinical guideline adherence is limited (n=314). A significant portion recognized the need for India- specific CPGs (n=247) but followed foreign guidelines (n=247). E-learning resources were deemed essential (n=355), yet many lacked SCI rehabilitation training (n=224). Financial constraints were the primary challenge (n=287), impacting treatment sessions and technology use.

Conclusion: This study highlights diversity in SCI rehabilitation practices and challenges faced by Indian physiotherapists. It advocates for India-specific CPG development to address disparities, enhance outcomes and optimize resource utilization. Access to e-learning resources and advanced technologies could bridge gaps.

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The relationship between playing mahjong and the execution function of switching: a pilot study

Z. C. K. Tse¹, B. K. H. Chau¹, M. K. Yeung², Y. Cao³, D. H. K. Shum^1,4,5

¹Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

²The Education University of Hong Kong, Psychology, Hong Kong, Hong Kong

³University of Hong Kong, Department of Social Work and Social Administration, Hong Kong, Hong Kong

⁴Polytechnic University, Centre for Aging SMART, Hong Kong, Hong Kong

⁵Polytechnic University, Mental Health Research Centre, Hong Kong, Hong Kong

Introduction: Playing mahjong is an intellectual leisure activity and it requires players to utilise multiple cognitive abilities such as attention and working memory. Preliminary evidence (Tse et al., 2022) has shown that playing mahjong was related to one component of executive function (EF; viz. working memory), but limited research has examined the association between mahjong and another component of EF (viz. switching). The neural underpinnings of the cognitive processes involved during the mahjong game also remained unclear. Therefore, the current study aimed to investigate the relationship between playing mahjong and switching, and provided additional evidence to support the association between playing mahjong and EF.

Objectives: To develop a computerised mahjong game and show that it involves the EF of switching using both behavioural measures and functional near-infrared spectroscopy (fNIRS).

Materials & method: Healthy participants were administered the switching version of the computerised mahjong game, color-shape task and color trials test. fNIRS was used to collect the changes in oxyhaemoglobin concentration in the prefrontal cortex.

Results: Behavioural results demonstrated that the participants exhibited a longer reaction time in the switching blocks of the computerised mahjong game and the color-shape task. Additional prefrontal activations were observed in the switching blocks of the computerised mahjong game.

Conclusion: Both behavioural and neural evidence support that playing mahjong is associated with the switching component of the EF. The beneficial effects of mahjong playing are likely to be due to the engagement of EF during the game and the active usage of the prefrontal area.

Tse, Z. C. K., Chau, B. K. H., Yeung, M. K., Cao, Y., & Shum, D. H. K. (2022, December 14-17). The relationship between playing mahjong and working memory: A pilot study [Poster presentation]. 12th World Congress of Neurorehabilitation, Vienna, Austria.

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Unveiling mobility hurdles: a comprehensive analysis of stroke survivors in india using the mobility disability scale

J. V. A. Dsouza¹, A. Sridhara Murthy¹, R. Chauhan¹, M. Natarajan²

¹St. John’s Medical College Hospital, Bangalore, India, Physiotherapy, Bangalore, India

²Manipal College of Health Professions, Physiotherapy, Manipal, India

Background: This study introduces the Mobility Disability Scale (MDS) as a specialized tool for evaluating mobility among stroke survivors in the Indian community, addressing a critical deficiency in outcome measures primarily designed for Western populations.

Objective: To assess the mobility of Indian stroke survivors in community setup using the MDS

Methodology: We enrolled a cohort of 133 community-dwelling first-onset stroke survivors in India. We collected demographic data via telephonic interviews, coupled with comprehensive assessments using the Mobility Disability Scale (MDS). Supplementary medical records were obtained from hospital databases.

Results: Males constituted 71% (n=102) of the cohort. Significantly, mobility challenges were prevalent, with 77% (n=111) reporting difficulties in vehicle usage and 57% (n=82) encountering obstacles while using public transportation. Moreover, 32% (n=46) faced challenges in self-care activities like bathing, and 31% (n=45) confronted issues related to tasks necessitating squatting. Community ambulation presented challenges for 21% (n=30), while 51% (n=73) were constrained from venturing outdoors during rainy conditions. The study revealed that 41% (n=59) avoided crowded areas, limiting their community engagement. Negotiating uneven terrains posed substantial difficulties for 37% (n=53), and 31% (n=45) encountered obstacles while crossing various physical barriers. Participants also reported challenges in responding to traffic signals (68%, n=98) and walking during conversations (43%, n=62). Additionally, 15% (n=22) reported a fear of falling, and an equal proportion faced job-related mobility constraints (15%, n=22).

Conclusion: These findings highlight the complex and multifaceted nature of mobility disabilities in Indian stroke survivors, emphasizing the imperative for tailored rehabilitation strategies. Addressing context-specific mobility challenges is essential to improve the well-being of this population.

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The effect of music therapy on cognition in neurorehabilitation – a pilot randomized controlled trial

K. G. Lim¹, W. F. Ng², W. F. Beh³

¹PERKESO, Music, Melaka, Malaysia

²St Andrew’s Community Hospital, Inpatient Therapy Services, Singapore, Singapore

³University of Malaysia, Music, Kuala Lumpur, Malaysia

Background: Music therapy has received more attention with its surging application in neuro-rehabilitation. Given the dearth of music therapy and cognitive rehabilitation research conducted in Malaysia, this pilot RCT study intended to assess the feasibility of both active and passive music therapy interventions versus the standard care condition in cognition among adults with neuro-rehabilitation needs.

Method: The study included participants aged 30 to 60, with MMSE scores between 10 and 22, and functional hearing, either with or without hearing aids. The exclusion criteria were: MMSE scores above 22 or below 10, documented hallucinations or delusions, hearing impairments, or language barriers. Each participant received one session of each of the following: active music therapy intervention, passive music therapy intervention, and standard care. Mini-Cog tests were conducted before and after each session and the scores were collected for data analysis.

Result: Out of the 227 individuals initially screened, 45 met the eligibility criteria and provided consent, but 7 of them were discharged before completing all conditions, resulting in a final participation count of 38 (comprising 31 males and 7 females) subjects in the study. Throughout the study, observations ensured the troubleshooting of any potential flaws for future recommendations. The results showed a non-significant difference [χ2(2) = 3.047, p = 0.218] in the outcome measure between the experimental and control conditions.

Conclusion: The music therapy pilot study was found to be feasible to deliver, and its results serve as a valuable resource for future research in cognitive rehabilitation and music therapy. There was an increase in Mini-cog test scores after the experimental conditions. A future definitive trial conducted across multiple facilities could expand the sample size.

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Impact of WFNR mentorship programme in developing countries – a case scenario

N. Surya¹, A. S. M M², G. Ramamurthy³, H. Someshwar⁴, S. Kamble⁵

¹Surya Neuro Centre, Neurology, Mumbai, India

²NG Hospital, Neurology, Coimbatore, India

³BG Hospital, Neurology, Tiruchendur, India

⁴NMC & BYL Nair Charitable Hospital, Physiotherapy, Mumbai, India

⁵Dr D Y Patil College of Physiotherapy, Physiotherapy, Pune, India

Background: WFNR mentorship program, an initiative to improve knowledge of young neurologists and physiotherapists in neurorehabilitation. Program provides professional relationship where mentor provides support, guidance and goals during program, helps for future career in neurorehabilitation

Aims: To analyze effect of mentorship program on their career progress

Materials: Mentee reports of Nirmal Surya analysed. Aspects of career progression, opportunities provided, leadership abilities were analysed

Results: Various aspects of impact are summarized. Training to review articles: Mentor provided opportunities to review articles and helped to look at articles in different perspective. Co-authoring articles: Mentor provided opportunities to mentees in co-authoring articles and chapters. This helped them to simplify laborious process of authoring. Organising public awareness programs: Mentor provided mentees to organize public awareness programs and helped to improve organizational and communication skills, leadership qualities. Providing opportunities in national and international conferences: Mentor provided opportunities to participate, debate in national and international conferences thereby improving communication skills of mentees. Incorporating evidence-based medicine in daily practice. Interaction with other mentees and faculties from different fields of neurorehabilitation. Organizing conferences and webinars on national and international level. Recreational and extra-curricular activities

Conclusion: Career progress significantly improved following enrolment in program under mentorship of Nirmal Surya. Career progression, leadership abilities, communication skills improved. Hence increasing enrolment of young specialists in mentorship program would enhance uplift in career hence ensuring formidable future & sustain progression in neurorehabilitation

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Rhythm interactive special enablers (R.I.S.E) – a collaborative community engagement program

W. F. Beh¹, Y. C. Lim², E. Nathaniel³

¹University of Malaysia, Music, Kuala Lumpur, Malaysia

²University of Malaysia, Social and Preventive Medicine, Kuala Lumpur, Malaysia

³Music Mart PJ, Kuala Lumpur, Malaysia

Background: The concept of neuroplasticity has become a focal point in the rehabilitation of spastic children, especially in improving their brain capacity for motor function regulation. However, a neurological program that requires repetitive movements may be challenging for spastic children. This is an often-overlooked issue that compromises the recovery rate. Literature supports the effectiveness of musical intervention in assisting children with special needs. Consulting prior studies, Rhythm Interactive Special Enablers (R.I.S.E.) will be developed as a rehabilitation program for spastic children to improve various developmental skills.

Objective: To facilitate the rehabilitation process with a musical experience to accompany the physical movement; To support the development of body coordination; To guide individuals to recognize and learn from their mistakes; To train individuals to be able to abide by guidelines and instructions.

Method: The project will be dispatched in two phases. The First Phase involves developing and reviewing the modules in R.I.S.E. as a musical therapeutic program for spastic children. The Second Phase will be the implementation of the R.I.S.E. program by trained members at the selected centre. The program will be conducted bi-weekly over 3 months, requiring 1 hour each time. Pre- and Post-intervention data will be collected and analyzed using SPSS Version 29.

Result: A significant number (n=50) of participants with spasticity enrolled in and were retained in the program. This industrial-academia collaborative R.I.S.E. program will yield credible research outcomes whilst also uplifting the welfare of the spastic community. Universiti Malaya will also meet its intended social responsibility. The positive short-term and intermediate impact on the stakeholders is anticipated, while the ownership of the program by related neurological care providers will undoubtedly remain in the long run.

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Living with neurological injury in Mauritius: sociocultural barriers and enablers

B. Soll^1,2, V. Oxenham³, S. Kowlessur⁴, R. Reebye^5,2

¹University of Derby, Psychology, Derby, United Kingdom

²Canadian Association of Neuro-Orthopaedics for Spasticity Consortium, Vancouver, Canada

³Macquarie University, Psychology, Sydney, Australia

⁴Mauritius Ministry of Health and Wellness, Health Promotion and Research, Port Louis, Mauritius

⁵University of British Columbia, Medicine, Vancouver, Canada

Background: Long-term neurorehabilitation services are very limited in Mauritius. Patients requiring multidisciplinary neurorehabilitation face significant physical and socio-cultural barriers. We aimed to investigate the sociocultural barriers and enablers of Mauritians living with neurological disabilities and their family-caregivers.

Method: Thematic analysis following an inductive approach allowed us to use a phenomenological epistemology. We conducted 34 semi-structured interviews with neuro-rehabilitation patients (N=18) and their primary caregivers (N=22). Patient aetiology included stroke (N=22), spinal cord injury (N=11), and traumatic brain injury (N=1). Patients without physical and/or cognitive disability were excluded. Data examining sociocultural influences on the patient experience were isolated.

Results: After isolating data concerning sociocultural experiences, 5 themes were revealed: abandonment; public stigma; shame; religion’s double-edged sword; and inaccessibility’s cutting message. Patients experience moderate to severe social exclusion due to their disability; most with adequate familial support come to accept home isolation. Religion either provided a sense of hope for patients or was used to shame them. We found that patients preferred going out during COVID-19 lockdowns, as they felt they would avoid being judged for their disabilities with fewer people out in the community. Combined with social rejection, poor accessibility paints a very clear picture for patients: you do not fit in this society; this place is not for you.

Conclusion: We recommend a mass campaign educating the Mauritian community about the multiple facets of disability, focussing on sociocultural enablers that will facilitate reintegration in community-based activities. We also recommend an emphasis on accessibility for patients to improve inclusivity and reframe the focus of rehabilitation to be strength-based rather than using an assisted or deficit-based model.

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Changes in functional independence after inpatient rehabilitation in patients with spinal cord injury: a simultaneous evaluation of prognostic factors

E. Loni¹, S. Moein¹, R. Bidhendi-Yarandi¹, N. Akbarfahimi¹, F. Layeghi¹

¹University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

Objective: This study aimed to investigate the improvements of functional independence following inpatient rehabilitation and compare those improvements between different levels and severities of Spinal Cord Injury (SCI). Prognostic factors affecting the patient"s outcomes were also studied.

Settings: Rofeideh Rehabilitation Hospital.

Outcome Measures: Spinal Cord Independence Measure version III (SCIM III), and Functional Independence Measure (FIM).

Method: In this retrospective cohort study, 180 patients with SCI were enrolled to record their functional independence upon admission and discharge, and the changes were compared between different levels and severities of injury using non-parametric tests. The prognostic factors of outcomes were studied by generalized estimating equation (GEE) analysis.

Results: The independence changes were significant for all the severities (American Spinal Injury Association Impairment Scale (AIS)) and levels of injury except for the patients with AIS A and B at upper cervical levels (P < 0.05). The level of injury, AIS, Length of Stay (LOS), and pressure ulcer had a significant prognostic value on patient’s outcomes. Furthermore, there was a significant difference between different levels of

injury with the same AIS grade in functional improvement (P < 0.05), while there was a significant difference between AIS groups with the same level of injury only at upper and middle cervical lesions (P < 0.05).

Conclusion: Recording the values of functional independence before and after rehabilitation in individuals with SCI can help clinicians approximately expect the outcomes of future patients. Moreover, a deeper study of the prognostic factors can provide a more logical expectation of rehabilitation outcomes.

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Effect of functional electrical stimulation on neuromechanic variables during gait in persons with stroke

G. Varas¹, G. Nuñez¹, P. Vargas¹, M. J. Alvarez¹, A. Torres¹, V. Perez¹, F. Covarrubias Escudero²

¹Catholic University of Chile, Health Science, Santiago, Chile

²Metropolitan University of Science Education, Santiago, Chile

Introduction: Stroke is a leading cause of disability worldwide. One of its main sequelae is hemiparesis, which causes gait disorders due to sensorimotor impairments. One strategy to re-educate gait is the use of functional electrical stimulation (FES) on the paretic lower extremity, however, it is not clear which muscles are most effective to stimulate.

Objective: To analyze whether the use of FES in hip, knee and ankle muscles improves temporal-spatial and neuromechanic variables during gait compared to a traditional approach of stimulation on ankle muscles in persons with stroke.

Methods: An analytical crossover study was carried out that measured cadence, gait speed, stride length, percentage of the gait cycle in double support and step-to-step transition (assessed by the force ratio between the front and back foot, and minimal vertical velocity of Center of Mass (CoM)) in three experimental conditions. In No FES condition participants walked without FES, in FES 2 condition they used FES in the anterior tibialis and gastrocnemius and in condition FES 5 FES was used in the gluteus maximus, quadriceps, hamstrings, tibialis anterior and gastrocnemius. A one-way ANOVA was used to analyze the variables in the three experimental conditions.

Results: A total of 12 participants participated in this study. No significant differences were found in spatiotemporal gait parameters between No FES and FES conditions. However, FES 2 condition and FES 5 condition showed lower force ratio and CoM minimal vertical velocity values compared to the No FES condition (p<0.05). No differences were observed between FES conditions (p>0.05).

Conclusion: FES showed immediate changes on neuromechanic variables such as step to step transition (assessed by the force ratio and CoM minimal vertical velocity). However, these changes were not translated into functional component of the gait.

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Perineal hygiene practices among women stroke survivors in India

D. Martis¹, P. Ramachandra¹, M. Natarajan¹, J. M. Solomon¹

¹Manipal College of Health Professions, Manipal Academy of Higher Education, Physiotherapy, Manipal, India

Introduction: Among women stroke survivors perineal hygiene may be affected due to mobility issues, muscle weakness, altered sensation, and cognitive impairments. There is insufficient research regarding perineal hygiene practices especially in LMICs such as India.

Objectives: To identify the perineal hygiene practices and to explore the perception regarding perineal hygiene among women stroke survivors living in community in India

Methods: A cross-sectional survey was conducted among women stroke survivors with more than 6 months of disease duration, aged between 30-65 living in the community. Participants with aphasia, cognitive dysfunction, neuromusculoskeletal dysfunction other than stroke, and uncontrolled epilepsy were excluded. A content-validated questionnaire containing questions related to perineal hygiene was used to study the population. To explore more regarding the perception, 8 participants from the survey group were recruited for an in-depth face-to-face interview.

Results: Total of 60 participants with a mean age of 55.5±7.9 participated in the study. Incontinence was found in 36.7% of participants. Most women used home remedies for the discomforts or problems in genital area, whereas only 16.7% approached for medical assistance.

In the qualitative interview, participants, reported to various barriers and facilitators for the perineal hygiene maintenance. Barriers and facilitators experienced by participant differ according to their impairment, family support and environmental factors. Participants reported that they feel uncomfortable discussing their perineal hygiene practices with their doctors.

Conclusion: More than 30% of female stroke survivors do not follow perineal hygiene practices. Participants’ knowledge and attitude were found to have an impact on the participant"s perception in maintenance of perineal hygiene.Education and awareness programs are needed to improve perineal hygiene and utilization of health services.

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Navigating the landscape of neurorehabilitation devices: a comprehensive analysis of market dynamics, trends, and opportunities in India

K. Kachroo¹, H. Sundar¹, Sesetti¹, J. Sharma², R. Srivastava³, A. Sharma⁴, R. Singh¹

¹Kalam Institute of Health Technology, Visakhapatnam, India

²Andhra Pradesh MedTech Zone (AMTZ), Executive Director – Kalam Institute of Health Technology, Visakhapatnam, India

³WISH Foundation, . . ., . . ., India

⁴Government of India, Artificial Limb Centre, Andhra Pradesh MedTech Zone (AMTZ), Senior Scientist, ICMR, . . ., India

Introduction: The neurorehabilitation devices market stands at the forefront of technological innovation, offering hope and transformative solutions for individuals recovering from neurological injuries and disorders. In this dynamic landscape, where advancements in artificial intelligence, virtual reality, and robotics converge, the purpose of this comprehensive study is to unravel the intricacies of the neurorehabilitation devices market. Aimed at providing valuable insights for stakeholders ranging from healthcare professionals and manufacturers to investors and policymakers, the report delves into market size, growth, key players, technological trends, regulatory considerations, challenges, and opportunities. Drawing from global and Indian perspectives, this analysis navigates through the evolving market dynamics, shedding light on the critical role neurorehabilitation devices play in improving the quality of life for those affected by neurological disorders.

Objective: This study aims to provide a comprehensive analysis of the neurorehabilitation devices market, covering aspects such as market size, growth, key players, technological trends, regulatory landscape, challenges, and opportunities and aims to equip stakeholders, including healthcare professionals, manufacturers, investors, and policymakers, with valuable insights to make informed decisions in this dynamic and rapidly evolving sector.

Methodology: This descriptive report encompasses an in-depth study of neurorehabilitation devices in India, examining various product types, end-users, market dynamics, and regional trends. Additionally, it will explore the competitive landscape, technological trends, and regulatory considerations shaping the industry. The data presented in this report has been sourced from publicly available information found on online platforms, all data has been carefully selected and analysed to provide a comprehensive overview of the market, enabling stakeholders to navigate the challenges and leverage emerging opportunities.

Conclusion: The field of neurorehabilitation devices in India Projected to reach INR 14,661 Cr by 2033 and the market promises significant growth supported by rising awareness, cost-effective solutions, and the potential of remote rehabilitation bridging healthcare gaps. This surge stems from factors – increasing neurological disorders, the emergence of affordable wearable and non-invasive technologies, and the burgeoning potential of telerehabilitation in rural areas. However, despite of the challenges mentioned above, High equipment costs and limited access to trained professionals pose potential hurdles to the field of neurorehabilitation devices. To overcome these, strategic government initiatives, innovative financing models. By addressing these gaps, India’s neurorehabilitation device market can revolutionize healthcare access and empower patients towards improved outcomes.

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The early stroke rehabilitation systems gaps

M. Yazdani¹, M. Saadatnia¹, M. Ghasemi¹, A. Chitsaz¹

¹Isfahan Neurosciences Research Center (INRC), Isfahan, Iran

Background: Efforts to identify beneficial rehabilitation program characteristics in stroke patients are ongoing. goals of this study that attention at the increased time of each session of intervention and Performing exercises with high intensity and repetition until exhaustion according to the evaluation and progress of patients.

Methods: The sample included twelve hemiparetic patients (54.3 ± 15.4 years old) with ischemic stroke (n = 7 control, n = 5 intervention). The study was started as early as possible after stroke and included an intervention group (including passive range of motion exercises, resistance training, assisted standing up, and active exercises on the healthy side of the body, in addition to encouraging voluntary contraction of affected limbs as much as possible, performing exercises with high intensity until exhaustion, three months, six days a week, for 2-3 hours per session.), and was teaching families and equipping homes. and control group including standard rehabilitation. The Fugle-Meyer Assessment, Box and Blocks Test and time up and go assessments were conducted.

Results: There was a significantly greater improvement in the intervention group compared to the control: FMA lower limbs (p = 0.001), total motor function (p = 0.002)and TUG test (p = 0.004). but no significant difference in FMA upper limbs between groups (p = 0.51)and BBT test (p = 0.3).

Conclusions: According to the results of this study, if we increase the time and number of rehabilitation sessions and use high-intensity and repetition exercises until exhaustion, we will get better results in less time.

Keywords: early stroke rehabilitation, motor function, systems gaps, free time

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Effectiveness of custom made rehabilitation programs across spectrum of deficits in chronic stroke: a case series

N. Karandikar¹, A. Ranade¹, N. Agashe¹

¹TEAM Phsyiotherapy Services, Neuro Physiotherapy, Pune, India

Purpose: To evaluate the effectiveness of custom-made rehabilitation programs across spectrum of deficits in chronic stroke.

Method: Participants with chronic stroke (>1 year of stroke) were included in this case series. 5 participants were selected participant 1: motor stroke upper extremity more involved Participant 2: motor stroke lower extremity more involved Participant 3: Sensory affection stroke Participant 4: Both sided stroke Participant 5: cognitive involvement along with sensory-motor deficits

The Rehabilitation programs for motor stroke involved intense muscle strengthening exercises. Neuromuscular electrical stimulation for training the patients for near normal movements, prevent compensations and facilitate correct movement patterns. Functional electrical stimulation was used to train correct gait patterns. Mirror therapy and CIMT was used to train functional movements. The sensory stroke case was given sensory re-education. For trunkcal control,protocol focusing on correct activation of trunk muscles ,teaching the patient how to use the stabilizer and mobilizer components of movement improving the motor control thereby facilitating biomechanically correct movements. The participant with cognitive affection was consulted with Neuropsychologist for cognitive rehabilitation and to give strategies to the physiotherapists how to cue the patient more effectively during therapy sessions to help the patient understand the movement patterns and functional mobility in a safe way and practice it in home environments.

The outcome measures used were the Fugl Meyer Assessment Scale, gait speed, Berg balance scale, Nottingham sensory Profile, FIM scale. All the above outcomes showed significant changes post 90 rehabilitation sessions of 60 mins each.

Conclusion: Intense, custom-made rehabilitation programs improve motor function, sensation perception and functional performance in chronic stroke cases.

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Mathematical modeling and statistical analysis in neurorehabilitation: a path towards enhanced recovery

O. Lawson ¹

¹Polytechnic University, Pure and Applied Science, Abule Egba, Nigeria

Neurorehabilitation is a critical field of study that focuses on improving the lives of individuals with neurological disorders and injuries, such as stroke, traumatic brain injury, and spinal cord injury. This research project delves into the intersection of mathematics, statistics, and neurorehabilitation to develop innovative strategies for optimizing the rehabilitation process.In recent years, there has been a growing recognition of the role that mathematical modeling and statistical analysis can play in understanding and improving neurorehabilitation outcomes. This study seeks to bridge the gap between the mathematical sciences and the healthcare domain, with a specific focus on the application of mathematical models and statistical techniques to assess and enhance the effectiveness of neurorehabilitation interventions.

Method: The research project will investigate various aspects of neurorehabilitation, including the assessment of patient progress, the optimization of rehabilitation protocols, and the prediction of long-term outcomes. Advanced mathematical models, such as differential equations and machine learning algorithms, will be employed to simulate the dynamics of neural recovery and predict individualized rehabilitation plans. Statistical analysis will be used to analyze large datasets of patient outcomes and identify key factors that influence recovery trajectories. By harnessing the power of mathematics and statistics, this research aims to provide healthcare professionals with valuable tools and insights for tailoring neurorehabilitation programs to the unique needs of each patient. Ultimately, the goal is to improve the quality of life for individuals affected by neurological disorders and injuries by optimizing the rehabilitation process and fostering more effective recovery strategies. This research project represents a significant contribution to the field of neurorehabilitation and underscores the importance of interdisciplinary collaboration between the pure and applied sciences, mathematics, and healthcare.

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Hand Rehabilitation Syrebo-patients with hand dysfunction caused by stroke, brain injury, cerebral palsy, hand trauma, orthopedic surgery, etc.

P. Zumbado ^1,2

¹VCH, Rehabilitation, New Westminster, Canada

²Syrebo, Rehabilitation, Shanghai, China

Background: U-limb dysfunction is a common disability after stroke. About 30-60% of stroke patients are still unable to use their u-limbs after 6 months of stroke, which seriously affects activities of daily living. Bilateral movement training is a new treatment emerging in recent years. Many studies have shown that bilateral movement training has significant advantages in improving neurological defects and promoting brain function recombination, compared with unilateral movement training. This study investigated the effect and mechanism of bilateral movement training on upper limb dysfunction in patients with hemiplegia.

Results: patient in the treatment group failed to complete all tests. Most patients in the treatment group felt sore and fatigue in the first few days of training, which gradually disappeared after continuous training without affecting the training. There were no significant differences in FMA-UE and MBI scores between the two groups before treatment. After treatment, FMA-UE and MBI scores in both groups were significantly higher than before treatment; the score of the treatment group was significantly higher than that of the control group

Conclusions: Bilateral movement training can significantly improve the upper limb motor function and daily living ability of hemiplegia patients during rehabilitation. To help patients relearn and recover hand motor functions, SYREBO innovative hand rehabilitation glove allows stroke patients to do bilateral movement training. With the help hand rehabilitation glove, he healthy hand with data glove can drive the affected hand with the power glove to move synchronously. Therefore, patients can pick up the cup or bottle with affected hand, which can promote the autonomic recovery of the brain and speed up the rehabilitation process of hand function high-end models have fine motor training that power glove can drive each affected finger to perform the flexion and extension, making training more effective a thorough.

P-287

Practice of integrated treatment in the management of stroke

S. K.N¹, F. P.V¹, A. Rahman²

¹Ayurgreen Hospital, Research and Development, Edappal, India

²Ayurgreen Hospital, Edappal, India

Introduction: Stroke is one of the major conditions which leads to death and disability. Timelines and effectiveness of treatments are essential to reduce morbidity and mortality of patients and can improve prognosis. An integrated system of rehabilitation refers to a comprehensive approach that combines various therapies, interventions, and support services to address the needs of individuals with physical, cognitive, or emotional impairments of stroke survivors.

Aim & objectives: To explore the practice effect of an integrated system of treatment modalities in stroke rehabilitation

Methodology: we established a team For rehabilitation from each system of medicine, including Physiotherapy, Robotics, Occupational therapy, Speech therapy, Ayurveda, and Naturopathy. The ailments of the patient are assessed by each medical team before and after rehabilitation as well as during the course of admission. We will analyse the conditions and outcomes of the patient every 3 weeks. Based on the patient"s condition we will do robotics which includes Huber, Geo, Arm motion, Aquaciser, etc. For co-ordinating all these systems together there should be one person.

Results: Through an integrative system, each patient got holistic patient care, and enhanced healing. Robotics provide high dosage and high-intensity training which results fast recovery. Combining knowledge from various treatment communities provides accurate diagnoses and effective treatment plans, especially for multifaceted medical conditions. Reduced duplication of tests and unnecessary procedures provides cost-effective health care. Interdisciplinary collaboration fosters innovation and accelerates medical research so we can improve QOL in a short period of time.

Conclusion: Collaboration with all healthcare providers for stroke rehabilitation provides resilience as well as buoyant recovery in a short period.

Keywords: Stroke, Rehabilitation, Occupational therapy, Physiotherapy, Ayurveda, Naturopathy, Speech therapy, Robotics

P-290

The outpatient rehabilitation setting in the multidisciplinary care of the patient with glioblastoma undergoing neurosurgery

F. Gottardello¹, K. Priftis², G. Lombardi³, S. Masiero⁴, F. Piccione⁵

¹"Ca’ Foncello" Hospital, Spinal Cord Unit, Treviso, Italy

²University of Padua, Department of General Psycology, Padua, Italy

³Istituto Oncologico Veneto IOV-IRCCS, Department of Oncology, Padua, Italy

⁴University of Padua, Department of Neuroscience, Neurorehabilitation Unit, Padua, Italy

⁵University of Padua, Section of Brain Injury Rehabilitation, Neurorehabilitation Unit, Padua, Italy

Introduction: Patients with Glioblastoma undergoing neurosurgery show neurological and functional deficits that require a comprehensive rehabilitation treatment.

Objectives: This longitudinal observational study aims to identify prognostic factors and outcomes of the outpatient rehabilitation of patients with Glioblastoma after surgery.

Methods: Between April 2021 and July 2023, 40 patients with operated Glioblastoma were evaluated. Clinical, surgical and oncological prognostic factors were correlated with the succesful conclusion of the outpatient rehabilitation plan. In order to quantify any functional and quality-of-life improvement brought by the rehabilitation, pre- and post-treatment values of clinical scales and specific questionnaires were compared (Charlson Comorbidity Index, Functional Ambulation Classification, Karnosky Performance Status, Fatigue Severity Scale, Functional Indipencence Measure, EORTC QLQ-C30, Warwick-Edinburgh Mental Well-Being Scale).

Results: only 9 patients with Glioblastoma undertook and completed individual rehabilitation plan, 23 patients did not begin or discontinued the treatment and 7 subjects were not included in the study due to diagnostic reclassification. Descriptive analysis of the data showed that treated patients underwent partial surgical resection, they had more left-sided lesions, fewer comorbidities and they received more second-line therapies compared to discontinued/untreated patients. Comparison of the pre- and post-treatment data of patients who completed the rehabilitation plan revealed a statistically significant reduction of fatigue (measured by FSS) and improvement of mental well-being (measured by WEMBS).

Conclusions: Prognostic factors recorded in our study, which possibly predicted rehabilitation outcomes, were not significant. However, our study confirm that outpatient rehabilitation treatment determines reduction of fatigue and improves mental well-being of patients with Glioblastoma undergoing surgery.

P-291

Morphologic Evaluation of the Fascicular Architecture of the C7 Nerve Root

U. Maierhofer¹, F. Jaklin¹, L. Reissig², D. Dotzauer¹, R. Blumer², O. Aszmann^1,3

¹Medical University of Vienna, Clinical Laboratory for Bionic Extremity Reconstruction, Vienna, Austria

²Medical University of Vienna, Division of Anatomy Centre for Anatomy and Cell Biology, Vienna, Austria

³Medical University of Vienna, Department of Plastic, Reconstructive and Aesthetic Surgery, Vienna, Austria

Introduction: The contralateral C7 transfer is an innovative procedure that recently has gained a lot of interest in the treatment of brachial plexus injuries and spastic hemiparesis. The C7 nerve root presents a complex network of fascicles, each with specific motor and sensory functions which exhibit a significant spacial variability. Understanding the spatial arrangement of these fascicles is crucial for targeted reinnervation and optimal functional outcomes.

Objectives: In this study, we aim to display the spatial arrangement of motor and sensory axons in the proximal and distal end of the C7 nerve root via immunofluorescence staining and analyze the fascicular rearrangement throughout the C7 root via micro CT.

Methods: The C7 root is harvested bilaterally in a group of 10 anatomic body donors within 24 hours post-mortem. Both the proximal and the distal end of the root are subjected to immunofluorescence staining using antibodies against neurofilament, choline-acetyltransferase, myelin basic protein, and tyrosine hydroxylase. The remaining part of the nerve root is stained with Lugol"s solution and imaged via micro computer tomography.

Results: We present topographic and quantitative data on the micromorphological distribution of sesnory and motor axons in the C7 nerve root. As C7 root transfers have recently shown good outcomes for various reconstructive indications, detailed data on its topography might improve outcomes even more.

References

Gu YD, Zhang GM, Chen DS, Yan JG, Cheng XM, Chen L. Seventh cervical nerve root transfer from the contralateral healthy side for treatment of brachial plexus root avulsion. J Hand Surg Br. 1992 Oct;17(5):518-21. doi: 10.1016/s0266-7681(05)80235-9. PMID: 1479244.

Terzis JK, Kokkalis ZT. Selective contralateral c7 transfer in posttraumatic brachial plexus injuries: a report of 56 cases. Plast Reconstr Surg. 2009 Mar;123(3):927-938. doi: 10.1097/PRS.0b013e31819ba48a. PMID: 19319057.

P-292

Randomised Evaluation of Early v Late cranioplasty: a pilot study

H. Mee^1,2, A. Kolias³, A. Helmy³, I. Timofeev⁴, F. Anwar², G. Whiting³, P. Hutchinson^3,4

¹University of Cambridge, Rehabilitation, Cambridge, United Kingdom

²Cambridge University Hospital NHS Foundation Trust, Rehabilitation, Cambridge, United Kingdom

³University of Cambridge, Neurosurgery, Cambridge, United Kingdom

⁴Cambridge University Hospital NHS Foundation Trust, Neurosurgery, Cambridge, United Kingdom

Background: Patients with significant brain swelling and/or raised intracranial pressure after TBI or stroke can undergo a decompressive craniectomy (DC) to help in management. Those who survive often require a second operation, known as cranioplasty. This aims to restore the integrity of the skull, giving a degree of mechanical protection with the timing of the procedure possibly having an impact on improved neurological outcomes and can have a significant impact on the type and intensity of neuro-rehabilitation.

Objective: To undertake a single centre, pilot randomised study comparing two distinct time intervals for cranioplasty: early (within 3 months after DC) vs standard of care (more than 6 months after DC) collecting functional outcomes at 6- and 12-months following DC.

Population: Adult patients (>16) who have undergone a DC for either TBI or stroke and who were clinically assessed for cranioplasty.

Data: Functional outcome measured using GOSE (dichotomised: unfavourable (1-3) or favourable (4-8)) and functional independence measured by functional independence measure (FIM).

Results: 14 patients randomised, 7 to each arm. At 6 months the number of patients with a favourable GOSE outcome in the early arm was 5/7 compared to 4/7 in the late group. Mean FIM total change increased by 27.7 (SD 26.94) (FIM motor 21.9, FIM cognitive 5.8) in early arm compared to 33.92 (SD 33.54) (FIM motor 26.42, FIM cognitive 7.5) in late arm. FIM efficiency was greatest in period with cranioplasty - 0.21 in early group compared to 0.13 in late group.

Conclusions: Although no definitive findings can be drawn, there is increase in the rate of functional independence following cranioplasty independent of timing. A further substantial study is required to evaluate any potential effect of timing on functional outcomes.

P-293

Changes in health-related quality of life among patients with stroke in the first months after discharge from hospital to home – a longitudinal cohort study

M. Balling¹, F. Skovbjerg¹, B. Ebbesen², A. Ghosh³, I. C. Brunner⁴

¹Hammel Neurorehabilitation Centre, Hammel, Denmark

²Aalborg University, Aalborg, Denmark

³Leiden University, Leiden, Netherlands

⁴Aarhus University, Aarhus, Denmark

Introduction: In Denmark, around 12000 people suffer from stroke each year. Change in functional abilities and other health-related factors resulting from stroke can affect health-related quality of life (HRQoL). Assessing HRQoL during the first 3 months after discharge may provide valuable insights into patients’ wellbeing.

Objective: The objective of this cohort study was to examine how HRQoL develops in patients affected by stroke during the first months after discharge to their home. Moreover, to examine if the outcome varies depending on whether HRQoL is measured by EuroQol-5 Domain (EQ-5D), Short Form 36 (SF-36), or Stroke Specific Quality of Life Scale-Short Form 12 items (SS-QoL-12).

Patients & methods: Forty-nine patients with mild-moderate stroke were recruited from two hospitals in Denmark from February 2020 to December 2021. The patients answered SF-36 and SS-QoL-12 once a month, and EQ-5D once a week. Data collected at one, two, and three months post-discharge were included in the primary analyses using paired t-tests. Correlations between the outcome measures were assessed using Pearson’s correlation coefficient.

Results: HRQoL improved from one to three months after discharge in SF-36 physical subscale with 3.46 points (-0.50; 5,03, p=0.06) and mental subscale with 5.78 points (2.45:9.19, p<0,01), as well as SS-QoL-12 with 2.74 points (0.73; 4.74, p<0,01). EQ-5D showed no development with an average difference of 0.00 (-0.06; 0.05, p=0.95). Good correlations were observed between the SF-36, mental sub-score and SS-QoL-12 and the physical sub-score.

Conclusion: HRQoL improves in the first months after discharge when measured with SF-36 and SS-QoL-12. The results indicate most improvement in emotional and mental wellbeing. Our results may suggest a psychological adjustment process after returning home while the greatest physical improvements have occurred earlier during rehabilitation.

P-294

External validation of a dynamic prediction model for upper limb function after stroke

I. C. Brunner¹, E. R. Andrinopoulou², R. Selles², C. Biering Lundquist¹, A. R. Pedersen³

¹Aarhus University, Aarhus, Denmark

²University Medical Center Rotterdam, Rotterdam, Netherlands

³Silkeborg Regional Hospital, Silkeborg, Denmark

Introduction: Accurate prediction of the recovery of upper limb (UL) function is crucial for targeted rehabilitation. A dynamic prediction model, adaptable to varying numbers of measurements and independent of predetermined time points, has been developed and cross-validated using data from four Dutch studies.

Objective: The aim of this study was to externally validate the dynamic prediction model’s accuracy in predicting UL function six months post-stroke.

Materials & methods: In this external validation study, follow-up data from 80 patients in the subacute phase after stroke, mean age 64 (SD11), 43 % female, were collected during and after their rehabilitation at a Danish Neurorehabilitation hospital.

Patients were assessed at 2 weeks, 3 months, and 6 months after stroke with the Action Research Arm Test (ARAT), Fugl-Meyer Motor Assessment upper limb (FMA), and Shoulder Abduction (SA) Finger Extension (FE), (SAFE) test.

Prediction accuracy at 6 months was examined for three categories of ARAT (0-57 points): mild (48-57), moderate (23-47), and severe (0-22). Two individual predictions of ARAT scores at +/- 6 months post-stroke were computed based on, respectively, baseline (2 weeks) and 3-month ARAT, FE, SA values. The absolute individual differences between observed and predicted ARAT scores were summarized.

Results: The prediction model performed best for patients with relatively good UL motor function, absolute error median (IQR) of 3 (2-9), and worst for patients with severe UL impairment, with a median (IQR) of 30 (3-39) based on 2-weeks post stroke measurements. Prediction accuracy substantially improved when data obtained 3 months after stroke was included compared to baseline at 2 weeks after stroke.

Conclusion: The clinical usability of the dynamic prediction model was found to be limited due to insufficient prediction accuracy at 2 weeks post-stroke and for patients with severe UL impairments. To enhance the model, the incorporation of biomarker data is suggested.

P-295

Brain function tests: empowering rehab clinicians, patients & caregivers in brain injury rehab: novel evaluation tools for assessing the functional abilities in brain injured patients

S. Sharan¹, S. Prathiba¹, V. Siddharth¹, C. Nikhil¹, A. Ganapathy¹, H. Sneha¹

¹PRS Neurosciences & Mechatronics Research Institute (PNMRI), Functional Neurosciences - neuromodulation & neuro rehabilitation, Bengaluru, India

Introduction: The global burden of neurological disabilities chronic nature of these problems lack of trained manpower & major impact that these have on the GDP demands an urgent need for Self "Evaluation Tools" for enhanced understanding of the functional capabilities and deficits. Usually any screening process requires at least 40-60 minutes with various experts which is difficult to devote to each patient with high caseloads. We needed an easy-to-administer, online, intuitive "screening tool" answered by non-medical person which helps in self-identification of these complex "functional disabilities and make the doctor consultation remedy-focused.

Objectives: We wanted to develop a self-evaluation tool to capture the functional ability of people with brain injury by assessing the current functioning, rehab potential he/ she has and map progress to describe outcomes.

Materials & methods: We interviewed about questions which the clinicians (neurologist, neurosurgeons, PT, OT, SLP & neuropsychologist) ask during consultation. We conducted a thematic analysis of the questions. Each question had predefined answers. We converted them into online evaluation and surveyed. This evaluation tool provided C2C (Coma 2 Community) level as result with prewritten reports. All the responses chosen are saved and can be emailed as a PDF. We also created a clinical evaluation matrix (GCS, RLA, DRS and MBI) to validate the outcomes of SEFA, called CEFA.

Results: SEFA tool used over 700 distinct questions that were categorized under 18 subcategories. This tool does not work with incomplete information. The reports were clinically satisfactory with accuracy of 70-90%. It could be answered by any person. It was deployed online for easy use.

Conclusion: SEFA tool was used as a time saving tool to report about the patient"s status. Though this tool requires further studies to use it as a standardized evaluation tool, it is a promising tool. SEFAv2.0 is in the process of development.

P-296

Spinal cord function tests – empowering the rehab clinician, patient & caregivers in SCI rehabilitation: novel evaluation tools for assessing the functional abilities in SCI

S. Sharan¹, S. Prathiba¹, A. Ganapathy¹, V. Siddharth¹, C. Nikhil¹

¹PRS Neurosciences & Mechatronics Research Institute (PNMRI), Functional Neurosciences - neuromodulation & neuro rehabilitation, Bengaluru, India

Introduction: The global burden of neurological disabilities, the chronic nature of these problems, and the major impact that these have on the GDP demands an urgent need for a Self "Evaluation Tool" for a quick yet enhanced understanding of the functional capabilities and deficits. Usually the screening process requires at least 40 minutes with various experts which is difficult to devote to each patient with high caseloads. We need a "screening tool" answered by non-medical person which helps in self-identification of these complex "functional disabilities and make the doctor consultation remedy-focused.

Objectives: We want to develop a self-evaluation tool to capture the functional ability of people with SCI by assessing the current functioning, rehab potential he/ she has and map progress to describe outcomes.

Materials & methods: We interviewed about questions which the clinicians (neurologist, neurosurgeons, PT, OT and SLP) ask during consultation. We conducted a thematic analysis of the questions. Each question had predefined answers. We converted them into online evaluation and surveyed. This evaluation tool provided C2C SCIR (Cot 2 Community) level as result with prewritten report. We also created a unique clinical evaluation matrix (ASIA & SCIM-iii) to validate the outcomes of SEFA, called CEFA.

Results: SEFA^® tool used over 700 distinct questions that were categorized under 18 subcategories. This tool does not work with incomplete information. The reports were clinically satisfactory with accuracy of 70-90%. It could be answered by any person. It was deployed online for easy use.

Conclusion: SEFA^® tool was used as a time saving tool to report about the patient’s status. Though this tool requires further studies to use it as a standardized evaluation tool, it is a promising tool. SEFAv2.0 is in the pipeline.

P-297

Clinical upper limb outcome measures and sensor-based arm use metrics: Concurrent validity and responsiveness across recovery phases after stroke

J. Pohl^1,2,3,4, G. Verheyden², J. Held⁵, C. Awai-Easthope^1,3,4, A. Luft^1,6,4, J. Veerbeek⁷

¹Lake Lucerne Institute, Vitznau, Switzerland

²KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

³cefir | center for interdisciplinary research, Vitznau, Switzerland

⁴University of Zurich and University Hospital Zurich, Neurology, Zurich, Switzerland

⁵Valens Clinics, Rehabilitation Center Triemli Zurich, Zurich, Switzerland

⁶cereneo Foundation, Vitznau, Switzerland

⁷Luzerner Kantonsspital, Neurocenter, Lucerne, Switzerland

Background: Concurrent validity and responsiveness of upper limb outcome measures are essential to interpret motor recovery after stroke. Regarding conventional rehabilitation, these measurement properties are needed for clinical assessments and in particular, for sensor-based arm use (AU) metrics.

Objectives: We aimed to investigate the concurrent validity and responsiveness of clinical outcome measures and AU metrics, excluding whole-body movements.

Methods: In a prospective cohort study, individuals with motor impairment were measured at days 3±2, 10±2, 28±4 and 90±7 after their first-ever stroke. Upper limb motor function was assessed using the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Box-&-Block Test (BBT), and the 14-item Motor Activity Log (MAL-14). Individuals wore five movement sensors (trunk, wrists, and ankles). Twelve sensor-based AU metrics were computed, excluding walking bouts. Concurrent validity across measures was analyzed by correlation matrices (Spearman, r_s) for each time point. Responsiveness was analyzed by correlating upper limb change scores (between time points) with patient-perceived change assessed by the Global Rate of Perceived Change (GRPC). Minimal clinically important change (MIC) values were estimated by ROC curve analysis (GRPC-anchor-based).

Results: Ninety-three individuals participated. Strong positive relations across time points were found between clinical measures and AU metrics (r_s: 0.73-0.94, p<0.01). Good responsiveness within days 9-28 was indicated by moderate-to-strong relations (r_s: 0.60-0.73, p<0.01), whereas relations were weaker for AU-metrics (r_s: 0.28-0.43, p<0.05). MIC cut-off values showed good predictive power (accuracies 67-87%).

Conclusions: We present measurement properties of clinical outcome measures and arm use metrics referring to conventional rehabilitation poststroke. Minimal-important change values benchmark effective interventions.

P-298

Profiling daily life performance recovery in the early subacute phase after stroke using a graphical modeling approach

J. Veerbeek¹, C. Hutter², B. Ottiger¹, N. Maaijwee¹, T. Vanbellingen^1,3, T. Nyffeler^1,3,4

¹Luzerner Kantonsspital, Neurocenter, Lucerne, Switzerland

²ETH Zurich, Chair for Mathematical Information Science, Zurich, Switzerland

³University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Switzerland

⁴University of Bern, Neurology, Bern, Switzerland

Introduction: Laboratory-based assessments have shown that stroke recovery is heterogeneous between patients and affected domains such as motor and language function. However, laboratory-based assessments are not ecologically valid and do not necessarily reflect patients" daily life performance.

Objective: To give an innovative view on stroke recovery by profiling daily life performance recovery across domains in patients with early subacute stroke and determine their interrelatedness, taking stroke localization into account.

Patients & methods: In early subacute stroke patients, daily life performance was observed at neurorehabilitation admission and weekly thereafter until discharge, using a scale containing 7 daily life domains. Graphical modeling was applied to investigate the conditional independence between recovery of these domains depending on stroke localization.

Results: There were 592 patients analyzed. Four clusters of interrelated domains were identified within the first 6 weeks poststroke. The first cluster included recovery in learning and applying knowledge, general tasks and demands, and domestic life. The second cluster comprised recovery in self-care and general tasks and demands. The third cluster included recovery in mobility and self-care; it incorporated interpersonal interactions and relationships in left supratentorial stroke, and learning and applying knowledge in right supratentorial stroke. The final cluster included only communication recovery.

Conclusions: Daily life recovery dynamics early poststroke show that although impairments in body functions are anatomically determined, their impact on performance is comparable. Second, some, but by no means all, domains show an interrelated recovery. Domains requiring cognitive abilities are especially interrelated and seem to be essential for concomitant recovery in mobility and domestic life.

Reference

J Am Heart Assoc. 2023;12:e030472. DOI: 10.1161/JAHA.123.030472

P-299

Supporting equity in symptom score reporting: development of a picture based version of the SP-36 limitations of activity domain for rehabilitation medicine

B. Stothers¹, A. Macnab¹

¹University of British Columbia, Medicine, Vancouver, Canada

Objective: The use of validated questionaries are important in rehabilitation medicine. Literacy and language barriers prevent patients from self reporting symptoms. We aimed to develop a picture based version of the 10 items in the limitations of activities (LoA) section of the SF-36 in an effort to increase equity in self reporting symptoms. We validated the picture based versus written versions and describe the methodology of picture based score development.

Methods: This was a prospective, cohort study including community dwelling adults. Participants were N=101 volunteers (43 male, 58 female) age 18-93 years, education level 52 post secondary, 44 high school grades 10-12, 5 grade 9 or less. Development consisted of 4 parts: 1) completion of our picture based SF-36 LoA developed using Poser software Version 11.0 (VIJO, California), 2) verbal and/or written descriptions of what they understood each picture to mean, 3) completion of text version of the SF-36 LoA score, 4) debriefing of participants as end user feedback to alter images to increase information capture.

Statistics: a quadratic weighted kappa score was used to analyze the correlation between the individual picture versus text based items in both questionnaires as an equivalent to an intra-class correlation coefficient. Demographics were compared using descriptive statistics.

Results: N= 101 subjects rated their health as 26.7% excellent, 25.7% very good, 29.8% good, 10.9% fair and 6.9% poor. Analysis showed strong correlation between text based SF-36 LoA questions and the picture based visual score-VSF-36 LoA (ICC=0.98) with question 10 correlating highest (ICC=0.9) and question 2 lowest (ICC=0.82).

Conclusions: The picture based version of the SF-36 LoA domain allows for evaluation of subjects regardless of language or literacy having good correlation to the text version in subjects with adequate literacy. Future directions should evaluate its use in a cohort representative of those in need.

P-300

Using ultrafast and conventional Doppler imaging for the assessment of intramuscular vascularity

T. Miller^1,2,3, N. Chambara^4,5, M. Ying⁴, M. Pang³

¹University of British Columbia, Medicine, Vancouver, Canada

²International Collaboration on Repair Discoveries (ICORD), Medicine, Vancouver, Canada

³Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

⁴Polytechnic University, Health Technology and Informatics, Hong Kong, Hong Kong

⁵Cardiff University, Health Science, Cardiff, United Kingdom

Background: Ultrafast ultrasound imaging techniques such as Angio PLanewave UltraSensitive (Angio-PL.U.S.) provide an alternative to conventional Doppler and contrast-enhanced ultrasound for the assessment of microvascular blood flow in populations with adverse tissue pathologies (e.g., breast lesions, carotid atherosclerotic plaques, renal cortices, and endoleaks following endovascular aneurism repair). However, the use of this technique for musculoskeletal applications remains understudied.

Objective: This cross-sectional study compared the use of ultrafast Angio-PL.U.S. and conventional color Doppler flow imaging (CDFI) for evaluating intramuscular blood flow.

Methods: Forty-five older adult participants were assessed (age=59.1±7.6). Intramuscular blood perfusion of the bilateral biceps brachii (BB) and medial gastrocnemius (MG) were estimated using the vascularity index (VI). Intra-limb (difference in VI between imaging techniques) and inter-limb differences [percent side-to-side differences (%SSD) in VI between limbs] were compared using Wilcoxon Signed Ranks and Mann-Whitney U tests, respectively. Associations between imaging techniques were also assessed using Spearman’s ρ.

Results: No differences were observed between dominant and non-dominant BB (p≥0.053) and MG (p≥0.756) for both CDFI and Angio-PL.U.S. Only VI measures for the non-dominant BB showed an intra-limb difference between imaging techniques (p=0.002). A significant %SSD between imaging techniques was found for BB (p=0.011), but not MG (p=0.089). Strong associations between CDFI and Angio-PL.U.S. were observed for bilateral BB and MG (ρ=0.616-0.814, p≤0.001).

Conclusions: Angio-PL.U.S. showed greater sensitivity in detecting bilateral limb differences in intramuscular blood perfusion. This technique demonstrates potential clinical utility for characterizing disease progression in populations with unilateral (e.g., stroke) or global musculoskeletal tissue changes (e.g., muscular dystrophy).

P-301

Using ultrasound elastography to assess exercise-induced changes in musculoskeletal tissue biomechanical properties: a systematic review and meta-analysis

T. Miller^1,2,3, U. Bello^3,4, C. Tsang³, S. Winser³, M. Ying⁵, M. Pang³

¹University of British Columbia, Medicine, Vancouver, Canada

²International Collaboration on Repair Discoveries (ICORD), Medicine, Vancouver, Canada

³Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

⁴Glasgow Caledonian University, Department of Physiotherapy and Paramedicine, Glasgow, United Kingdom

⁵Polytechnic University, Health Technology and Informatics, Hong Kong, Hong Kong

Background: A growing number of studies have investigated the use of ultrasound elastography to evaluate alterations in tissue biomechanical properties in-vivo.

Objectives: To determine the effect of exercise-induced changes in musculoskeletal biomechanical properties when evaluated using ultrasound elastography.

Methods: This review was prospectively registered. A systematic search of Web of Science, Scopus, MEDLINE, CINAHL and EMBASE databases was performed in accordance with PRISMA guidelines. Bias was assessed for true and quasi-experimental studies using the Cochrane Risk of Bias or ROBINS-I tools, respectively. Quality of evidence was determined using GRADE criteria. Meta-analyses were conducted for adequately powered subgroups based on exercise type, dosage, as well as the location or structures measured.

Results: Forty-six studies were included in the final review. Overall bias was low or unclear for true experimental studies, and moderate for quasi-experimental studies. Quality of evidence was moderate at the outcome level for randomized control trials involving high dose (≥15 min) static stretching exercises targeting lower limb muscles. Sensitivity analyses found similar reductions in biomechanical properties for static stretching (Hedges"s g=0.513, 95% CI=0.185-0.842) compared to combined stretching exercises (g=0.406, 95% CI=-0.243-1.725). No significant differences were found when using exercise subtype as a grouping factor (i.e., static vs combined stretching exercises) (Q=0.214).

Conclusion: Moderate evidence supports the use of static stretching in high cumulative doses which target lower limb muscles to produce reductions in tissue biomechanical properties among healthy populations. Additional subgroup analyses were underpowered. Based on the review findings, ultrasound elastography shows potential clinical applicability in evaluating the effect of exercise-induced biomechanical alterations in musculoskeletal tissues.

P-302

Does vitami D 25 (OH) influence early knee osteoarthritis?

B. Kaffoura¹, N. Amer¹, F. Alshehhi¹

¹EHS, Physical Therapy and Rehabilitation, Ras Al Khaimah, United Arab Emirates

Background: Low vitamin D levels have adverse effects on calcium metabolism, osteoblastic activity, and bone mineral density. This deficiency could increase susceptibility to osteoarthritis.

Methods & objective: It’s a cross-sectional study comparing the "Controlled group" and the "Arthritic group. "Data was collected from 120 patients, with 60 in each group. The arthritic group consists of patients with knee osteoarthritis, while the controlled group includes individuals without the condition. Results show a higher prevalence of knee osteoarthritis in individuals over 60 and in their late 50s.The arthritic group has higher BMI values, especially in the elder age groups.

Results: Despite the fact that vitamin D levels contributing in Prevention of knee osteoarthritis, the sample groups of current study showed contradictory results that shows the Vitamin D levels are higher in the arthritic group. It means that the Vitamin D level has no effect on reported cases of knee osteoarthritis. Similarly, female is more in arthritic group as compared to males that shown female gender might be a risk factor for developing the Knee osteoarthritis.

Furthermore, Results of independent t test shows that Age (p value= .000), and BMI (p value= .001), there are statistically significant differences in means between the groups with Age showing a significant difference even after accounting for unequal variances. However, for Vitamin D (p value= .140), there is no statistically significant difference in means, and the assumption of equal variances is also met which means that the population variances of the both selected groups are not significantly different from each other for their vitamin D level.

Therefore, the findings of this analysis support the well-established understanding that age is a significant risk factor for knee osteoarthritis. As individuals grow older, the likelihood of developing knee osteoarthritis increases substantially.

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Unlocking rehabilitation insights: designing a data dashboard for quantitative analysis of rehabilitation activity data

P. Trayner^1,2, C. Giblin¹, S. Lake³, A. Bateman³

¹Clinical Neuropsychology Services, Manchester, United Kingdom

²University of Manchester, Psychology and Mental Health, Manchester, United Kingdom

³University of Essex, School of Health and Social Care, Essex, United Kingdom

Introduction: Goal Manager® is a cloud-based application incorporating a digitised version of the International Classification of Disability and Functioning (ICF), allowing healthcare services to assess patients and co-ordinate their rehabilitation. Funding from Innovate UK supported the development of a Data Dashboard within the platform, to analyse rehabilitation data gathered with the ICF assessment and other outcome measures.

Objectives: To establish the data needs of clinicians, service providers and legal professionals when analysing ICF and goal-based data, to create the initial iteration of the Data Dashboard.

Patients & methods: Seven focus group discussions were held with 12 neurorehabilitation professionals to discuss use cases of the Data Dashboard. Pre-existing and prospective Goal Manager® users discussed how the software could be deployed within their services and identified opportunities for future development.

Results: Preliminary thematic analysis of meeting transcripts identified five main themes of discussion: 1) The fundamental nature of outcome tracking; 2) Standardisation of therapeutic dosage and accountability; 3) Intuitive treatment plans; 4) The contextual importance of holistic care; 5) The individualistic nature of reporting needs. Identified use cases for the dashboard included service-wide monitoring, obtaining funding support, and legal considerations.

Conclusion: Participants recognised that analysis of functional change through ICF data was invaluable to track rehabilitative outcomes. Feedback demonstrated the need for the Data Dashboard in many rehabilitation contexts, with end users recognising the time saving elements, particularly in resource-constrained service environments. Participants strongly supported future research applications considering rehabilitation processes based on ICF functional change, to create common understanding amongst service providers and inform treatment plans.

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Making systematic change: implementing a digital solution to measure outcomes

P. Trayner^1,2, C. Giblin¹

¹Clinical Neuropsychology Services, Manchester, United Kingdom

²University of Manchester, Psychology and Mental Health, Manchester, United Kingdom

Introduction: Digital fatigue is rife in healthcare services, as professionals express frustration with current and legacy software (DHSC, 2020). The cloud-based application Goal Manager® was designed from clinical experience to co-ordinate rehabilitation goals and automate reporting by creating a digital solution for outcome measurement, using Goal Attainment Scaling (GAS) and functional change from International Classification of Functioning, Disability and Health (ICF) assessments.

Objectives: Funding from the European Regional Development Fund (ERDF) supported a trial deployment of Goal Manager® within the National Health Service (NHS), assessing user experience, interoperability with electronic patient record systems, and the utility of new elements, a Patient Portal and Data Dashboard, to enhance accessibility to clinical data.

Materials & methods: Goal Manager® was deployed within a hospital-based stroke service, with training tailored to the service"s need. Staff utilised Goal Manager®, generating reports at discharge, and assessed the efficacy of the Patient Portal and Data Dashboard.

Results: Staff satisfaction levels and effectiveness of Goal Manager® were analysed by thematic analysis of interview transcripts and statistical analysis of questionnaire data. Thematic analysis produced themes of 1) Accessibility, 2) Involvement, 3) Maximising Resources, and 4) Technology Readiness. Questionnaire analysis demonstrated utility of the software and highlighted areas for improvement.

Conclusion: This study detailed the advantages of a digital alternative for goal setting within the NHS, particularly in outcome measurement and monitoring. Findings demonstrated that implementation preparedness for technological solutions was influenced by professional readiness, highlighting the need to consider this in future deployments. Study feedback will shape the Patient Portal and Data Dashboard interface, enhancing outcome measure tracking to better serve public need.

P-305

EXALT ergometer: bridging clinical needs and technological innovation for lower extremity rehabilitation

C. Martin¹, M. Hamel¹, S. Richard², F. Michaud², K. Lebel^2,1, É. Riesco^2,1

¹Research Center on Aging - CIUSSS de l’Estrie-CHUS, Sherbrooke, Canada

²Sherbrooke University, Sherbrooke, Canada

Introduction: Clinical lower extremity training holds considerable promise in rehabilitating patients with various illnesses, including stroke, neurological disorders, and any conditions leading to prolonged immobilization. Nevertheless, there is currently no ergometer on the market that provides precise evaluation, can be safely operated in clinical settings, is accepted by both patients and health workers, and is financially accessible for healthcare institutions.

Objectives: To develop a cycle ergometer meeting these criteria, employing a "develop with clinical intent" model (DCI) that prioritize clinical needs over technological advancements.

Materials & methods: An interdisciplinary team, comprising healthcare professionals, kinesiologists, and engineers, was assembled to develop the EXALT ergometer. The 1st phase of the DCI involves technological development with a focus on the clinical workflow. The resulting prototype is lightweight, features a universal fixation system for hospital bed, and includes an embedded touch screen. The system is also integrated with OpenTera for data management and remote access to training data, enabling telerehabilitation. The 2nd phase, involving clinical viability and design iteration, followed. EXALT underwent testing with 13 patients and 4 healthcare workers in hemodialysis.

Results: The evaluations indicate that 77% of the patients and 75% of the professionals expressed a desire to use the ergometer regularly. However, only 54% percents of the patients found the pedaling comfortable, and 62% found the ergometer well-adapted in terms of functionality and comfort.

Conclusion: EXALT exhibits significant potential, though an additional revision cycle is needed before viable clinical implementation. This development phase introduces a removable tablet to facilitate the work of professionals, an advanced control model to enhance pedalling smoothness, and a new attachment method to improve comfort and stability.

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Recovery rates of Berg Balance Scale in stroke patients. A retrospective study

D. A. Castillo Gallardo¹, C. López Pascua¹

¹Centro Lescer, Physiotherapy, Madrid, Spain

Introduction: Stroke is one of the main causes of disability worldwide standing in second position. In Spain there are 329.500 post stroke patients that have long term disability according to the INE. With balance recovery being a very challenging aspect and demanded target of our patients we decided to conduct a retrospective study of our database to assess the recovery rates through the Berg Balance Scale.

Material & methods: We collected data from July of 2006 until April 2023 with a total of 367 patients that suffered a stroke and had an initial and final Berg Balance Scale. Minimum time between tests was of 3 months and maximum time of evolution between test was 10 years. All test were done by a trained physical therapist in Centro Lescer.

Patients with associated diseases such as cancer, spinal cord injury, metabolic encephalitis, dementia, head trauma, infectious diseases and vascular malformations were excluded with a result of 349 patients with a stroke. Then we separated patients from ischemic and he morrhagic and removed

those patients that after the ischemic stroke had an hemorrhagic onset (19 patients). With an ending result of 210 ischemic and 120 hemorrhagic stroke patients.

Results: Our data showed that patients who suffered a hemorrhagic stroke had an improvement of 8,47% during their rehabilitation process as ischemic patients improved an 7,01% in the Berg Balance scale. From ischemic group women improved 6,23% while men improved 8,71%. From hemorrhagic group women improved 6,96% while men improved 9,51%.

Discussion: Since stroke rehabilitation is a very wide process that involves many therapists in our clinic, from neuropsychologist, speech, occupational and physical therapist. Having recovery rates of different disabilities such as balance impairments, could help us anticipate which patients could need more intensive care in this domain and design better rehabilitation plans adapted to the needs of the patients and their families.

P-307

The difference between people with and without chronic nonspecific low back pain in postural balance tasks

F. Liu¹, H. Nan², X. Wang¹, J. Sui¹

¹Inner Mongolia Medical University, First Clinical Medical College, Hohhot, China

²Inner Mongolia Medical University, Physical Therapy and Rehabilitation, Hohhot, China

Background: The postural balance is one of important ability to perform normal activities of daily life. Ability of postural balance in patients with chronic nonspecific low back pain (CNLBP) has been reported in several studies, most studies have analyzed the bipedal stance position, only little evidence has shown deference between people with and without CNLBP in postural balance when performing different balance tasks.

Objectives: In order to offer more specific guideline on balance training of people with CNLBP, the study has compared the data of static and dynamic postural balance tasks between people with and without CNLBP.

Method: The study included 42 subjects, 21 patients with CNLBP were served as the CNLBP group while 21 healthy subjects served as the healthy group. Static and dynamic postural balance were evaluated using a pressure platform (MTD-balance system, Germany) and a dynamic balance evaluation system (XY-PH-V Balance training and evaluation system, China).

Results: (1) Compared to the healthy group, patients in the CNLBP group performed worse in the one-legged stance, and the left-right weight-bearing difference in the two-legged alternate stance and semi-squat when bipedal standing (p < 0.05). (2) The limits of stability (LOS) on the left and rear left side of the CNLBP group were significantly lower than those of the healthy group (p < 0.05). (3) The postural stability indices (PSI) of the CNLBP group was significantly higher than those of the healthy group in bipedal standing with eyes closed, centre of gravity shift when bipedal standing and unilateral standing with eyes open (p < 0.05).

Conclusion: Compared the two sets of data, patients with CNLBP were less likely to maintain their balance in the one-legged and more difficult bipedal standing tasks. According to the result, it might be helpful for people suffer from CNLBP whom could be suggested a specific balance training to improve their balance ability and activities of daily life (ADL).

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Investigating the impact of patient-reported outcome measures in audiology outside the clinical environment

K. Vilamitjana¹, J. Cummine¹, W. Hodgetts¹

¹University of Alberta, Rehabilitation, Edmonton, Canada

Introduction: According to the World Report on Hearing by the World Health Organization, more than 1.5 billion people experience some degree of hearing loss. Untreated hearing loss in older adults has several potential negative consequences ranging from social isolation to an increased risk of dementia. These findings, with the fact that only 1 in 5 people who need a hearing aid are wearing one, are deeply concerning and need immediate attention. The gap in adoption may stem from a disparity between traditional clinical hearing measurements and real-world, ecologically valid assessments. The severity of hearing loss alone doesn"t capture its full impact; improvement at home and responsiveness to daily communication needs are crucial.

Objectives: To investigate the impact of patient-reported outcome measures in audiology outside the clinical environment.

Methods: A scoping review titled "Do Patient-Derived Outcome Measures Improve Success Rate in Older Adults Fit with Hearing Devices?" identifies literature gaps on patient-derived outcome measures and success rates. Another inquiry, "Are the Current Self-Reported Outcome Measures in Audiology Relevant to the Patient"s Communication and Lifestyle Needs? Explores the relevance of existing self-reported outcome measures.

The study"s broader implications are discussed in relation to "To What Extent Does an Online Home-Based and Patient-Derived Outcome Increase Patient Empowerment and Long-term Success with Hearing Rehabilitation?"

Conclusion: Hearing assessments, hearing aid performance, and outcome measures are all essential to patient-centred care; each involves a critical stage of the rehabilitation process. By integrating a virtual platform with outcome measures in audiology, we can use home-based measures and bridge the gap between the clinic and the patient"s relevant environment.

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Inter and intra-rater reliability of the gross motor function classification system applied by physical therapy students

L. Flores ¹

¹PUCE, Physiotherapy, Quito, Ecuador

Cerebral Palsy (CP) is the most frequent movement disorder in children. For the functional classification of this condition, standardized guidelines like the GMFCS have been established, it evaluates the activities of daily living based on the child’s functional limitations. The role of the physical therapist is to evaluate the levels of the GMFCS presented by children with CP depending on their functional capacity and to be able to pigeonhole said capacity in the corresponding level.

Objective: Determine the inter- and intra-evaluator reliability of the GMFCS applied by Physical Therapy students in the last year of study.

Method: The motor behavior of 20 patients with a previous diagnosis of CP between the ages of 18 months and 18 years was evaluated. The evaluation was carried out by 20 physical therapy students in their last year of study, with an interval of 7 days between the pretest and post-test and by watching patients’ videos. To determine the degree of inter- and intraobserver agreement, the Fleiss Kappa coefficient was used, and the standard error of measurement was calculated, considering α=0.05.

Results: Inter-rater reproducibility of 0.70 was found, according to the KAPPA coefficient, which, according to the Landis and Koch scale, is considerable, ranging between 0.47 and 0.90. The analysis for Grade V was 0.28 and for Grade I 0.14, with Grade V being the best identified by the students. The intra-evaluator reproducibility registered an average coefficient of 0.13, which shows the difficulty of the students to maintain the diagnosis in the two moments of the test.

Conclusions: The students’ little experience in determining the patients’ functional level could be a confounding factor in the post-test when over-analyzing the cases and trying to find the best functional diagnosis.

Damiano DL, Longo E.Early intervention evidence for infants with or at risk for cerebral palsy:an overview of systematic reviews.Dev Med Child Neurol.(2021) 63(7):771–84

P-310

Innovative balance assessment in real-world clinical settings: a protocol development study using markerless motion capture

M. Azhdar¹, D. Timmerman^1,2, E. Armstrong¹, M. Ferguson-Pell¹

¹University of Alberta, Rehabilitation, Edmonton, Canada

²Leading Edge Physical Therapy, Edmonton, Canada

Introduction: Falls among seniors, often associated with impaired balance, pose significant threats to independence and quality of life. Traditional clinical balance assessments relying on visual observation present challenges in sensitivity, standardization, and precision.

Objectives: This protocol development study aims to enhance balance assessment precision in a real-world physiotherapy clinic by leveraging Markerless Motion Capture (MMC) technology. The study also seeks to gather clinician and patient feedback on MMC usability, with the overarching goal of improving clinical outcomes. Long-term objectives include the establishment of normative data through MMC assessments.

Patients & methods: A total of 60 participants have been recruited for this protocol development study. Participants have already completed simultaneous assessments using Markerless Motion Capture (MMC) and the Berg Balance Scale. Cluster analysis will be employed to group participants, providing insights into the relationships between traditional balance assessments and those conducted through MMC technology. Quantitative data, comprising 14 measures from the Berg Balance Scale and MMC assessments for each participant, will be analyzed. Additionally, Patient and Clinician-Reported Experience Measures have been administered to gather subjective feedback.

Discussion: We intend to demonstrate heightened precision in clinical fall risk assessments, MMC technology offers a promising alternative to conventional methods, potentially enhancing patient care and fall prevention strategies. As an emerging technology, Markerless Motion Capture has the potential to bridge the gap between clinical and laboratory assessments of balance, providing clinicians with a cost-effective and versatile method for obtaining measurements of balance ability. This study sets the stage for advancing the integration of innovative technologies into routine clinical practice.

P-311

GoPro-based mobility assessment: bridging the gap between technology and clinical practice for functional mobility evaluation

S. Houde^1,2, C. Martin^1,2, K. Lebel^1,2

¹Sherbrooke University, Sherbrooke, Canada

²Centre de Recherche sur le Vieillissement, Sherbrooke, Canada

Introduction: The timed-up and Go (TUG) test is widely used to assess functional mobility, offering insights into overall mobility and fall risk. However, it lacks specificity in detailing limitations. Instrumented versions of the TUG (iTUG), such as the inertial-based iTUG, provides information on functional sub-systems, but its clinical use is hindered by high costs and complexity. Bridging the technology-clinical practice gap is imperative for instrumented mobility testing. The commercially available GoPro action camera, integrating inertial sensors and RGB video affordably, presents an interesting potential.

Objective: To develop and validate a mobility assessment tool utilizing a GoPro camera positioned at the trunk.

Methods: Two healthy adults performed multiple iTUG, varying their gait velocities (slow ~= 0,54m/s; normal ≅ 0,95m/s), as well as their gait patterns to mimic mobility limitations. Participants wore the GoPro on their trunk and 39 markers for optoelectronic motion capture gold standard (GS). Inertial data signal processing identified TUG phases (sit-to-stand transfer - STS, walk, turn). Spatio-temporal parameters were derived from a combination of inertial data and pattern recognition.

Results: Trunk angle accuracy during STS was within 5.2º, on average. Gait phase parameters, including stride duration and length, were detected within 11ms and 17mm, respectively. Double support time was identified with a mean error of 13ms, equivalent to 0.6% of the stride phase. Turn velocity was detected within an average error of 3.2deg/s.

Conclusion: The proposed approach holds promise for enhancing classical clinical assessment, offering an accessible and objective evaluation of functional mobility. Future developments include a mobile app to control the system, validation on pathological population, with plans for free availability.

P-312

Transcranial direct current stimulation (tDCS) in individuals with severe craniobrain injury in the subacute phase: feasibility study

Y. Rodrigues Antunes¹, M. Barçante¹, J. C. Souza Alves¹, I. Manhoni Baiense¹, G. Campos Santana¹, B. Naeme De Lima Cordeiro¹, F. Zanela da Silva Arêas¹

¹Universidade Federal do Espírito Santo, Vitória, Brazil

Traumatic brain injury (TBI) is one of the main causes of disability and mortality in young adults, and current scientific evidence shows that cognitive impairment is one of the main limiting factors in post-TBI patients¹ ². Non-invasive brain stimulation has been studied for use as a complementary therapy, however, its application in individuals with severe TBI in the subacute phase is challenging³. The objective of this study was to determine the feasibility, in terms of recruitment, intervention and measurement of the application of a protocol of transcranial direct current stimulation (tDCS) for a randomized controlled clinical trial, in patients who suffered severe TBI in the subacute phase. This is a prospective, single-group feasibility study with a pre-test, post-test and follow-up in which subjects with severe TBI who had a Glasgow Coma Scale (GSE) score < or = 8 on the admission or at some point during hospitalization, were included in the study. The protocol included daily tDCS sessions, and feasibility was measured by examining recruitment, intervention, and assessments. The final sample consists of eight individuals, all male, with a mean age of 37.5 years. The satisfaction and adherence of participants and family members does not seem to be an obstacle to the intervention, with the organization and hospital management being the most difficult factor. This study may serve as an aid for researchers to investigate, through a randomized controlled clinical trial, the efficacy of neurostimulation in patients with TBI in the in-hospital subacute phase. ¹BRUNS, J., JR.; HAUSER, W. A. The epidemiology of traumatic brain injury: a review. Epilepsia, v. 44, n. s10, p. 2-10, 2003; ²DEWAN, M. C. et al. Estimating the global incidence of traumatic brain injury. J Neurosurg, p. 1-18, 2018; ³MAAS, A. I. R. et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol, v. 16, n. 12, p. 987-1048, 2017.

P-313

Don’t trust everything you see. Even salt looks like sugar

N. Singh¹, B. Goodman²

¹Baylor College of Medicine, Physical Therapy and Rehabilitation, Houston, TX, United States

²OrthoAlabama Spine and Sports, Physical Therapy and Rehabilitation, Birmingham, AL, United States

Introduction: Lumbar epidural steroid injections are the most frequently performed interventional procedure in the management of low back and radicular pain. They can be performed by multiple approaches, such as lumbar interlaminar (midline and parasagittal), lumbar transforaminal and caudal. A unanimous consensus between efficacy of an epidural steroid injection and presence of injectate in the ventral epidural space exists.

Objective: To explore pattern of injectate dispersal with parasagittal interlaminar lumbar epidural steroid injections.

Materials & methods: It was a retrospective, observational, single-center study. Ten patients satisfying all inclusion and exclusion criteria were enrolled in the study. All patients received the injection under fluoroscopic guidance. After 15 minutes, all patients had a computerized tomographic (CT) scan of the lumbar spine. Subsequently, dispersal patterns were analyzed on both, epidurograms and CT images.

Results: Images with presence of contrast in the ventral epidural space, corresponding to the level of injection were considered positive. Epidurograms revealed presence of contrast in the dorsal epidural space of all the patients (n=10, 100%) and in the ventral epidural space of five patients (50%). The CT images however, were suggestive of presence of contrast in dorsal epidural space in 100% of the patients and in ventral epidural space of 90% of the patients. Similarly, a bilateral dispersal pattern was noted in the transverse plane in 50% of patients with epidurograms and in 90% of patients with post-injection CT images. Additionally, a higher cephalad dispersal of injectate was observed with a mean of 12.97± 2.66 cms (9.1-17.09) as compared to a mean caudal migration of 4.2±1.56 cms (0.5-5.43).

Conclusion: This study supports the use of interlaminar approach as a reliable technique in non-operated spines to deliver medication to the ventral epidural space.

P-314

A new approach to the management of neuropathies and pain from neurorehabilitation

D. Jiménez Masa¹, J. López-Sánchez¹, C. Vázquez González¹, J. Alegre Ayala¹, J. Sánchez-Aguilar¹

¹European Center of Neuroscience, Madrid, Spain

Background: Classically, the rehabilitation of plexopathies has been approached from the point of view of improving the deficit and only considering the physiological structural processes of peripheral nerve recovery. However, some authors have presented an approach beyond the deficit in recent years, including functional and psychosocial aspects, based on the International Classification of Functioning, Disability and Health model.

Methods: A patient of 49 years with limitations of functionality, mobility, strength and neuropathic pain caused by a brachial plexopathy secondary to a hematoma compression in the subclavian area of 3 months of evolution started a period of rehabilitation of 30 weeks.

Periodic assessments were made in different spheres. For the deficit of the body functions, the S-LANSS scale and a self-applied pain calendar, surface electromyography, goniometry and grip dynamometry were used. The upper limb activity and function were assessed through the Box and Block Test, the Nine Hole Peg Test and the Manual Ability Measure 36. Other specific and relevant objectives for the patient were measured with the Goal Attainment Scale.

The motor rehabilitation treatment consisted of pain managing, strength training, motor control and mass task-oriented practice, combined with functional electric stimulation, electromyographic real time feedback, robotic therapy and telerehabilitation of intensity and duration appropriate to the patient that varied according to the structural and functional capacities along the process.

Results obtained showed a global improvement of the patient, obtaining in most of the assessments normative data.

Conclusion: This case report proposes an approach of the brachial plexus injury (BPI) from the neurorehabilitation point of view, based on the principles of motor learning and the neurophysiological basis of motor control, illustrating the clinical reasoning carried out and how it evolves through the patient recovery.

P-315

Testing sensorimotor processing with tendon vibration and transcranial magnetic stimulation in subacromial impingement syndrome

É. Bouchard¹, L. Lauzier¹, M. Boudier-Revéret², S. Sobczak³, L. Munger¹, K. Épiphane Ketounou¹, M. P. Perron¹, S. Ngomo¹, L. D. Beaulieu¹

¹UQAC, Health Science, Chicoutimi, Canada

²CHUM, Physiatrie, Montreal, Canada

³UQTR, Anatomie, Trois-Rivières, Canada

Introduction: Persisting chronic pain caused by shoulder impingement syndrome (SIS) are observed in up to 50% of cases. SIS often presents with an altered proprioception and control over the upper trapezius (UT) and scapular muscles during shoulder elevation. However, neural mechanisms involved in these sensorimotor alterations and their role in pain chronicization remain understudied.

Objectives: To investigate mechanisms of sensorimotor control, using transcranial magnetic stimulation (TMS) and vibration-induced kinesthetic illusions (VIB-KI), in healthy and persons with SIS.The hypothesis was that VIB-KI would be less clear and of lower speed/amplitude, along with lower corticospinal excitability for the painful shoulder vs. the non-painful one and vs. healthy counterparts.

Patients & methods: Fifteen participants with SIS and fifteen controls took were recruited. Proprioceptive processing was tested by VIB-KI of shoulder adductors (illusions of shoulder elevation) and corticospinal excitability was tested with TMS over the motor cortex area controlling theupper trapezius muscle.

Results: Participants with SIS and controls reported similar VIB-induced illusions in terms of clearness, direction and success rate. However, they showed significantly lower speed/amplitude on the painful versus non-painful side in participants with SIS (p = 0.035). No difference was found for TMS data, but procedures were challenged by high motor thresholds, discomfort and fear of pain, especially in participants with SIS.

Conclusions: The lower speed/amplitude of illusions obtained on the painful side might be implying a less effective, but still functional processing of muscle spindles afferents. The pairing of VIB and TMS technologies thus appear complementary for a specific investigation of mechanisms underlying sensory and motor impairments. Our study provides novel evidence on the integrity of proprioceptive and corticospinal functions in persons with SIS.

P-316

Canadian physicians use of corticosteroids for complex regional pain syndrome: a cross-sectional survey of physician practice patterns

F. Kassam¹, S. Dhatt^2,1

¹University of British Columbia, Vancouver, Canada

²University of British Columbia, Vancouver, Canada

Objective: Complex regional pain syndrome (CRPS) continues to remain a challenge to both diagnose and treat, with no consensus or guidelines for management. Corticosteroids are one of the pharmacological management options that have been studied, however, there remains no clear consensus in the literature regarding its use. With no validated treatment algorithms, the use of corticosteroids, among other treatment regimens, are left to individual practitioners. The purpose of this study was to investigate the practice patterns of physicians who use corticosteroids to treat CRPS.

Methods: A cross-sectional survey composed of an invitation email and a 48-item questionnaire was distributed to all members of the Canadian Association of Physical Medicine & Rehabilitation, the national organization for Physical Medicine and Rehabilitation (PM&R) specialists.

Results: Majority of the respondents were PM&R specialists, and all practiced in Canada. The most common setting for assessment and management of CRPS was outpatient clinics, while the most common cause was stroke. 100% of respondents used corticosteroids to treat CRPS, most commonly in the acute phase (

Conclusion: Corticosteroids are commonly used amongst physicians in Canada for the treatment of CRPS. Understanding how physicians treat CRPS can lead to the creation of treatment algorithms and guidelines, and ultimately improve patient outcomes.

P-317

Caudal epidural injection in adolescent patient with linezolid-induced peripheral polyneuropathy

H. C. Ahn¹, J. H. Cho¹

¹Keimyung University, Rehabilitation, Daegu, South Korea

Introduction: Linezolid has been associated with peripheral polyneuropathy. Managing the complication is challenging due to limited treatment options and the potential for incomplete resolution of symptoms even after discontinuation. Caudal epidural injection is used for the management of peripheral polyneuropathy, and shows promise in providing symptomatic relief.

Objectives: We present an adolescent patient who had taken ultrasonography-guided caudal epidural injection for the treatment of severe neuropathic pain due to linezolid-induced peripheral polyneuropathy.

Patients & methods: 18-year-old adolescence with acute myeloid leukemia was referred for the management of severe pain in both soles. The patient started taking linezolid for the treatment of non-tuberculous mycobacteria. The electrodiagnostic study conducted before chemotherapy for leukemia was normal. Three months after the linezolid management, he reported the continuous prickling pain with tingling sensation in both soles. The follow-up electrodiagnostic evaluation showed absent sensory nerve action potential amplitudes in bilateral sural and superficial peroneal nerves, and decreased conduction velocity of right tibial nerve. Therefore, the patient was diagnosed with linezolid-induced peripheral polyneuropathy in both lower extremities. He took oral gabapentin, duloxetine, amitriptyline, and naproxen but the pain insufficiently decreased. Caudal epidural injection with 1ml of dexamethasone 2ml of ropivacaine, and 12ml of normal saline was performed via ultrasonography

Results: The patient reported a noteworthy relief of the pain and paresthesia without post-procedural complications. After one more repeated procedure, the symptoms were markedly improved. The analgesics were tapered down to gabapentin only, and he reported no aggravation of symptoms.

Conclusion: Caudal epidural injection is an effective treatment for linezolid-induced peripheral polyneuropathy even for the adolescent patient.

P-318

Test-retest reliability of a new qualitative pain assessment model: preliminary results of the WORDSforPAIN project

M. De Marco¹, L. Cipriani², M. Baccini³, G. Relli⁴, A. Livoti⁵, M. L. del Vicario³, L. Chiari³, G. Cherubini¹, S. Doronzio^1,3, D. Bardi³, R. Lanfredini², F. Cecchi^1,3

¹University of Florence, Experimental Science, Florence, Italy

²University of Florence, Department of Humanities, Florence, Italy

³IRCCS Carlo Gnocchi Foundation, Florence, Italy

⁴University of Florence, Master of Science in Rehabilitation Sciences for Heath Care Professions, Florence, Italy

⁵University of Florence, Physical Therapy and Rehabilitation, Florence, Italy

Introduction: Pain is a leading cause why people need rehabilitation and a predictor of recovery. Currently no tool returns information on pain based on patients" narrative.

Objectives: To develop a qualitative pain assessment model based on Artificial Intelligence (AI) and verify its test-retest reliability.

Materials & methods: Prospective cohort study, founded by Tuscany Health Ecosystem (National Recovery and Resilience Plan), aimed to enroll 200 adults with nonspecific spinal pain. Participant"s narratives on their pain experience and other biopsychosocial variables are collected twice (one week apart) at baseline (T0-T1) and discharge (T2); some outcomes are also recorded at a 6-months phone follow-up (T3). The ontological-philosophical analysis of the patients’ narratives is conducted manually by the researchers to be compared with the results that will be obtained by AI techniques of Natural Language Processing. To estimate its reliability, kappa statistics and percentage of agreement are calculated.

Results: This is a preliminary analysis on 36 subjects, 12 men (mean age 60.74 ± 14.33). By the manual classification, 7 pain dimensions (corporeality, general attitude, evaluation, temporal orientation, positive/negative emotions, and style) emerged. Test-retest reliability evaluation on 11 stable subjects declaring no changes in their condition showed null (k = -0.320) to substantial (k = 0.744) reliability, agreement ranging from 45.45% to 90.91%. A clear imbalance was found between dimensions presence/absence, where some of them were present in almost all subjects, leading to underestimation of reliability in some dimensions (kappa paradox).

Conclusion: The proposed approach matches narrative medicine and AI to personalize rehabilitation pathways. Results must be considered carefully due to limited data, but data on at least 100 participants are expected by Apr 2024, allowing a more robust estimate of reliability and a preliminary estimate of validity.

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Comparison of the effects of botulinum toxin doses on nerve regeneration in rats with experimentally induced sciatic nerve injury

K. Nam¹, S. Hwang¹, J. H. Park¹

¹Dongguk university, Rehabilitation, Goyang, South Korea

Introduction: Botulinum neurotoxin A (BoNT/A) is suspected to directly stimulate axonal regeneration in injured peripheral nerves, leading to neurological recovery, in recent studies. There is, however, no study on the dosage of BoNT/A that best promotes neurological recovery. This study compared the effects of BoNT/A on nerve regeneration using various doses.

Methods: Sixty-five six-week-old rats with sciatic nerve injury were randomly allocated to three experimental groups, a control group, and a sham group. The experimental groups received a single session of intraneural BoNT/A (3.5, 7.0, or 14 U/kg) injection immediately after nerve-crushing injury. The control group received normal intraneural saline injections after sciatic nerve injury. At three, six, and nine weeks after nerve damage, immunofluorescence staining, ELISA and toluidine blue staining was used to evaluate the regenerated nerves. Serial sciatic functional index analyses and electrophysiological tests were performed every week for nine weeks.

Results: A higher expression of GFAP, S100β, GAP43, NF200, BDNF, and NGF was seen in the 3.5 U/kg and 7.0 U/kg BoNT/A groups. The average area and myelin thickness were significantly greater in the 3.5 U/kg and 7.0 U/kg BoNT/A groups. Sciatic functional index and compound muscle action potential amplitudes exhibited similar trends.

Conclusions: These findings indicate that 3.5 U/kg and 7.0 U/kg BoNT/A groups exhibited better nerve regeneration than the 14 U/kg BoNT/A and control group. As the 3.5 U/kg and the 7.0 U/kg BoNT/A groups exhibited no statistical difference, we recommend using 3.5 U/kg BoNT/A for its cost-effectiveness.

P-320

Transcranial magnetic stimulation in central post-stroke pain: a systematic review

T. C. Wee¹, Y. Li¹

¹Changi General Hospital, Rehabilitation, Singapore, Singapore

Introduction: Central post-stroke pain (CPSP) is a form of neuropathic pain that occurs after a cerebrovascular accident. Transcranial magnetic stimulation (TMS) is a non-invasive brain neurostimulation technique that can be used as an adjunct treatment strategy as part of a comprehensive stroke rehabilitation program.

Objectives: A systematic review was performed to evaluate the efficacy and safety of TMS in patients with CPSP.

Materials & methods: A Medline/Pubmed database search was searched from inception till 30 August 2023. Studies were restricted to the English Language. Clinical trials not limited to randomised controlled trials (RCTs), observational studies and case series/studies were included. Two reviewers independently reviewed the titles and abstracts of 143 records. 130 records were excluded. 13 full texts were reviewed and ten were eventually selected for inclusion in the systematic review. Two reviewers independently extracted relevant information pertaining to study types, patient characteristics, intervention details, outcome measures, and adverse effects. Any disagreements were to be resolved with mutual discussions.

Results: There are three RCTs, six observational studies, and one case report. There was significant heterogeneity amongst the studies. Most of the studies contained small sample sizes and reported positive outcomes. No serious adverse effects were reported.

Conclusion: TMS may be considered as a complementary treatment to current treatment strategies for CPSP and it is generally safe.

P-321

Practice approaches of physical therapists in managing psychosocial problems in people with Parkinson’s disease

A. Babarinde¹, M. Landers²

¹University of Nevada Las Vegas, Interdisciplinary Health Sciences, Las Vegas, NV, United States²University of Nevada Las Vegas, Physical Therapy, Las Vegas, NV, United States

Introduction: Physical therapists (PTs) primarily focus on managing the motor symptoms of people with PD to improve their functional capacity for daily activities. These patients may have psychosocial problems requiring proactive attention and sometimes referral. The physical therapy clinical practice guideline for PD encourages collaboration with other healthcare teams for holistic and quality patient care. However, PTs’ approaches when presented with such problems are unknown.

Objectives: This study aimed to explore PTs’ practice approaches and barriers in evaluating and referring patients with PD who have psychosocial problems.

Materials & methods: A web-based survey was created and reviewed by a panel of experts, covering PTs’ demographics, practice approaches, referral destinations, and barriers faced when evaluating and referring patients with psychosocial problems. In July and August 2023, 98,118 United States licensed PTs were invited to participate via State Boards’ mailing lists.

Results: The survey had 445 female and 147 male respondents. The mean age was 44.2 ± 12.3 years, with 42% having > 13 years of experience in PD management. For patients with psychosocial problems, 76.7% of PTs provide useful resources or refer them to other health professionals, often referring physicians, support groups, and (neuro)psychologists. The major barriers for PTs when evaluating psychosocial problems were time constraints (78.9%), clinical workload (69.1%), and lack of training (68.2%). Access to healthcare professionals (76%) and patient unwillingness (75%) were major challenges faced by PTs in patient referrals.

Conclusion: PTs typically refer patients with PD and psychosocial issues to other professionals and provide resources instead of addressing these problems directly. Addressing identified barriers may better equip PTs to provide optimal care for patients with these problems.

P-322

Physical therapists’ understanding of psychosocial problems in people with Parkinson’s disease

A. Babarinde¹, M. Landers²

¹University of Nevada Las Vegas, Interdisciplinary Health Sciences, Las Vegas, NV, United States

²University of Nevada Las Vegas, Physical Therapy, Las Vegas, NV, United States

Introduction: Psychosocial problems, like depression and anxiety disorders, affect people with Parkinson"s disease (PD) and can manifest at any disease stage, reducing their quality of life. Experts emphasize addressing patients’ emotional and social needs, alongside physical needs. Despite the promotion of the biopsychosocial model, physical therapists’ (PTs) knowledge about psychosocial problems and their impact is unknown.

Objectives: This study aimed to assess PTs’ knowledge and attitudes towards psychosocial problems in people with PD.

Materials & methods: A web-based survey was created and reviewed by a panel of experts, covering PTs’ demographics, knowledge, attitudes, and practices. Between July and August 2023, through emails obtained from State Boards" mailing lists, 98,118 United States licensed PTs were invited to take part in the study.

Results: The survey was completed by 592 participants (mean age = 44.2 ± 12.3 years; > 50% held clinical doctorates; average years of experience = 18; 42% had > 13 years experience in PD management). Participants reported the prevalence rate of psychosocial problems was 80.4%, with over 90% reporting increased problems at Hoehn and Yahr stages 3-5. Fear of falling, fear of disease progression, and depression were the most common problems. Most (94.4%) were knowledgeable about psychosocial problems and their impact on rehabilitation outcomes with 90.1% supporting PT screening, management, and referrals for these issues. While 81.9% were confident in identifying these problems, only 61.1% and 77% reported confidence in evaluating patients and making appropriate referrals, respectively.

Conclusion: This study shows a gap in PTs’ knowledge and attitudes, especially in evaluating and referring patients with psychosocial problems. Addressing this disparity could enhance patient care experience and reduce care costs, aligning with the Institute for Health Care Improvement Quadruple Aim.

P-323

Effect of an intensive, structured, and progressive physiotherapy intervention on PD patients – a pilot study

A. Ranade^1,2, N. Agashe^1,2

¹Deenanath Mnageshkar Hospital, NeuroPhysiotherapy, Pune, India; ²TEAM Phsyiotherapy Services, Neurophysiotherapy, Pune, India

Introduction: Parkinsons disease is a neurodegenerative disorder requiring long-term medical and Physiotherapy management to improve and maintain independent lifestyle. Many patients cannot continue treatment for a longer duration due to affordability, lack of motivation, availability of resources and correct dosage of exercise.

Objectives: To find the effects of an intensive, structured, and progressive exercise protocol in early to moderate PD.

Patients & methods: 40 participants (20 experimental, 20 control), diagnosed with idiopathic PD, on stable drug dose, were included. Subjects were excluded with known musculoskeletal, cardiovascular, or underlying neurological disorders, Parkinsons plus syndromes.

Participants were screened at 0, 4th and 8th week using: Unified Parkinsons disease rating scale, Mini BESTest, Gait speed: 10m walk test, Time to do 5 times sit to stand -5xSST(functional LE strength), Sit to stand repetitions in 30 sec.(Endurance)

Participants in experimental group were given a structured, intensive, and targeted exercise programme, progressed timely according to patient"s abilities. Participants in control group were asked to follow their regular exercise routine.

Results: Paired t-test confirms significant results for UPDRS((p<0.0001), Gait speed(<0.001) ,MINI BEST(<0.0004), 5Xsst (>0.03) sit to stand in 30 sec (>0.0007)at the end of 8 weeks of treatment for experimental group only. Control group also shows significant change in minibest(>0.003) only .Rest all the tests either show a negative change or remained same.

Conclusion: A structured, intense, and targeted exercise program gives significant improvement in PD patients. If these patients exercise lifelong according to specific protocol designed and progressed at regular intervals, they can improve, maintain independence. A larger longitudinal study to understand long term efficacy of our protocol will be beneficial. We aim at forming PT Guideline"s for PD patients at large.

P-324

Temporal coordination of head, trunk, and feet during 360-degree turning in Parkinson’s disease

P. Burgos^1,2, F. Horak¹, C. Batista¹, P. Carlson-Kuhta¹, A. Ragothaman¹, V. Shah¹, M. Mancini¹

¹Oregon Health Science University, Neurology, Portland, OR, United States

²University of Chile, Physical Therapy, Santiago, Chile

Introduction: The activity where people with Parkinson"s Disease (PD) have the most falls is during turning; however, turning is less studied than straight-ahead gait or balance. It has been hypothesized that people with PD use an en-bloc turning strategy, whereas healthy controls (HC) use a cephalocaudal strategy.

Objectives: This study aims to describe different turning strategies in PD. We hypothesize that a multitude of different temporal strategies (cephalo-caudal, caudo-cephalic, or en bloc strategy) is used in PD due to the severity of motor deficits.

Methods: 47 individuals with idiopathic PD in ON state (age=67±7, disease duration=8±5, MDS-UPDRS-III=32±10, MoCA=26±2). The task was to turn 360 degrees for 1 minute, alternating clockwise and counterclockwise turnings. Turning strategies were measured with 5 inertial sensors (head, sternum, lumbar, right foot, and left foot). Using the gyroscope (yaw axis) we estimated 1) simultaneous onsets of the head, sternum, and lumbar segments (en-bloc turning), versus 2) the axial segment that was leading turnings. Additionally, we computed the Kendall correlation between the trial"s turning metrics (en-bloc%, head-onset%, sternum-onset% and lumbar-onset%) with clinical features (disease duration, miniBESTest, and MoCA).

Results: 8/47 PD participants had en-bloc turning trials strategy; the head led the turning motion in 17 people, the lumbar in 13, the sternum in 2, and another 7 did not have a clear preference in their cephalocaudal strategy.

Correlations show that the PD participants who started with their lumbar segment(caudo-cephalic) had better global cognition (MoCA, r=0.37, p=0.006) and Balance (miniBESTest, r=0.31, p=0.03), and participants who began with their head(cephalo-caudal) had longer PD duration (r=0.28, p=0.03).

Conclusions: The cephalo-caudal strategy seems to be related to more compromised PD patients. The en-bloc strategy was not correlated with clinical features.

P-325

Use of Metronome as auditory cue to promote chewing in oral dysphagia in Parkinson’s disease: a case study

T. Sanghavi¹, J. Dave²

¹All India Institute of Speech and Hearing, Mysuru, India

²Terna Physiotherapy College, Navi Mumbai, India

Introduction: In India, the prevalence of dysphagia in Parkinsonian syndromes has been found to be 57.14%; being 55.16% in Parkinson’s disease. The most noticeable dysphagia symptoms typically manifest in the final stages of Parkinson’s disease (PD). Patients with Parkinson’s disease usually exhibit the typical repeating backward-forward movement of the bolus during the oral stage of swallowing. As a result, issues with swallow initiation, incomplete swallow, and premature food fall can happen.

Objectives: To observe the clinical utility of metronome as an auditory stimulus to improve mastication performance as measured by time taken to initiate swallow and to observe the clinical utility of metronome as an auditory stimulus on SWAL-QOL.

Materials & method: A metronome app, designed by the company Stonekick was used by the clinician. The rate of presentation was set to 40 bpm as suitable for the patient. Patient was asked to take a bite of the food and keep it in the mouth. As soon as the beats started, patient had to start chewing. After 8-10 rotatory cycles, metronome is paused to indicate pushing the bolus back with the tongue and swallowing it. Over a period of 4 weeks, 8 repetitions of the trial were done. SWAL-QOL was administered before and after the procedure.

Results: Statistical analysis was done using paired t-test to compare the time taken to chew before and after using metronome and wilcoxon signed rank test to compare effects of metronome on SWAL-QOL. There was no significant difference between the time taken to chew. On SWAL-QOL, the minimum difference between pretest and post-test scores was found to be for fatigue and sleep. The maximum difference was found for food selection

Conclusion: This study explores use of metronome as an auditory cue to improve chewing performance in a patient with Parkinson"s disease.

P-326

Cognitive flexibility training can improve postural function in people with Parkinson’s disease

A. Singh¹, M. Leedom^1,2

¹University of South Dakota, Biomedical Sciences, Vermillion, SD, United States

²University of South Dakota, Physical Therapy, Vermillion, SD, United States

Introduction: Postural instability, a prevalent and incapacitating symptom in Parkinson’s disease (PD), profoundly affects daily functioning. Impairments in executive function, especially cognitive flexibility, can contribute to postural instability in PD individuals.

Objectives: To explore the specific interplay between cognitive aspects and postural control in people with PD.

Patients & methods: 36 participants were enrolled, comprising 12 PD subjects with postural instability (PDPI+), 12 PD subjects without postural instability (PDPI–), and 12 age-matched healthy controls. We conducted cognitive evaluations using the MoCA and the NIH Toolbox-Cognition Battery (NIHTB-CB), tests like Dimensional Change Card Sort (DCCS), Flanker Inhibitory Control and Attention (FICA), Pattern Comparison Processing Speed Test (PCPS), Picture Sequence Memory (PSM), and Picture Vocabulary (PV). Additionally, a Clinical Balance Score (CBS) was obtained during clinical assessment. Statistical analyses included ANOVA, ANCOVA, Pearson correlation, and partial correlation.

Results: PDPI+ individuals demonstrated significant cognitive deficits compared to healthy controls, particularly in cognitive flexibility (DCCS). Notably, cognitive flexibility emerged as a pivotal cognitive domain linked with postural instability. Within PD subjects, strong negative correlations existed between CBS scores and cognitive flexibility (DCCS) scores, indicating a robust relationship between cognitive flexibility and postural control. These associations remained significant even after adjusting for age, DD, and LEDD.

Conclusion: Our findings underscore the substantial impact of cognitive flexibility on postural control in PD individuals, underscoring the necessity for thorough cognitive assessments in clinical care. These results emphasize the potential of targeted interventions to enhance cognitive flexibility and, subsequently, bolster postural stability in PDPI+ individuals.

P-327

Domain-specific and global changes in King’s Parkinson’s Pain Scale (KPPS) after Transcranial Direct Current Stimulation (TDCS) over M1 in Parkinson’s disease patients

Y. González Zamorano¹, F. J. Sánchez Cuesta², J. Fernández Carnero¹, M. Moreno Verdú³, A. Arroyo-Ferrer², J. P. Romero Muñoz²

¹King Juan Carlos University, Physical and Occupational Therapy, Madrid, Spain

²Universidad Francisco de Vitoria, Experimental Science, Madrid, Spain

³Brain, Action and Skill Laboratory (BAS_Lab), Institute of Neuroscience (Cognition and Systems Division), Brussels, Belgium

Background: Parkinson´s Disease (PD)-related pain is underdiagnosed and undertreated. The King´s Parkinson´s Pain Scale (KPPS) is the unique specific scale that evaluates the 7 different types of PD-related pain: musculoskeletal; chronic; fluctuation-related; nocturnal; orofacial; discoloration, oedema/swelling; and radicular pain. Transcranial direct current stimulation (tDCS) enhances corticospinal excitability in M1 and other pain processing areas, but its effectiveness for PD-related pain is not yet known.

Objective: To determine the effectiveness of tDCS on PD-related pain.

Methods: This is a randomized, triple-blind, parallel-design study with 22 subjects (63.23±12.07). They were assigned to one of two intervention groups: active-tDCS vs sham-tDCS. The active group received 10 sessions of 20 min of anodal tDCS on M1 at 2 mA intensity. The tDCS stimulator was turned off in the sham group at 30 seconds. KPPS global score and scores of the 7 domains separately were evaluated pre-, post, and 15 days follow-up.

Results: Significant between-group differences in KPPS global score in favor of the active group over sham were achieved at follow-up (p=0.014) but not immediately (p=0.059). Significant between-group differences were only found for the fluctuated-related pain domain at follow-up (p=0.004). Within-group differences were also found in favor of the active group between pre-and post-intervention (P<0.001) and between pre- and follow-up in nocturnal pain (P<0.01) and discoloration/oedema/swelling pain (P<0.001).

Discussion: tDCS ameliorated clinical perceived PD pain, especially fluctuation-related, nocturnal, and discoloration/oedema/swelling domains. Deep Brain Stimulation (DBS) has also been demonstrated to reduce the overall score of the KPPS, addressing fluctuations and nocturnal pain. Both DBS and tDCS influence activity within the periaqueductal gray, enhancing descending pain systems providing insight into the analgesic effects of tDCS on PD pain.

P-328

Effects of transcranial direct current stimulation (tDCS) on pain modulation in individuals with parkinson’s disease (PD) in "Off" state: a crossover pilot study

Y. González Zamorano¹, A. Martínez Benito², M. Moreno Verdú³, J. Fernández Carnero¹, J. Herreros Rodríguez⁴, B. Madroñero Miguel⁵, J. P. Romero Muñoz⁵

¹King Juan Carlos University, Physical and Occupational Therapy, Madrid, Spain

²Universidad Autónoma de Madrid, Centro Superior de Estudios Universitarios La Salle, Madrid, Spain

³Brain, Action and Skill Laboratory (BAS_Lab), Institute of Neuroscience (Cognition and Systems Division), Brussels, Belgium

⁴Hospital Infanta Leonor, Madrid, Spain

⁵Universidad Francisco de Vitoria, Experimental Science, Madrid, Spain

Background: The mechanisms of Parkinson´s Disease (PD)-related pain involve complex changes in both dopaminergic and non-dopaminergic pain modulation systems. TDCS is a non-invasive technique that has been shown to improve clinical perceived pain and enhance descending pain pathways after ten sessions in PD patients in "On" state. However, its effects on PD-related pain in the "Off" state have not been tested.

Objective: To determine the immediate effects of tDCS on pain in PD patients in "Off" state and its potential coadjutant effect to dopaminergic medication.

Methods: This is a triple-blind, controlled, crossover pilot trial with 9 subjects (61.3±11.6 years old). The sequence was randomly assigned as active tDCS or sham tDCS. The active group received one session of 20 min anodal stimulation over M1 at 2mA intensity while in an "Off" state. The sham group followed the same protocol, but the tDCS stimulator was turned off at 30 seconds. All patients took their usual dopaminergic medication after the treatment. Patients were evaluated at pre-, post-tDCS, and post-medication intake. Outcomes included Conditioned Pain Modulation (CPM), Pain Pressure Thresholds (PPT) in painful and non-painful areas, Numeric Pain Rating Scale (NPRS), and Global Rating of Change Scale (GROC).

Results: Statistically significant differences were only found for local PPT at post-tDCS (p=0.046), but not post-medication. No statistically significant differences were found for the rest of the outcome measures, neither post-tDCS nor post-medication.

Discussion: Anodal tDCS over M1 immediately improved PPT in painful areas in PD patients in "Off state". No effects were found for clinical perceived pain, PPT in a non-painful area, or CPM. Furthermore, no synergistic effect with dopaminergic medication was found. TDCS could immediately reduce peripherical hyperalgesia in PD patients in "Off" state, but more sessions would be needed to influence descending pain pathways and clinical pain.

P-329

Comparison of cognitive orientation to daily occupational performance and conventional occupational therapy in Parkinson’s disease: a randomized clinical trial

A. Taheri¹, T. Mousavi¹, H. Dalvand¹, A. Shamili¹, S. Gharebaghy², A. Almasi³

¹Tehran University of Medical Sciences, Occupational Therapy, Tehran, Iran

²Mashhad University of Medical Sciences, Occupational Therapy, Mashhad, Iran

³Arak University of Medical Sciences, Epidemiology, Arak, Iran

Background: Parkinson"s disease (PD) is a chronic progressive neurodegenerative disorder. One of the most common problems in individuals with Parkinson"s disease is Occupational Performance problems. Cognitive Orientation to daily Occupational Performance (CO-OP) is one of the client-centered and problem-solving approaches in occupational therapy. The aim of this study was to determine the effectiveness of CO-OP approach in individuals with Parkinson"s disease.

Method: A double-blind, randomized controlled trial was conducted to compare the benefits of 12-session CO-OP interventions for individuals with Parkinson disease. Twenty patients were referred to Hospitals and rehabilitation centers in Tehran, were randomised to the experimental (N=10) and control group (N=10). The experimental group conducted CO-OP approach while the control group conducted conventional occupational therapy. The outcome measures include: The Canadian Occupational Performance Measure (COPM), Goal Attainment Scale (GAS), the Functional Independence Measure (FIM), the Berg Balance Scale (BBS), the Activities-specific Balance Confidence Scale (ABC), and Parkinson fatigue scale (PFS).

Results: Performance (P<0/05) and satisfaction (P<0/05) of COPM, and GAS score (P=.030) were significantly higher in experimental group than the control group. No significant differences were found on FIM score (P=.67) between experimental and control groups, and No significant differences were found on BBS, ABC, and PFS scores (p > 0/05).

Conclusion: The CO–OP group demonstrated significantly greater improvements in performance, satisfaction and goal attainment than the control group. CO-OP can be a new and effective approach to occupational therapy intervention for individuals with Parkinson"s disease. We suggest that occupational therapists consider this approach in their practice for individuals with Parkinson"s disease.

P-330

Prevalence of non-motor symptoms in Brazilians with Parkinson’s disease

F. Lopes¹, P. Scalzo², A. P. Vargas¹

¹Sarah Rehabiliation Hospital, Neurorehabilitation, Belo Horizonte, Brazil

²Federal University of Minas Gerais, Biology, Belo Horizonte, Brazil

Introduction: Non-motor symptoms (NMS) are as disabling as motor signs in Parkinson’s disease (PD), increasing morbidity and mortality rates. In Brazil, studies and statistical data on its prevalence are practically non-existent.

Objectives: To verify the prevalence and profile of NMS among users of the SARAH Network with PD.

Method: Data were collected from medical records of patients diagnosed with PD followed up in six units of the SARAH Network between 2015 and 2022. Information on cognitive function was evaluated (Mini Mental State Exam, MMSE and The SCales for Outcomes in Parkinson’s disease-COGnition, SCOPA -COG), depressive symptoms (Beck Depression Inventory, BDI and Geriatric Depression Scale, GDS) and sleep problems (Parkinson’s Disease Sleep Scale, PDSS).

Results: 209 medical records were evaluated. The sample consisted predominantly of men (n=119, 56.9%) with a mean age of 72.6 (±11.2) and a mean time since PD diagnosis was 7.7 (±5.8). Most patients have mild to moderate motor impairment and are completely or partially independent. Impairment of cognitive function was identified in 34.1% (MMSE) and 44.9% (SCOPACOG), symptoms suggestive of depression in 40.2% (BDI) and 38.8% (GDS) and problems with sleep in 52.9% (PDSS).

Conclusions: The present study shows the high prevalence of these NMS, present even in the early stages of the disease. This information is important as it can contribute to population-based studies, guiding therapeutic conduct and public health actions in this population.

P-331

Metric properties of inertial sensor-derived measures during the execution of UPDRS motor items in subjects with Parkinson disease: a systematic review

G. Cherubini¹, S. Doronzio^1,2, G. Lombardi³, M. Piazzini², T. Ciapetti², M. Baccini², F. Cecchi^1,2

¹University of Florence, Experimental Science, Florence, Italy

²IRCCS Carlo Gnocchi Foundation, Florence, Italy

³University of Florence, Department of Neuroscience, Psychology, Medication Area and Child Health, Florence, Italy

Introduction: Numerous studies have relied on Inertial Measurement Units (IMUs) to quantify clinical outcomes, aiming to enhance data digitization and improve professional communication. However, demonstrating consistent validity, reliability, and responsiveness in these sensor-derived measures remains a challenge.

Objective: To inspect the metric properties of the IMU-derived measures when performing any items of the section III of the Movement Disorder Society – Unified Parkinson"s Disease Rating Scale (MDS-UPDRS).

Methods: We developed a search strategy on 5 databases (PubMed/Embase/Scopus/ CINHAL/Web of Science).

For articles examining the metric properties of IMU in PD. Conference proceedings, review articles, non-wearable IMUs, no English full text were excluded. Research results were uploaded to Rayyan and duplicates removed. Two researchers independently screened the results by title/abstract and full text, to select eligible studies. Data extraction is ongoing, as well as quality appraisal of included article using the Cosmin checklists. Data from different studies will be pooled, when possible, by conducting meta-analyses for each metric property.

Results: The research led to 1271 papers; after duplicates removal, 956 studies were obtained. Screening by title and abstract resulted in 547 articles. 2 non-English studies and 31 conference proceedings were excluded. The full-text screening retrieved studies on gait (214), dyskinesia (87), Freezing of Gait (85), UPDRS (38), Timed Up and Go (32), balance (30); activity monitoring (15), and Activities Daily Living (13). Studies on UPDRS are currently being analysed and quality appraisal and quantitative synthesis are expected to be completed by March 2024.

Conclusion: This systematic review will provide the state-of-the-art on the use of IMUs in the assessment of motor impairment in people with PD and on the metric properties of the derived measures.

P-333

The protective role of cardio-respiratory fitness in Parkinson’s disease

J. Cristini¹, F. Seo¹, A. Potvin-Desrochers², H. Lajeunesse², A. Dagher³, R. B. Postuma³, P. Rosa-Neto^3,4, J. Carrier⁵, A. W. Amara⁶, S. Steib⁷, C. Paquette², M. Roig¹

¹McGill University, Physical and Occupational Therapy, Montreal, Canada

²McGill University, Department of Kinesiology & Physical Education, Montreal, Canada

³McGill University, The Neuro (Montreal Neurological Institute-Hospital), Montreal, Canada

⁴McGill University, Translational Neuroimaging Laboratory, The McGill University Research Centre for Studies in Aging, Montreal, Canada

⁵University of Montreal, Psychology, Montreal, Canada

⁶University of Colorado, Neurology, Aurora, CO, United States

⁷University of Heidelberg, Department of Exercise, Training and Active Aging, Institute of Sport and Sport Science, Heidelberg, Germany

Introduction: People with Parkinson’s disease (PwPD) experience relentless motor and cognitive deterioration as well as sleep problems, which lead to a drastic reduction in quality of life. Exercising regularly to maintain an optimal cardio-respiratory fitness level could alleviate motor and non-motor symptoms in PD¹.

Objectives: To investigate whether PwPD and higher capacity to utilize oxygen during a symptom-limited graded exercise test (VO2peak), the gold standard measure of cardio-respiratory fitness and a proxy measure of physical activity, exhibit less severe motor and non-motor symptoms.

Materials & methods: Baseline data from an ongoing randomized controlled trial (RCT) including 35 PwPD were analyzed². Motor and cognitive function, sleep quality, and quality of life were assessed with the Unified PD Rating Scale part III, SCales for Outcomes of PD–cognition, PD Sleep Scale 2 and actigraphy, and PD quality of life, respectively. Associations between VO2peak and motor and non-motor outcomes were assessed with multivariate regression.

Results: Individuals with a higher VO2peak showed better motor (R² = 0.508; B = -0.549; p = 0.004) and cognitive (R² = 0.640; B = 0.475; p < 0.000) function, as well as quality of life (R² = 0.394; B = -1.039; p = 0.001). Objective and subjective sleep quality were not associated with VO2peak.

Conclusion: Overall, our results highlight that fitter PwPD exhibit better motor and cognitive function, but not sleep quality. Longitudinal RCTs will determine whether these associations are causal and whether exercise by improving VO2peak may improve PD symptoms².

References

1. Petzinger, G. M., et al. Lancet Neurol (2013).

2. Cristini, J., et al. Phys Ther (2023).

P-334

Exploring the influence of reaction time on postural stability among patients with Parkinson’s disease: a cross-sectional study

J. Anbalagan ^1,2

¹Akkara Foundation, Occupational Therapy, Kasaragod, India

²Tamil Nadu Dr. M.G.R. Medical University, Occupational Therapy, Coimbatore, India

Introduction: Cardinal symptoms of Parkinson"s Disease (PD) were closely correlated with Reaction Time (RT) and Postural Instability (PI). PI, a major PD feature causing falls and diminishing mobility, function, and life quality, remains unresponsive to current treatments, escalating patient morbidity. Prior literature suggests additional factors contributing to PD postural instability. Therefore, this study aimed to explore the influence of RT on postural stability among patients with PD.

Objectives: The study was to measure the RT, postural stability, risk of fall, and BESTest sub-systems; 2. To find out the relationship between disordered systems underlying postural stability and RT for patients with PD.

Method: This Cross-sectional Survey study was conducted in and around Coimbatore. A total of 246 patients were screened using Hoehn &Yahr Scale, MoCA, and Visual Acuity Test. Therefore, 100 patients with PD, who fulfilled the selection criteria were administered using Pull Test, Audio Visual Reaction Timer, Balance Evaluation System Test (BESTest), and Berg Balance Scale.

Results: The study results revealed that the mean visual reaction time (VRT) was 0.87 seconds and 0.88 seconds for right and left respectively. Of the participants, around 35% had moderate PI and 44% had mild PI. Also, there was a strong positive correlation between postural stability and VRT [right (r = 0.915; p = 0.000); left (r = 0.929; p = 0.000)] for patients with PD.

Conclusion: Poor performance in VRT and decrease postural stability were also associated or influenced with risk of fall, duration of disease, severity of the disease, and sub- systems of BESTest. But age, gender, and medication (syndopa) had minimal effects on RT and postural stability.

Reference

Paunikar Vaishali M, Shastri N, Baig M. Effect of Parkinson"s disease on audiovisual reaction time in Indian population. Int J Biol Med Res. 2012;3(1):1392-6.

P-335

Motor effects of combining bilateral repetitive transcranial magnetic stimulation and EEG-guided neurofeedback in Parkinson’s disease: a pilot randomized, four-arm controlled trial

J. P. Romero Muñoz^1,2,3, A. Arroyo-Ferrer^1,2, M. Moreno Verdú^4,1, M. D. del Castillo⁵, J. I. Serrano⁵

¹Francisco de Vitoria University, Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Madrid, Spain

²Francisco de Vitoria University, Experimental Science, Madrid, Spain

³Hospital Beata María Ana, Brain Damage Unit, Madrid, Spain

⁴Université Catholique de Louvain, Brain, Action and Skill Laboratory (BAS-Lab), Institute of Neuroscience (Cognition and Systems Division), Brussels, Belgium

⁵CSIC, Center for Automation and Robotics, Madrid, Spain

Introduction: Bilateral Repetitive Transcranial Magnetic Stimulation (rTMS) over the Primary Motor Cortex (M1) and EEG-guided neurofeedback techniques can reduce motor symptoms in Parkinson"s disease (PD). However, the effects of their combination are unknown.

Purpose: To determine the immediate and short-term effects on motor symptoms of rTMS and EEG-guided neurofeedback, alone or combined, compared to no intervention, in people with PD.

Methods: A pilot randomized, single-blind, 4-arm controlled trial was conducted. Over 2 weeks: Group A received eight bilateral, high-frequency (10 Hz) rTMS sessions over M1 (each M1 = 1000 pulses at 80%RMT); Group B received eight 30-minute EEG-guided neurofeedback sessions (64-channels, 10-20 system) focused on reducing average bilateral alpha and beta bands in 6 central channels; Group C received a combination of these protocols (rTMS as a priming method); Group D did not receive any therapy. The effects were measured by UPDRS-III, Timed Up and Go test (TUG) and Percentage of Limits of Stability (%LOS) at post-intervention and two weeks later. Treatment effects for each active Group (A-C) compared to control (Group D) were obtained by longitudinal analysis of covariance with mixed-effects models.

Results: 40 people with PD participated (27 males, age = 63 ± 8.26 years, baseline UPDRS-III = 15.63 ± 6.99 points, H&Y = 1-3). For UPDRS-III, Group C showed the largest overall effect (β = -3.8 points [95% CI = -6.1, -1.5], p = 0.02), followed by Group A (β = -2.4 points [95% CI= -4.7, -0.1], p = 0.32) and Group B (β = -0.99 points [95% CI = -3.2, 1.2], p = 1.00). For TUG and %LOS, negligible effects were observed between Groups A-C and Group D (TUG: β ≤ 0.5 seconds [95% CI = -1.6, 1.5], p = 1.00; %LOS: β ≤ 1.5% [95% CI =-10.2, 9.7], p = 1.00).

Conclusions: Combining rTMS and EEG-guided neurofeedback diminished overall motor symptoms, but this was not reflected by changes in functional mobility or postural stability.

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Investigation of deviations in aging trajectories across difference brain regions in Parkinson’s disease

J. D. Zhu¹, Y. C. Chen², A. C. Yang^1,2,3,4

¹National Yang Ming Chiao Tung University, Digital Medicine and Smart Healthcare Research Center, Taipei, Taiwan

²National Yang Ming Chiao Tung University, Institute of Brain Science, Taipei, Taiwan

³Taipei Veterans General Hospital, Medicine, Taipei, Taiwan

⁴National Yang Ming Chiao Tung University, Brain Research Center, Taipei, Taiwan

Introduction: With the advancement of artificial intelligence technology, recent studies have integrated machine learning approaches with neuroimaging to predict and classify neurodegenerative diseases. Brain age prediction is considered a crucial method for quantifying the aging processes of brain structures. Although current studies have investigated the significant brain aging associated with Parkinson’s disease, these studies have not delved into the differences across brain regions.

Objectives: This study aimed to construct region-specific brain age prediction models and investigate deviations in aging trajectories across different brain regions of patients with Parkinson’s disease.

Materials & methods: We trained brain-age prediction models for 90 brain regions using T1-weighted MRI scans from 230 healthy participants. An independent test dataset, comprising 95 healthy controls, was utilized to validate the model performance, which was then compared to a dataset of 95 patients with Parkinson’s disease. After predicting the brain age of each participant, we calculated the brain age gap. The brain age gap differences between the two groups were analyzed by ANCOVA controlled for chronological age and sex.

Results: Our findings revealed that most brain regions in patients with Parkinson’s disease exhibited significantly accelerated aging. Out of 90 brain regions, seventy-one showed significantly accelerated aging, especially those in the temporal lobe, frontal lobe, precuneus, and insula.

Conclusion: By establishing region-specific brain age prediction models, we can afford a more comprehensive insight into the neuropathological changes in Parkinson’s disease across different brain regions. Furthermore, this approach offers a quantitative methodology for assessing brain deterioration in Parkinson’s disease.

P-337

Monitoring patients with Parkinson’s disease: translational validation of an approach based on smartwatches

K. Lebel^1,2, E. Goubault de Brugière^1,2, C. Martin², P. Boissy^2,3, J. F. Danault⁴, C. Duval^5,6

¹Sherbrooke University, Génie électrique et génie informatique, Sherbrooke, Canada

²Research Center on Aging - CIUSSS de l’Estrie-CHUS, Sherbrooke, Canada

³Sherbrooke University, Département de chirurgie, service d’orthopédie, Sherbrooke, Canada

⁴Rutgers University, Kinesiology, Newark, NJ, United States

⁵UQAM, Département des sciences de l’activité physique, Montreal, Canada

⁶CRIUGM, Montreal, Canada

Introduction: Parkinson"s disease (PD) significantly impacts functional mobility, commonly assessed with standardized tests and patient-reported outcomes. These methods lack the ability to capture the daily-life impact of PD. While various technologies claim to address this gap, their validation is limited, and concerns about private data persist.

Objective: Develop and validate a technological in-home monitoring system for functional mobility and symptomatology in PD using smartwatches.

Materials & methods: Twenty-two persons (66.2 ± 8.3 years old) with PD (Hoehn & Yahr 1 or 2) participated. In the lab, participants wore two Apple watches and 39 markers for Optitrack"s gold standard. Trials of 3, 4 and 5 minutes were conducted in a simulated free-living environment. Participants then took the watches home with a data transmission unit for the next three days. A home visit captured 30 minutes of real-life mobility using Xsens" full-body motion capture system alongside the watches, establishing a reference for home validation. Initial analysis assessed feasibility, precision of the identification and segmentation algorithms (I&S), and symptoms assessment quality in the lab. Subsequent validation with in-home data accounted for real-life variability.

Results: Successful data collection and autonomous secured data transfer confirmed feasibility. Participants wore the watches an average of 11.2 hours/day, with 40% active time. In the lab, I&S algorithms based on the watches exhibited over 84% accuracy in detecting walking, turning, sitting, and standing. Tremor affected 60% of participants to varying degrees, with ongoing validation for dyskinesia and freezing of gait. Next steps involve optimizing I&S for in-home variability and developing a symptoms variation report.

Conclusion: This approach holds promise to enhance research and clinical understanding of PD by enabling a structured, robust, and secured collection of everyday mobility and symptomatology data.

P-338

Digital measurement of ocular microtremor in Parkinson’s disease: reliability and clinical validation evidence

L. Graham^1,2, R. Vitorio¹, P. Tait¹, C. McDonald², R. Walker³, A. Godfrey⁴, R. Morris^1,3, S. Stuart^1,3,5

¹Northumbria University, Sports, Exercise and Rehabilitation, Newcastle upon Tyne, United Kingdom

²Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom

³Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom

⁴Northumbria University, Computer Science, Newcastle upon Tyne, United Kingdom

⁵Oregon Health Science University, Portland, OR, United States

Ocular microtremor (OMT) is a fixational eye movement linked to brainstem activity. OMT frequency is 70-80Hz in healthy adults and research suggests it is reduced neurological diseases like Parkinson"s Disease(PD) making it a potential biomarker.

Objectives: 1) examine the reliability of the novel iTremor ONE device (Head Diagnostics Ltd., Dublin, Ireland) in measuring OMT frequency (Hz) in people with PD (PwPD); 2) investigate the clinical validity of OMT as a relevant disease measure through relationship with traditional clinical rating scales.

22 PwPD participated in a home-based assessment of cognitive (Montreal Cognitive Assessment, MoCA), motor (motor section of the Unified Parkinson"s Disease Rating Scale, UPDRS-III) and OMT measures (3 readings taken for each eye). PwPD completed a reliability assessment of OMT frequency at the same time of day, exactly one week after their initial assessment. Interclass correlation coefficients (ICC) were used to assess test-retest reliability of the iTremor ONE. Pearsons correlations were used to compare baseline OMT frequency to the clinical rating scales.

Average OMT frequency was 65.42Hz (SD 4.3) in the right eye, 64.42Hz (SD 4.9) in the left, and 64.948Hz (SD4.4) for both eyes together. The iTremor ONE reliably measured OMT in PwPD. OMT frequency had excellent agreement in the right, left and both eyes (ICC .940, ICC .925, ICC .921 respectively). OMT frequency was positively correlated with MoCA (r =.657, p= .001), negatively with UPDRS-III score (r=-.450, p=.041), highlighting that reduced OMT relates to worse cognitive ability and disease severity in PwPD.

The iTremor ONE provides a reliable measure of OMT in PwPD, and OMT is associated with cognition and disease severity in PwPD. Preliminary findings encourage research with a larger cohort to confirm current findings.

P-339

Physiotherapy after Subthalamic Nucleus Deep Brain Stimulation in patients with Parkinson’s disease: a Delphi consensus study on safety and efficacy

M. Guidetti¹, R. Duncan², F. Lena³, T. Bocci¹, A. Fasano^4,5,6,7, T. Foltynie⁸, K. D. Foote⁹, C. Hamani^10,11,12, J. K. Krauss¹³, A. A. Kühn^{14,15,16,17,18}, P. Limousin⁸, A. M. Lozano^5,6,19, N. V. Maiorana¹, N. Modugno³, E. Moro²⁰, M. S. Okun^9,21, S. Oliveri¹, M. Santilli³, A. Schnitzler^22,23, Y. Temel²⁴, L. Timmermann²⁵, V. Visser-Vandewalle²⁶, J. Volkmann²⁷, A. Priori¹

¹University of Milan, Health Science, Milan, Italy

²Washington University, Neurology, St. Louis, MO, United States

³IRCCS INM Neuromed, Neurology, Pozzilli, Italy

⁴University of Toronto, Neurology, Toronto, Canada

⁵Krembil Research Institute, Toronto, Canada

⁶CRANIA Center for Advancing Neurotechnological Innovation to Application, Toronto, Canada

⁷KITE, University Health Network, Toronto, Canada

⁸UCL Queen Square Institute of Neurology, Department of Clinical and Movement Neurosciences, London, United Kingdom

⁹University of Florida, Neurosurgery, Gainesville, FL, United States

¹⁰Sunnybrook Health Sciences Centre, Sunnybrook Health Sciences Centre, Toronto, Canada

¹¹Harquail Centre for Neuromodulation, Toronto, Canada

¹²University of Toronto, Department of Surgery, Toronto, Canada

¹³Medical University, Neurosurgery, Hannover, Germany

¹⁴Charité, Neurology, Berlin, Germany

¹⁵Humboldt University Berlin, Berlin, Germany

¹⁶Charité, Berlin, Germany

¹⁷DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany

¹⁸Humboldt University Berlin, Berlin, Germany

¹⁹University of Toronto, Neurosurgery, Toronto, Canada

²⁰Grenoble Alpes University, Neurology, Grenoble, France

²¹University of Florida, Department of Neurology, Norman Fixel Institute for Neurological Diseases, Gainesville, FL, United States

²²Heinrich-Heine University, Department of Neurology, Center for Movement Disorders and Neuromodulation, Duesseldorf, Germany

²³Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University, Duesseldorf, Germany

²⁴Maastricht University, Neurosurgery, Maastricht, Netherlands

²⁵University Hospital of Marburg, Neurology, Marburg, Germany

²⁶University of Cologne, Department of Stereotactic and Functional Neurosurgery, Cologne, Germany

²⁷University Hospital Würzburg, Neurology, Wuerzburg, Germany

Introduction: Deep brain stimulation of the subthalamic nucleus (STN-DBS) reduces tremor, rigidity, and akinesia in Parkinson"s Disease (PD)1. However, DBS effects on axial (e.g., postural instability) and gait impairments (e.g., freezing of gait) is quite unclear2. Physiotherapy (PT) improves postural stability, gait, and those symptoms resistant to dopaminergic replacement (e.g. freezing of gait) in PD patients without DBS3. However, PT has not been systematically assessed for PD patients with DBS.

Objectives: (I) gather the opinion of DBS experts on motor rehabilitation after DBS implant in PD patients, and (II) foster further investigation on this topic.

Materials & methods: We performed a systematic scoping review of the clinical research articles assessing PT programs in PD patients with STN-DBS to elaborate a questionnaire, which was then sent to chosen clinical and academic DBS experts (n=21) according to Delphi method process 4.

Results: Panellists strongly agreed that PT might help maximizing the effect of stimulation, improving motor symptoms and quality of life in PD patients with STN-DBS. Interestingly, they suggest PT to be prescribed in the treatment guidelines both in acute and chronic phase with the physiotherapist as part of the multidisciplinary team (for all, >88% strongly agreed, median ± IQR: 5 ± 0). Conventional PT (81% strongly agreed, median ± IQR: 5 ± 0) should be preferred over massage or manual therapy (81% disagreed, median ± IQR: 2 ± 0).

Conclusion: PT might be a beneficial complementary treatment for PD patients with STN-DBS, and its role and effect should be further explored.

References

1. Limousin, P. et al. Nature Reviews Neurology 2019 15:4 15, 234–242 (2019)

2. Duncan, R. P. et al. Pilot and Feasibility Studies 4, 1–7 (2018)

3. Cosentino, C. et al. Movement disorders : official journal of the Movement Disorder Society 35, 523–536 (2020)

4. Hsu, C.-C. et al. Practical assessment, research, and evaluation 12, 10 (2007)

P-340

Neural correlates of balance in Parkinson’s disease: a systematic review

P. Tait¹, L. Graham¹, R. Vitorio¹, T. Watermeyer², J. O’Keefe³, E. Timm³, S. Stuart^1,4, R. Morris^1,4

¹Northumbria University, Sports, Exercise and Rehabilitation, Newcastle upon Tyne, United Kingdom

²Northumbria University, Psychology, Newcastle upon Tyne, United Kingdom

³Rush Medical College, Chicago, IL, United States

⁴Oregon Health Science University, Portland, OR, United States

Aims: An increasing number of studies employ cortical brain-imaging techniques, such as functional near-infrared spectroscopy (fNIRS) and mobile electroencephalography (EEG). Similarly, behavioural studies have evaluated cognitive performance in relation to balance, in people with Parkinson’s disease (PwPD). This review aims to provide a overview of all studies that have assessed cognitive associations of balance in PwPD, and/or assessed cortical function, using fNIRS and/or EEG, in relation to standing tasks.

Methods: Scopus, PubMed, and ProQuest were searched between January 1980 and December 2022. Two authors reviewed the search results independently, using pre-established selection criteria detailing measurement technique, cohort, and balance task/device.

Results: Behavioural studies generally demonstrate a positive association between cognitive function and performance on balance tasks. Only 7 brain-imaging studies met the inclusion criteria, revealing distinct cortical activity in PwPD compared with healthy age-matched controls during standing tasks. PwPD exhibited higher levels of HbO² in the prefrontal cortex and greater inter-regional and inter-hemispheric connectivity. Additionally, PwPD with balance issues showed differences in cortical activation patterns, including lower mid-frontal and mid-cerebellar theta-band power, compared to PwPD without balance impairments. This suggests a compensatory mechanism that attempts to redress and ameliorate the postural control issues caused by subcortical dysfunction.

Conclusions: The limited number of studies and lack of standardisation regarding protocols, measurement devices, and data analysis make it challenging to draw concrete conclusions. A nuanced approach that considers all relevant variables regarding protocol and data analysis is recommended. Moreover, the integration of behavioural (cognitive) measures, in addition to objective balance measures, may be a valuable addition to mobile imaging studies.

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The role of life-long exposure to stimulating activities in explaining the gap between brain changes and telerehabilitation response in Parkinson’s disease

S. Isernia¹, S. Di Tella², F. Rossetto¹, F. Borgnis¹, M. Cabinio¹, C. Pagliari¹, A. Pirastru¹, A. Torchio¹, A. Castagna¹, M. C. Silveri², V. Blasi¹, F. Baglio¹

¹IRCCS Carlo Gnocchi Foundation, Milan, Italy

²Università Cattolica del Sacro Cuore, Milan, Italy

Introduction: The latest evidence supported the role of life-long stimulating activities in influencing response to non-pharmacological interventions in neurological disorders. This link has been interpreted in view of the cognitive reserve (CR) hypothesis, which explains the mismatch between disease-related brain susceptibility and functions in terms of the effect of experiential and genetic factors.

Objectives: To test the role of CR proxies and basal ganglia integrity on telerehabilitation treatment response in early Parkinson"s Disease (PD).

Materials & methods: Forty-two people with PD (M_age=68.88±8.02) participated in an asynchronous multidimensional telerehabilitation program (4-months, 40min 5s/w). They performed a 3T MRI examination (T1-3D sequence) and completed the Cognitive Reserve Index questionnaire (CRIq) before the treatment (T0). The 6-Minute Walk Distance (6MWD) was assessed at T0 and after treatment (T1) as the outcome measure. Three indexes were extracted: basal ganglia integrity (BG), CRIq total score, and treatment response (6MWD ∆). Participants were categorized as responders or non-responders based on the 6MWD Minimal Clinical Important Difference. Correlations and predictive models were run to test the association between neuromotor function at T1, CR proxy, and BG separately for responders and non-responders.

Results: Twenty-three participants were categorized as responders. Results showed a direct association between 6MWD and CRIq both at T0 and T1 only in the responders (p<0.001) and a link between BG and 6MWD in both responders and non-responders. Only in the responders, the CRIq score (β=0.24, p=0.024) significantly predicted the 6MWD increment, together with the 6MWD baseline score (β =0.70, p<0.001).

Conclusion: These findings hint at a complex relationship between CR and telerehabilitation treatment outcomes. Future research may contemplate the role of CR proxies on functional status before personalizing rehabilitation pathways.

P-342

Assessing patient recognition of symptoms and knowledge about Parkinson’s disease at Hospital Canselor Tuanku Muhriz

S. H. Mat Desa¹, N. N. Y. Nor Aziz¹, N. Mohamed Ibrahim^1,2, N. Majid^1,2

¹University Technology MARA (UiTM, Nursing and Health, Bandar Puncak Alam, Malaysia

²Hospital Canselor Tuanku Muhriz, Medicine, Kuala Lumpur, Malaysia

Introduction: A crucial factor in achieving favorable treatment outcomes for Parkinson’s disease (PD) patients is their ability to recognize symptoms and possess knowledge about the condition. This study aims to evaluate the level of symptom recognition, knowledge, and perception of PD among patients at Hospital Canselor Tuanku Muhriz, PPUKM.

Methods: We conducted a survey utilizing the Knowledge and Perception of Parkinson"s Disease Questionnaire (KPPDQ) among patients with Parkinson’s disease attending the Neurology Clinic at Hospital Canselor Tuanku Muhriz, PPUKM. A total of 169 participants were enrolled and completed the KPPDQ.

Results: Among the age groups, individuals aged 30-39 and 40-49 exhibited a lower percentage of participants with a high level of knowledge, while those aged over 70 displayed a higher percentage of participants with elevated knowledge levels. The correlation between age groups and knowledge levels was statistically significant. Participants diagnosed with PD for longer durations (6–10 years and >11 years) demonstrated a higher percentage of elevated knowledge levels compared to those diagnosed within the past five years (1–5 years). The link between years since diagnosis and knowledge levels was statistically significant. Ethnicity was also significantly associated with knowledge levels. Participants of Chinese ethnicity showed a greater proportion of high knowledge levels compared to Malay and Indian participants. Additionally, participants who had experienced a Parkinson’s disease event demonstrated a higher proportion of elevated knowledge levels compared to those without such an experience.

Conclusions: This study emphasizes the continuous need for enhancing patient education and knowledge regarding Parkinson’s disease. Addressing gaps in knowledge, correcting misconceptions, and promoting accurate information are essential tasks for healthcare professionals and support organizations.

P-343

Effects of an incremental gait training on a treadmill and a customized virtual reality rehabilitation protocol, first results from the VIRTREAD-PD study: a randomized controlled trial in persons with PD

S. Doronzio^1,2, G. Lombardi^3,2, M. Baccini², A. Gualerzi⁴, S. Pancani², S. Campagnini², D. Longo^1,2, A. Maselli², G. Cherubini^1,2, M. Piazzini², T. Ciapetti², C. Polito², S. Pinna^1,2, C. De Santis¹, M. Bedoni⁴, C. Macchi^1,2, S. Ramat⁵, F. Cecchi^1,2

¹University of Florence, Experimental Science, Florence, Italy

²IRCCS Carlo Gnocchi Foundation, Neuromotor Research Unit PROMISE@LAB, Florence, Italy

³University of Florence, Neurosciences, Psychology, Drug Research and Child Health, Florence, Italy

⁴IRCCS Carlo Gnocchi Foundation, Nanomedicine and Clinical Biophotonics, LABION, Milan, Italy

⁵Azienda Ospedaliero Universitaria Careggi, Parkinson Unit, Neuromusculoskeletal and Sense Organs Department, Florence, Italy

Background: Gait disturbance and falls lead to functional autonomy and quality of life reduction in persons with Parkinson’s Disease (pwPD). Targeted treadmill training and Augmented Virtual Reality (AVR) showed promising results on gait-related outcomes and fall risk. The benefits associated with AVR-mediated rehabilitation are worth exploring.

Objective: To investigate the effects of customized gait-rehabilitation treadmill training with AVR (TT-AVR) versus its standard counterpart without AVR (TT).

Patients & methods: PwPD, in the II-III Hoehn & Yahr stage, with gait or balance disturbances and no severe cognitive impairment were included in this preliminary analysis. PwPD underwent a baseline assessment (T0), 24 sessions of incremental TT (control group) or incremental TT-AVR (intervention group), and a final assessment (T1). Primary outcomes: the POMA and the MDS-UPDRS scales. Secondary outcomes: the Timed Up and Go (TUG), the Montreal Cognitive Assessment Total Score (MoCA-TS), and the space-time parameters of gait (S/T gait), estimated with Optogait.

Results: Preliminary data of the first 30 subjects (14 control, 16 intervention) completing the study are presented. No differences were found between groups in demographic and clinical features at T0. Comparing T1 vs T0, both the groups improved in the scores of the POMA, the MDS-UPDRS, the MoCA TS, and the S/T gait. A statistically significant improvement was observed in the intervention group in the MDS-UPDRS part II (T0=16; T1=14; p=0.005) and IV (T0=4; T1=0; p=0.027) and the TUG score (T0=9.87s; T1=8.72; p=0.015), whereas within the control group in the S/T gait (p<0.05).

Conclusion: The present preliminary results show a within-group improvement in different parameters, suggesting an advantage in favor of TT-AVR for functional mobility, and of TT for gait kinematics. Results on the whole sample will clarify the effectiveness of AVR on the rehabilitation of gait and balance disturbances in PD.

P-344

Dysphagia: the experience of people with Parkinson’s disease

W. Alolayan¹, J. Rieger¹

¹University of Alberta, Rehabilitation, Edmonton, Canada

Background: Dysphagia is a prevalent symptom of Parkinson"s Disease (PD), affecting up to 82 % of people with PD. Despite its prevalence, research in this area is limited, primarily focusing on clinical aspects, limiting input from those living with the condition. Consequently, a gap exists in understanding their experiences and identifying specific needs and considerations for managing dysphagia. For instance, the use of digital health solutions for rehabilitative interventions in PD has been promising. However, to harness this potential effectively, it is crucial to explore the perspectives of individuals with PD on utilizing technology for dysphagia management. Qualitative research in this matter may offer explanations for unexpected findings in quantitative data.

Objectives: We aim to comprehend PD-related dysphagia from the viewpoint of those affected, delving into their lived experiences with dysphagia and dysphagia therapy. Additionally, we seek to understand their perspective on employing technology solutions for remote care.

Methods: A qualitative inquiry of a phenomenological methodological design was adopted. Semi-structured interviews were conducted and themes were developed using thematic analysis. interview questions were shared with a person with PD and their input was integrated. Demographic variables were collected, and the Swallowing Disturbance Questionnaire (SDQ) and the Montreal Cognitive Assessment (MoCA) were administered for descriptive purposes.

Results: Eighteen person with PD, aged between 48 and 82, including 11 males, 6 females, and 1 genderqueer participant, were interviewed—time since diagnosis varied from 4 months to 22 years. Interviews were conducted online and lasted one hour. Initial codes are being identified, including "frustration", "embarrassment", "quality of life", "access", "embrace technology", "try anything", and "evidence matters". The full thematic analysis is underway and findings will be shared before the congress.

P-347

Relationship between tactile perception and quality of upper limb movement in children with hemiplegic cerebral palsy

A. R. Tsai¹, Z. C. Weng¹, K. J. Liang¹, Y. W. Hsieh², H. L. Chen¹, T. N. Wang¹

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

²Chang Gung University, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Taoyuan, Taiwan

Introduction: Children with Hemiplegic Cerebral Palsy (HCP) often encounter sensorimotor challenges impacting their engagement in daily activities. However, the relationships between various types of tactile perception and movement haven"t been thoroughly explored.

Objectives: To examine the associations between specific aspects of tactile perception and quality of upper limb movement in children with HCP.

Patients & methods: 47 children diagnosed with HCP involved in this study (22 girls and 25 boys, aged 5 to 12 years with an average of 8.9). The tactile perception was assessed by the moving and static two-point discrimination (2PD) and the Tactile Perception Test (TPT), encompassing 4 subtests evaluating different aspects of tactile perception: stereognosis, roughness, hardness and heaviness. The upper limb movement quality was measured by the Melbourne Assessment 2 (MA2), covering Range of Motion (ROM), fluency, accuracy, and dexterity. The multiple linear regression analyses were used to investigate associations between tactile perception and upper limb movement quality in children with HCP.

Results: Regression analysis revealed that 68% of the variance in ROM was explained by stereognosis and static 2PD, 77% of the variance in Accuracy was explained by static 2PD and hardness, 76% of the variance in Dexterity was explained by stereognosis and hardness, and 73% of the variance in Fluency was explained by stereognosis only.

Conclusion: This study indicates that various aspects of tactile perception contribute to explaining the variance in quality of upper limb movement in children with HCP. Both stereognosis and static 2PD, two forms of spatial perception, notably influence overall upper limb movement quality. Unique texture perceptions, such as hardness partially explain affected hand accuracy and dexterity. These findings emphasize that interventions for HCP children should consider specific tactile perception training to improve quality of upper limb movement.

P-348

Journey of a five year old from hypoxic ischaemic encephalopathy sequalae to home

M. Sengupta ¹

¹Narayana R N Tagore Hospital, Physical Therapy and Rehabilitation, Kolkata, India

A five-year-old child without any known co-morbidity was found cyanosed and unresponsive at home. He was immediately taken to the hospital, cardiac arrest was suspected and a prolonged cardiopulmonary resuscitation was followed by mechanical intubation. After a turbulent, intensive care course and a prolonged disorder of consciousness, a Physiatrist supervised, neuro rehabilitation program was started. Physiotherapy, occupational therapy, a speech swallowing pathologist, and a child psychologist were involved. Post-decannulation, the patient showed a transient improvement in all domains. However persistence of stridor and worsening of functionality led to the re-exploration of causes. Huge adenoids were found to be the culprit. Post adenoidectomy, complications were noted and a neurorehabilitation program was innovated and customized at every stage. Simultaneously a large section of the society came forward with philanthropic intentions to help the family. The child showed remarkable improvement and was discharged in an ambulatory state with improved speech and cognition. A supervised home program followed and over a period of 6 months, the child was ready to return to school. This case is an example of inter departmental liaison and uniqueness of a successful paediatric rehabilitation of an apparently near dead patient.

P-349

Discovering the untold story: the experiences and support needs of parents caring for children with cerebral palsy in Saudi Arabia: work in progress

A. Alqahtani^1,2, M. Finlayson¹, D. Macdonald³, H. Aldersey¹, A. Fakolade¹

¹Queen’s University, Rehabilitation, Kingston, Canada

²Qassim university, Rehabilitation, Buraydah, Saudi Arabia

³Queen’s University, Nursing, Kingston, Canada

Background: Family caregivers provide essential support for children with cerebral palsy (CP), a neurological disorder that affects movement and coordination. The experiences and needs of parents of children with CP can inform service provision for families affected by this disorder. Existing research has primarily focused on mothers’ perspectives of children with CP in Western, high-income countries. The experiences of parents of children with CP in Saudi Arabia (SA), have received minimal research attention.

Objective: This qualitative exploratory descriptive study aimed to explore the caregiving experiences of parents of children with CP in SA, including identifying their support needs from a socioecological perspective.

Materials & methods: Twelve Saudi parents of children with CP completed a demographic survey and were enrolled in the study. We have conducted semi-structured interviews with these individuals. Interviews are being transcribed verbatim and will be analyzed using reflexive thematic analysis. Data analysis is expected to be completed by March 2024.

Results: Our participants represented families of children (ages 2-16) with different types of CP. Family members were equally distributed between mothers and fathers (50% each). About half of the parents reported a monthly income of under 6,000 SAR (approximately CAD 2000), and more than half of the participants had a high school education or less. Based on the initial interview notes, the parents expressed emotional and financial challenges and highlighted the need for an improved educational and healthcare system.

Conclusion: Improving existing programs and services for children with CP in SA requires a better understanding of the experiences of their caregivers. The knowledge gained in this study can guide healthcare providers, policymakers, and researchers in addressing challenges and developing culturally sensitive interventions and services that meet the needs of parents and children with CP.

P-350

Theory-driven exergame-based rehabilitation program to improve reaching movements of children with cerebral palsy: a design consideration

B. de Souza da Silva¹, Y. Chen¹

¹Georgia State University, Physical Therapy, Atlanta, GA, United States

Virtual rehabilitation appears to be a useful tool for providing beneficial and motivational rehabilitation conditions. Approaches to promoting motor learning have attracted considerable attention in recent years. Cerebral palsy is the most common physical disability in childhood and causes activity limitations that are attributed to non-progressive disorders that occurred in fetal or infant brain development. Therefore, many affected children often present with substantial deficits in upper limb movement capabilities. One of the main objectives of cerebral palsy rehabilitation is to improve the reach characteristics of patients and, thus, obtain the highest possible level of movement coordination capacity. As previous studies indicate a relationship between reaching and coordination, this article proposes a rehabilitation program for cerebral palsy that targets upper limb coordination deficiencies to improve reaching in children with cerebral palsy. Currently, available cerebral palsy rehabilitation programs lack a viable, theory-based model consistent with widely accepted motor learning principles and theories in rehabilitation. To address this gap, we developed a set of virtual reality games specifically for cerebral palsy rehabilitation and ordered according to an established two-dimensional motor skill classification taxonomy. We argue that the following "exergame"-based rehabilitation program guarantees individualized motor learning progression and coordination in a learning environment that allows for variable practice and, therefore, optimizes progressive reaching execution capacity. The development of the virtual reality game and the validation of this project are under development and will be completed as a doctoral thesis.

P-351

Effectiveness comparison of therapist-based and Kinect-based bimanual intensive training on upper limbs kinematics in children with unilateral cerebral palsy

C. W. Ye¹, Y. A. Tsai¹, T. Y. Shih¹, T. C. Hsu², T. N. Wang¹, H. L. Chen¹

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

²Taipei Veterans General Hospital, Neurological Institute, Division of Cerebrovascular Diseases, Taipei, Taiwan

Introduction: Motor deficit in children with unilateral cerebral palsy (UCP) often leads to poor bimanual coordination and function limitation. Bimanual intensive training (BIT) has gradually been popularized because of its effectiveness and naturality. Still, executing BIT in the clinic is challenging, as the prolonged time may be burdening for the therapist and de-motivating for children with UCP. Virtual Reality (VR) game has great potential to compensate for BIT"s weakness. Thus, we developed a Kinect-based BIT (K-BIT) program, integrating the advantages of BIT and VR, and compared its effectiveness with that of therapist-based BIT (T-BIT).

Objectives: Compare the effectiveness of T-BIT and K-BIT on motor control strategies in children with UCP.

Patients & methods: 27 children with UCP were randomly assigned to two groups (T-BIT: K-BIT=14:13), each receiving 36 hours of intervention in 8 weeks. Unimanual and bimanual reaching tasks were recorded with a motion capture system (Vicon Vero v2.2). The reaction time (RT), movement time (MT) of the reaching task, and the endpoint control parameters of the affected hand: peak velocity (PV), percentage of MT when PV occurred (PPV), and movement units (MU) were calculated. The 2-way mixed RMANCOVA examined the improvement between groups and reaching tasks.

Results: The K-BIT group has a significantly shorter RT, indicating better movement preparation efficiency. The T-BIT group has significantly fewer MU in the vertical direction, specifically in the bimanual reaching task, indicating the T-BIT group has a better ability to improve movement smoothness.

Conclusion: Overall, the effectiveness of K-BIT and T-BIT are comparable, showing K-BIT as a feasible alternative. Nonetheless, the two BITs had unique advantages respectively. To improve movement smoothness, T-BIT was favorable. To facilitate effective movement preparation, K-BIT was favorable.

P-352

Rhythm and dance can improve motor and cognitive skills in children with cerebellar dysfunctions

D. Dellacherie^1,2, V. Bégel², A. Bachrach³, A. Delval^4,5, J. Laroche³, O. Goze¹, S. Nguyen¹, S. Dalla Bella^6,7

¹University Hospital of Lille, Department of Pediatric Neurology, Lille, France

²University of Lille, Psychology, Villeneuve d’Ascq Cedex, France

³Université Paris 8, 3UMR 7023 CNRS, Paris, France

⁴Hôpital Salengro, Service de neurophysiologie clinique, Lille, France

⁵University of Lille, Unité INSERM 1171, Lille, France

⁶University of Montreal, Psychology, Montreal, Canada

⁷International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Canada

Introduction: Patients with cerebellar anomalies exhibit difficulties in motor (including gait) and cognitive skills, but very few rehabilitation protocols are proposed at the moment. Sensorimotor training involved in dance is likely to boost a neuronal circuitry including the cerebellum, the basal ganglia and the cerebral cortex. Dance may be used as a physical therapy in neurological conditions and its positive impact on motor and cognitive domains is well documented. However, no studies have tested the effect of a rhythm and dance training protocol in children with developmental cerebellar anomalies so far.

Objectives: The purpose of this study was to show that dance is an efficient way to reduce difficulties associated with cerebellar dysfunctions.

Patients & methods: 7 children (7 to 11 years old) with cerebellar developmental anomalies participated in a 2-month dance training protocol (two 1.5h sessions per week). A test-retest design protocol with multiple basis was used to assess children"s capacities in perceptual and sensorimotor rhythmic abilities, gait, motor and cognitive skills.

Results: Significant improvements were observed in sensorimotor synchronization (finger tapping with a metronome and with music), balance (jumping on one leg), gait and executive functioning (flexibility) (Non-parametric tests, p < .05). Almost all the participants displayed better performances in these skills after the training.

Conclusion: The results indicate that a 2-month dance training protocol is associated with distinct improvements in sensorimotor, motor (including gait) and cognitive skills in children with developmental cerebellar anomalies. It paves the way for future development of new rehabilitation based on rhythm in children with cerebellar dysfunctions.

P-353

Management of spinal deformity and oblique pelvis in unilateral cerebral palsy

H. Belabbassi¹, S. Ait Ziane¹

¹Medicine Faculty Saad Dahleb University, Physical Therapy and Rehabilitation, Alger, Algeria

Introduction: Neuro-orthopedic deformities secondary to cerebral palsy are very common. Asymmetric clinical forms of cerebral palsy can have more complex consequences by directly impacting the pelvis and then the spine.

Objective: The objective of our presentation is to show these consequences and their management through two clinical cases.

Patients & methods: We present two patients who are afflicted with unilateral cerebral palsy. Both children had neuro-orthopedic disorders in the ipsilateral upper and lower limbs, as well as bothersome spasticity. The care protocol included a codified program of physiotherapy, equipment, botulinum toxin injection and occupational therapy.

During their monitoring, we noted the development of an oblique pelvis associated with scoliosis. The therapeutic attitude was a program of flexibility and spinal traction with brace for the first patient, while consisting of unilateral shorts for the second.

Results: After three years of wearing the brace, the results were satisfactory with stabilization of the curvatures during the growth peak.

Conclusion: The examination of the pelvis and spine constitutes a crucial step in the monitoring of brain-injured children during the growth period, especially in asymmetrical forms.

Conservative treatment proves important by allowing the stabilization of the spinal deformity and that of the pelvis by correcting posture during walking.

Keywords: spinal deformity, oblique pelvis cerebral palsy, treatment.

P-355

Effectiveness of individualized multicomponent intervention for sensory food aversion feeding disorder (SFAFD) in children: case series

K. Mohandass ^1,2

¹Akkara Foundation, Occupational Therapy, Kasaragod, India

²Tamil Nadu Dr. M.G.R. Medical University, Occupational Therapy, Coimbatore, India

Introduction: Sensory Food Aversion Feeding Disorder (SFAFD) in children is characterized by a persistent refusal to consume most or all foods and can be effectively addressed through a multicomponent intervention

Objective: To enhance the acceptance and consumption of non-preferred foods while improving parental coping attitudes toward their child’s mealtime behavior

Methods: Population: Seven children with SFAFD, based on Chatoor’s classification; Timeline: 30-session with1 hour for 5 days a week; Intervention: sensory-based activities, behavioral modification, and parental education

Materials: Food Preference Questionnaire (FPQ), Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and Child Sensory Profile 2 (CSP2)

Results: Statistically improvements were observed in both child & parent subscales (Frequency, Z=-2.366, p=0.018, CI=0.005-0.009 and Problem, Z=-2.384, p=0.017, CI=0.006-0.010) as measured by the BPFAS. The effect size for BPFAS was large for both frequency (r=0.8) and problem behavior (r=0.90). post-intervention improvements were also noted in the CSP2 oral domain (Oral, Z=-2.371, p=0.018, CI=0.005-0.009), with a large effect size (r=0.89). However, no differences were found in CSP2 Touch (Z=-1.841, p=0.066, CI=0.000-0.726) and Visual (Z=-1.342, p=0.180, CI=0.240-0.262) domains, although medium effect sizes were observed (Touch r=0.69; Visual r=0.50). The FPQ demonstrated a difference (Z=-2.384, p=0.017, CI=0.000-0.482) with a large effect size (r=0.90). Children with SFAFD exhibited increased acceptance of previously refused foods and mealtime behaviors such as gagging, spitting, and vomiting were notably reduced

Conclusion: This study underscores the effectiveness of an intervention in enhancing the acceptance of non-preferred foods and empowering mothers to manage mealtime behaviors in SFAFD

Reference

Suarez MA. Multicomponent treatment for food selectivity in children: Description and case report. Nutri in Clinical Practice. 2015 Jun

P-356

Structure of the gastrocnemius fascia in idiopathic toe-walking in children with sensory integration disorder: sonographic findings

L. Berna¹, J. L. Bacco^2,3, G. Aguilera⁴, R. Núñez⁴, F. Ocaranza⁵, R. Castellón⁶

¹Siloé Rehabilitation Center, Viña del Mar, Chile

²Teletón Rehabilitation Institute, Valparaíso, Chile

³Frontera University, Medicine, Temuco, Chile

⁴Neuro Anku Rehabilitation Center, Occupational Therapy, Villa Alemana, Chile

⁵Valparaíso University, Neuro sciences PhD, Valparaíso, Chile

⁶Gustavo Fricke Hospital, Imagenology, Viña del Mar, Chile

Introduction: Idiopathic Toe-Walking (ITW) observed in children with sensory integration disorder (SID) is a common clinical problem. However, sonographic characteristics of other structures rather than the gastrocnemius muscle appear not to have been largely studied and may be unique and different compared with other pediatric conditions.

Objective: To establish sonographic characteristics of the gastrocnemius fascia in children with SID who present ITW.

Patients & method: 10 children between 2 – 6 years old diagnosed with SID and ITW, with no invasive treatment and their clinical data were recorded. Medial Gastrocnemius fascia, in transversal and longitudinal ultrasound measurement at upper/middle third were measured, obtaining 18 muscles. Measurement was also recorded on 4 children (8 muscles) without SID or ITW as control. Data was compared with t-student.

Results: Ultrasound findings at gastrocnemius fascia on SID group were statistically thicker at transversal (1,06 mm SD 0,12) and longitudinal (1,12 mm DE 0,12) compared with control group (0,79 mm SD 0,12- and 0,87-mm SD 0,12) with t-student (0,007).

Conclusion: Gastrocnemius fascia in children with sensory integration disorder and idiopathic toe-walking presents thickening at ultrasound, a characteristic that, to our knowledge, has not been previously reported. Further research is required to fully understand mechanisms in toe-walking in SID.

P-357

Gluthatione’s influence on gene expression in children with autism spectrum disorder

M. Indriasari ¹

¹Binawan University, Nutrition, Jakarta, Indonesia

Autism Spectrum Disorder (ASD) is a neurodevelopmental disease that impacts communication, conduct, and social interaction. Several studies indicate that alterations in gene expression may be crucial in the development of ASD. Glutathione, a naturally occurring antioxidant, plays a key function in controlling sulfur metabolism and healing oxidative damage in cells. According to some study, children with ASD have lower amounts of glutathione in their systems, which might influence gene expression and contribute to ASD symptoms. The purpose of this literature review is to assess the effect of glutathione on gene expression in children with ASD. Various literature sources, including scientific publications done on people and experimental animals, were investigated. These findings suggest that giving glutathione to animals with ASD increases the expression of genes involved in synaptic function. According to the findings of this literature review, glutathione may have a crucial role in treating ASD symptoms through modulating gene expression. However, further study is needed to assess the efficacy and safety of utilizing glutathione in children with ASD in a more thorough and bigger sample size. Further research into the influence of glutathione on gene expression in children with ASD might lead to a better understanding of ASD pathophysiology and the potential of glutathione as a therapeutic target to alleviate ASD symptoms.

Keywords: Glutathione, Gene Expression, Autism Spectrum Disorder

P-358

Efficacy of low level laser therapy for treating autism spectrum disorder

N. Sarwade¹, A. Phatak¹

¹Private Practice, Vadodara, Gujarat, India

Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects communication, cognition, and behavior. There is a great need for a safe and effective treatment for ASD. This study examined the efficacy of low-level laser therapy, a form of photobiomodulation, for the treatment of ASD.

Objectives: There is a close relationship between retained primitive reflexes and sensorimotor and cognitive development in general and in ASD in particular. Low Level Laser Therapy (LLLT) is a safe form of treatment to promote reflex integration. However, few studies have explored the use of LLLT for treating ASD.

Patients & methods: This study examined the efficacy of LLLT, in five participants, children and adolescents with ASD aged 5-16 years.

We used red, infrared, and violet lasers. Subjects received treatment with cold laser for primitive reflexes during each session, which lasted for an hour. Each participant received ten sessions.

A checklist was created to check which symptoms due to retained reflexes were present in each participant. A software was generated which calculated the percentage of symptoms present, associated with each reflex. Parents of the participants filled out the checklist at baseline and after ten sessions.

Student’s t test was used to compare the significant improvement in percentages of the symptoms in pre and post treatment values of reflex integration.

Results: The results indicated improvement in several reflexes. Moro Reflex and Fear Paralysis Reflex showed statistically significant improvements after treatment (n=5 , Student"s t-test, P < 0.05 and P < 0.01 respectively).

Conclusion: Using LLLT significantly improves reflex integration and is an effective modality to treat ASD. In the future, suggestion is to conduct this study with a large number of participants.

Reference

Leisman G, Machado C. Effects of Low-Level Laser Therapy in Autism Spectrum Disorder. Adv Exp Med Biol. 2018 ;1116:111-130.

P-360

Exploring hypoxic and ischemic brain injury: observational insights and treatment approaches in indian children with cerebral palsy

P. Kapoor¹, S. Pal¹

¹Bharati Vidyapeeth (Deemed to be University), School of Audiology and Speech Language Pathology, Pune, India

Background: This study examines hypoxic ischemic brain injuries in the context of Cerebral Palsy (CP) in India. Children with CP commonly experience issues like epilepsy, hearing loss, and feeding difficulties. These feeding problems result from communication barriers, oral-motor dysfunction, and aspiration. Despite various assessment tools for feeding issues, there’s a lack of options in Indian languages. This study focuses on the complexities of hypoxic ischemic brain injuries, particularly within the context of CP.

Objectives: Evaluate the impact of hypoxic and ischemic brain injuries on individuals’ neurological and cognitive functions and provide observational insights to enhance the scientific understanding of these injuries.

Method: A cross-sectional design with convenient sampling was utilized. The translated version of Behavioral Pediatrics Feeding Assessment Scale (BPFAS) in Marathi was used, comprising 35 items for parents to assess their child’s eating behaviors and their own feelings or strategies regarding feeding problems. The study included 27 parents of children with CP, divided into three age groups. Inclusion criteria required parents to be native Marathi speakers, and their children to be aged 9 months to 7 years with CP attributed to hypoxic ischemic encephalopathy, rest were excluded.

Results: A descriptive analysis calculated standard deviations and means, revealing no significant gender impact on BPFAS scores. Notably, the study identified distinct feeding challenges among children with CP who displayed milder picky eating tendencies, while younger children in the ’General Toddler Refusal’ category exhibited common issues like whining and food refusal. The ’Toddler Refusal—Textured Foods’ category emphasized difficulties with specific food textures, underscoring the need for tailored interventions. Additionally, the ’General Older Children Refusal’ and ’Stallers’ categories highlighted CP-related behaviors in food choice negotiation and eating habits.

P-361

Motor planning of upper extremity in children with unilateral cerebral palsy

T. Y. Chen¹, A. R. Tsai¹, C. Y. Yang², K. J. Liang¹, H. L. Chen¹, T. N. Wang¹

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

²Shuang Ho Hospital, Taipei Medical University, Physical Therapy and Rehabilitation, New Taipei, Taiwan

Introduction: Motor planning is the ability to imagine the process related to task in advance and to anticipate the result of the oncoming action before performing motor execution. Previous study indicated that individuals with unilateral cerebral palsy(UCP) may have problems in motor planning. However, the motor planning performance of children with UCP has not been fully explored.

Objectives: This study aimed to investigate the differences in the motor planning performance of children with UCP and typical developing(TD) children under different conditions.

Patients & methods: 20 children with UCP(mean age10y2mo±2y1mo) and 20 age-matched TD children were recruited in this study. Motor planning performance was assessed by the end-state-comfort(ESC), the tendency to complete a motion in a comfortable posture, of the cup-bottle tasks. Two-way mixed repeated-measures ANOVA was conducted to compare the ESC differences of the UCP and TD groups in different conditions.

Results: The result showed that there were significant differences between Group and Condition in both hands(Dominant: p=0.001; Non- Dominant: p=0.018). The post-hoc tests showed that the more-affected hand of children with UCP had the largest ESC percentage in the functional bimanual asymmetric task compared to the other conditions. On the other hand, the less-affected hand of children with UCP had the worst ESC performance in the bimanual symmetric task.

Conclusion: This study demonstrates that functional tasks enhance motor planning in the more-affected hand of children with UCP, whereas bimanual symmetric tasks may negatively affect the motor planning of the less-affected hand. This phenomenon can be attributed to the adaptation of the less-affected hand to imitate the action of the more-affected hand, resulting in suboptimal performance. Thus, to enhance bimanual motor planning performance, it is crucial to include bimanual task assessments, consider task functionality and symmetry during intervention.

P-362

Animal-assisted intervention for walking and balance training partenered with a rehabilitation dog for children living with cerebral palsy: a mixed methods case series

V. Caron¹, A. Oates², C. Dell², J. Lanovaz², S. Oosman², R. Pinto², A. Zucker-Levin², S. J. Donkers¹

¹University of Saskatchewan, Rehabilitation, Saskatoon, Canada

²University of Saskatchewan, Saskatoon, Canada

Introduction: Pediatric physiotherapy (PT) requires innovation & creativity to effectively improve participation. For children living with Cerebral Palsy (CP) improving walking & standing balance requires high intensity & consistent motivation. Animal-assisted interventions (AAIs) increase wellbeing & participation. Rehabilitation dogs (RD) are highly trained to support PT, but AAIs partnered with RD have not been explored in CP.

Objectives: Mixed-methods case series to explore the impact of an AAI with a RD on community participation, walking & balance ability in CP.

Materials & methods: Children with CP (6-18 y.o.a) were recruited for an individualized, 8-week AAI for walking & balance in community settings. At 4 timepoints (0wks, 8wks, 16wks, 24wks), they walked a 10m walkway to collect temporospatial parameters with & without the RD; balance was assessed using the Kids Mini BESTest. Dual-task cost (DTC) was calculated. VAS & semi-structured interviews explored impact of the RD-AAI on participation, enjoyment & confidence. An individual responder analysis & interpretive descriptive methodology were used.

Results: 11 children (GMFCS I n=6, GMFCSII n=5) with spastic CP completed the 0wk assessment & interview. 4 children completed the AAI & FU period, to date. At 16wks,all(n=4) increased above the MCID for the BESTest; DTC decreased 14-25%. All (n=11) reported increased perceived enjoyment & confidence when walking with the RD. 3 themes were constructed: the RD is my friend (strength of bond built); the RD is here to support me (psychosocial, physical); I am independent (engagement, participation).

Conclusion: In children living with CP, an RD-AAI improved balance ability, reduced DTC & improved self-reported confidence & enjoyment of walking. Children highlighted the meaningful contributions the RD had on their perceived walking & balance abilities. Children expressed the importance of having support from the RD to encourage independence in exploring community.

P-364

The impact of central-peripheral combined magnetic stimulation on fine motor function in children with spastic hemiplegia

W. Ye¹, Q. Ai zhen¹, W. Min¹

¹Xuzhou Medical University, Rehabilitation, Xuzhou, China

Objective: The aim of this study was to investigate the effect of central peripheral combined magnetic stimulation on the improvement of upper limb motor function in children with hemiplegic cerebral palsy. A total of 40 children aged 4-6 years with hemiplegic cerebral palsy were prospectively selected and randomly assigned to either a control group or a study group, with 20 cases in each group. Both the study group and the control group received conventional rehabilitation treatment. Additionally, the study group received transcranial magnetic stimulation of the M1 area of the healthy cerebral cortex at a frequency of 1 Hz for 20 minutes, followed by peripheral magnetic stimulation of the median nerve on the affected side at a frequency of 10 Hz for 10 minutes. The control group received pseudo-peripheral magnetic stimulation. Both groups of children received treatment once a day for 20 days, with 10 days of rest, for 4 consecutive courses of treatment. The upper limb motor functions of the children were evaluated using the Fine Motor Function Measure (FMFM) and Carroll Upper Extremity Function Test (UEFT) before and after 4 treatment sessions to compare the results between the two groups. After treatment, significant differences were observed within the FMFM grasping energy area, manipulation energy area, upper extremity joint mobility energy area, and UEFT scores of the children in both groups compared to before treatment (p < 0.05). Additionally, statistically significant differences were observed between the FMFM scores and UEFT scores of the study group and those of the control group (p < 0.05).

Conclusion: Both central magnetic stimulation and central-peripheral combined magnetic stimulation can improve the fine function of the upper limbs in hemiplegic children. However, central-peripheral combined magnetic stimulation has a better therapeutic effect.

P-365

The efficacy of kinect-based bimanual intensive training program: daily motor functions in children with unilateral cerebral palsy

Y. A. Tsai¹, C. W. Ye¹, L. C. Hsiao¹, M. Y. Wu¹, T. N. Wang¹, H. L. Chen¹

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

Introduction: Children with unilateral cerebral palsy (UCP) show impaired motor function in unilateral upper extremities that affects the performance of activities of daily living (ADLs), which are mainly composed of bimanual tasks. Bimanual intensive training (BIT) has been found to improve both unilateral impairments and bimanual coordination in children with UCP. However, there are challenges for therapists in implementing BIT. The lack of quantified supervision makes the assurance of the training dose of affected upper extremities during BIT difficult. Also, maintaining the motivation of children in intensive training is challenging. Given that the benefits of using virtual reality (VR) in rehabilitation, such as enhanced motivation and performance recording, have been recognized, this study aims to combine BIT and VR by proposing a Kinect-based BIT.

Objectives: Comparing the efficacy of Kinect-based BIT and therapist-based BIT in improving motor function in ADLs of children with UCP.

Patients & methods: 34 school-aged children with UCP were recruited and allocated into the 36-hour Kinect-based BIT or therapist-based BIT groups within 8 weeks. Both programs contain symmetrical and asymmetrical bimanual games with individually tailored difficulty levels. Before and after the intervention, Pediatric Motor Activity Log-Revised (PMAL-R) and ABILHAND-Kids were collected as the outcomes of unilateral and bilateral motor functions in ADLs, respectively. ANCOVA was used to analyze the differences between groups.

Results: No significant differences were found between Kinect-based and therapist-based BIT groups, indicating that Kinect-based BIT is a feasible and effective program for children with UCP.

Conclusion: Kinect-based BIT is a game-styled intervention designed from BIT principles and has comparable efficacy with therapist-based BIT on motor functions in ADLs. To sum up, Kinect-based BIT is an effective program to implement in the clinical or home-based field.

P-366

Effectiveness of the intensive and distributed bilateral intensive training for children with unilateral cerebral palsy

Z. C. Weng¹, T. Y. Chen¹, K. J. Liang¹, Y. S. Lia¹, H. L. Chen¹, T. N. Wang¹

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

Introduction: Bilateral intensive training (BIT), one of the most promising evidence-based neurorehabilitation programs, has been frequently applied to children with UCP. Previous studies have compared the treatment effectiveness of the BIT by different ages, materials, and delivering dosages. However, whether the dosing schedule (i.e., intensive or distributed) influences the effectiveness of BIT in children with UCP is unclear.

Objective: This study aims to investigate the efficacy of the intensive and distributed BIT for children with UCP.

Materials & methods: A total of 35 children aged 5-12 years old with UCP were recruited. The participants underwent 36 hours of BIT intervention with two scheduling frequencies. The assessments included the Bruininks–Oseretsky Test, the Observation Test of Capacity, Performance, and Developmental Disregard Questionnaire (OTCPDDQ), the Melbourne Assessment-2, and the Pediatric Motor Activity Log-Revised (PMAL-R). The group of intensive BIT was assessed at the initiation of treatment (week 0), the end of the one-week treatment (week 1), and 8 weeks after the initiation of treatment (week 8). The group of distributed BIT was assessed at week 0 and week 8.

Results: The results showed significant differences between groups on the OTCPDDQ and the PMAL-R. The motor frequency of the OTCPDDQ presented greater improvement in the distributed group, both immediately post-treatment and at week 8 compared to the intensive group. Besides, the motor quality of the PMAL-R in the intensive group demonstrated a larger improvement at week 8, relative to the distributed group.

Conclusion: The intensive and distributed BIT interventions yield distinct benefits across different outcome measures. The distributed schedule promotes increased utilization of the affected hand on bimanual functional activities, while the intensive schedule receives greater improvements in motor quality of the affected hand eight weeks after the initiation of treatment.

P-367

NX210c peptide: a promising drug candidate for the treatment of Parkinson’s disease

S. Lemarchant¹, J. Le Douce¹, A. Henriques², N. Callizot², Y. Godfrin^1,3

¹Axoltis Pharma, Lyon, France

²Neuro-Sys, Gardanne, France

³Godfrin Life-Sciences, Caluire-et-Cuire, France

Parkinson"s disease (PD) is characterized by the accumulation of α-synuclein and blood-brain barrier (BBB) disruption, thereby contributing to the loss of dopaminergic neurons in the substantia nigra. Here, we have evaluated the effect of a subcommissural organ-spondin-derived peptide (NX210c) on PD progression using in vitro and in vivo rat models.

Primary rat dopaminergic neurons were exposed for 48h to human α-synuclein and treated simultaneously with NX210c (100, 250, 500 µg/mL) or its vehicle (water), or to 6-OHDA and then treated for 2h with NX210c or its vehicle. Neuronal survival, neurite growth, microglial activation and/or α-synuclein aggregation were evaluated by immunocytochemistry.

Sprague Dawley rats were subjected to an injection of AAV1/2-hA53T-α-synuclein or an empty AAV (control) in the substantia nigra, and treated 2 days later with NX210c at 2.5, 5 or 10 mg/kg and then once a day for 41 days. Rats were sacrificed on D42 to measure dopamine levels (LC-MS/MS), dopamine transporters (autoradiography), and α-synuclein aggregation (ELISA) in the striatum.

NX210c reduced α-synuclein-induced neurite network retraction, neuronal death and microglial activation in dopaminergic neuron cultures, when applied in parallel of α-synuclein regardless of the dose used. Dopaminergic neurons were also protected from 6-OHDA when post-treated for 2h with NX210c at 500 µg/mL, likely due to the decrease in α-synuclein aggregation (-71%, p=0.004, n=4-5).

In vivo, daily treatment with NX210c at 5 mg/kg significantly increased dopamine levels and its transporters in the striatum compared with that of untreated PD rats (n=9-11, p<0.05. No effect was observed at 2.5 and 10 mg/kg. In this model, NX210c did not reduce α-synuclein aggregation (p>0.05).

NX210c is a promising drug candidate for reducing neuropathological changes in PD, notably the loss of dopaminergic neurons and the leakage of the BBB.

P-368

NX210c drug candidate peptide promotes functional recovery and repair in a rat cervical clip-compression model of spinal cord injury

S. Lemarchant¹, N. Punjani^2,3, S. Altamentova², J. Chio^2,3, J. Wang², Y. Godfrin^1,4, M. Fehlings^2,5

¹Axoltis Pharma, Lyon, France

²University Health Network, Krembil Research Institute, Toronto, Canada

³University of Toronto, Medicine, Toronto, Canada

⁴Godfrin Life-Sciences, Caluire-et-Cuire, France

⁵University of Toronto, Neurosurgery, Toronto, Canada

More than half of spinal cord injuries (SCI) occur at the cervical level, leaving patients with partial to total loss of autonomy. Regaining arm/hand and bladder functions are the most important priorities for cervical SCI patients, yet with no satisfying therapeutic solutions. NX210c is a 12-aa peptide derived from a glycoprotein involved in axonal guidance during brain development, which is under preclinical and clinical development (Axoltis Pharma). The aim of this study was to evaluate the efficacy of NX210c to promote functional recovery and tissue repair in a cervical SCI model.

Adult female Wistar rats were subjected to a C6/C7 clip compression-contusion injury and treated once daily with intraperitoneal injections of NX210c (8 mg/kg) or its vehicle from 4h or 8h post-injury (n=16-17/group). Sham rats received a laminectomy with vehicle treatment from 4h post-injury (n=12). Neurobehavioral tests were performed for up to 8 weeks post-injury, and rats were then sacrificed for histological assessments.

Early administration of NX210c at 4h increased forelimb grip strength from 3 weeks post-injury (p<0.05) and improved several static and dynamic aspects of locomotion including interlimb coordination (i.e., regularity index or base of support of the forelimbs; CatWalk). When delaying first administration to 8h post-injury, NX210c promoted weight gain, accelerated bladder control recovery from 14 to 9 days post-injury, and improved trunk balance (inclined plane) from 1 week post-injury (p<0.05). Using histology (n=6/group), we demonstrate that NX210c reduced the cavity size and protected both white and gray matter when injected from 8h post-injury (p<0.05).

NX210c improves motor function, bladder control, and white matter preservation, with more benefits observed at the later initial injection timepoint. This study constitutes a strong proof of concept for the use of NX210c as an innovative treatment for patients suffering from acute SCI.

P-369

Donepezil and memantine combined in the treatment of Alzheimer’s disease

C. Tomicki ^1,2

¹Unidep, Pato Branco, Brazil

²Univesity, Pato Branco, Brazil

Introduction: Alzheimer’s disease is currently the main cause of dementia, progressive loss of memory and cognition, directly impacting the lives of affected individuals. Currently, there is no cure for AD and the treatment is still under discussion, with the two main medications being donepezil and memantine, which have demonstrated greater effectiveness in combined treatment and improved quality of life for patients.

Objectives: to carry out a bibliographical review study regarding the use of memantine and donezepil in the treatment of Alzheimer’s disease, indicating the harms and benefits of combined treatment and the clinical evolutions presented by patients who are adept at this pharmacological introduction.

Materials & methods: Scientific articles from the electronic databases PUBMED and MEDLINE were used. After selecting 5 articles, only 3 met the inclusion criteria and were used for the theoretical foundation of the research. The main keywords used were: "donepezil" and "memantine" and "Alzheimer" and "treatment".

Results: The effectiveness of the combined treatment of donepezil and memantine was identified in controlling the main symptoms of Alzheimer’s disease in moderate to severe stages, such as memory loss, loss of the ability to perform simple activities and the ability to process and store information.

Conclusion: It was concluded that the combined treatment between donepezil and memantine were effective in reducing the progression of symptoms in Alzheimer’s disease in more advanced stages of the disease, and this drug therapy was also recently approved by the FDA, increasing the quality of life of affected patients for this disease.

P-370

Does the intramuscular injection of Botulinum Neurotoxin-A induce muscular weakness in adult-onset neurological patients with focal spasticity? A systematic review

R. Gill^1,2, G. Williams^1,2, M. Banky^1,2, E. Moore^1,2, Z. Yang², P. Medina Mena¹, C. C. A. Woo³

¹Epworth Healthcare, Physiotherapy, Richmond, Australia

²University of Melbourne, Physiotherapy, Melbourne, Australia

³Neurological Rehabilitation Group, Physiotherapy, Melbourne, Australia

Background: Botulinum neurotoxin-A (BoNT-A) intramuscular injection is standard clinical practice for treating focal muscle spasticity. However, the impact that BoNT-A has on muscular strength remains unclear.

Objectives: To investigate the effect of Botulinum Neurotoxin-A injections on focal muscle strength in adults with neurological conditions.

Method: A systematic literature search of eight databases was completed. The methodology and reporting of results were performed in accordance with the PRISMA guidelines (CRD42022315241). Article quality was assessed using the Downs and Black checklist and PEDRO scale. Where able, data extraction included the type and dose of Botulinum Neurotoxin-A injections, pre and post agonist/antagonist muscle strength and spasticity outcomes. Short, medium and long-term strength change results were analysed.

Results: The search identified 7709 articles (duplicates removed) of which 42 met the inclusion criteria. A meta-analysis could not be performed due to the heterogeneity of studies. The most common outcome measures were the Medical Research Council Scale and grip strength dynamometry. Most studies reported outcomes at six weeks post-injection with minimal reporting of long-term results. Five studies found a significant weakening of lower-limb muscles six weeks post-injection. Grip strength typically increased and remained significantly stronger at three to six months post-injections (four studies). Elbow extensor strength increased at six weeks post-injection to the elbow flexors (four studies).

Conclusion: Overall, the impact of Botulinum Neurotoxin-A on muscle strength is inconclusive. The impact of Botulinum Neurotoxin-A on muscle strength, especially when examining long-term outcomes, remains unknown. Current clinical strength measures used in this field have limited capacity to detect change. High-quality evidence is required to examine the quantifiable impact of Botulinum Neurotoxin-A on strength.

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Survey of canadian physiatrists’ view on therapeutic value of medical cannabis

K. Ethans¹, A. Casey¹, C. O’Connell^2,3, A. Khandelwal⁴, H. Chaudhary¹

¹University of Manitoba, Winnipeg, Canada

²Dalhousie University, Halifax, Canada

³University of New Brunswick, Fredericton, Canada

⁴Health Sciences Centre, Winnipeg, Canada

Introduction: In the past, medical cannabis (MC) has been a highly disputed treatment option amongst medical practitioners and the public. In 2001, cannabis became legally available for medical purposes, which eventually led to the legalization of cannabis for non-medical use in 2018. However, there are mixed views amongst medical practitioners due to deficient research studies and mixed results in safety and efficacy regarding MC. Physiatrists are experts in symptom management, particularly in pain and spasticity management, and so this study will focus on this specialty group.

Objective: To study practice patterns and attitudes specifically in physiatrists across Canada as many of their patients suffer from pain and spasticity and may be candidates to consider MC.

Materials & methods: A 24-item, web-based survey questionnaire was sent to 348 physiatrists across Canada.

Results: 109 physiatrists responded, the majority agreed that there is medicinal value in MC. 61% stated they felt comfortable discussing MC however, only 31% of respondents felt comfortable authorizing it. 42% of respondents had reported never authorizing MC. Number of years practicing did not affect comfort level when discussing MC, but those with 21+ years of experience authorized it more. There was a significant relationship between sub-specialty and frequency of prescribing MC, most prescriptions authorized for neuropathic pain, musculoskeletal pain, and spasticity. Most respondents agreed that there was insufficient educational exposure in medical school and residency. Governmental and institutional guidelines remained unclear for the majority.

Conclusion: Addressing cannabinoids in medical school and residency is important to improve the therapeutic and counseling aspects of patient care in addressing safety and preventing misuse. With clearer guidelines, more research on MC efficacy, physiatrists will be more knowledgeable and better able to improve patient lives.

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Awareness of the vestibular system in neurorehabilitation: a scoping review

C. M. Costa^1,2,3, R. Póvoa³, A. Correia^4,5, C. Mendes Pereira⁶, A. I. Almeida⁶, H. Santos⁷, M. D. C. Nunes¹, R. Castillo Ramos⁸, J. Rosmaninho Seabra⁸, T. Miller^9,10, D. J. Tomás²

¹Hospital Garcia de Orta, Lisbon, Portugal

²Escola Superior de Saúde Atlântica, Physiotherapy, Barcarena, Portugal

³Egas Moniz School of Health & Science, Physiotherapy, Monte da Caparica, Portugal

⁴Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal

⁵Escola Superior de Tecnologia de Saúde de Lisboa - Instituto Politécnico de Lisboa

, Physiotherapy, Lisbon, Portugal

⁶Escola Superior de Saúde - Instituto Politécnico de Setúbal, Physiotherapy, Setúbal, Portugal

⁷Escola Superior de Saúde de Alcoitão, Physiotherapy, Alcabideche, Portugal

⁸Joaquim Chaves Saúde, Lisbon, Portugal

⁹University of British Columbia, Vancouver, Canada

¹⁰University of British Columbia, Vancouver, Canada

Introduction: The vestibular system plays a critical role in the multimodal sensorial integration of balance and movement. Individuals with central neurological dysfunctions often exhibit balance impairments and/or alterations in sensorimotor integration looping. Yet most physiotherapy interventions seldom incorporate vestibular system recruitment or optimization.

Objectives: This scoping review aimed to systematically map and describe information regarding vestibular physiotherapy interventions in neurorehabilitation.

Materials & methods: The review was conducted in accordance with PRISMA-ScR guidelines. Relevant databases were searched for indexed articles published from inception to September 2023. The following search syntax was used: neurorehabilitation or neurological physiotherapy; vestibular system; vestibular physiotherapy or vestibular rehabilitation; and neurological conditions or neurological disorders. Systematic reviews, randomized controlled trials, cohort studies, literature reviews and case studies in Portuguese, English, French and Spanish, describing the use of vestibular physiotherapy interventions in neurorehabilitation, were considered eligible.

Results: Among 6,890 screened studies, 25 studies were included in the preliminary review phase. Recurring themes were comprehensive interventions integrating the vestibular system. Studies involved participants with traumatic brain injury (mild to severe), stroke and multiple sclerosis, with few approaching all the central conditions in a systematic form. Nevertheless, all studies reported improvement in functional outcomes.

Conclusion: Our preliminary findings reveal a paucity of literature on this topic, suggesting a substantial knowledge gap in clinical practice. Optimization of vestibular function could potentially enhance sensorimotor recruitment, leading to improved recovery outcomes. Opportunities exist to research and to create awareness about the vestibular system among clinicians in the neurophysiotherapy community.

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Effects of cognitive task complexity and type on dual-task interference during obstacle negotiation in people with chronic stroke

C. Tsang¹, T. Miller^2,1,3, M. Pang¹

¹Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

²University of British Columbia, Medicine, Vancouver, Canada

³International Collaboration on Repair Discoveries (ICORD), Medicine, Vancouver, Canada

Background: When attempting to perform two tasks simultaneously, dual-task interference (DTI) can effect cognition and/or locomotion in people with stroke. Although obstacles are frequently encountered while ambulating in community settings, previous studies have largely focused on investigating DTI during level-ground walking conditions.

Objective: To investigate the influence of cognitive task complexity and type on dual-task walking performance after stroke.

Methods: Ninety-three individuals with stroke [age=62.4(6.7)years] participated. For each dual-task condition, a mobility task (obstacle-crossing) was performed concurrently with 1/5 cognitive tasks (serial-subtractions, category naming, clock test, auditory discrimination, shopping list recall). Each cognitive task involved low and high complexity levels, yielding a total of 10 dual-task conditions. Dual-task effect (DTE = single-task - dual-task / single-task) on walking distance (mobility DTE) and number of correct responses (cognitive DTE) were calculated for each condition.

Results: Medium interaction effects were observed for cognitive task type and complexity, which influenced both cognitive (ηp2=0.12, p<0.001) and mobility performance during dual-tasking (ηp2=0.06, p=0.005). Among cognitive tasks, serial-subtraction had the greatest interference effect on both cognitive (Mean DTE=-9.2 to -21.5%) and mobility performance (Mean DTE=-18.7 to -19.1%). Overall, "mobility interference" (reduced walking distance without a decline in cognitive performance) was the most common DTI pattern observed.

Conclusion: Cognitive task type and complexity level interact to influence the degree and pattern of DTI. Individual differences in cognition and mobility, arousal level and subliminal task prioritization may also affect DTI patterns. Standardized assessments involving distinct cognitive domains are necessary for profiling DTI during walking among individuals with chronic stroke.

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Network analysis of drawing behavior facilitates the detection of perceptual atypicalities in mothers of autistic children

P. Parchini¹, S. Mokhtari², F. Bakouie²

¹University of Alberta, Rehabilitation, Edmonton, Canada

²Shahid Beheshti University, Institute for Cognitive & Brain Science, Tehran, Iran

Introduction: Detecting cognitive atypicalities in biological relatives of autistic individuals could enhance our understanding of the condition and contribute to the development of more effective rehabilitation plans for them.

Objective: This study aimed to investigate the visuoperceptual atypicalities in mothers of autistic children (mASD) using network analysis.

Methodology: The drawing performance of 44 mASD while copying Rey Osterrieth Complex Figure (ROCF) was scanned and converted into a network. The adopted perceptual and switching strategies of these mothers were compared to the performance of 45 mothers of typically developed children (mTD) using graph-based measures. The autistic traits of both groups were assessed using the AQ questionnaire.

Results: The network analysis revealed a positive relationship between the frequency of repetitive drawing patterns and both AQ total (p =0.002) and attention to detail subscale (p = 0.005) in mASD. This suggests that an increase in autistic traits and attention to detail in mASD is associated with a tendency to repeat a particular drawing pattern during the reproduction of complex figures, whereas mTD did not exhibit this repetitive drawing pattern.

Conclusion: This study highlighted the visuoperceptual atypicalities in the mASD group during the course of task completion, despite achieving a similar final outcome as the mTD group. We suggest that step-by-step analysis and scanning of the process of completing a perceptual task the use of network analysis could be a novel and promising approach to facilitate clinical decision-making.

P-375

A novel technique for evaluating vestibular perception of rotation while standing

J. Donald¹, R. Chua¹, M. Carpenter¹

¹University of British Columbia, Kinesiology, Vancouver, Canada

Both central and peripheral vestibular deficits can contribute to an altered perception of self-motion (Staab et al. 2013). Assessments of vestibular perception are often performed while subjects are seated and rely on minimum detection thresholds, otolith function (i.e. subjective postural/visual vertical), or induced perceptions of head rotation via sinusoidal physical or electrical stimulation (Peters et al. 2015). This highlights a gap in the field of vestibular perception when stimulation is not uniform, and subjects are not seated. Therefore, we developed a novel technique to assess vestibular perception while standing using unpredictable whole-body physical rotations in the yaw plane. Nine healthy young adults stood with their eyes closed on a custom-built rotating platform while being rotated in the yaw plane. Each subject experienced 4 different pseudorandom platform rotations (±30°, 0.03-0.15Hz) that lasted 113s. A handheld rotary dial was used to track perceived rotation of the platform, while inertial measurement units (IMU) were used to track head position relative to the neck and platform. Coherence, gain, and phase analyses were conducted on potentiometer signals from the rotary dial and platform. Results show a strong coupling between perceived and actual platform rotation, averaged across all frequencies, in both coherence (0.63) and gain (0.91). IMU data also revealed a strong coupling between the head and neck in the yaw plane to platform rotation. Average phase (7.1°) and phase lag (310ms) of the perceived versus actual platform rotation was similar to what has been previously reported in this frequency range (8.5°, 400ms; Peters et al. 2015). Future work using this protocol will be conducted on older adults, and in a state of postural threat. Assessing vestibular perception of whole-body rotations can provide novel insight into the vestibular mechanisms that may contribute to balance deficits associated with aging and neurological disorders.

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Baseline scores and diagnostic accuracy of the Oxford Visual Perception Screen

K. Vancleef¹, K. Cowen¹, R. Castellani¹, R. Shorthouse¹, S. Webb², A. Kusec², L. Shaw³, N. Demeyer²

¹Durham University, Psychology, Durham, United Kingdom

²University of Oxford, Oxford, United Kingdom

³University of Newcastle, Newcastle upon Tyne, United Kingdom

Introduction: An estimated 75% of stroke survivors are left with undiagnosed visual perception problems. These problems are related to difficulties in interpreting the images from the eye which is needed for object recognition or reading. To improve diagnosis, we developed the Oxford Visual Perception Screen (OxVPS), a 15-minute performance-based screening tool suitable for stroke patients with aphasia and neglect.

Objectives: Study 1: Establish baseline scores for typical performance on OxVPS in a healthy population. Study 2: Determine sensitivity and specificity of OxVPS in detecting visual perception problems after a stroke.

Materials & methods: Study 1: A convenience sample of community dwelling older volunteers without a neurological history completed OxVPS, which includes 10 visual perception tasks such as naming pictures, counting stars, and reading a text. For each task of OxVPS, we determined the baseline score for typical performance as the 5th centile of all scores from our healthy volunteers. Study 2: Stroke survivors with sufficient understanding of English and ability to concentrate for 15 minutes were recruited at rehabilitation units in the UK within 6 weeks of their stroke. This convenience sample completed OxVPS and a gold standard perception test: Rivermead Perceptual Assessment Battery (RPAB), a 45-90 minute battery of tasks including colour matching, cube copying, and sequencing pictures. Performance of stroke survivors was compared with the baseline scores and the total number of "failed" tasks was used as an overall indicator of visual perceptual problems.

Results: Study 1: Baseline scores for each subtest were 3-4 out of 4 correct (N=56). Study 2: We estimated a sensitivity of 82% and a specificity of 86% for OxVPS in detecting visual perception problems identified with RPAB (N=24).

Conclusion: We present the normative data and diagnostic accuracy of the OxVPS, a standardised and stroke-specific visual perception screening test.

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Evaluation of an interactive educational workshop on knowledge and understanding of mental capacity, mental health and medico-legal aspects in relation to the legal system in Bangladesh and a comparision with UK statutory laws for disability

M. Sakel¹, K. Saunders², C. Williams³, E. Bryant³, A. Ahmed⁴, J. Keene⁴, J. Sarkar⁵, S. A. Jaker⁵, N. Akter⁶, D. Wilkinson⁷

¹East Kent University NHS Hospital, Neurorehabilitation, Canterburry, United Kingdom

²University of Kent, Health Service Research, Canterburry, United Kingdom

³Swansea University, Psychology, Swansea, United Kingdom

⁴Birmingham and Solihull Mental Health NHS Foundation Trust, Forensic Medicine, Birmingham, United Kingdom

⁵Bangladesh Judicial Service Commission, Dhaka, Bangladesh

⁶Centre for Policy Development, Sociology, Dhaka, Bangladesh

⁷University of Kent, Psychology, Canterburry, United Kingdom

Introduction: Bangladesh is 6th most densely populated country in the world with enormous public health issues related to mental health (MH) which are virtually ignored(1).The relevant legal framework(MH Act,2018,Persons Disabilities Act,2013) is identified to have significant limitations including a lack of adequate training for MH care service providers on basic human rights (1).

Objective: To evaluate perceived baseline knowledge and attitudes toward mental capacity (MC) and mental illness, workshop learning and potential for subsequent knowledge implementation.

Method: 2 hr transdisciplinary panel workshop (WS) October 2022 for legal professionals at Judicial Administration Training Institute, Bangladesh (BH).4 verbal talks and discussion. Adapted anonymous research-based paper survey(2) in 4 parts(A-D) distributed preworkshop (PRW) for completion postworkshop. Verbal consent taken.

Results: 17 participants (P) completed survey. Mean age 40.38yrs (SD=6.66),13 men,3 women. Majority were judges (88.2%) with min 11yrs work in current organisation (70.6%).B:PRW MC knowledge 88.2% felt they understood the term MC, though 88.2% rated no awareness of UK MC Act(2005).88% rated it would be useful for MCA legislation to be introduced in BH.C:P rated the WS as useful and were positive but not certain, that the WS learning would become part of their work in the future. D:Majority of P rated it would be useful to have more training in mental illness in legal context. Overall P had positive attitudes towards training on MC particularly relating to how MC is affected by neurological injuries & supported the introduction of legal policy around MC in BH.

Conclusion: WS evaluation indicates usefulness and positive attitudes to explore implementation aspects further in the future.

1.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8554921/pdf/S2056474021000015a.pdf

2.NoMad: Implementation measure based on Normalization Process Theory. [Measurement instrument] http://www.normalizationprocess.org

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A trans-sectorial clinical pathway for persons with severe neuro-disabilities – qualitative research to assess its appropriateness and practicality

S. Reichl¹, A. Bartsch-de Jong², T. Groß³, N. Vallejo Rancol⁴, T. Platz⁵

¹University Medicine Greifswald, Neurorehabilitation, Greifswald, Germany

²Schoen Clinik Bad Aibling, Bad Aibling, Germany

³University of Regensburg, Neurology, Regensburg, Germany

⁴Terapy Center, Burgau, Germany

⁵University Medicine Greifswald, Neurorehabilitation Research Group & Institute for Neurorehabilitation and Evidence-based Practice, Greifswald, Germany

Background: For the healthcare project OptiNIV¹, a guideline- and evidence-based clinical pathway (CP) for the trans-sectorial multi-professional community-based rehabilitation of neurological patients with a need for home-based intensive care with support by a regional outreach team from the neurological early rehabilitation centre was developed.

Objectives: Within the framework of semi-structured interviews with teams after practical testing of the CP, features of the CP and its working aids were to be reviewed for appropriateness and practicality in this qualitative research project.

Materials & methods: The teams were visited by two independent raters for audio-recorded interviews and consequently underwent a multi-stage qualitative analysis and interpretation process.

Results: Ten interview participants from three teams were interviewed. It was possible to form 5 code categories with 12 code subcategories based on the interview transcripts.

The teams named numerous healthcare-related barrier observations, expressed negative clinical care observations, and consequently a more negative expectation reflection regarding the care situation in the community.

With regard to observations made in the context of their own project interventions expressions mostly indicated intervention success. Nevertheless, negative expectation reflections on the implementation of the CP prevailed in terms of both medical aspects and concerning networking.

Conclusion: While the CP was not challenged conceptually by the field experience made, the teams implementing the trans-sectoral collaboration faced major challenges for the to be established continuum of care approach. The shortcomings reported require a high degree of engagement in networking activities as well as a targeted and coordinated use of resources available in the community.

Reference

1 Platz et al. BMC Neurology 2022; 22:290. doi: 10.1186/s12883-022-02814-y. https://drks.de/search/en/trial/DRKS00027326

P-379

Vocational rehabilitation for coloradans living with traumatic brain injury

C. Parsons ¹

¹Colorado State University, Occupational Therapy, Centennial, CO, United States

Introduction: Individuals with brain injury are employed at rates lower than persons with other disabilities (Gormley et al., 2019). Vocational rehabilitation (VR) provides integral services to support people with brain injuries prepare for and attain employment (Wehman et al., 2005).

Objectives: In Colorado, USA, accessing VR services is problematic for individuals with brain injury, despite systematic improvements across the state. Little is known about the population of Coloradans with brain injury who get VR or their employment status. Thus, objectives are to: (1) comprehensibly describe characteristics of Coloradans with traumatic brain injury (TBI) in VR and (2) determine relevant factors that influence Coloradans exiting VR with employment.

Sample & methods: We examine 259 cases of Coloradans with TBI served by VR with descriptive statistics and multinomial logistic regression to determine the odds of exiting VR (1) before receiving services, (2) after establishing services, but without employment, or (3) with employment.

Results: The sample was majority male (55.5%, n=144) and overwhelmingly White (90.7%, n= 235) with a median age of 36. Almost half of individuals (49%, n=127) reporting receipt of monthly public support. Significance of disability and certain monthly public support programs emerged as major predictors of employment status at program exit.

Conclusion: We recommend improved coordination among public programs to meet the needs of the most significantly disabled individuals with TBI.

Gormley, M., Devanaboyina, M., Andelic, N., Røe, C., Seel, R. T., & Lu, J. (2019). Long-term employment outcomes following moderate to severe traumatic brain injury: A systematic review and meta-analysis. Brain Injury, 33(13–14), 1567–1580.

Wehman, P., Targett, P., West, M., & Kregel, J. (2005). Productive Work and Employment for Persons With Traumatic Brain Injury: What Have We Learned After 20 Years? The Journal of Head Trauma Rehabilitation, 20(2), 115–127.

P-380

Optimising self-efficacy and self-management during interactions within community rehabilitation and support services for people with progressive neurological conditions

K. Jackson¹, S. Kilinc¹

¹Teesside University, School of Health and Life Sciences, Durham, United Kingdom

Introduction: A relational approach to self-management for people with progressive neurological conditions recognises the importance of interactions which promote self efficacy. The reality of self efficacy, engagement and self management can be understood by learning from experts by experience.

Aim: To explore how self-efficacy and self-management can be optimised during interactions within community rehabilitation and support services for people with progressive neurological conditions.

Method: A participatory qualitative study with people with progressive neurological conditions (co-researchers). Purposive sampling of six participants with Parkinsons Disease and four with Multiple Sclerosis. Data collected using a Life Grid Tool and two 40 minute individual interviews per participant. Reflexive Thematic Analysis used.

Results: The particpatory approach facilitated shared learning about specific, personal self efficacy, individual self management and community based support. Four themes (fourteen subthemes) were identified: Embrace knowledge and expertise of people with progressive neurological conditions; Enhance access to breadth and depth of community based rehabilitation and support; Understand who people are and how they think; Mandate for quality interactions within health and social care settings.

Conclusion: People with progressive neurological conditions propose the following methods for optimising self-efficacy and self-management: Embrace the role of peer support; Expand connectivity between public health, primary care and voluntary agencies; develop mechanisms to improve continuity and responsiveness (online/telephone/face to face); Facilitate conversations about specific self efficacy for self management (self referral, information, physical activity, purposeful activities).The findings highlight that quality interactions which are respectful of individual personality, values, beliefs, personal self-efficacy and priorities should be mandatory.

P-381

Prevalence of depression and anxiety among adults in Diu – a cross-sectional study

K. Kumari ¹

¹IIPHG, Public Health, Gandhinagar, India

Background: Depression and anxiety are two common mental health disorders worldwide, affecting individuals across different cultures and age groups.

Objective: To estimate the prevalence of depression and anxiety among adult population of Diu and find its association with socio-demographic factors.

Methodology: An observational cross-sectional study was conducted which included a representative stratified random sample with the proportional allocation of 422 individuals in rural and urban areas. A questionnaire included socio-demographic and clinical characteristics were utilized. In addition, Gujarati version of PHQ-9 and GAD-7 questionnaire was used to screen for depression and anxiety respectively. Data analysis was done in SPSS version 26.

Results: The study included 410 adults of Diu. majority of participants were between 18-35 years old (51.2%), females (78.8%) and married (65.9). The prevalence of anxiety based on GAD-7 scale was 18.8%. Among them, 15.1% reported mild (5-9) and 1.7% and 2.0% reported moderate (10-14) and severe (>15) symptoms respectively. Based on the PHQ scale, 44.1% people of the sample reported having no depression, while 34.1% reported minimal depression (1-4). About 13.2% of respondents reported mild depression (5-9), while 5.9% reported moderate depression (10-14), 2.2% reported moderately severe depression (15-19) and 0.5% of respondents reported severe depression (21-27). Level of anxiety and depression were both found to be significantly associated with Place of residence. However, Tobacco consumption had a significant association with PHQ-9 scores only.

Conclusion: The data indicates that a considerable proportion of respondents reported experiencing mild to severe depression and anxiety respectively (i.e, PHQ-9 and GAD-7 score >5). While the mild cases (score 5-9) may not be as severe as moderate or severe depression and anxiety, it still warrants attention as it can progress into more severe forms if left unaddressed.

P-382

Educating competent health care professionals through hybrid education: a case illustration on student outcome comparison

K. Mu ¹

¹Creighton University, Occupational Therapy, Omaha, NE, United States

Hybrid education has increasingly become an instructional norm in higher education including health care professions. Through a case study illustration in occupational therapy, this poster presentation reports the findings of a series of research studies that examined and compared student learning outcomes between traditional face to face and hybrid programs. The authors of the studies hypothesized there is no difference on the student learning outcomes between face to face and hybrid education. The findings of the series of studies on student learning outcome comparison support the hypothesis. For instance, in the earliest study, using a retrospective, between-group comparison method, a total of 94 entry level OTD students from hybrid pathway in Alaska (13 students) and face to face pathway in Omaha (81 students) participated in the study. Results of the study revealed no significant difference on the students" learning outcome variables including students" GPA at the end of each academic year, overall cumulative GPA, Level II fieldwork performance, grade on the NBCOT practice exam and final NBCOT pass rate. Findings of a series of studies conducted by the author and colleagues support the results of the study. Taken together, these findings are consistent with previous research studies suggesting that hybrid program is an effective way in post-secondary professional education. Results of the study will provide guidance to occupational therapy programs in curriculum design, content delivery and program refinement/development, particularly in the rural or remote areas.

This presentation focuses on the effectiveness of hybrid education, discusses lessons learned in hybrid healthcare professional education and shares best practices in hybrid education through the rich history in hybrid education at a university in the Midwest of USA.

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Assistive technology intervention for dementia care: a six-month experience

S. C. Chen¹, C. J. Chen¹, C. J. Hu¹, J. Q. Er¹

¹Taipei Medical University, Physical Therapy and Rehabilitation, Taipei, Taiwan

Introduction: Dementia care is the most critically growing burden in the elderly care. The number of people with dementia is increasing promptly. It is foreseeable that dementia care will become a major social and family issue globally. Digital Healthcare is an important trend worth to be developed and studied.

Objective: To analyze the Efficacy of Assistive Technology (AT) for Dementia Care in 3 months & 6 months after Intervention. To establish a successful Novel AT Care Model.

Materials & methods: 69 cases diagnosed with dementia, with CDR level between 0.5 to 2 or long-term care case-mix system (CMS) between 2-5, complaints of impaired daily functions have been recruited and divided into experimental & control groups. Except regular care, the experimental AT group received additional AT care (AT devices and AT services). The control non-AT group received regular care only. We compared the Neuropsychiatric Inventory (NPI), Quality of Life-Alzheimer"s Disease (QoL-AD), and Chinese version of the Zarit Burden Interview (CZBI) 0-month, 3-month, and 6-month after recruitment. Succeeding assessments will be conducted persistently in 12-month & 24-month.

Results: The result reveals that there was no improvement of NPI, QoL, CZBI 3 or 6 months after AT intervention, as compared to the baseline.

Conclusions: The intervention of AT for dementia care shows no significant efficacy in the first 6 months. It is caused by suboptimal AT performances. The "Novel AT Care Center" is not yet well-constructed. We will continue to optimize the AT model for dementia care. Education & training for AT service members & caregivers will be incorporated into this system. Feedback & optimization of system is important for success. We expect that beneficial contributions of the AT Care Model can only come true by AT Usability Education & Training for related AT care members & caregivers.

(Acknowledgement: sponsored by Taiwan NSTC 112-2627-M-038-001-)

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Prognostic indicators, impact of medical and vocational rehab and workplace related factors on Return to Work (RTW)

W. Schupp¹, D. Claros-Salinas², A. Thomas²

¹Private Practice "Neurology & Rehabilitation", Therapy Center Hardpark, Fuerth, Germany

²Claros-Salinas/Schupp/Thomas GbR, Suesel, Germany

Introduction: Return to work (RTW) is an important goal in neurorehabilitation. About 1/4 till 1/3 of stroke survivors worldwide are in an age of work life, the number is even higher in survivors of TBI. But the rate of RTW maintains below 50% in the last ten years.

Objectives: For planning an interventional field study, we systematically reviewed the literature on successful RTW medical and vocational rehab interventions in acquired brain lesions (ABI).

Material & methods: Systematic search in PubMed or EMBASE for reviews and meta-analyses within the last ten years on prognostic indicators for RTW, medical or vocational rehabilitation measurements, structured qualitative interviews with ABI survivors or employers.

Results: About 70 reviews and meta-analyses showed: Age and gender have no prognostic power for RTW, only a small trend for men, nor do initial severity or localization of the brain lesion. Cognitive impairments, and aphasia indicate poorer RTW chances than sensorimotor deficits. Fatigue, and affective or behavioral disorders decrease RTW rates. A high level in basic ADL, after a first rehabilitation procedure, has the highest prognostic value. Case management and early involvement of the employers can increase RTW rates. Higher education and job level, an existing employment and bigger employers are good conditions. Patients need motivation and adaptive power. All parties need adaptiveness, cooperativeness, and purposefulness. The impact of specific vocational rehab remains unclear, combined medical and vocational rehab approaches seem to be of advantage.

Conclusion: Based on these facts, a RCT field study was started, combing medical rehab and aftercare, case management, and vocational interventions aimed to increase the rate of RTW after ABI. The study is performed in the bigger region of Cologne, financed by the German Statutory Pension Insurances (DRV) and the German Federal Ministry of Work and Social Affairs (BMAS).

P-386

Overview of randomized controlled trials of moderate to severe traumatic brain injury: a systematic review

R. Teasell¹, C. Flores-Sandoval¹, E. A. Bateman¹, H. MacKenzie¹, K. Sequeira¹, M. Bayley², S. Janzen¹

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

²University of Toronto, Toronto, Canada

Introduction: Timely and appropriate medical, surgical, and rehabilitative care is critical to improving outcomes for persons with moderate to severe TBI.

Objectives: To characterize the randomized controlled trials (RCTs) of moderate to severe traumatic brain injury (TBI) in the literature.

Materials & methods: Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO for RCTs up to December 2022 inclusive, in accordance with PRISMA guidelines. Inclusion criteria were: (1) mean age ≥18 years; (2) ≥50% moderate to severe TBI; and (3) the study design was a RCT.

Results: 662 RCTs of 91,946 participants published from 1978 to 2022 met inclusion criteria. The number of RCTs published annually has increased steadily. The most reported indicators of TBI severity were the Glasgow Coma Scale (543 RCTs, 82.0%), duration of post-traumatic amnesia (120 RCTs, 18.1%), and loss or disorder of consciousness (65 RCTs, 9.8%). 432 (65.3%) RCTs focused on medical/surgical interventions, mostly in the acute phase post-injury, while 230 (34.7%) addressed rehabilitation, mostly in the subacute and chronic phases. Medical/surgical RCTs had larger sample sizes, and rehabilitation RCTs accounted for only one third of RCTs and were primarily conducted in the chronic phase post-injury relying on smaller sample sizes.

Conclusion: There is a substantial gap in research in the subacute phase post injury. As acute phase medical/surgical interventions improve mortality after TBI, increasing research in the subacute and chronic phases as well as increasing rehabilitation focused TBI RCTs will be important to optimizing the long-term outcomes and quality of life for persons living with TBI.

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Sex differences in individuals enrolled in randomized controlled trials of moderate to severe traumatic brain injury

C. Flores-Sandoval¹, H. MacKenzie¹, E. A. Bateman¹, K. Sequeira¹, M. Bayley², R. Teasell¹

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

²University of Toronto, Toronto, Canada

Introduction: Understanding sex differences among persons with moderate to severe traumatic brain injury (TBI) is critical to addressing the unique needs of both males and females from acute care through to rehabilitation.

Objectives: To examine the proportion of female and male individuals included in randomized controlled trials (RCTs) of interventions for moderate to severe TBI.

Materials & methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was conducted up to and including December 2022 using MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO databases. Studies were included if they met the following criteria: (1) human participants with a mean age ≥18 years, (2) ≥50% of the sample had moderate to severe TBI; and, (3) the study design was a RCT. Data extracted included author, year, country, sample size, number of female/male participants, and time post injury.

Results: 662 RCTs met criteria for inclusion published 1978-2022 totalling 91,946 participants. 595 RCTs (90%) reported sex, encompassing 86,662 participants (94.3%). The average proportion of female participants was 23.14% and the percentage increased a small but significant amount over five decades. There was a significantly lower percentage of female participants in RCTs initiated in the acute phase (≤ 1 month) when compared to RCTs conducted in the chronic phase (≥ 6 months) post-injury (p<0.001).

Conclusion: Female participants are underrepresented in RCTs of moderate to severe TBI. Addressing this underrepresentation is critical to establish effective treatments for all persons with TBI.

P-388

Overview of randomized controlled trials of post stroke upper extremity rehabilitation conducted in in low and middle-income and high-income countries

R. Teasell¹, S. Mehrabi¹, M. Safaei Qomi¹, J. Fleet¹, S. P. Dukelow², M. Murie Fernandez³, A. Hernett¹

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

²University of Calgary, Neuroscience, Calgary, Canada

³Neurorehabilitation Unit, Hospital Ciudad de Telde, Las Palmas, Telde, Spain

Introduction: Understanding the variability of post stroke upper extremity (UE) rehabilitation randomized controlled trials (RCTs), including quality markers and study characteristics, by comparing lower to middle income countries (LMICs) with higher income countries (HICs) can identify potential strengths, gaps and differences, and the impact of different resources on the research.

Objective: To systematically review post stroke UE rehabilitation RCTs to identify trends in time and differences in study qualities, sample sizes, and time post stroke phases in LMICs compared to HICs.

Materials & methods: CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to April 1, 2021. Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English (2) ≥50% of participants were diagnosed with stroke, 3) included adults ≥18 years old, and (4) applied an intervention to the hemiparetic UE as the primary objective of study. Extracted variables were summarized using standard descriptive statistics. Data analyses were performed using SPSS (V29.0).

Results: From 5,408 records, 1,276 RCTs were eligible. 298 RCTs were conducted in LMICs and 978 in HICs. The number of RCTs was increasing over years for both groups with no time and group interaction. The mean sample size was significantly higher in LMICs compared to HICs (p<0.001). RCTs in LMICs were more likely to be performed in the subacute phase while RCTs in HICs were more likely to be performed in chronic phase. Despite the comparable PEDro scores in two groups, the RCTs of HICs were published in journals with significant higher impact factors than those in LMICs.

Conclusions: The stroke UE rehabilitation research is growing worldwide. Although the quality markers of RCTs in LMICs are not inferior to RCTs in HICs, those in HICs have been published in journals with higher impact factor, leading to potentially greater impacts on future research and clinical practice recommendations

P-389

What do you do when there are gaps in peer-reviewed evidence? Insights from the Canadian guideline for rehabilitation of adults with moderate to severe traumatic brain injury

O. Yaroslavtseva¹, J. Gargaro¹, E. Patsakos¹, A. Nair^1,2, M. Bayley^1,2

¹University Health Network, Research, Toronto, Canada

²University of Toronto, Toronto, Canada

Background: The quality and quantity of evidence varies widely across different aspects of Moderate to Severe Traumatic Brain Injury (MSTBI) Rehabilitation research. In areas where published evidence is lacking, it is necessary to build a consensus to address the clinical needs in a practical way by engaging clinicians and people with lived experience (PWLE) of MSTBI.

Methods: A rigorous multi-component guideline review process was used to ensure that recommendations reflect the rapidly emerging evidence and address the priorities identified by end users and PWLE. The components include: (1) Systematic review of published MSTBI evidence; (2) Priorities identified by PWLE of MSTBI and guideline end users through surveys and focus groups; (3) Diverse interdisciplinary expert panels that include PWLE; (4) Synchronous and asynchronous review of the current published evidence, clinical and lived experience; (5) Rigorous grading of available evidence; (6) Expert panel voting to achieve a minimum of 75% by 80% of the expert panel.

Results: Since 2015, this review process has yielded 351 recommendations divided into 21 chapters focusing on different domains of MSTBI rehabilitation. Currently, the Guideline includes 239 Consensus-based recommendations which comprise 68% of the Guideline. Two new sections were added in 2022/23: Telerehabilitation - 14 recommendations including 11 (79%) consensus-based and Intimacy and Sexuality - 10 recommendations including 9 (90%) consensus-based. Recommendations were added that responded to PWLE comments that the guideline did not stress the importance of continuing rehabilitation into the community through participation in daily activities and promoting hope for ongoing improvements.

Conclusions: In the absence of published evidence, consensus-based recommendations that are based on expert opinion are necessary to guide practice, incorporate the needs, values and voices of PWLE and identify directions for future research in the field.

P-390

Effects of transsectoral long-term neurorehabilitation for patients with acquired brain injury

C. Dohle^1,2, A. Sterr¹, T. Strank¹, M. Schrader¹

¹P.A.N. Zentrum für Post-Akute Neurorehabilitation, Berlin, Germany

²Center for Stroke Research, Charité – University Medicine, Berlin, Germany

Background: Acquired brain injuries (ABI) are among the most common causes for permanent disability in adulthood. The consequences of ABI can be alleviated by intensive and focused therapy. However, it is assumed that during inpatient rehabilitation, not all patients can exploit their full potential for improvement. Thus, a concept of further long-term neurorehabilitation is urgently needed.

Methods: The P.A.N. Center for Post-Acute Neurorehabilitation combines living with pedagogical support with medical treatment and intensive therapy on one site. In the following, the effect of this concept on different levels are presented: activity (Barthel Index / BI), activity / participation ("Hilfebedarf von Menschen mit Behinderung" / HMBW with five selected subdomains), up to five individually defined goals (Canadian Occupational Performance Measure / COPM, grouped into nine categories) and discharge destination. Differences between admission (AD) and discharge (DI) are compared using the Wilcoxon rank test (WRST).

Results: Between 01/2015 and 04/2022, a total number of 168 patients completed their treatment and agreed to have their data analysed anonymously. Their average length of stay was 18 months. The patients showed a significant improvement in their BI (median value (MV) - AD: 55 points, -DI: 80 points - WRST: z=-9.180, p<.001). In the HMBW, four out of five domains showed a decrease in the need for assistance: everyday living (p<.001), individual basic care (p<.001), shaping social relationship (p=.003) and communication (p<.001). The need for assistance for cultural and social participation even increased. In the COPM, significant improvements were recorded for performance in 8 out of 9 categories and for satisfaction in 7 out of 9 categories. Over 70 % of the patient moved into living with moderate need for assistance at discharge.

Conclusion: The rehabilitation potential of many patients is not fully exploited even after months of inpatient rehabilitation. A coordinated, transsectoral, long-term neurorehabilitation approach can lead to significant improvements in both activity and participation, even in the chronic phase of ABI. Individual goal-setting is more suitable to capture improvements than global scores.

P-391

AMBER: a device for hand motor and cognitive rehabilitation. Development and proof of concept

L. Valenzuela Lopez¹, M. Moreno Verdú¹, R. Álvarez², G. Delgado Oleas³, L. Soliverdi³, A. Arroyo-Ferrer¹, F. J. Sánchez Cuesta¹, Y. González Zamorano⁴, M. Barrachina Fernández⁵, C. Sánchez Ávila⁵, J. P. Romero Muñoz^1,6

¹Universidad Francisco de Vitoria, Experimental Science, Madrid, Spain

²Universidad Antonio de Nebrija, Madrid, Spain

³CSIC-UPM, Centro de Automoción y Robótica, Madrid, Spain

⁴University, Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Madrid, Spain

⁵Universidad Politécnica de Madrid, Madrid, Spain

⁶Hospital Beata María Ana, Madrid, Spain

Introduction: Stroke survivors usually exhibit concurrent motor and cognitive impairment. Historically, stroke recovery strategies have been implemented separately in terms of motor and cognitive neurorehabilitation. However, recent studies show that manual motor interventions can have a positive impact on cognitive recovery [1], [2].

Objective: The objective of this work is to introduce AMBER, a novel device designed for simultaneous assessment and training of finger motor functions and cognitive features. Our focus is on validating the precision and reliability of its evaluation functionality.

Methods: AMBER, a portable device using force-sensitive resistors, assesses finger motor function and cognitive features. Three types of exercises (with different difficulty levels) were developed to evaluate hand function and cognition. A pilot study with 36 healthy subjects tested reliability. Validity was assessed against three gold standards for strength, processing speed and memory.

Results: Regarding the correlation between fingers strength measured by the device and its gold standard, there is a moderate to good correlation (r=0.563-0.781, p<0.001). In terms of processing speed, a significant positive correlation was also observed (r=0.383-0.702, p<0.05), being higher as the difficulty of the exercises increased. Evaluating memory exercise demonstrates a strong positive correlation when compared to conventional cognitive evaluations (r=0.637, p<0.001). Test-retest reliability of three measurements (strength, reaction time and memory) shows moderate to good results (ICC = 0.715-0.900).

Conclusions: AMBER has the potential to revolutionize hand rehabilitation by providing therapists with a versatile and reliable tool for comprehensive patient assessment and treatment. It measures precise finger force and assesses cognitive functions, including processing speed, attention, and memory.

P-392

Facial expressions of older adults during interactions with a tabletop robot

A. M. Panchea^1,2,3, M. A. Maheux^1,3, K. Lebel^1,2, D. Létourneau^1,3, F. Michaud^1,3

¹Sherbrooke University, Department of Electrical and Computer Engineering, Sherbrooke, Canada

²Research Center on Aging - CIUSSS de l’Estrie-CHUS, Sherbrooke, Canada

³Interdisciplinary Institute for Technological Innovation (3iT), Sherbrooke, Canada

Introduction: Facial expressions are vital indicators of human health, and autonomous recognition holds promise for improving personalized rehabilitation by detecting emotions like pain or boredom. This recognition also offers valuable insights for optimizing the interaction with social robots. Despite its importance, there’s limited research on automatic emotion recognition in older adults (OAs), a globally expanding demographic.

Objectives: This study seeks to validate an automatic emotion recognition software utilizing facial action units (AUs), employing data collected through interactions with a socially assistive robot in long-term care residences.

Materials & methods: Six OAs (50% women, mean age = 80 ± 8 years) participated. T-Ttop, a socially assistive robot, engaged with the OAs, prompting for entertainment (dance) or basic questions (weather inquiry). T-Top, equipped with advanced audio and vision sensors, and deep learning perceptual processing capabilities, recorded each interaction locally. Emotion levels for happiness, sadness, surprise, fear, anger, and disgust were extracted from OAs’ facial expressions using OpenFace 2.2.0.

Results: Participants interacted with T-Top for an average of 7.8 minutes. Analyses confirmed T-Top’s success in capturing OAs’ faces, indicating the feasibility of this approach. The software reported a 95.9% confidence in face detection during each interaction, excluding frames below 70% facial tracking confidence. AUs associated with happiness were identified in every interaction video captured.

Conclusion: This pilot study demonstrates T-Top’s potential for advancing knowledge about OAs’ emotional well-being through innovative technological solutions. These findings suggest the potential of socially assistive robots, like T-Top, to enhance research and clinical understanding of OAs by detecting facial expressions during in-person interactions in their homes or through remote approaches such as telerehabilitation.

P-393

Observing physiotherapy practice with stroke patients to inform the development of lower-limb soft wearable exoskeletons for rehabilitation of mobility

L. Morris¹, M. Cramp¹, A. Turton¹, R. Ditesawaat¹, N. Rahman¹, S. Hoh¹, J. Rossiter¹

¹University of the West of England, Bristol, Bristol, United Kingdom

Background: Physiotherapy with patients with stroke is restricted by staffing capacity. Exoskeletons may ameliorate these challenges; however, rigid exoskeletons have been poorly informed by clinical expertise and use with patients is limited.

Objectives: To inform development of soft exoskeletons for stroke rehabilitation through observation and analysis of physiotherapist and patient treatment sessions targeting sit-to-stand and gait training.

Methods: Physiotherapy sessions with 15 patients with stroke were video recorded. Interviews with physiotherapists (n=10) were undertaken. Videos were reviewed and discussion elaborated on therapists" clinical reasoning and assistive device potential. Biomechanical data and clinical measurements were collected from a subset of stroke participants. Analysis was informed by Framework Method. Three researchers agreed on an Analytical Framework that was applied across cases; this was informed by a literature review and consultation with experienced physiotherapists. Interviews were coded inductively. Codes regarding patient context, therapist facilitation and clinical reasoning were linked, and raw data presented. Cases were analysed collectively, through identifying overarching themes. Biomechanical data was used to further understand patient mobility.

Results: 7 themes on physiotherapy assessment/facilitation of stroke, predominantly themes regarded modulating hip and/or knee flexion and extension, and foot placement. Nine themes regarded device functions; three were specifically for knee, ankle and hip joint functions. The main theme was a device reducing the assistance from therapists. Two threads across themes included a device: facilitating co-contraction of muscular groups and various functions; providing cues for movement.

Conclusion: Observation and discussion of physiotherapists" practice yielded useful information for lower-limb assistive device development.

P-395

Test-retest reliability and concurrent validity of IMU sensor-based kinematic metrics during upper limb exercises in stroke patients

A. J. Langerak¹, G. R. H. Regterschot¹, S. L. Roux¹, R. Selles¹, G. Ribbers¹, C. G. M. Meskers², B. J. F. Van Beijnum³, H. Bussmann¹

¹Erasmus MC, Rehabilitation, Rotterdam, Netherlands

²Amsterdam University Medical Center, Amsterdam, Netherlands

³Universiteit Twente, Enschede, Netherlands

Introduction: Telerehabilitation, using wearable motion sensors like Inertial Measurement Units (IMUs), can potentially overcome barriers in dose-dependent upper limb stroke rehabilitation. Yet, the reliability and validity of upper limb IMU-based kinematic measures remain unexplored.

Objective: To evaluate the test-retest reliability and concurrent validity of IMU-based kinematic metrics during upper limb exercises in stroke patients.

Methods: Thirty stroke patients with mild or moderate upper limb impairments underwent test and retest sessions, performing repeated IMU-based kinematic measures during two exercises: reach to grasp and reach to target. Four kinematic metrics were extracted using a custom MATLAB script. Data analysis included test-retest reliability (Intraclass correlation coefficient (ICC)) and concurrent validity (Spearman’s correlation with Fugel Meyer Assessment (FMA) and Action Research Arm Test (ARAT)).

Results: Preliminary analysis of ten stroke patients shows ’good’ reliability for Shoulder elevation range of motion (ROM) (ICC =.75, p=.03). Wrist SPARC, Wrist peak velocity and Elbow flexion ROM show non-significant "poor" to "moderate" reliability (resp. ICC =.15; .67; .69, p >.05). Concurrent validity analysis indicates "strong" correlation with FMA for Wrist peak velocity (r =.70, p =.04) and "moderate" correlation for Shoulder elevation ROM (r = -.62, p =.01). Non-significant correlations were found for Wrist SPARC and Elbow flexion ROM with FMA (resp. r = -.01; .28, p >.05), and for all four kinematic metrics with ARAT (r = -.16 – .37, p >.05).

Conclusion: Preliminary results suggest that Wrist peak velocity and Shoulder elevation ROM present moderate to good test-retest reliability and concurrent validity with FMA, whereas this was low in Wrist SPARC and Elbow flexion ROM. Ongoing data analysis (n=30), including additional metrics, will increase statistical power and understanding of IMU-based measures in upper limb stroke rehabilitation.

P-396

Determinants of implementation of an overground powered exoskeleton locomotor training program for individuals with a spinal cord injury: perceptions of clinicians and managers

C. Charette¹, A. Champagne², M. E. Lamontagne^3,1, F. Routhier^3,1, L. J. Bouyer^3,1, A. K. Blanchette^3,1

¹Cirris, CIUSSS-CN, Québec, Canada

²Université Laval, Psychology, Québec, Canada

³Université Laval, École des sciences de la réadaptation, Québec, Canada

Introduction: Powered exoskeleton (PE) represents a promising locomotor training tool for individuals with neurological conditions, by enabling earlier and more intensive training. However, evidence on how to implement PE locomotor training program (PE-LTP) for individuals with a spinal cord injury (SCI) in clinical practice remains limited, as do the factors influencing implementation.

Objective: This study aims to examine clinicians" and managers" perceived barriers and facilitators to the implementation of an overground PE-LTP for individuals with a SCI in inpatient rehabilitation unit.

Participants & methods: Clinicians and managers from the Quebec City SCI rehabilitation unit were recruited. An interview guide was created based on the constructs of the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews (45 min) were conducted, transcribed verbatim and coded according to the domains and constructs of the CFIR framework.

Results: Twelve participants (9 healthcare professionals, 1 physiatrist, 2 managers) were recruited. Of all determinants, 35.7% were related to the inner setting domain, 21.9% to the intervention characteristics, 16.3% to the individuals" characteristics, 14.9% to the implementation process and 11.2% to the outer setting. Concerns were raised about patient selection criteria, patient expectations, time and human resources, effective multidisciplinary team communication and the perceived complexity of PE technology. Clinical experience, motivation and multidisciplinary team culture, as well as patient motivation to use the proposed technology were all identified as facilitators.

Conclusion: PE-LTP is a complex intervention. The inner setting appears to be a crucial domain for the successful implementation of the proposed training program. Addressing the perceived barriers and facilitators will help refine the implementation plan of the PE-LTP and ultimately, increase its uptake in clinical practice.

P-397

Lifeglov – the next generation soft robotic device for stroke rehabilitation: patient involvement & co-design of the Lifeglov prototype

C. Chung¹, C. Bradley¹, Y. Chun¹, R. Armstrong¹, W. Juner¹

¹NHS Lothian, Therapy Services, Edinburgh, United Kingdom

Introduction: Despite stroke being a leading cause of disability worldwide, only 12% stroke patients in the UK receive the recommended level of rehabilitation. Bioliberty"s Lifeglov is among the next generation of rehabilitative technology that uses soft robotics, affordable materials, is portable, and programmable for individualised practice. In this NHS-industry collaboration, Bioliberty"s engineers and stroke professionals carried out patient involvement work to co-design the Lifeglov prototype and its software application.

Objectives: Obtain feedback from stroke patients with a range of hand weakness and spasticity on the Lifeglov hardware; Obtain feedback from stroke patients on the design of the accompanying software/app

Patients & methods: Between 18/8/2023 – 25/8/2023, 9 stroke patients from hospital and the community underwent the following patient involvement activity (approved by ACCORD and NHS Borders R&D).

Lifeglov user feedback session: 1.1. Verbal introduction by Bioliberty"s engineers; 1.2. Questionnaire on the lived experience of stroke rehabilitation ; 1.3. User testing: donning and doffing; perceived usefulness in stroke recovery and feedback on the control of the device

Software user feedback: Usability testing interviews (participant + interviewer + scribe) to assess prototype design and develop user insights

Results: Lifeglov hardware: Patients felt the glove was comfortable and easy to don/doff Therapists" feedback was obtained to inform the product"s use case in acute and chronic strokes; Lifeglov software: Participants expressed high levels of satisfaction. The app interface was user-friendly

Conclusion: The acceptability of the LifeGlov and software to patients allows progression to further testing leading to a formal clinical validation study to evaluate Lifeglov and its software on a patient profile.

P-398

Family goals related to robotic walking and feasibility of use in the community for children with impaired mobility

C. Diot¹, K. Eldred¹, J. Youngblood², B. Norman², K. Larkin-Kaiser², E. Condliffe^1,2

¹Alberta Children’s Hospital, Calgary, Canada

²University of Calgary, Calgary, Canada

Background: Children with severe mobility impairments can experience walking in community and home settings with a robotic walker, called the Trexo. However, whether this is an effective rehabilitation intervention is unknown.

Objectives: We evaluated how a community-based robotic-walking intervention in children with severe mobility impairments impacted goals, and the ability to adhere to a recommended intensive program.

Patients & methods: This experimental prospective cohort study included 13 participants who cannot walk in community settings, 46% female, median age of 6 years (4-23). Each participant was lent a Trexo with a recommended use of ≥150 minutes/week for 12 weeks.

The Canadian Occupational Performance Measure (COPM) was used to establish goals for each participant. Parents gave a Performance score and Satisfaction score for their child before and after 12 weeks of robotic walking. Feasibility was captured by the amount of robotic walking. The median change scores (25th-75th percentile) are reported for each outcome. Statistical differences in COPM scores were tested with the Wilcoxon signed-rank test.

Results: COPM scores increased for both Performance and Satisfaction with a change of 3.6 (1.8-4.4) and 3.3 (2.8-4.7), respectively (p = 0.001). Both change scores are above the minimal clinically important difference of 2 points. Goals focused on improving aspects of gait and mobility (27%), increasing head or postural control (23%), and improving transfers or activities of daily living (20%). Participants walked for 145 (98-172) minutes/week, taking 7,539 (4,773-9,533) steps/week over 5 (4-5) days/week.

Conclusion: Robotic walking on most days/week in the community for 3 months significantly improves Performance and Satisfaction scores. It is feasible for families and support staff to use the Trexo 5 days/week. This is part of a larger study exploring effects on physical activity, bone and muscle health, postural control, and qualitative impacts.

P-399

Enhancing recovery in stroke patients through robotic-assisted therapy

F. P.V¹, S. K.N¹, A. A.B¹

¹Ayurgreen Hospital, Physiotherapy, Edappal, India

Introduction: Stroke is a leading cause of long-term disability, often impairing motor functions and affecting the overall quality of life. Traditional rehabilitation approaches are evolving, with robotics emerging as a promising tool to facilitate motor function and enhance recovery. This case study explores the effectiveness of robotics in fostering motor function among stroke patients.

Aim & objective: To assess the impact of robotic-assisted therapy on the motor recovery and functional outcomes of stroke patients during the rehabilitation process.

Methodology: Select a diverse group of stroke patients with varying degrees of impairment. Randomly assign participants to either the robotic-assisted therapy group or a conventional therapy group. The robotic-assisted therapy group undergoes sessions with a specialized robotic device designed for upper or lower limb rehabilitation with high intensity and high repeatations movement. Conventional therapy group receives standard rehabilitation exercises without robotic assistance.

Duration: Conduct therapy sessions over a predefined period, with regular assessments in each 3 weeks

Results: Motor Function Improvement: Analyse changes in motor control, coordination, and muscle strength. Explore correlations between neuroplasticity and functional improvements. Patient Satisfaction and Engagement: Assess the perceived level of engagement and motivation during sessions.

Conclusion: This case study aims to contribute valuable insights into the effectiveness of robotics in promoting motor function recovery among stroke patients with high intensity and repeated movements. The findings may guide future rehabilitation practices and underscore the role of technology in optimizing recovery outcomes for individuals affected by stroke.

Key words: Robotics, Stroke, Motor Function

P-400

Emg-based control of a low-cost robotic feeding device for quadriplegic individuals: a preliminary study

I. M. Cayer^1,2,3, A. M. Panchea^1,2,3, K. Lebel^1,3, F. Ferland^1,2

¹Sherbrooke University, Electrical engineering, Sherbrooke, Canada

²Interdisciplinary Institute for Technological Innovation (3iT), Sherbrooke, Canada

³Research Center on Aging - CIUSSS de l’Estrie-CHUS, Sherbrooke, Canada

Introduction: Robotic solutions hold significant potential in assisting individuals with impairments in performing activities of daily living. For quadriplegic individuals, robotic devices often replace rather than assist limbs, putting them at risk of muscle atrophy and joint stiffness. The low cost, custom upper limb rehabilitation device, AMARA, was developed to assist quadriplegic individuals in feeding using their own arm.

Objective: To determine if the bicep contraction signal, measured by electromyography (EMG), can trigger the feeding action of the robotic device. Specifically, this preliminary study aims to (1) characterize the difference in muscle activation between healthy and quadriplegic individuals" muscle activation performing a feeding task; and (2) evaluate the potential of a cost-effective EMG compared to a high-end system in terms of accuracy.

Materials & methods: Six healthy participants (30 ± 5 years old, 50% female) and one 19-year-old quadriplegic participant were enrolled. Two portable EMG sensors were used: the high-end Cometa System and the consumer-grade M40 Muscle Sense. Participants were instructed to perform a feeding task 10 to 12 times with both EMG sensors attached to their dominant arm biceps.

Results: Both EMG sensors yielded similar results for all participants, with a mean difference of 6.5% and 12.0% for healthy and quadriplegic participants, respectively. The quadriplegic individual"s signal reached 72.9% of the healthy participants" mean amplitude.

Cnclusion: This preliminary study demonstrates that the EMG signal obtained from a quadriplegic individual can serve as an on-off switch for the AMARA rehabilitation device, providing autonomy to the user and acting as a rehabilitation stimulation. This finding holds promise for improving the quality of life and independence of quadriplegic individuals in performing essential tasks.

P-402

Development of a soft/rigid hybrid exoskeletal upper-limb rehabilitation robot system for patients with stroke: a result of pilot usability test

J. S. Choi¹, W. K. Chang¹, H. M. Cho¹, W. S. Kim¹, B. K. Jung², J. H. Shin³, H. Soul⁴, N. J. Paik¹

¹Seoul National University Bundang Hospital, Rehabilitation, Seongnam-si, South Korea

²Seoul National University, Mechanical Engineering, Seoul, South Korea

³National Rehabilitation Center of Korea, Rehabilitation, Seoul, South Korea

⁴Neofect, Advanced Technology Research Team, Seongnam-si, South Korea

Introduction: We developed a prototype of soft/rigid hybrid exoskeletal upper limb rehabilitation robot consisting of 4 units (shoulder, elbow, wrist/forearm and hand/finger). Shoulder and elbow units were made of rigid steel exoskeleton to compensate gravity and allow the patient"s movement in multiple directions. The wrist/forearm and hand/finger units were made of fabric and plastics that can be worn like sleeve and glove. It assists the patient"s movements using wires connected to motor. Software system consists of patient administration, calibration of motor intensity for each patient and rehabilitation programs to induce the upper limb movement.

Objectives: To assess the usability of the upper limb robot and gather qualitative feedback from the patients and the occupation therapists (OT).

Methods: 5 chronic stroke patients and 5 OT who had experience in robot rehabilitation were recruited. A patient and an OT were matched and used the robot with 20 min rehab program. The usability test scenario consists of learning of the system, donning, calibration, performing rehab programs and doffing. Both patient and OT performance on given scenario was measured as well as the System Usability Scale (SUS) and qualitative feedbacks.

Results: The patients" mean age was 55.4 years old. The mean experience of OT was 13.2 years. 2 patients required assist from OT when donning the distal limb, while 1 patient failed to wear the distal limb even with the help. Only 1 OT succeeded to calibrate properly while others needed assist from the manufacturer. The mean SUS of the patients was 63.6 and was 59.2 in the OT. The qualitative feedback includes need for improvement of donning procedure; easier, simplified stepwise protocol. OT asked for simplified calibration procedures with more durable soft exoskeleton.

Conclusion: The pilot test shows importance of user-friendly design especially in the distal upper limb robot. The results will help upgrade the robotic system for better usability

P-403

A deep learning model for predicting joint torque from mechanomyogram

J. Son¹, F. Shi^2,3, W. Z. Rymer^2,3

¹New Jersey Institute of Technology, Biomedical Engineering, Newark, NJ, United States

²Northwestern University, Biomedical Engineering, Chicago, IL, United States

³Shirley Ryan AbilityLab, Chicago, IL, United States

Background: Muscle strength is an important clinical measure, as muscle weakness is associated with severe motor impairments in many populations. Unfortunately, there is currently a lack of practical clinical tools for quantifying muscle strength. Thus, this study aims at evaluating a deep learning model for predicting ankle plantar flexion torque from time-series MMG signals during isometric plantar flexion contraction.

Method: This study used the previous dataset of 10 healthy young individuals with no history of neuromuscular diseases in their lower limb. The dataset contains time-series ankle joint torque and 3-axis MMG signals collected from the medial gastrocnemius during isometric plantar flexion contractions at different contraction intensities. The proposed deep learning model was based on a stacked bidirectional long-short term memory and dense layers. Using repeated random sub-sampling, the dataset was randomly divided into training (80%), validation (10%), and test (10%). The mean absolute error (MAE), RMS error (RMSE), RMSE normalized to interquartile range (RMSEIQR) between the measured and predicted normalized mean torque data were calculated as the performance metrics. Moreover, linear regression analyses were conducted to determine the slope and coefficient of determination (R2) of relationships between the measured and predicted normalized mean torque data.

Results: The average MAE, RMSE, and RMSEIQR were 0.021 ± 0.005, 0.053 ± 0.022, and 0.126 ± 0.053 for the test dataset, respectively. The linear regression analyses demonstrated that the proposed model predicted well for the test dataset (slope: 0.971 ± 0.039, R2: 0.972 ± 0.022).

Discussion: This study demonstrated the feasibility of using an MMG-based sensor for quantifying muscle strength. Future studies are required to test the proposed model with datasets collected from other muscles and from other populations.

P-404

High-intensity naturalistic sensorimotor robotic neurorehabilitation: first clinical usability results

R. Rätz¹, R. Müri¹, L. Marchal-Crespo^2,3,1

¹University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Switzerland

²Delft University of Technology, Cognitive Robotics, Delft, Netherlands

³Erasmus Medical Center, Rehabilitation, Rotterdam, Netherlands

Introduction: Neuroscience evidence suggests that neurological patients should engage in high-intensity and task-relevant neurorehabilitation interventions to recover their upper-limb functions. Rehabilitation robots together with virtual reality can support therapists in providing high-intensity training, but current solutions lack the provision of naturalistic somatosensory information coming from the interaction with tangible virtual objects, crucial to promoting recovery.

Objectives: To fill in this gap, we co-designed with clinicians a novel rehabilitation robot capable of high-fidelity haptic rendering -i.e., representing interaction forces with tangible virtual objects- during training of functional reach and grasp movements and evaluated its usability in a clinical setting.

Materials & methods: The robotic design was driven by clinical requirements gathered in a survey with 33 medical professionals. The design includes a custom-made robotic hand module for grasping mounted on a robotic base that supports reaching movements. The robot is complemented by virtual training tasks that provide realistic and naturalistic somatosensory information enabling simultaneous sensory and motor training.

We conducted a mixed-method usability study to collect qualitative and quantitative data from seven therapists and seven stroke inpatients in the Department of Neurology, University Hospital Bern, Switzerland, using standardized questionnaires and semi-structured interviews.

Results: The results show good perceived usability by therapists and patients and high enjoyment of the training by the patients. The high fidelity of the interaction with virtual objects was especially praised during the interviews. We also identified a few points for improvements in the mechanical design.

Conclusion: Our device provides congruent and naturalistic sensations during reach and grasp training, opening the door to more holistic sensory and motor robotic neurorehabilitation.

P-405

Examining differences in treatment between robot – assisted therapy and conventional occupational therapy for post-stroke individuals

L. Kennet¹, D. Rubin-Asher¹, S. Portnoy¹, Y. Levanon¹

¹---, Kfar- Saba, Israel

Introduction: Motor impairment is common deficit following stroke. Occupational therapy combines repetitive and intensive exercises to enhance motor learning and limb movement and function. The use of robotic devices in therapy has seen a significant rise. Thus, it is important to research treatment characteristics of Robotic Therapy, especially among patients with severe impairment in upper limb, who have difficulty producing active movement.

Objective: To compare the treatment characteristics and patient and therapist satisfaction, between Robot Assisted Therapy and Conventional Occupational Therapy.

Patients & methods: A cross-sectional intra-subject study. The study included 3 occupational therapists and 30 sub-acute post stroke patients (24 men, 6 women, age range 43-83). Each subject received one Robot Assisted Therapy session and one conventional occupational therapy session. The repetitions number, motion time of upper limb and kind and amount of compensations were documented. The Visual Analogue Scale for pain was administered each session. A subjective satisfaction questionnaire was completed by the subjects and occupational therapists after each session.

Results: The Robotic Therapy had significantly fewer repetitions, shorter time of upper limb motion and lower reports of pain. There were differences in the type of compensations but not the amount. Patients" satisfaction levels were high in both treatments with no significant difference. Occupational therapists reported significantly higher satisfaction in Robotic Therapy. Conclusion: Both types of treatment provide intensive, repetitive, and motivational care. Patients with pain in who avoid movement might benefit from Robotic Therapy. Combining occupational therapists in Robotic Therapy might improve their satisfaction. Data, such as the number of repetitions and types of compensations, can help occupational therapists plan a more exact rehabilitation program to reach optimal results.

P-406

Robot-assisted gait training plus conventional rehabilitation after cerebral toxoplasmosis infection: a case report

N. R. Reyes¹, C. F. Leochico¹, R. Ramirez¹, R. Rey-Matias¹

¹St. Luke’s Medical Center, Physical Therapy and Rehabilitation, Quezon City, Philippines

Introduction: Cerebral toxoplasmosis is a rare infection and majority of survivors have residual deficits, which can be addressed through rehabilitation. Robotic training is gaining popularity in the field of rehabilitation due to the concept of neuroplasticity. This novel report presents our experience with a robot-assisted exoskeleton for gait training combined with conventional physiotherapy for a patient with chronic motor and functional impairments secondary to cerebral toxoplasmosis.

Objectives: This novel report highlights the multifaceted role of robots in neurorehabilitation in our local setting to address the limits of human-assisted therapy and amplify innovative experience-dependent cortical reorganizations to potentially improve functional outcomes in a more efficient and technology-forward manner.

Patient & methods: A 50-year-old male, known case of B-cell lymphoma, underwent chemotherapy, previously well and independent who had cerebral toxoplasmosis in 2014 and remained to have significant motor and functional impairments despite having conventional rehab for 7 years. He underwent home based- robotic assisted gait training by means of Hybrid-assistive limb combined with conventional rehabiliation.

Results: The HAL-assisted gait training program provided additional improvements in the following: gait speed, stride length, cadence, muscle tone, and strength. The increase in lower limb strength translated to improvements in sit-to-stand and ambulation activities, and can possibly reduce falls risk.

Conclusion: Robotic-assisted rehab combined with conventional rehab is feasible and safe for a patient with chronic disability from a CNS infection. Further research is warranted to make any sound conclusion about the cost-effectiveness of HAL and determine appropriate treatment dosages per desired outcome across different neurologic conditions.

P-407

Impact of overground robot-assisted gait training on quality of life, depression and anxiety in chronic complete spinal cord injury (SCI): a case report

N. S. Kamsani ¹

¹Alexandra Hospital, Singapore, Singapore

Introduction: Robot-assisted gait training (RAGT) devices, such as the Ekso, have been widely used in various neurological conditions, even in patients with complete spinal cord injuries. It has been shown that Ekso actively recruits trunk muscles through postural control mechanisms, thus improving sitting balance for such patient groups (Chisholm et al, 2017). While there are many studies investigating the physiological benefits of RAGT in patients with complete SCIs, the effects of RAGT in quality of life, depression and anxiety symptoms remain relatively unknown.

Objectives: To investigate the impact RAGT has on quality of life, depression and anxiety in people with complete and chronic spinal cord injury.

Patients & methods: 2 individuals with chronic (10 years & 3 years) complete spinal cord injury from T5-T7, undergone 12 sessions of robot-assisted gait training with EksoGT. Each session lasts 60 minutes which consists of RAGT coupled with conventional physiotherapy. Health-related quality of life was measured using the EQ-5D-5L tool. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression. These tools were administered before and after completing the 12 sessions.

Results: In one individual, there was no improvement in EQ-5D-5L scores for the 5 dimensions, whereas there was improvement in scores for pain and anxiety dimensions in the other individual. However, both EQ-VAS scores showed an average of 23.1% improvement after 12 RAGT sessions. For HADS, both depressive and anxiety symptoms improved after undergoing 12 sessions of RAGT.

Conclusion: Paraplegics, even in chronic phase, will benefit from undergoing robot-assisted gait training to improve health-related quality of life, as well as reducing anxiety and depressive symptoms.

P-408

Effects of a technology-assisted and task-oriented arm-hand training (ReHab-TOAT) in chronic stroke: a randomized controlled clinical trial

J. Elmanowski^1,2,3, M. Kleynen⁴, R. Geers², Y. Janssen-Potten^2,3, J. Verbunt^1,2,3

¹Adelante Rehabilitation Centre, Rehabilitation, Hoensbroek, Netherlands

²Adelante Rehabilitation Centre, Center of expertise in rehabilitation and audiology, Hoensbroek, Netherlands

³Maastricht university, Department of Rehabilitation Medicine, Care and Public Health Research Institute, Maastricht, Netherlands

⁴Zuyd University of Applied Sciences, Research Centre for Nutrition, Lifestyle and Exercise, Faculty of Health, Heerlen, Netherlands

Introduction: ReHab-TOAT is a technology-assisted and task-oriented arm-hand training program for stroke patients. A robotic system, based on a remote handling concept, provides force feedback during arm-hand training. The training consists of games based on motor patterns of daily-living activities, self-efficacy principles and focuses on transferring training improvements to daily life. Previous research confirmed the feasibility of ReHab-TOAT and showed potential clinical relevant improvements in stroke patients.

Objectives: The aim was to investigate whether ReHab-TOAT is more effective than usual care in chronic stroke patients on arm-hand function and arm-hand skill performance.

Patients & methods: Thirty chronic stroke patients suffering from moderate to severe arm-hand problems were included in this RCT. The control group received therapy-as-usual, while the experimental group additionally received a 4-weeks training program with ReHab-TOAT, 3x per week, 1.5hrs per day. Primary outcome was arm-hand function measured by the Fugl-Meyer Assessment (FMA). Secondary outcome measures were arm-hand skill performance (ARAT), and perceived performance (MAL). In this preliminary analysis the differences of pre-post measures were compared between groups by using the Mann–Whitney U test.

Results: No statistically or clinically relevant differences between groups were obtained for the FMA (m=1.45, p=0.80) and ARAT (m=1.62, p=0.59). However, significant difference was found on all three items of the MAL in favor of the experimental group (activities attempted m=1.30, p=0.00 & amount of use m=0.18, p=0.00 & quality of use m=0.22, p=0.00)

Conclusion: ReHab-TOAT was not superior to usual care to improve arm-hand function and arm-hand skill performance of stroke patients Effects regarding the perceived performance (MAL) are promising but need to be further investigated, e.g. by using accelerometers.

P-409

Reliability of the robotic brace for dynamic trunk support system for trunk control function assessment in patients with spinal cord injury

R. Wang¹, N. Wang¹

¹Peking University first Hospital, Rehabilitation, Beijing, China

Instruction: How to accurately assess the trunk control ability in patients with SCI has always been a clinical difficulty.

Objective: To investigate the test-retest reliability of the Robotic Brace for Dynamic Trunk Support System (RoboBDsys) in evaluating seated trunk control function in patients with SCI.

Patients & methods: From October to December, 2022, 20 wheelchair-dependent patients with spinal cord injury were recruited. All participants completed RoboBDsy trunk control test including static control test, dynamic control test and resistance test on the seated platform. The evaluation indexes were the supporting torque regression slope exerted by the robot platform on the direction of x, y, α, and θ, which were recorded as Kx, Ky, Kθ, Kα and average supporting torque which were recorded as Fx, Fy, Mθ, Mα in the static control test; the Range of Motion (ROM) of trunk in four directions in the dynamic control test; Center of Pressure (COP) related 8 parameters reflecting the swing of COP. The test interval was 1 week, intraclass Correlation Coefficient (ICC) values was calculated between 2 times of RoboBDsy trunk control test.

Results: There were 13 participants completed two tests. In the static control test, the ICCs of four indexes were 0.418-0.742 between 2 tests; the ICCs of all indexes in dynamic control test were 0.633-0.848; the ICCs of seven indexes were 0.400-0.873 excepted COP Mean Amplitude (MA) in the right resistance test, the ICCs of seven indexes were 0.546-0.832 excepted COP Mean Frequency (MF) in the left resistance test, the ICCs of all indexes were 0.507-0.860 in the anterior resistance test, the ICCs of COPx Mean Volecity (COPx MV), COPy MV, sway area and sway path were 0.483-0.847 in the posterior resistance test, which all showed moderate to high test-retest reliability.

Conclusion: RoboBDsys is a reliable tool for evaluating seated trunk control function in patients with SCI.

P-410

Classification of spasticity patterns of the upper limb in patients with multiple sclerosis: observational study

M. Filippetti¹, L. Linde¹, R. Di Censo¹, N. Smania^1,2, A. Picelli^1,2

¹University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy

²Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy

Introduction: "Spastic paresis" identifies a condition characterized by a neurological component (spasticity, spasticity and co-contraction, spasticity and dystonia) and a myopathic component (spastic myopathy) often intertwined with each other. The main objective of this retrospective study was to research the presence of specific postural patterns in the upper limbs in patients with multiple sclerosis in comparison with stroke postural patterns.

Materials & methods: In this retrospective single-centre study medical records of outpatients with multiple sclerosis attending the dedicated outpatient clinic of the University Hospital of Verona from April 2016 to April 2023 were analysed. The criteria applied for the identification of the aggregate postures/patterns were mainly three: the presence of a descriptive analysis of the districts affected by spasticity or the presence of an Ashworth scale (MAS) score ±1 or the treatment with botulinum toxin of muscles determining the pattern examinated.

Results: 57 patients were enrolled. From the comparison with the patterns of Hefter et al. 2012 emerged: no patient could be classified into pattern I/II and pattern V according to Hefter, 3 patients fell into type III (average dose 125.5U), 5 into type IV (average dose 77.7U ) and 5 patients in a pattern characterized by only flexed elbow (average dose 116U). The others have been results unclassified.

Conclusions: From these preliminary data, it has been highlighted that it is not possible to apply the aggregate postures/patterns found in patients with stroke to patients suffering from multiple sclerosis. This evidence would be confirmed not only by the clinical evaluation but also by the analysis of the different muscles treated and the average dose of botulinum toxin inoculated to the patients in our sample, compared to those indicated in the works present in the literature derived from stroke patients.

P-411

Living with spasticity during the COVID-19 pandemic. A qualitative study of patient, carer and physician experiences

K. Saunders¹, M. Sakel², R. Faruqui³, J. Keene⁴, D. Wilkinson⁵

¹University of Kent, Health Service Research, Canterburry, United Kingdom

²East Kent Hospitals University NHS Foundation Trust, Neurorehabilitation, Canterburry, United Kingdom

³Kent and Medway NHS and Social Care Partnership Trust, Psychiatry, Maidstone Kent, United Kingdom

⁴King Edward VI Five Ways School, Birmingham, United Kingdom

⁵University of Kent, Psychology, Canterburry, United Kingdom

Background: Approximately 4.4 million people in England (8% of total population) are living with a long term neurological condition (LTNC) of sudden onset or progressive nature. Within this group are individuals who experience severe difficulties with spasticity, which requires regular treatment with botulinum toxin injection. Spasticity is a complex clinical phenomenon acknowledged to have an adverse impact on quality of life, level of independence and mental wellbeing.

Objective: To gain insight into the lived experiences of the challenges encountered by patients, carers and a spasticity service lead during the COVID-19 pandemic.

Method: Qualitative study with semi-structured interviews by telephone.11 participants were recruited. Data was audio-recorded, transcribed, anonymised and coded. Data analysis utilised the One Sheet of Paper method to identify themes, which were discussed and further analysed by the interdisciplinary research team and patient and carer participants. Health Research Authority Ethics approval ref:21/PR/1386);IRAS ID:306570;NHS UK Hospital Research & Innovation ref:2021/NEURO/01.NCT Reg:NCT05435404

Results: Of 11 participants, aged 36-77 yrs,7 comprised individuals with spasticity related to LTNC,3 carers and 1 clinical spasticity service lead.6 were male and 5 were female. 4 participants were living with spasticity related to chronic stroke; 2 were living with spinal cord injury and 1 was living with Multiple Sclerosis. Qualitative analysis revealed 6 themes: experience of living with spasticity during the pandemic; impact of the pandemic on health;access and experience of out-patient clinic appointments;coping strategies during the pandemic; system improvements and learning from this time period.

This study provides insight into the impact of the COVID-19 pandemic on out-patient spasticity services and suggests there is scope for improving system and service delivery through the allocation of research funding to support lessons learnt.

P-412

A 5-year retrospective cohort of individuals receiving botulinum toxin type a for post stroke spasticity

A. McIntyre^1,2, R. Teasell^3,4,5, M. Saikaley³, T. A. Miller^3,4,5

¹Western University, Nursing, London, Ontario, Canada

²London Health Science Centre, Emergency Medicine, London, Ontario, Canada

³Parkwood Institute, Parkwood Institute Research, London, Ontario, Canada

⁴St. Joseph’s Health Care London, Physical Therapy and Rehabilitation, London, Ontario, Canada

⁵Western University, Physical Therapy and Rehabilitation, London, Ontario, Canada

Introduction: Botulinum toxin type A (BTX-A) is a well-known treatment for post stroke spasticity (PSS). The use of BTX-A for PSS necessitates a comprehensive evaluation of the individual’s unique condition, taking into account potential treatment benefits.

Objective: Among a cohort of individuals with PSS (modified Ashworth Scale scores, mAS ≥1) attending a specialized spasticity clinic, the objectives of this study were to (1) determine the prevalence of BTX-A use and primary reasons for use; and (3) compare characteristics of BTX-A users with non-users.

Patients & methods: A 5-year (2015-2020) retrospective cohort of patients who attended a specialized spasticity outpatient clinic in Southwestern Ontario, Canada were included. Sociodemographic, clinical, stroke-related, rehabilitation-related, and outcome measure data were extracted from paper charts and electronic databases and compared between BTX-A users with non-users.

Results: A total of 122 (20.3%) patients developed PSS by 3-4 months post stroke and were subsequently referred to the specialized spasticity clinic. BTX-A was administered to 41 (33.6%) patients (mean age=59.1±15.0 years; 48.8% females) to primarily improve mobility (n=14, 34.1%) and pain (n=14, 34.1%) related to PSS. Compared to non-BTX-A patients, BTX-A users were significantly younger, and had greater stroke severity, motor impairment, hemiplegia, and use of SSRIs. Further, BTX-A users had lower Functional Independence Measure scores, and inpatient rehabilitation lengths of stays (p<.005 for all).

Conclusions: Patients presenting with PSS should be referred to specialized spasticity clinics. BTX-A may be a suitable treatment for some patients depending on their presentation and goals. The comparison between BTX-A users and non-users reveals specific patient profiles which may be useful for clinicians when making decisions about its application.

P-413

Predictors of spasticity 3-6 months post stroke: a 5-year retrospective cohort study

A. McIntyre^1,2, R. Teasell^3,4,5, M. Saikaley³, T. A. Miller^3,4,5

¹Western University, Nursing, London, Ontario, Canada

²London Health Science Centre, Emergency Medicine, London, Ontario, Canada

³Parkwood Institute, Parkwood Institute Research, London, Ontario, Canada

⁴St. Joseph’s Health Care London, Physical Therapy and Rehabilitation, London, Ontario, Canada

⁵Western University, Physical Therapy and Rehabilitation, London, Ontario, Canada

Introduction: Post stroke spasticity can manifest gradually after the initial event. Challenges in referring patients for treatment may lie in a lack of specialized knowledge among medical providers. Factors linked to heightened risk of post stroke spasticity in the early phase include stroke severity, paresis, age, and time since stroke

Objective: To identify predictors of post stroke spasticity (PSS; modified Ashworth Scale scores, mAS ≥1) at 3-6 months.

Patients & methods: A 5-year (2015-2020) retrospective cohort of patients who attended inpatient stroke rehabilitation in Canada were included. Sociodemographic, clinical, stroke-related, rehabilitation-related, and outcome measure data were extracted from paper charts and electronic databases. In total, 922 individuals (n=338; 55.8% males; mean age=70.9±14.2 years) attended and 606 (65.7%) returned for an outpatient visit.

Results: Most patients had a first ever (n=518; 85.5%), ischemic (n=470; 77.6%) stroke with hemiplegia (n=449, 74.1%). PSS at 4 months was 20.3% (N=122); 41 (33.6%) individuals received botulinum toxin. A binary logistic regression significantly predicted PSS (χ2(7)=190.868, p<.0001) with good model fit (χ2(8)=5.577, p=0.695). Significant predictors of PSS included younger age, presence of aphasia, family history of cardiovascular disease or stroke, use of selective serotonin reuptake inhibitors, hemorrhagic stroke, lower Functional Independence Measure scores, and lower Chedoke-McMaster Stroke Assessment impairment and activity inventory scores (p<.005 for all).

Conclusion: Patients should be monitored closely for PSS after discharge from stroke rehabilitation and throughout the care continuum to ensure proper identification, referral for specialist care, and timely management.

P-414

Intervention based on FES and splinting for treating the non-neural hyper-resistance of the hand joints in a person with incomplete spinal cord injury

M. Pellico¹, A. Miguel¹, A. Martín-Odriozola^2,3,1

¹Fesia Clinic, Physiotherapy, San Sebastián, Spain

²Fesia Technology, San Sebastián, Spain

³University of the Basque Country (UPV/EHU), Department of Physiology, Leioa, Spain

Introduction: Hyper-resistance of the joint is one of the most common symptoms in persons with spinal cord injury (SCI). There are both neural and non-neural factors contributing to the observed joint hyper-resistance. Non-neural alterations affect to the musculoskeletal system, including reduced muscle length, increased tendon length and an increase in joint stiffness. Although different treatments have been tested, there is no consensus on which of them is optimal one.

Objectives: This case study explores the impact of using modifiable splinting combined with functional electrical stimulation (FES), to improve musculoskeletal movement restrictions in the hands of a person with SCI.

Patients & methods: The case a person with incomplete SCI presenting with musculoskeletal-origin movement restrictions of the hands is presented. The patient was treated with a 24-hour modifiable splinting targeting the wrist, metacarpophalangeal and interphalangeal joints in their maximum extension. 3 30-minute FES sessions were done weekly, using selective and repetitive stimulation of forearm extensor muscles. Passive range of motion measurements were taken at baseline and after the 4-week treatment.

Results: There was an increase of 20º in wrist extension and 10º in metacarpophalangeal extension after the treatment. These changes were painless and maintained once the orthosis were removed.

Conclusion: This case study highlights the efficacy of the combination of modifiable splinting and FES as an intervention for non-neural factors contributing to joint hyper-resistance of the hand in a person with incomplete SCI. The observed gains in range of movement underscore the potential benefits of tailored orthotic solutions in combination with FES, optimizing functional outcomes for individuals with spinal cord injuries. Further research and larger studies are warranted to validate and generalize these findings within the broader context of spinal cord injury rehabilitation.

P-415

Neuromuscular electrical stimulation as a spasticity reduction tool before functional hand and gait training in two persons with stroke

A. Martín-Odriozola^1,2,3, M. Pellico³, C. Rodríguez-de-Pablo¹, H. Zabaleta-Rekondo¹

¹Fesia Technology, San Sebastián, Spain

²University of the Basque Country (UPV/EHU), Department of Physiology, Leioa, Spain

³Fesia Clinic, Physiotherapy, San Sebastián, Spain

Introduction: Neuromuscular electrical stimulation (NMES) is one of the techniques used for motor rehabilitation after stroke. Spasticity is among the parameters in which significant improvements have been found. The volume of publications on this subject is growing, but there is still no consensus on treatment doses, electrical parameters, and optimal patient profiles.

Objectives: The aim of this work was to show the results of two case in which NMES was used to reduce spasticity before carrying out a functional therapy of the hand and the leg in two persons with stroke.

Patients & methods: The cases of two persons with stroke are reported in this case series. The subjects started a comprehensive physiotherapy programme, in which the initial 20 minutes of the upper (subject 1) or lower (subject 2) limb rehabilitation sessions consisted of spasticity reduction therapy using NMES, and the remaining 10 minutes consisted of functional hand dexterity or gait rehabilitation exercises. Modified Ashworth Scale (MAS) of the wrist, thumb, and fingers 2, 3, 4 and 5 extensor muscles was assessed in subject 1 at baseline, every therapy day before and after the stimulation, after the eight-week treatment and ten weeks after completion. MAS was also assessed in the plantar flexor muscles of subject 2 at baseline and every therapy day before and after the stimulation.

Results: The results show great spasticity reduction effects both in upper and lower limb muscles. Although the greatest changes occurred intra-session, there were also changes that were maintained with the passing of the sessions in the pre-treatment scores, mainly in the lower limb. In addition, some effects were maintained 10 weeks after finishing the treatment in the upper limb.

Conclusion: This case series provide examples of the successful use of electrical stimulation as a spasticity reduction tool before functional training.

P-416

To pump or not to pump? An evaluation using temporary intrathecal device coupled with goal attainment scaling to assess the indication and predict outcome of intrathecal baclofen therapy

S. Carda¹, E. Grana¹

¹Lausanne University Hospital (CHUV), Neuroscience, Lausanne, Switzerland

The most challenging part in intrathecal baclofen treatment (ITB) is to predict if it will result in a functional gain for the patient or not. This can be an issue mainly for patients with high functional level (i.e. patients with gait function), patients extremely disabled (in which trunk tone reduction might reduce the ability to effectively sit in a wheelchair). To overcome this problem, some Authors have developed ITB tests with an implanted temporary catheter connected to an external pump, however, one difficulty remains in objectively describe outcomes in patients who are extremely heterogeneous. In this case-series we will report our first series of seven patients in which we evaluated outcomes of using Goal Assessment Scaling. The test was performed over 5 days. One patient (n°4) had severe post-lumbar puncture syndrome that required a blood-patch after catheter removal, and this complication severely impacted patient’s functional level during the test. However we considered the goals as not attained, and he refused a second test. Patient 5 did not reach the planned goals, showing even more difficulties in gait (with preserved speed), and a reduction in function in his upper extremities. The test was considered as negative and he was not candidate to pump implantation. Patient 7 attained the first goal but not the second; since he lost his ability of performing a therapeutic gait (within parallel bars) he preferred wait before further pump implantation even if he judged his test as positive for the main goal. There were no other complications during testing. The other four patients underwent definitive ITB pump implantation, which was started at the dose used at the end of the test. Our case series shows that ITB testing with an external pump is feasible and safe and, combined with GAS evaluation, allows an objective evaluation for the indication on subsequent pump implantation.

P-417

Diagnostic nerve blocks. A retrospective analysis of 2020-2022

S. Carda¹, G. Moresco², E. Grana¹

¹Lausanne University Hospital (CHUV), Neuroscience, Lausanne, Switzerland

²Institutiton de Lavigny, Lavigny, Switzerland

Diagnostic nerve blocks are used to discriminate contracture from hypertonia in patients with spasticity or to identify the role of different muscles in a specific pattern or functional problem. There are several descriptions of their effect on lower limb (mainly tibial nerve block), but less evidence is available on other nerves (of upper and lower extremity). We describe here a retrospective analysis of a cohort of patients who underwent diagnostic nerve blocks between 2020 and 2022. Chart review of patients with disabling spasticity referred to the spasticity clinic of our University Hospital. Blocks have been always performed by ultrasound and EMG-Stim guide. All nerves have been blocked with lidocaine 2%, with a maximal dose per session of 200 mg. Blocks have been classified as diagnostic (when the aim was to rule out contracture) or functional (to assess the possible functional improvement with subsequent botulinum toxin treatment or selective neurotomy). We collected the complete data for 43 patients and 74 blocks. Upper extremity: 20 blocks on 10 patients, 9 diagnostic and 11 functional. Among the 9 diagnostic blocks, 2 of them (22%) pointed out a muscle contracture. All functional blocks allowed to an improved function (either passive or active). All patients have been evaluated and filmed before and after the block. Lower extremity: 56 blocks on 33 patients. Over 21 diagnostic blocks, 7 (33%) showed a contracture. Among 35 functional blocks, 6 of them (17%) did not led to an improvement of function. No side effects have been noted. Nerve blocks are safe and effective to rule out spasticity over contracture, but also to assess functional improvement, even in the upper limb. Most patients who clinically seems to have contracture (even at the upper extremity) have severe hypertonia.

Upper Limb Nerve	N	Lower Limb Nerve	N
Musculocutaneous	6	Tibial to Soleus	17
Lateral Pectoral	3	Tibial to Tibialis Posterior	13
Radial	2	Tibial to Gastrocnemius	10
Median	4	Obturator	5
Ulnar	2	Tibial to Flexor Hallucis Longus	3
Thoracodorsal to Latissimus Dorsi	1	Femoral to Rectus Femoris	4
Suprascapular to Supraspinatus	2	Tibial to Flexor Digitorum Longus	2
		Peroneal to Peroneus Longus	2

P-418

Effectiveness of abobotulinumtoxinA in adults with lower limb spasticity: top line results from the AboLiSh observational study

A. Esquenazi¹, R. D. Zorowitz², S. Ashford³, A. S. Grandoulier⁴, P. Maisonobe⁴, C. Hannes⁴, J. Jacinto⁵

¹MossRehab Jefferson Health, Elkins Park, PA, United States

²MedStar Health, Washington and Georgetown University School of Medicine, Washington, DC, United States

³London North West University Healthcare NHS Trust, London, United Kingdom

⁴Ipsen, Boulogne-Billancourt, France

⁵Centro de Medicina de Reabilitaçãode Alcoitão, Estoril, Portugal

Introduction: While the efficacy and safety of abobotulinumtoxinA (aboBoNT-A) in reducing lower limb spasticity has been established in controlled clinical trials, there is a paucity of data on real-life clinical goal attainment in practice.

Objectives: Assess longitudinal goal attainment after ≥1 aboBoNT-A injection(s) in the lower limb over 16-months using the cumulated Goal Attainment Scaling – Leg (GASleg) T score in routine practice.

Methods: Prospective, observational study (NCT04050527). Ambulatory patients (≥18 years able to take ≥5 steps with/without assistance) with unilateral lower limb spasticity were treated with aboBoNT-A to achieve individualized treatment goals.

Results: 430 participants were enrolled, of which 384 underwent ≥1 BoNT-A injection cycle and had ≥1 GAS-leg assessment (effectiveness population); 65.9% of patients also received treatment for upper limb spasticity. Patients generally achieved their goals as expected over repeated cycles; mean cumulated GAS-leg T score at 16 months was 48.2 [47.4, 48.9] (mean change from baseline of 9.9 [9.1, 10.7]). Participants injected with a guidance technique at baseline (electromyography, electrostimulation, or ultrasound) were more likely to attain their primary treatment goals during cycle 1 (odds ratio: 1.9 [95% CI 1.1, 3.1], p=0.02). Adverse events were mostly mild-moderate and were reported by 56 (13.5%) patients. Six patients (1.4%) had an AE possibly/probably related to treatment.

Conclusion: This large, international study provides evidence for the benefit of repeated cycles of aboBoNT-A for lower limb spasticity and demonstrates the importance of appropriate injection guidance techniques. Treatment with aboBoNT-A was generally well-tolerated and safe.

P-419

Effects of muscle shortening maneuver on a child with cerebral palsy: a case report

D. Longo¹, G. Cherubini¹, G. Fanucci¹, M. Borelli¹, F. Ferrarello², M. A. Bagni¹

¹University of Florence, Experimental Science, Florence, Italy

²Azienda Usl Toscana Centro, Department of Allied Health Professions, Unit of Functional Rehabilitation, Prato, Italy

Background: Physiotherapy plays a fundamental role in the rehabilitation of cerebral palsy minimizing deficits in function/structure, and promoting activity and participation, in line with the ICF classification. Based on the scientific evidence available in the literature, two different methods were selected to create a 3 months intensive treatment plan.

Objective: Aim of this study was to assess their possible effectiveness on a child with diplegia.

Methods: A 10-year-old child diagnosed with cerebral palsy at GMFCS level 1, who had not undergone any physiotherapy treatment before, was recruited for the study. This allowed the development of a rehabilitation program involving two different methods to assess the efficacy of the treatments:muscle strengthening and muscle shortening maneuver (MSM). The child was assessed at baseline (T0), at the end of the 6-week muscle strengthening treatment (T1), other 4 weeks after the MSM (T2), and finally, a follow-up assessment was conducted 3 months after the treatments were discontinued (T3). The evaluated outcome measures included: Gross Motor Function Measure (GMFM), tonic stretch reflex threshold (TSRT), passive (PROM) and active (AROM) range of motion of the lower limbs, lower limb muscle strength, Timed Up and Go test (TUG), 10-meter walk test (10MWT), gait analysis, Selective Control Assessment of the Lower Extremity (SCALE), and Modified Ashworth Scale (MAS).

Results: Muscle strengthening led to improvements in GMFM (primary outcome) beyond its MCID. The combination of both methods increased the TSRT for the right ankle, enhanced PROM and AROM of knee flexion and extension dorsiflexion (particularly for the left ankle), PROM and AROM of hip flexion with knee flexion, PROM of hip flexion with knee extension, strength in specific muscle groups, gait parameters assessed through gait analysis, and improved performance times in functional tests (TUG and 10MWT). No changes were observed in SCALE and MAS assessments.

P-420

A retrospective cohort analysis of cryoneurolysis for upper extremity spasticity in patients with cerebral palsy

F. MacRae^1,2,3, A. Benny⁴, M. Hashemi^2,3, P. Winston^2,3,4

¹Western University, Health and Rehabilitation Sciences, London, Ontario, Canada

²Vancouver Island Health Authority, Victoria, Canada

³Canadian Advances in Neuro Orthopedics for Spasticity Consortium, Kingston, Canada

⁴University of British Columbia, Vancouver, Canada

Introduction: Cerebral palsy (CP) is a common cause of childhood disability, with morbidity extending into adulthood. Spasticity in CP is typically treated with botulinum neurotoxin type-A injections. Alternative treatments include selective rhizotomies or antispasmodic medications. While each treatment has its advantages, there is a need for minimally invasive, long-lasting, selective treatments for focal spasticity.

Objectives: To determine the efficacy of cryoneurolysis for upper extremity spasticity in patients with CP.

Methods: A retrospective cohort analysis of patients with CP who underwent cryoneurolysis for pain and spasticity as part of their normal course of care. Outcome measures related to spasticity severity, function and range of motion, and adverse events were collected, depending on each patient"s specific presentation and treatment. Spasticity severity was assessed using the modified Ashworth scale (MAS), and the Tardieu scale - maximum passive range of motion when the limb is moved as slowly as possible (V1).

Results: In all, 14 participants (9 female, median age = 39.5 years) were included in the cohort. All participants had undergone cryoneurolysis in at least one nerve that innervates a muscle that crosses the shoulder, elbow, and/or wrist. In total, 77 nerves were treated. The median number of nerves treated per participant was 5.5 (max=10). Statistically significant decreases in MAS were observed for shoulder flexion and abduction up to one year. Most patients had improved spasticity as per MAS for elbow and wrist extension up to one year post treatment. No adverse events were reported; pain during the procedure was common.

Conclusion: Cryoneurolysis may be an effective treatment for upper limb spasticity in patients with cerebral palsy. A small sample size limits the generalizability of the present study. Further research is required to fully understand the effects of this treatment in the CP population.

P-422

Moving casting into clinical practice: a knowledge translation proposal

J. Yiu¹, F. Wong², B. Marcoux²

¹Vancouver Coastal Health, Professional Practice, Vancouver, Canada

²GF Strong Rehab Centre, Vancouver, Canada

Introduction: Weakness, spasticity, and immobilization following acquired brain injury (ABI) often lead to contracture development. Loss of range in the affected ankle, elbow, and hand have been significant barriers to rehabilitation, limiting retraining of standing, walking, and functional use of the arm. Over time, the development of join stiffness, pain, and skin issues greatly limit an individual’s participation in activities of daily living and lower their quality of life.

Although a few stroke clinical practice guidelines have recommended the use of casting to manage contracture after ABI, most clinicians at Vancouver Coastal Health (VCH) do not use this intervention. As such, a few trained physical and occupational therapists joined to form a casting team with the goal of moving casting into clinical practice.

Objectives: This proposal describes a knowledge translation process to integrate casting for contracture management in the ABI population into clinical practice across various sites of VCH.

Materials & methods: Using the Knowledge to Action (KTA) conceptual framework, the casting team reviews evidence for casting and follows the 8 phases of the action cycle, namely, problem identification, knowledge adaptation, identifying barriers to knowledge use, implementation and integration of the intervention into practice, monitoring, evaluating, and sustaining knowledge use. Implementation strategies comprise of information sessions, casting workshops, and skill mentoring. The casting team will measure client progress using standardized assessments and clinicians’ perception of practice change using survey/focus groups. Professional practice leadership team will update casting protocol and clinical practice guideline. Timeline for the project is one year.

Conclusion: It is expected that this project will help improve client outcomes and standardize quality of practice in contracture management in the ABI population across settings within VCH.

P-423

Repeated Botulinum toxin A injections for a period of two years in stroke patients – effect on muscle stiffness, goal attainment and functional outcome

J. Simic^1,2, A. Opheim², B. Biering-Sørensen³, D. J. Curtis³, F. Biering-Sørensen⁴, K. Østlie⁵

¹Sunnaas Rehabilitation Hospital, Spasticity clinic, Bjørnemyr, Norway

²Sunnaas Rehabilitation Hospital, Research, Bjørnemyr, Norway

³Rigshospitalet (National Hospital), Neurology, Copenhagen, Denmark

⁴Rigshospitalet (National Hospital), Brain and Spinal Cord Injury, Copenhagen, Denmark

⁵Innlandet Hospital, Physical Therapy and Rehabilitation, Ottestad, Norway

Introduction: Botulinum toxin A (BoNT-A) is a well-documented first-line treatment for focal spasticity and has to be repeated regularly. It is unknown whether muscle properties change due to long-term BoNT-A treatment and if they are associated with the treatment outcome.

Objectives: To assess long-term effects of BoNT-A injections on muscle stiffness and the association between muscle changes, goal attainment, spasticity and walking function in stroke survivors.

Patients & methods: A two-year prospective cohort feasibility study. Eligible adults had a single stroke, spasticity in calf muscles determined with Modified Ashworth Scale (MAS) and can cooperate. They receive BoNT-A injections in medial gastrocnemius muscle (GM) and other leg muscles in a physician selected dose every 3 months. Anterior tibial muscle (TA) in the spastic leg is used as control muscle and to assess muscle changes in non-injected muscles. On each visit stiffness of GM and TA in both legs is measured with Shear Wave Elastography (SWE). Goal achievement is evaluated with Goal Attainment Scale. Walking function is tested with 10m walk test (10mWT) and spasticity with MAS. Physical activity is logged in a diary.

Results: To date, 20 patients are included, of whom four have had 12-month follow-ups. SWE results indicate reduced muscle stiffness in the injected muscles over time and mostly unchanged stiffness on the non-affected side. In 3 patients muscle stiffness is reduced 1,7-2,9% in one year. In one patient muscle stiffness increased, probably due to inactivity in the last 6 months. The 10 mWT shows no changes in walking velocity. The MAS shows reduced spasticity in the treated muscles. The patients achieved all treatment goals defined at baseline, some of them more than expected in the same period.

Conclusion: Preliminary results suggest that long-term BoNT-A treatment reduced muscle stiffness which is positively associated with goal attainment, decreased spasticity and increased activity level.

P-424

Reduction of pain in spasticity patients naïve and non-naïve to OnabotulinumtoxinA treatment: results from the aspire study

J. Wissel¹, E. Duarte², W. Feng³, M. Schwartz⁴, M. Nelson⁵, T. Musacchio⁶, C. List⁷

¹Vivantes Klinikum Spanda, Berlin, Germany

²Hospitals del Mar i l’Esperança, Barcelona, Spain

³Duke University, Durham, NC, United States

⁴MS Biostatistics, Clermont, FL, United States

⁵AbbVie, Medical Affairs, Chicago, IL, United States

⁶AbbVie, Global Medical Affairs, Rome, Italy

⁷Brooks Rehabilitation, Jacksonville, FL, United States

Introduction: Spasticity is associated with several central nervous system disorders and is often accompanied by pain. OnabotA may reduce pain in spasticity patients regardless of prior BoNT treatment.

Objective: Assess pain relief in spasticity patients naïve and non-naïve to onabotulinumtoxinA (onabotA) treatment from the Adult Spasticity International Registry (ASPIRE) study.

Patients & methods: ASPIRE is a 2-year, international, multicenter, prospective, observational registry study (NCT01930786) [1]. Adult patients were treated with onabotA over 96 weeks for up to 8 total treatments. This subanalysis includes patients with Numerical Pain Rating Scale (NPRS)>0. Outcome measures include pain assessed by NPRS, changes in functional impairment by the Disability Assessment Scale (DAS) for upper limb (UL) and lower limb (LL), and patient and clinician satisfaction, as well as safety.

Results: A total of 494 patients with baseline NPRS > 0 were included in the subanalysis (naïve [N=189], non-naïve [N=305]). Mean starting onabotA dose was 314U (SD 180U) in naïve patients and 364U (SD 204U) in non-naïve patients. Patients in both groups had improvements in NPRS scores from baseline. Model-estimated mean NPRS were significantly reduced after treatment (naïve Tx 1-7, P ≤.0001; non-naïve Tx 1-7, P ≤.0001). Most patients in both naïve and non-naïve groups were satisfied/extremely satisfied that onabotA helped their pain associated with spasticity (Tx1: 71%, 86%, Tx2: 78%, 89%, Tx3: 84%, 88%, respectively) and would continue to use onabotA for treatment of their spasticity. 1.1% (n=2) naïve patients reported 3 treatment-related serious adverse events (TRSAEs), with 0 reported TRSAEs in non-naïve patients.

Conclusions: In this ASPIRE subanalysis, pain was reduced in spasticity patients naïve and non-naïve to onabotA treatments. No new safety events were observed.

Reference

J Rehabil Med. 2017;49(8):659-66.

P-425

Initial validation of structured patient self-reports on three treatment-relevant symptoms of upper limb spastic movement disorders (UL-SMD) after stroke

K. Fheodoroff¹, B. Senft², P. Klein³, A. Kivi^3,4, J. Wissel⁴

¹KABEG Gailtal-Klinik, Neurorehabilitation, Hermagor, Austria

²Sigmund Freud Private University, Psychology, Vienna, Austria

³Vivantes Klinikum Spandau, Neurology, Berlin, Germany

⁴Vivantes Klinikum Spandau, Neurorehabilitation, Berlin, Germany

Introduction: Up to 43% of stroke survivors develop spastic movement disorders (SMD) with muscle stiffness, impaired control of voluntary movements and spasticity-associated pain syndromes. Few studies report on patients" perspective of SMD. A structured approach to patients" self-reports (PSR) on UL-SMD is lacking.

Objective: To investigate if patients" self-reports are valid in identifying disabling UL-SMD.

Methods: We developed a brief survey on treatment-relevant symptoms of disabling UL-SMD (elbow, wrist, fingers) in three different levels of detail and collected responses from chronic stroke survivors on symptom severity, completeness, and comprehensiveness of the questionnaires.

Modified Ashworth Scale (mAS) data for muscle tone, Medical Research Council Scale (MRC) for voluntary movements and Spasticity Associated Arm Pain Scale (SAAPS) were assessed by experienced therapists (ET).

Statistic validity was tested using percentage agreement, sensitivity and specificity.

Results: 56 (39 male) chronic stroke survivors (age=67.21 ± 9.08) completed the three PSR versions. Completeness (between 77.8 and 83.0%) and comprehensiveness (between 74.5 and 90.7%) was high in all three versions.

Sensitivity was sufficient for MRC in all three segments (elbow, wrist, fingers) and specifity was higher in the more detailed questionnaires. There was low sensitivity for muscle tone (ET) and muscle stiffness (PSR) in elbow, and moderate sensitivity in wrist and finger. Due to the small number of individuals with pain, sensitivity for SAAPS was acceptable only for the detailed questionnaire on finger pain / discomfort.

Conclusions: Structured UL-PSR might be useful in detecting treatment relevant symptoms of disabling UL-SMD. Our data will help us optimizing patients" questionnaires in terms of specifity and sensitivity as well as comprehensibility.

P-426

Cryoneurolysis and quadriplegia: a case report on pain and spasticity management

L. Schatz¹, S. Herzog², M. Hashemi³, P. Winston³

¹University of Victoria, Victoria, Canada

²University of British Columbia, Vancouver, Canada

³Vancouver Island Health Authority, Victoria, Canada

Introduction: Spasticity, a common symptom following spinal cord injury, often leads to pain, muscle contracture, and compromised daily activities. Cryoneurolysis, a minimally invasive, toxin-free procedure proven effective for pain, is gaining recognition for treating spasticity. It involves using an ultrasound-guided probe to freeze and destroy overactive target nerves.

Objectives: To assess the impact of cryoneurolysis on joint range of motion, by reducing spasticity and pain in a quadriplegic patient.

Patient & methods: A 52-year-old male with C4 incomplete quadriplegia presents with severe end-stage right hip osteoarthritis, as well as spasticity in the upper and lower extremities with hip flexion spasms. Previous attempts with maximum-dose botulinum toxin injections for the lower limb proved insufficient. Percutaneous cryoneurolysis was performed bilaterally on the peripheral nerves to the rectus femoris, anterior and posterior divisions of the obturator nerve, intramuscular branches of the medial and lateral hamstrings, the right vastus intermedius, right psoas at the hip, bilateral intramuscular branches of FDS, and the left FCR palmaris longus.

Results: After the procedure, the patient experienced increases in inter-knee distance of 14 cm, 15° of bilateral hip abduction, 35° and 5° for right and left knee extension and 5° and 25° for left and right wrist extension respectively. On 6-week follow-up, the patient reported improvements in performing daily activities, such as independent showering and no falls. The examining physician noted a significant decrease in clonus and muscle tone. On 3-month follow-up, results were sustained for inter-knee distance, left hip abduction, and bilateral knee and wrist extension.

Conclusion: Cryoneurolysis is a non-surgical, percutaneous procedure which could be considered for pain and spasticity management in patients with quadriplegia. It can provide an option for improved quality of life and independence for patients.

P-428

Long-term effect of the selective tibial neurotomy for the treatment of the spastic foot evaluated by a patient goal-centered approach

P. Mertens¹, J. Luauté², C. Dauleac¹

¹University hospital of Neurology, Neurosurgery, Lyon, France

²University hospital of Neurology, Neurorehabilitation, Lyon, France

Objective: To evaluate the long-term effectiveness of selective tibial neurotomy (STN) associated with a postoperative rehabilitation program for the treatment of the spastic foot, according to a goal-centered assessment.

Study design: Observational design with retrospective chart review of prospective data.

Methods: Consecutive adult patients with spastic foot, irrespective of the etiology, who benefited from STN, followed systematically with a rehabilitation program, were included in this study. The primary outcome measure was the achievement at 5-year follow-up of individual goals define preoperatively using the Goal Attainment Scaling methodology (T-score). The secondary outcomes measured the modified Ashworth scale (MAS), the walking abilities, and the modified Rankin score (mRS). Assessments were performed preoperatively (T0), at 1-year (T1) and 5-years (T2) follow-up.

Results: A total of 68 STN were performed in 65 patients. At 5-years (T2) follow-up, 83.8% of goals were achieved at least "as expected". The T-score was significantly higher at T1 (62.2 ± 10.9) and T2 (58.3 ± 10.2) than T0 (37.7 ± 2.8, p < 0.00001); and wasnot significantly different between T1 and T2 (p = 0.06). Compared to T0, at T1 and T2, deformities (equinus, varus, and claw toes, p < 0.0001), MAS (p < 0.0001), walking distance (p < 0.0001), and mRS (p < 0.0001) were significantly improved. Compared to T1, at T2, only MAS increased slightly but remained below the preop value (p = 0.02). There was no difference between T1 and T2 about others parameters (motor strength of the targeted muscles, walking abilities, mRS).

Conclusion: This study showed that combination of STN and rehabilitation program are able to successfully achieve the sustainability of personal goals expressed most of the patients suffering from spastic foot.

P-429

An innovative approach to treating spastic and contractures shoulder: combining percutaneous cryoneurolysis and percutaneous needle tenotomy. A case series

P. Winston^1,2, L. Schatz¹, S. Herzog¹, A. Speirs¹, M. Hashemi¹, R. David^3,4

¹Vancouver Island Health Authority, Physical Therapy and Rehabilitation, Victoria, Canada

²Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, Canada

³University of Poitiers, Médecine Physique et de Réadaptation - CHU Poitiers, Poitiers, France

⁴PRISMATICS Lab, CHU de Poitiers, Poitiers, France

Background: The management of the spastic shoulder has undergone advancements thanks to innovative microinvasive therapies such as percutaneous cryoneurolysis to address muscle spasticity. Percutaneous tenotomy has emerged as a promising technique for addressing musculotendinous retraction (contracture). Both must be addressed for functional limitations and pain associated with the spastic shoulder.

Objectives: To address adduction and internal rotation of the shoulder, common presentations in post-stroke patients, often caused by spasticity and musculotendinous retraction leading to contracture of the pectoralis major and minor muscles after an optimal management of spasticity muscles.

Method: Severe refractory shoulder spasticity with contracture was treated in seven patients at a single expert rehabilitation center. The treatment approach involved cryoneurolysis to the medial and lateral pectoral nerves to reduce spasticity, followed by a percutaneous needle tenotomy of the pectoralis major tendon if musculotendinous retraction remained.

Results: Following each step of the procedures, there was an immediate improvement in shoulder forward flexion, abduction, and external rotation. These positive outcomes translated to an increased level of independence and an overall improvement in the patients’ quality of life after the procedure.

Conclusion: The combined neuro-orthopedic procedure of percutaneous cryoneurolysis and tenotomy demonstrates promise as a management strategy for patients experiencing shoulder spasticity with contracture. Further research and validation of this treatment approach may establish it as a valuable option for individuals with refractory shoulder spasticity and contracture.

Reference

Scobie J, Winston P. Case Report: Perspective of a Caregiver on Functional Outcomes Following Bilateral Lateral Pectoral Nerve Cryoneurotomy to Treat Spasticity in a Pediatric Patient With Cerebral Palsy. Front Rehabil Sci. 2021;2:719054.

P-430

Spasticity interventions in cerebral palsy for people with and without intellectual disabilities – a comparative analysis

R. Palanichamy ^1,2

¹Powys Teaching Health Board, Therapy, Brecon, United Kingdom

²Swansea University, Health Science, Swansea, United Kingdom

Purpose: The main purpose for this narrative literature review is to analyse and describe the best available evidence for spasticity intervention in Cerebral Palsy for people with Intellectual Disabilities and provide the clinicians an overview of how the evidence could be used to inform decision-making, compare and choose the appropriate intervention in this population. This would be comprehensive resource for practitioners in the field of neuro-rehabilitation for evidence implementation of these interventions. This review also assisted in identifying the gaps in evidence and to discover new research areas.

Methods: A critical review of research literature published in English language from 1994 to 2014 was conducted. The Studies were critically appraised and comparatively analysed in cerebral palsy population. In this narrative review AACPDM (American Academy of Cerebral Palsy and Developmental Medicine) methodology was followed to present the evidence in an organised fashion. The reviewer has analysed the collected data and synthesized all the information based on the outcome measures in the studies using a hierarchy of research design rigour.

Results: There are extensive researches highlighting the needs for people with intellectual disabilities however there are barriers while applying in clinical practice as the quality of evidences for spasticity interventions are low and the complications are high. The findings offer deeper insight into the spasticity and its associated problems and the role of multidisciplinary team members while planning the treatment goals. Further research work is indicated in this population to improve the quality of life

1. Spasticity in People with Intellectual disabilities are under-recognised and undertreated, particularly amongst those with severe and profound intellectual disabilities.

2. The use of BTX-A injections and ITB has shown positive outcome even in participants who had a very long-standing spasticity and are wheelchair dependent.

P-431

Multisite treatment in upper and lower limb with percutaneous cryoneurolysis for hemiplegia in long standing refractory post stroke spasticity

R. David^1,2, M. Hashemi³, L. Schatz³, P. Winston^3,4

¹University of Poitiers, Médecine Physique et de Réadaptation - CHU Poitiers, Poitiers, France

²PRISMATICS Lab, CHU de Poitiers, Poitiers, France

³Vancouver Island Health Authority, Physical Therapy and Rehabilitation, Victoria, Canada

⁴Canadian Advances in Neuro-Orthopedics for Spasticity Consortium, Kingston, Canada

Background: Spasticity is common after stroke. Though termed focal spasticity, it is typically involves multiple sites. Spastic hemiplegia severely impairs functional capability and mobility, impacting activities of daily living and social participation. Percutaneous cryoneurolysis is a novel mini-invasive, treatment that may be beneficial to improve outcomes for multisite focal muscle spasticity.

Objectives: The aim is to demonstrate the feasibility of treating multiple sites affected by spasticity at once in a patient with spastic hemiplegia refractory to conventional treatment.

Method: A non-ambulatory patient, twelve years post stroke, with severe spasticity who was treated with 300-units of onabotulinum toxin every three months was referred for his spasticity that had plateaued with treatment. Diagnostic nerve blocks with 2% lidocaine were performed to select the most responsible muscles contributed to the spastic positioning. He underwent percutaneous cryoneurolysis to: thoracodorsal nerve, intramuscular subscapularis, medial and lateral pectoralis nerves, musculocutaneous nerve branches to biceps brachii and brachialis, median nerve trunk above the elbow and tibial nerve trunk.

Results: The patient demonstrated immediate reduced spasticity, and increased range of motion and functional improvement in his shoulder, elbow, wrist, fingers and ankle. This result improved at the four months follow up: MAS 3 at baseline to 2 at follow-up and joint passive range of motion: shoulder flexion 85° to 130°; shoulder abduction 85° to 130°, elbow extension increased from -50° to -15° of full range; wrist extension 25° to 60°, ankle dorsiflexion -40° to 0°. There were no side effects reported by the patient.

Reference

Winston P. Cryoneurotomy as a Percutaneous Mini-invasive Therapy for the Treatment of the Spastic Limb. Arch Rehabil Res Clin Transl.

Winston P. Analysis of side effects of cryoneurolysis for the treatment of spasticity. Am J Phys Med Rehabil.

P-432

Reduction of lower limbs spasticity after suppression of intravesical noxious stimulus evidenced by gait analysis

S. Ribault¹, C. Oberle¹, H. Ardaillon¹, L. Arsenault¹, J. Gailleton¹, L. Delporte¹, G. Rode¹

¹Lyon Civil Hospitals, Physical Therapy and Rehabilitation, Lyon, France

Background: Spasticity is characterized by a muscle hypertonia due to a velocity-dependent increase in tonic stretch reflexes, mostly related to hyperactive spinal reflexes. After spinal cord injury, the impact of noxious stimuli on autonomic dysreflexia is well documented. It is admitted in clinical practice that sublesional noxious stimuli can also increase spasticity. However, this has never been demonstrated in the litterature.

Objective: to demonstrate the impact of a noxious stimulus (bladder lithiasis) on spasticity of lower limbs in a man with spinal cord injury and the reduction of spasticity after bladder lithotrity and the improvement of gait using quantitative gait analysis.

Method: In this single case study, clinical evaluation was performed on the subject before and after bladder lithiasis removal, by two physiotherapist using ASIA score and the Modified Ashworth scale. Quantitative gait analyses were compared before and 3 months after lithiasis resection.

Results: Regarding gait kinematic, there was a reduction of the right knee recurvatum, and of the double bump of flexion in swing phase. As for the ankle, in the stance phase, the right ankle maximum dorsiflexion increased while in the swing phase, the double bump of ankle dorsiflexion disappeared. Surface electromyography showed a reduction of spasticity in triceps surae, especially in the right gastrocnemius muscle at swing. Treatment of the bladder lithiasis led to a reduction of spasticity in S1 dependent muscles (soleus, gastrocnemius, gluteus maximus muscles). [MOU1] There was no modification of spasticity in muscles depending on higher metamers. These results suggest that lithiasis created a noxious stimulus regarding the S2, S3 and S4 metamers with a diffusion of the spinal reflex to the upper metamer S1. This is the first demonstration of a causal link between an intravesical noxious stimulus and an increase in the subject"s spasticity, through a disinhibited spinal nociceptive reflex.

P-433

Ultrasound image guided injection of botulinum toxin for the management of spasticity: a Delphi study to develop a international scope of practice, competency, and a governance framework

S. Ashford¹, G. Morris², M. Smith³

¹London North West University Healthcare NHS Trust & King’s College London, Regional Hyper-acute Rehabilitation Unit & Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom

²Cardiff University, Health Science, Cardiff, United Kingdom

³Cardiff University, Health Science, Cardiff, United Kingdom

Introduction: Ultrasound guided injection of botulinum toxin for the management of spasticity is increasingly being used in practice, but what constitutes current best practice has not been defined. There is a need to establish a scope of practice, competency and governance.

Objectives: To establish a scope of practice, competency (through education) and governance framework for ultrasound image guided injection of botulinum toxin in the management of spasticity

Materials & methods: A purposively selected multidisciplinary (physicians, physiotherapists, occupational therapists) panel of experts (n=15) were engaged in a Delphi study.

In round 1, open-ended questions were posed relating to (i) potential scope of practice for "ultrasound imaging in spasticity management"; (specifically relating to ultrasound image guided injection of Botulinum Toxin) (ii) education/competency and (iii) governance considerations. In round 2, respondents were asked to rate their level of agreement with the statements generated.

Results: Three different scopes of practice relating to ultrasound imaging in spasticity management were accepted. The primary scope of practice was the use of ultrasound imaging to guide safe and accurate delivery of botulinum toxin. Relating to this primary scope, seven competency requirements were agreed relating to areas including image optimisation and interpretation, needle visualisation and safety. A singular, broad governance statement was generated.

Conclusion: Relating specifically to guided injection of botulinum toxin for management of spasticity, we present a scope of practice, competency, and governance. These are integrating within a framework approach to provide a mechanism for increased patient access to accurate, safe, and effective focal spasticity treatment. The framework supports focused training routes, greater inter-profession communication and wider clinical community engagement in spasticity management using this modality.

P-434

Exercise therapy for the improvement of muscle strength and function of upper extremity in adults with cervical spinal cord injury: a systematic review with network meta-analysis

C. Arienti¹, S. G. Lazzarini¹, S. Negrini², C. Kiekens³

¹IRCCS Carlo Gnocchi Foundation, Cochrane Rehabilitation, Milan, Italy

²University “La Statale”, 2. Department of Biomedical, Surgical and Dental Sciences, Milan, Italy

³IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

Introduction: Many studies evaluated the efficacy of different types of exercise to improve muscle strength and functional limitation of the upper extremity.

Objectives: Consequently, the study aims to evaluate the effects of specific types of exercise treatments on muscle strength and functional limitation of the upper extremity, activities and participation, and quality of life in adults with cervical spinal cord injury.

Materials & methods: We carried out a network meta-analysis. We investigated the following databases: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and CINAHL using the following keywords: "exercise therapy", and "cervical spinal cord injury". We evaluated the risk of bias in included studies and whether the transitivity has been respected. We performed network meta-analysis in a frequentist context by using a random-effects model and accounting for correlations induced by multi-arm studies.

Results: We included 27 RCTs and the findings of our network meta-analysis show that none of the exercise types significantly improved all outcomes. Indirect comparisons of the different types of exercise did not identify any type of exercise which was significantly more effective at improving all outcomes than any other type of exercise.

Conclusion: Our findings suggest that there is currently no clear evidence to support selecting specific types of exercise therapy as tools to promote impairment and hand-arm recovery in patients with cervical spinal cord injury. Further, a better methodological quality of the research is needed to improve the quality of evidence to address more strong information for clinical decision-making in the spinal cord injury field.

P-435

The role of the corticospinal pathway in the recovery of voluntary movement with epidural spinal cord stimulation in individuals with chronic, severe spinal cord injury

J. D’Amico^1,2, K. Metz¹, M. Gorassini¹

¹University of Alberta, Edmonton, Canada

²Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Canada

Background: Spinal cord injury (SCI) causes a marked interruption in descending inputs to the spinal cord. Epidural spinal cord stimulation (ES) and task-specific training can facilitate recovery by harnessing the functional capacity of circuits below the lesion. It remains unclear whether this recovery is mediated through residual corticospinal inputs.

Objective: Examine whether the recovery of voluntary movement relies on the presence of effective, residual corticospinal input.

Methods: Thirteen individuals with chronic, motor complete SCI who had previously received an ES implant and undergone ABT were enrolled. Individuals performed a functional neurophysiological assessment (FNPA) to assess the levels of voluntary muscle activity (sEMG) during a series of 3-s lower extremity (LE) tasks (with and without ES). Nine individuals also participated in an assessment of corticospinal connectivity. TMS motor evoked potentials (MEPs) were elicited at rest, during reinforcement maneuvers, and voluntary attempts both in the absence and presence of ES. The rate and magnitude of EMG responses during both assessments are reported and compared between the two conditions.

Results: There was a significant increase in muscle activity during lower extremity motor tasks in the presence of ES (all p < 0.05). Of interest, MEPs were very rarely seen in these same muscles and were quite small and variable when present. MEPs were present in 11± 8% of trials without ES, and 19± 29% of trials with ES. During voluntary contractions, MEP amplitudes were 50 ±36 µV and 129 ± 156 µV, in the absence and presence of ES, respectively. There did not appear to be a correlation between the rate or amplitude of MEPs and the ability to perform voluntary tasks during the FNPA.

Conclusions: ES facilitates voluntary movement in individuals with chronic, severe SCI, however it is likely that subcortical pathways such as the propriospinal or reticulospinal pathways may facilitate some of this recovery.

P-436

Success is a journey: pilot implementation of the Ideal Care Pathway for traumatic spinal cord injury

M. Wiest¹, J. Gargaro¹, C. Coburn², D. Boileau³, D. Taylor⁴, J. Duley⁵, S. Mehta⁶, L. Roach⁷, T. Murray⁷, M. Bayley¹

¹University Health Network, KITE Research Institute, Toronto Rehabilitation Institute, Toronto, Canada

²Home and Community Care Support Services, Ontario, Canada

³Vista Centre Brain Injury Services, Ottawa, Canada

⁴St. Joseph’s Care Group, Thunder Bay, Canada

⁵Hamilton Health Sciences, Hamilton, Canada

⁶Parkwood Institute Research, London, Ontario, Canada

⁷Health Sciences North, Sudbury, Canada

Introduction: In partnership with a diverse group of key partners, the Neurotrauma Care Pathways developed an Ideal Care Pathway for traumatic spinal cord injuries (tSCI). The tSCI Care Pathway addresses known gaps in care related to, for example, unclear expectations during patient journeys, limited access to high-quality primary care and the much-needed lifelong community supports. With the Pathway at hand, it is time to start the journey to address these gaps.

Objective: to describe implementation projects addressing key elements of the tSCI Care Pathway in Ontario, Canada.

Methods: Provincial Working Groups composed of people with lived experience and their families, clinicians, healthcare administrators, community service providers, policymakers and researchers set implementation priorities: education for persons with lived experience and their families, and care coordination and navigation. We identified regional teams to champion the implementation of four projects. Each team received a grant to co-design with persons with lived experience and their families a care map and implementation manual related to the implementation priorities. The projects had to implement an ongoing sustainability plan and evaluation strategies.

Results: The four pilot implementation projects include: 1) a regional remote non-specialized trauma centre re-evaluating patient journeys and optimizing practices; 2) a regional non-specialized rehabilitation hospital improving transition to primary care; 3) a community-based provider facilitating post-traumatic stress disorder training after tSCI; and, 4) translating a successful research project on mental health education into clinical practice.

Conclusion: These implementation projects are initial steps of the journey towards the success of the tSCI Care Pathway. Success will be represented by all Ontarians living with a tSCI and their families receiving equitable care and supports to address their chronic needs over the lifespan.

P-437

Determinants of the practice of adapted sports and physical activity in individuals with spinal cord injury: a 20-year retrospective study

C. M. Lemes ponzo Ribeiro^1,2, A. Alvim², F. Caliman Reis^1,2, E. Stieler², I. L. Bastos Lobo², M. T. de Mello², A. Silva²

¹Sarah Rehabiliation Hospital, Physical Therapy, Belo Horizonte, Brazil

²UFMG - Federal University of Minas Gerais,, Physical and Occupational Therapy, Belo Horizonte, Brazil

Background: Adapted sports are recommended as a tool to improve quality of life, social inclusion and cardiometabolic status, and yet, despite all the benefits, there are difficulties for people with SCI to maintain physical activity after rehabilitation.

Objectives: To investigate the determinants of the practice of adapted sports and physical activity in individuals with spinal cord injury (SCI).

Methods: This was a retrospective cohort study developed at SARAH Network of Rehabilitation Hospitals. Participants were adults with traumatic SCI, aged between 18 and 50 years at the time of the injury, admitted between 2000 and 2020. Medical records were selected from individuals who experienced an adapted sports initiation program during a hospitalization. A semi-structured form was filled out regarding sociodemographic data, as well as information related to health history and sports practice.

Results: The medical records of 1,806 adults with SCI were assessed. After the rehabilitation program, 55.8% of the individuals became physically active and 9.6% became athletes. Female gender was associated with sedentarism(OR: 2.87, CI 1.07-7.73). A background in physical activity (OR:10.26, CI 1.30-80.83), and longer follow-up time of physically active individuals by the rehabilitation team (OR:0. 94, CI 0.84-0.97) increased the chances of theindividual becoming an athlete. A lower number of sports tried in hospitalization (OR:21.6, CI 3.12- 150.71) and in the community (OR:5.07, CI 1.47-17.42) increased the chances of the individual developing a sedentary profile.

Conclusion: The determinants of the practice of physical activity or adapted sport were gender, background in physical activity, follow-up time by the rehabilitation team, and number of sports disciplines tried during hospitalization and in the community.

Keywords: Sports for persons with disabilities; exercise; spinal cord injuries; health.

P-438

A case of spinal cord injury secondary to spontaneous intracranial hypotension

D. Bang ¹

¹Singapore General Hospital, Rehabilitation, Singapore, Singapore

Introduction: Spontaneous intracranial hypotension (SIH) is a rare but well-established syndrome caused by cerebrospinal fluid leak. In severe cases of SIH, subdural hematomas (SDH) may develop but spinal manifestations are rare.

Objectives: To discuss a case of spinal cord injury secondary to SIH and the importance of rehabilitation.

Patients & methods: 47-year-old male with known history of cervical spondylosis presented with orthostatic headache. Glasgow coma scale (GCS) on admission was 15. Computed tomography (CT) of the brain revealed bilateral SDH. Magnetic resonance imaging (MRI) of the brain showed sagging of midbrain, decreased mamillopontine distance and distended dural venous sinuses suggesting underlying intracranial hypotension. He underwent epidural patch with fibrin sealant and bilateral burr hole drainage of SDH to relieve the mass effect.

Results: Post procedure patient"s GCS was E1VTM6. CT myelography showed spinal longitudinal epidural collection confirming dural leak, likely at C5/6 osteophyte level. Patient underwent another epidural patch which was complicated by asystole collapse secondary to neurogenic shock. After resuscitation his GCS recovered to 15, but he had motor deficit in bilateral upper and lower limb weakness (more prominent in upper limbs). MRI of the spine was suspicious of cord infarct from C3-C4 to C7. Besides the clinical picture of central cord syndrome, he had mild cognitive deficits, namely selective attention and working memory. He underwent rehabilitation in an inpatient rehabilitation unit for 5 weeks – focusing on balance and gait training, upper limb strengthening and coordination. At the time of discharge, he was independent in community ambulation and needed minimal assistance in basic activities of daily living.

Conclusion: To our knowledge this is the first case report of central cord syndrome as a rare complication of SIH. Early identification and proper rehabilitation can lead to positive outcomes.

P-439

Adaptive outdoor physical activities for adults with mobility disability: a scoping review

P. Derakhshan¹, W. Miller¹, B. Mortenson¹, A. Bundon², D. Labbé³, T. Bolt⁴

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²University of British Columbia, Kinesiology, Vancouver, Canada

³University of Illinois, Department of Disability and Human Development,, Chicago, IL, United States

⁴RAD Recreational Adaptive Society, Invermere, Canada

Introduction: Outdoor physical activity (PA) contributes to the physical and mental health and well-being of individuals with a mobility impairment. However, individuals are commonly excluded from outdoor PA due to accessibility challenges. No reviews were found on factors that facilitate/hinder participation and inclusion of individuals with mobility disabilities in adaptive outdoor PA. This makes it challenging to establish the key components for implementing inclusive outdoor PA interventions.

Objectives: To identify barriers and facilitators to participation in adaptive outdoor PA and identify suggestions for adaptive outdoor PA design.

Materials & methods: A scoping review of qualitative and quantitative studies was conducted based on the methodological framework of Arksey & O’Malley. Barriers and facilitators were categorized into 4-levels based on a Social Ecological Model (SEM). Suggestions for interventions designed to overcome accessibility issues of outdoor PA were classified based on Universal Design (UD).

Results: Thirty-seven factors regarding barriers and facilitators of outdoor adaptive PA were extracted from 20 studies published between 2002 and 2023. Barriers and facilitators were identified primarily in the SEM’s four levels: intrapersonal, social environmental, physical environmental, and policy-related. Eleven design suggestions were identified and categorized according to the seven principles of UD. Our study identified gaps in the presented barriers and facilitators and the design suggestions of the included studies, mainly at the environmental level, such as a lack of innovation in program delivery and logistics.

Conclusion: Our study identified gaps in knowledge about facilitators and barriers to outdoor adaptive PA and the design of interventions addressing them. Future research should focus on the strategies addressing these gaps by involving individuals with mobility disability in designing interventions to understand their needs better.

P-440

Exploring the effect of functional electrical stimulation (FES) cycling paired with repetitive transcranial magnetic stimulation (rTMS) to improve lower extremity function following incomplete spinal cord injury (iSCI)

F. Ghahremani¹, S. Schabrun¹, S. Peters¹, L. Brunton¹, J. Unger¹

¹University of Western Ontario, Health and Rehabilitation Sciences, London, Ontario, Canada

Introduction: Lower extremity functional impairments are common following motor incomplete Spinal Cord Injuries (iSCI). Functional Electrical Stimulation (FES) cycling and repetitive Transcranial Magnetic Stimulation (rTMS) are non-invasive interventions that have been shown to improve muscle strength and gait parameters in this population. Although studies have investigated the effect of FES cycling or rTMS alone on lower limb function post-SCI, to our knowledge, no studies have paired these two interventions.

Objectives: To evaluate the feasibility, safety, adherence rate, and acceptability of pairing FES cycling and rTMS using descriptive statistics. A secondary objective is to examine the effect of FES cycling paired with active rTMS on lower limb function including gait speed, muscle strength, and balance compared with FES cycling alone (sham rTMS).

Methods: This is a double-blind pilot randomized controlled trial consisting of 12 sessions over six weeks with four assessment sessions. Several measures related to lower extremity function will be evaluated throughout the assessment sessions including walking speed, muscle strength, postural sway, timed up-and-go test, and Walking Index for Spinal Cord Injury (WISCI) II. The sample for this study includes adults with non-progressive iSCI who are at least one year post-injury and able to walk for 10 metres without the help of another person.

Results: The data collection for this study is currently ongoing; preliminary findings suggest that pairing rTMS and FES cycling is feasible, acceptable, and safe in people with iSCI and lower extremity functions including gait speed, muscle strength, balance, and functional tests may be improved.

Conclusions: This pilot study demonstrates preliminary feasibility for conducting a larger trial to investigate the effectiveness of the combined use of FES cycling and rTMS to enhance lower extremity function following iSCI.

P-441

Experiences and perceptions of yoga from people with spinal cord injury, yoga therapists and clinicians

H. Prajapati¹, B. Mortenson¹, K. Best², W. Miller¹

¹University of British Columbia, Rehabilitation, Vancouver, Canada

²Université Laval, Rehabilitation, Québec, Canada

Introduction: Yoga offers a promising approach to facilitate mind-body integration. While evidence supports the benefits of yoga for various neurological conditions, research in spinal cord injury (SCI) is limited. Understanding the barriers, values, and anticipated outcomes associated with yoga for people with SCI may facilitate uptake of yoga.

Objectives: To explore experiences and perceptions of yoga among people with SCI, yoga therapists and clinicians.

Methods: Interpretive description methodology was used, and in-depth semi-structured interviews were conducted using zoom. People with SCI were 18 years and older, living in the community, and had traumatic SCI. Yoga therapists were certified instructors and clinicians (physiotherapists, occupational therapists) had more than 5 years of experience in SCI populations. Interviews were recorded and transcribed verbatim. Data were analyzed thematically.

Result: 8 individuals with SCI (median age 60 years), 5 yoga therapists (50 years), and 4 SCI clinicians (40 years) were interviewed. Preliminary analysis resulted in 4 themes: Physical, mental, and social benefits; Accessibility challenges and need for adapted programs; Importance of adaptions and props, and Appropriate delivery methods. Most people with SCI favoured virtual delivery, while yoga instructors and clinicians preferred in-person sessions, especially during the initial customization of the yoga intervention.

Conclusion: Our result suggest the potential of yoga as a valuable resource for individuals with SCI, offering overall health benefits. However, addressing the challenges related to access and meeting the needs for program delivery were identified as crucial steps to facilitating the uptake of yoga by people with SCI. Thus, the heterogeneity of people with SCI requires yoga to be tailored to meet their unique needs and preferences. This likely requires hybrid options for yoga delivery (in person, virtual, combination) and technique adaptations.

P-442

Comparison of the energetic and physiologic impact of seated vs standing active arm passive leg exercise for people with spinal cord injuries

J. Mattie¹, J. Laskin², J. Borisoff^1,3

¹BCIT, Applied Research, MAKE+, Burnaby, Canada

²University of British Columbia, Medicine, Faculty of Occupational Science and Occupational Therapy, Vancouver, Canada

³International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada

Introduction: The NuStep™ is a seated Active Arm Passive Leg Exercise (AAPLE) cardiovascular exercise machine for people with spinal cord injuries (SCI). Motivated by research showing benefits of standing in SCI (e.g., for secondary conditions), we developed a standing AAPLE machine - the AAPLEwalk. This elliptical-like exercise device raises users from sitting and allows arm-driven walking-like motions while the user is fully supported in standing. We anticipate this machine could provide benefits to cardiovascular fitness and elicit lower limb muscle activity.

Objective: This study aims to assess the energetic and physiologic impact of the AAPLEwalk"s standing elliptical type action compared to the sitting stepping motion of the NuStep.

Patients & methods: Eight individuals with ASIA A SCI below C6 will be recruited to attend 4 sessions. In Session 1, users will be set up on the AAPLEwalk, and low and medium workload intensities established. In Sessions 2 and 3, participants will exercise on one of the machines (order randomized, workloads matched). Ventilatory and pulmonary gas exchange indices will be measured while participants exercise at both workloads (data collected for 4-5 min/workload). Heart rate will be continuously measured. Participants will complete the Borg scale to assess perceived exertion. Session 4 (completed only by a subset), will explore motor unit activation/ recruitment of lower limb muscles during exercise. Participants will be instrumented with EMG surface electrodes and lower limb EMG data will be collected as participants exercise on each machine at both workloads.

Results: Three people have completed the study. Further data collection is underway. We anticipate that AAPLEwalk will provide a superior exercise experience as compared to the widely used NuStep.

Conclusion: Findings from this pilot study will inform future physiological research and may contribute to improving rehabilitation and exercise among people with SCI.

P-444

Quntifying pelvic floor muscle function and rehabilitation effect using transvaginal near infrared spectroscopy

L. Stothers¹, A. Macnab¹

¹University of British Columbia, Vancouver, Canada

Introduction: Rehabilitation of the pelvic floor muscles (PFM) in women with partial spinal cord injury (SCI) lacks physiologic measures to quantity improvement. In elite athletes, a non-invasive optical technology, ear infrared spectroscopy (NIRS) is used to optimize muscle training.

Objectives: To develop a transvaginal NIRS interface and define a NIRS-derived absolute measure applicable to quantifying PFM rehabilitation exercise treatment effect.

Materials & methods: A circumferential grid of light emitting diodes and photodiode detectors was designed. Placed in the vagina during PMF rehabilitation exercise, the NIRS system monitors changes in oxy and deoxy-hemoglobin concentration (O2Hb/HHb) in real time at multiple points in the PFM before, during and after sustained maximal voluntary contractiion (SMVC).

Results: From O2Hb/HHb data sets obtained in N=14 subjects, the slope of recover of PFM reoxygenation after SMVC was identified. This parameter, used in sports medicine, reflects muscle oxygen kinetics (’fitness’). hence, in rehabilitatiion, where the slope of recovery shortens over time, improved PFM physiologic function can be identifiedm and rehabilitation treatment effect quantified.

Conclusion: PFM monitoring using a transvaginal NIRS interface is feasible. NIRS data allow quantification of PFM oxygen kinetics; applying a measure validated in sports science (reoxygenation recovery time after SMVC) will allow more objective evaluation of PFM dysfunction in patients with partial SCI, and offers an absolute meausre of the training effect of rehabilitation exercise regimens.

P-445

Using heart rate variability to predict autonomic dysreflexia triggered by bladder distention

M. Calderón-Juárez^1,2, T. Miller^1,2, S. Samejima^1,3,2, C. Shackleton^1,2, R. N. Malik^1,2, R. Sachdeva^1,2, T. W. Dorey⁴, A. Krassioukov^1,2,5

¹University of British Columbia, Physical Therapy and Rehabilitation, Vancouver, Canada

²University of British Columbia, International Collaboration on Repair Discoveries, Faculty of Medicine, Vancouver, Canada

³University of Washington, Rehabilitation, Seattle, WA, United States

⁴University of Calgary, Medicine, Calgary, Canada

⁵Vancouver Coastal Health, GF Strong Rehabilitation Centre, Vancouver, Canada

Spinal cord injury (SCI) can lead to autonomic dysreflexia (AD). This condition is characterized by sudden episodes of high systolic blood pressure (≥20 mmHg above baseline), often triggered by bladder distension. Individuals with sensory-complete SCI may not sense their bladder fullness until AD occurs, leading to severe complications. Predicting AD episodes is crucial to create preventative interventions, but predicting AD episodes has proven challenging due to their sudden and imperceptible nature. Heart rate variability (HRV) is a noninvasive tool that measures the beat-to-beat autonomic control of the cardiovascular system. This study aims to develop an algorithm for AD prediction by monitoring HRV changes during urodynamics (UDS) when bladder distention occurs.

We included 24 participants with chronic motor-sensory complete SCI above T6 that underwent UDS, while monitoring their blood pressure and heart rate using high-resolution electrocardiography (ECG). HRV metrics, such as the standard deviation of normal-to-normal heart cycles (SDNN), were calculated in 60-second windows from the start to finish of UDS. The maximal sympathetic stimulation moment (SDNN nadir) was used to predict AD events through receiver operating characteristic (ROC) curve analysis.

Results showed a gradual decrease in SDNN preceding AD events (31.1±15.9 ms) compared to the start of UDS (44.5±23.2 ms, p<0.05). During AD, there was a significant increase in SDNN (66.7±37.9 ms). Using the SDNN nadir, AD events were predicted within an average of 3.4 minutes before blood pressure zenith (sensitivity=66.7%, specificity=87.5%, area under the curve=81.1%, SDNN threshold≤39.46 ms).

This pioneering study employs HRV to predict AD episodes, offering significant clinical implications. The algorithm can be integrated into wearable devices for real-time prediction. Moreover, it can complement interventions, such as transcutaneous spinal cord stimulation, to prevent AD.

P-447

Autonomic dysreflexia exacerbates bone loss after spinal cord injury in rats

N. Liu¹, G. Cui¹, H. Xing¹

¹Peking University Third Hospital, Rehabilitation, Beijing, China

Introduction: Rapid and extensive bone loss was found after spinal cord injury (SCI). Various mechanisms are involved in the progress of abnormal bone metabolism after spinal cord injury, including changes in mechanical stress, lack of sunshine exposure, etc. The possible influence of the changed sympathetic activity on bone structure after spinal cord injury still remains uncertain.

Objectives: This study aims to investigate the effect of autonomic dysreflexia (AD) on the bone metabolism after spinal cord injury.

Materials & methods: 34 adult male Sprague-Dawley rats were randomized to receive (A) SHAM surgery (T3 laminectomy), (B) SCI (T3 transection), or (C) SCI+AD (T3 transection + AD induction). systolic blood pressure (SBP) and heart rate (HR) were recorded every week. Micro-CT analysis, TRAP staining and detection of NE, OCN, CTX-I, RANKL/OPG were performed at 6 weeks.

Results: At 6 weeks post injury, systolic blood pressure (SBP) and NE expression were significantly increased in SCI+AD group compared with SHAM group and SCI group. Micro-CT scanning showed that the volume of cancellous bone and the thickness of trabecular bone in fourth lumbar vertebral body and proximal femur of SCI+AD rats significantly decreased compared to SCI group. HE staining showed that bone mass significantly decreased in SCI+AD group compared with SCI group. TRAP staining showed increased number of osteoclasts (p=0.0035), CTX-I activity in peripheral blood was significantly increased in the SCI+AD group (p=0.0046), while RANKL expression was found significantly increased in distal femur and lumbar vertebrae after SCI, and further increase in SCI+AD group at distal femur.

Conclusion: We conclude that abnormal sympathetic activity plays an important role in bone remodeling after spinal cord injury. Increased sympathetic activity related to autonomic dysreflexia may exacerbate bone resorption, leading to extensive bone loss and development of osteoporosis.

P-448

Impact of autonomic severity of spinal cord injury on the hypoxic ventilatory response

R. H. Y. Lee^1,2, J. A. Inskip^1,2, R. H. J. Ravensbergen^1,2, L. J. Rietchel¹, S. M. O’Connor¹, V. Claydon^1,2

¹Simon Fraser University, Biomedical Physiology and Kinesiology, Burnaby, Canada

²International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada

The neurological consequences of spinal cord injury (SCI) are extensive, and predispose to sleep apnea with recurrent hypoxic exposure. While respiratory muscle paralysis may impair responses to hypoxia, the additive impact of injury to autonomic pathways on responses to hypoxia is unclear.

We characterised the hypoxic ventilatory response (HVR; rise in minute ventilation [VE] per % decrease in blood oxygen saturation [SpO₂]) and decline (HVD; rate of diminishing VE_max response following HVR) in people with SCI, considering autonomic completeness of SCI.

We tested individuals with SCI (autonomically-complete n=7, 37±14yrs; autonomically-incomplete n=8, 39±10yrs) and healthy controls (n=12, 34±13yrs). Autonomic completeness was defined by lesion level (>T7), low frequency systolic arterial pressure variability (LFSAP; <1mmHg²), and plasma noradrenaline (<0.56nM). Participants underwent isocapnic hypoxic (P_ETCO₂≅42mmHg, P_ETO₂=50mmHg) end-tidal forcing for 10 minutes with continuous measurement of SpO₂, tidal volume (V_T), and respiratory frequency (RF). HVR was determined until VE_max, and HVD from VE_max to 10min.

All groups desaturated similarly (85.2±2.8%; p=0.56) at the time of VE_max (180±68s; p=0.21). HVR was lower in autonomically-complete SCI than control (0.33±0.17L/min/% vs 0.88±0.56L/min/%; p=0.03). VE_max was correlated with LF SAP (R=0.43, p=0.03) but not lesion level, and lower in autonomically-complete SCI than control (12.7±3.6L/min vs 22.4±8.5L/min; p=0.04), driven by a smaller V_T (0.86±0.27L vs 1.28±0.36L; p=0.05) rather than lower RF (15±6bpm vs 17±4bpm; p=0.37). Those with autonomically-incomplete SCI produced a similar HVR (0.71±0.70L/min/%; p=0.54) and VE_max (17.6±8.4L/min; p=0.33) as controls. HVD was similar between all groups (p=0.74).

The autonomic contribution to the blunted HVR may reflect altered chemoreceptor responses, and/or habituation to sleep apnea. Assessing autonomic injury with respiration during SCI rehabilitation is paramount.

P-449

Cure in the context of communicating progress in spinal cord injury research in traditional news and social media

S. Malhas¹, T. Barretto¹, S. Go¹, J. Yim¹, J. Illes¹

¹University of British Columbia, Medicine, Vancouver, Canada

Introduction: Traditional news and social media play a key role in communicating biomedical research in neurorehabilitation to both healthcare providers and the communities they serve. Prior research on spinal cord injury (SCI) specifically reveals a disconnect between scientific advances and discourse around them, which has both medical and ethical implications.

Objectives: This study examines the use of the highly laden word cure as it pertains to reporting research on SCI. We compare traditional news uses of the term with community discourse on social media for accuracy and authenticity in portraying novel interventions.

Methods: English language media articles from 2012 to 2022 on SCI were retrieved via NexisUni, Factiva, and Canadian Newsstream spanning five countries. Articles were excluded if the primary focus was not SCI-related research. We applied a rich coding analytic strategy to the subset of articles referencing cure to identify emergent themes. A cross-sectional analysis of posts on the content aggregator Reddit examines discourse among users with lived experience.

Results: Cure appears in three main contexts in traditional news reporting (N=51/272 total n articles): use of the term, users, and barriers to finding one. In 86% (44/51) of articles analyzed, the word cure is contextualized as a possibility; in 47% (24/51) cure is used specifically by researchers; and, in 43% (22/51), cure is used by article"s author. In 94% (48/51) of articles discussing a barrier to finding a cure, 71% (34/48) reference research barriers regarding strength of scientific evidence or animal-human translation. The Reddit analysis is underway.

Conclusion: The data suggest that references to cure for SCI, while apparent, are cautiously contextualized in news reporting. Appropriate communication of progress is essential for the discourse that follows, as well as the ongoing management of expectations, hope, and trust of affected individuals for rehabilitation outcomes.

P-450

Life-changing diagnosis: patients’ perspective on the prognosis disclosure of SCI

S. Salizzato¹, E. Zanin¹, F. Flaminio¹, M. Spinelli², L. Simoncini³, P. Pauletto^1,4, S. Masiero⁴, H. Cerrel Bazo^1,4

¹ORAS Regional HUB Spinal Cord Injury/Brain Injury Center, Motta di Livenza, Italy

²Spinal Unit-NeuroUrology Center, Niguarda Hospital-University Milano Bicocca, Milano, Italy,, Milan, Italy

³Montecatone Rehabilitation Institute, Montecatone, Italy

⁴University of Padua, PM&R Department & Medical School, Padua, Italy

Introduction: While the matter of prognosis disclosure in life-limiting diagnoses (oncology/terminal pathologies), known as "bad news", has been well documented, life-changing diagnosis, like Spinal Cord Injury (SCI), with apparent more certainty about the outcomes that should make prognosis communication easier, unfolds unexpected challenges. In particular, the complexity associated to different SCI aspects demands the professionals to consider various aspects during prognosis communication. So far, a gold standard for the disclosure of the SCI prognosis is not available, often neglecting what the patients need to know and understand about the prognosis.

Objectives: The aim of this study was to explore how SCI persons may perceived differently the prognosis communication after they received.

Materials & methods: SCI patients were assessed for demographic and clinical variables, AIS-ISNCSCI, CIRS, Barthel Index, SCIM, depression and coping abilities. They were asked to complete a structured questionnaire investigating different aspects interrelated with the prognosis communication: the role of the setting, knowledge transmission, emotional perception, clinical factors associated to SCI. The questionnaire was administered the same day of prognosis disclosure.

Results: Differences were found according to clinical conditions and psychological variables of SCI patients. Realistic goals and expectations differ upon SCI patients and depend on how much knowledge they have acquired and on the outcome expectations explained during the prognosis communication. Specific needs might vary according to neurophysiological/neuropathological features of SCI.

Conclusion: Following our results, during the disclosure professionals must deal with the common aspects associated with a good communication prognosis, but also they must consider specific features of SCI more in depth according to the single patient, thus promoting a new understanding of his/her new life-changing condition.

P-451

Risk of fracture among patients with spinal cord injury: a nationwide cohort study in South Korea

S. Kim¹, B. Kim², K. D. Han², J. Park¹, J. E. Yoo^3,4, H. L. Choi⁵, W. H. Chang¹, I. Y. Cho¹, D. W. Shin¹

¹Samsung Medical Center, Seoul, South Korea

²Soongsil University, Seoul, South Korea

³Healthcare System Gangnam Center, Seoul, South Korea

⁴Seoul National University College of Medicine, Seoul, South Korea

⁵Severance Hospital, Seoul, South Korea

Objectives: Clinical concerns about preventing and managing fractures after spinal cord injury (SCI) have been growing. This study investigates the risk of fractures among SCI patients according to the presence of disability, disease severity, and level of injury.

Methods: We performed a retrospective cohort study using the Korean National Health Insurance Service (KNHIS 2010–2018) database. We included 5,190 SCI patients and 1:3 age- and sex-matched control participants. The primary outcome was fracture, and the cohort was followed until December 31, 2019.

Results: SCI patients had a higher fracture risk than the matched controls (adjusted hazard ratio [aHR] 1.33, 95% CI 1.16–1.54). The risk of fracture was higher in the presence of disability (aHR 1.57, 95% CI 1.19–2.07), especially among patients with severe disability (aHR 1.65, 95% CI 1.05–2.60). Higher fracture risks were observed among SCI patients regardless of injury level, but statistical significance was found only with cervical-level injury (aHR 1.74, 95% CI 1.29–2.34 (cervical SCI with disability), aHR 1.26, 95% CI 1.05–1.50 (cervical SCI without disability)). When we considered site-specific fractures, vertebral (aHR 1.31, 95% CI 1.04–1.64) and hip fracture risks (aHR 2.04, 95% CI 1.39–2.98) were both higher among SCI patients than the controls. SCI patients with disability and cervical-level injury showed the highest hip fracture risk (aHR 3.67, 95% CI 1.90–7.07).

Conclusion: Compared with the controls, SCI patients were at higher risk of any fracture, particularly hip fracture, especially those with disability and cervical-level injury. Clinicians should be aware of the fracture risk among SCI patients to provide proper management.

P-452

Unmet healthcare needs in spinal cord injury: an Australian cross-sectional study

T. Geraghty^1,2, B. Samantha¹, M. Aurora^3,4, R. Marshall^5,6, A. Nunn⁷, J. Middleton^3,4

¹Griffith University, Hopkins Centre, Brisbane, Australia

²Princess Alexandra Hospital, Rehabilitation, Brisbane, Australia

³University of Sydney, Sydney, Australia

⁴John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia

⁵South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, Australia

⁶University of Adelaide, Health Science, Adelaide, Australia

⁷Victorian Spinal Cord Service, Austin Health, Melbourne, Australia

Introduction: Appropriate and timely lifelong access to healthcare services following spinal cord injury (SCI) is critical to prevent complications and maintain quality of life. Yet, unmet healthcare needs following SCI are common.

Objectives: This study aimed to describe health service use, unmet care needs and satisfaction with health services in the previous 12 months; and explore the association between unmet healthcare needs and health service use.

Patients & methods: Analysis of cross-sectional survey data for 1,579 Australians, who were aged >18 years, at least 1-year post-injury and living in the community. Bayesian penalized regression was used to model six binary outcomes: unmet healthcare needs and the use of hospitals, general practitioners (GPs), allied health practitioners and rehabilitation and other medical specialists.

Results: Participants were mostly male (73%) with a median SCI duration of 13 years. Unmet needs were reported by 17%. Service costs (30%), inadequate provider skills (19%) and service unavailability (19%) were the most common reasons for unmet needs. There was evidence of an effect for provider experiences on unmet healthcare needs, but no evidence that unmet healthcare needs had an effect on the use of GPs, allied health practitioners, and rehabilitation or other medical specialists. GPs were accessed most often (80%), with some allied health practitioners among the least accessed (psychology accessed by 12% and dietitians by 10%). Satisfaction with GP services (81%) was higher than that for specialist SCI services (67%) and local hospitals (62%).

Conclusions: One in five reported unmet healthcare needs in the context of high healthcare use. Levels of access appear high but collectively, suggest low utilisation of important health services. Increased primary and specialist shared care responsibility and greater utilisation of telehealth modalities are needed to improve health access for people with SCI.

P-453

Dysreflexic dilemma: do we need a revised definition for autonomic dysreflexia?

V. E. Lucci¹, E. Sober-Williams¹, C. McBride², R. Willms³, R. Solinsky⁴, C. Mathias⁵, V. Claydon¹

¹Simon Fraser University, Biomedical Physiology and Kinesiology, Burnaby, Canada

²Spinal Cord Injury British Columbia, Vancouver, Canada

³GF Strong Rehabilitation Centre, Vancouver, Canada

⁴Mayo Clinic, Physical Therapy and Rehabilitation, Rochester, MN, United States

⁵University College London, London, United Kingdom

Neurological injury following spinal cord injury (SCI) is associated with autonomic dysreflexia (AD), a condition unique to individuals with high-level (≥T6) SCI affecting autonomic pathways. AD is defined as a rise in systolic arterial pressure (SAP) of >20mmHg in response to sensory stimuli below injury level. This definition provides a simple, inexpensive, accessible clinical tool for use during rehabilitation and return to the community.

Mitigating AD is a key priority for improving quality of life after SCI, and AD is associated with significant morbidity and mortality. The exact cause of AD-related harm is unknown, and may not be reflected in the current diagnostic criteria. Using a partnered approach, we provide commentary on the benefits and limitations of the current definition for AD and propose considerations for future research.

A SAP increase of 20mmHg is relatively small and likely well-tolerated, especially given the high prevalence of resting hypotension after SCI. Accordingly, additional criteria for AD, including a higher SAP criterion, or incorporation of AD duration, magnitude, and concurrent heart rate (HR) responses have been proposed. Given the pathophysiology of AD, bradycardia during suspected AD may discriminate AD from physiological responses (such as stress, exercise, or discomfort) where increased blood pressure is accompanied by unchanged or increased HR. Consideration of associated symptoms may also be helpful, but is complicated by "silent" AD where the absence of symptoms may not imply the absence of AD, or convey a reduction in risk.

The current definition of AD is a simple tool that can readily be adopted for clinical and research use. However, potential misidentification of AD contributes to a mixed body of research and clinical uncertainty. Additional consideration is needed to determine whether alternate quantification would increase sensitivity and specificity to detect AD, or improve prediction of risks associated with AD.

P-454

Activation of the pelvic floor muscles during Lokomat- and Ekso-assisted walking in controls and people with motor-complete spinal cord injury

X. Zhou^1,2, A. Williams^1,2, J. Kramer^2,3, J. S. Blouin¹, T. Lam^1,2

¹University of British Columbia, Kinesiology, Vancouver, Canada

²Vancouver Coastal Health, International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada

³University of British Columbia, Anesthesiology, Pharmacology, and Therapeutics, Vancouver, Canada

Introduction: The pelvic floor muscles (PFM) are crucial for maintaining continence and a potential therapeutic target for bladder management after spinal cord injury (SCI). They can be co-activated with trunk and gluteal muscles, and are active during regular walking in able-bodied controls. There is some evidence that locomotor training could improve bladder outcomes in people with motor-complete SCI (mcSCI), but it remains unclear if the PFM contribute to such improvements. Current exoskeletons available for SCI rehabilitation require varying levels of trunk control (e.g., the Ekso vs. Lokomat), thus offering opportunities to assess the engagement of the PFM during locomotion in people with mcSCI.

Objectives: To (1) characterize PFM activation patterns with respect to exoskeleton device (Lokomat vs. Ekso), locomotion speed, pelvis acceleration, and synergistic muscle activity in controls; (2) explore the presence of PFM activity during exoskeleton-assisted walking in people with mcSCI.

Patients & methods: Eleven able-bodied adults and 3 mcSCI participants enrolled in this cross-sectional study. We recorded electromyography (EMG) from the PFM and lower back, abdominal, gluteal, and leg muscles, as well as pelvis acceleration, during walking in the Lokomat and Ekso at slow (1 km/h) and fast (1.3-2.2 km/h) speeds.

Results: In controls, PFM activity was 53% and 63% higher during walking in the Ekso than Lokomat at slow and fast speeds, respectively. The higher PFM EMG amplitude was associated with greater pelvis acceleration and trunk and gluteal muscle activation. Bursts of PFM activity tended to coincide with the single support period. Despite mcSCI, PFM activity could be elicited during exoskeleton-assisted walking in the SCI participants.

Conclusion: The Ekso is more effective in eliciting PFM activity in controls, likely related to greater synergistic muscle activation. Further investigation is needed to better understand this phenomenon in people with mcSCI.

P-455

Variability and potential mechanisms of altered spinal reflexes after incomplete spinal cord injury as assessed with the soleus H-reflex

Y. Sun^1,2,3, A. Khan⁴, M. Gorassini^4,5, T. Lam^1,2, J. Yang^4,6

¹University of British Columbia, Kinesiology, Vancouver, Canada

²International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada

³University of Victoria, Exercise Sciecne, Physical and Health Education, Victoria, Canada

⁴University of Alberta, Neuroscience and Mental Health Institute, Edmonton, Canada

⁵University of Alberta, Biomedical Engineering, Edmonton, Canada

⁶University of Alberta, Physical Therapy, Edmonton, Canada

Introduction: Spinal cord injury (SCI) often leads to altered spinal reflexes, such as increased clonus at the ankle, and reduced rate-dependent depression (RDD) of the soleus H-reflex. These measures putatively reflect the excitability of the Ia-motoneuronal pathway and likely other unknown pathways. While these measures are often used to assess neural plasticity after interventions, their test-retest reliability in people with SCI remains unclear. Further, the relationship between these measures, which may suggest differences in circuitry, are unknown.

Objectives: To examine: 1) the reliability of the maximal H-reflex and M-wave ratio (HMAX/MMAX), RDD and clonus, and 2) the relationship between these measures in people with and without SCI.

Participants & methods: People with chronic motor incomplete SCI (n=15) were compared with age-matched controls (n=15). HMAX/MMAX ratio was obtained from the H and M recruitment curve. RDD was evoked from a train of 15 stimuli, applied at frequencies of 2, 1, 0.5, and 0.2 Hz. Clonus was measured while participants walked on a treadmill at a self-selected speed for 3 mins. The same tests were repeated on a different day about one week apart. The reliability of each measurement was determined by the Intraclass Correlation Coefficient. Pearson"s correlations between the measures on Day 1, and the relationship of change between days were determined.

Results: Good reliability was seen in controls for all measures, but not RDD for those with SCI. Correlations between the measures on Day 1 were not significant in both groups. The changes of HMAX/MMAX moderately correlated with changes in RDD and clonus in those with SCI.

Conclusion: These H-reflex measures are more variable in people with SCI. Averaging data from two baseline tests is recommended for assessing the neural plasticity before and after intervention. Correlation analysis results suggest pathways beyond the Ia-motoneuron are involved in the different measures.

P-456

Peripheral mechanism of stroke rehabilitation

G. Wan¹, J. Li^2,1

¹Nanjing Medical University, Rehabilitation, Nanjing City, China

²Nanjing Medical University, Rehabilitation, Nanjing City, China

Stroke has a high rate of disability and mortality, and can leave various functional impairments. The goal of rehabilitation for stroke patients is not only to prolong life, but also to improve their quality of life. The rehabilitation mechanism for stroke patients not only focuses on the directly damaged brain tissue, but also includes the nerves, cardiovascular and cerebrovascular system, respiratory system, muscles, bones, metabolism, immune system, and mental health that are not directly damaged. These peripheral mechanisms of stroke rehabilitation should also receive high attention. These mechanisms interact and promote each other, jointly driving the patient’s recovery process. This article reviews the relevant peripheral mechanisms of stroke rehabilitation based on relevant domestic and international literature.

P-457

Comparative analysis of Prism adaptation and mirror therapy in unilateral neglect management following stroke: an experimental study

H. Someshwar¹, N. Surya², J. Someshwar³

¹NMC & BYL Nair Charitable Hospital, Physiotherapy, Mumbai, India

²Bombay Hospital and Medical Research Center, Neurology, Mumbai, India

³Epilepsy Foundation, Mumbai, India

Introduction: Unilateral neglect is a debilitating consequence of stroke, often impeding rehabilitation progress and impacting daily functioning. This experimental study aims to compare the efficacy of two promising interventions, Prism Adaptation and Mirror Therapy, in ameliorating unilateral neglect among stroke survivors.

Methods: A randomized controlled trial was conducted with post-stroke patients exhibiting unilateral neglect. Participants were randomly assigned to either the Prism Adaptation group (n=50) or the Mirror Therapy group (n=50). Standardized assessments including the Behavioral Inattention Test (BIT) and the Catherine Bergego Scale (CBS) were employed to measure neglect severity before and after the intervention.

Results: The study revealed significant improvements in both groups post-intervention (p < 0.05). However, the Prism Adaptation group exhibited a greater reduction in neglect severity as evidenced by a higher mean change in BIT scores (Prism Adaptation: M=14.6, SD=3.2; Mirror Therapy: M=11.2, SD=2.8). Additionally, the CBS scores demonstrated a more pronounced improvement in the Prism Adaptation group (Prism Adaptation: M=8.4, SD=1.9; Mirror Therapy: M=6.1, SD=1.5).

Conclusion: This study provides valuable insights into the comparative efficacy of Prism Adaptation and Mirror Therapy in the management of unilateral neglect following stroke. While both interventions demonstrate effectiveness, Prism Adaptation emerges as a potentially superior option, offering a promising avenue for tailored rehabilitation strategies for individuals grappling with post-stroke neglect. Further research is warranted to explore the long-term benefits and potential synergistic effects of combining these interventions.

P-458

Exploring the significance of family-based rehabilitation: a qualitative study among caregivers of stroke survivors

N. Surya¹, H. Someshwar²

¹Bombay Hospital and Medical Research Center, Neurology, Mumbai, India

²NMC & BYL Nair Charitable Hospital, Physiotherapy, Mumbai, India

Introduction: Stroke not only impacts the survivor but also places a significant burden on their families, who often assume the role of primary caregivers. This qualitative study aims to delve into the experiences and perspectives of caregivers of stroke survivors, specifically focusing on the importance and impact of family-based rehabilitation in the recovery process.

Methods: Semi-structured interviews were conducted with a purposive sample of 18 caregivers of stroke survivors. Participants were recruited from various healthcare facilities and support groups. Thematic analysis was employed to extract recurring themes and insights from the interviews.

Results: The analysis revealed several key themes regarding the importance of family-based rehabilitation. Caregivers emphasized the pivotal role they play in the recovery journey, serving as motivators, advocates, and providers of emotional support. Additionally, the collaborative nature of family-based rehabilitation was highlighted, with caregivers expressing a sense of empowerment and fulfilment through their active involvement in the rehabilitation process.Furthermore, caregivers identified improved communication, enhanced understanding of the survivor’s needs, and the creation of a supportive home environment as integral outcomes of family-based rehabilitation. They also acknowledged the challenges and stressors associated with their caregiving role, underscoring the need for tailored support and resources.

Conclusion: Acknowledging the crucial role of caregivers in the rehabilitation process is essential in developing comprehensive and inclusive rehabilitation programs. Tailoring support and resources to meet the needs of caregivers can lead to more effective and holistic care for stroke survivors and their families. Further research is warranted to explore specific strategies for implementing and enhancing family-based rehabilitation in clinical settings.

P-459

A systematic review of randomized controlled trials of post-stroke upper extremity rehabilitation in low-middle-income and high-income countries and within different regions of high-income countries

S. Mehrabi¹, J. Fleet¹, A. Hernett¹, M. Safaei Qomi¹, R. Teasell¹

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

Introduction: Understanding the variability of interventions in post stroke upper extremity (UE) rehabilitation randomized controlled trials (RCTs), across countries and regions will identify strengths, gaps, discrepancies, and current research directions.

Objective: To systematically review post stroke UE rehabilitation RCTs to identify interventions used in low and middle-income countries (LMICs) compared to high-income countries (HICs) and within the different regions of HICs.

Materials & methods: CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to April 1, 2021. Studies were eligible for inclusion if (1) were RCTs or crossovers in English (2) ≥50% of participants were diagnosed with stroke, 3) included adults ≥18 years old, and (4) applied an intervention to the hemiparetic UE as the primary objective of the study. Countries were divided into HICs and LMICs based of their growth national incomes. The HICs were further divided into 3 regions of North America, Europe, and Asia & Oceania. Data analyses were performed using SPSS (V29.0).

Results: 1,276 RCTs met inclusion criteria. 76 different interventions were identified. Of all, robotics and task specific training (TST) were the top two interventions in all RCTs with a significantly higher rate in HICs than LMICs. While robotics was applied in the three regions of HICs with a comparable rate, 45% of all TST RCTs in HICs were performed in North America. There was a higher percentage of neuromuscular electrical stimulation (NMES) in LMICs, although almost all EMG-triggered NMES were performed in HICs. rTMS and acupuncture were the most commonly studied interventions in LMICs, significantly higher than HICs; within HICs the same two interventions were studied more in Asia & Oceania when compared to Europe and North America.

Conclusions: World-wide interventions for post stroke UE motor rehabilitation are studied in RCTs in different world regions at varying rates.

P-460

A systematic review of female participation in randomized controlled trials of post-stroke upper extremity rehabilitation in low to middle-income countries and high-income countries in different world regions

S. Mehrabi¹, L. Cameron¹, A. Bowman¹, J. Fleet¹, J. Eng², M. Bayley³, R. Teasell¹

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

²University of British Columbia, Physical Therapy, Vancouver, Canada

³University of Toronto, Toronto, Canada

Introduction: It is established that female participation is lower than men in stroke trials. However, less is known about female participation in post stroke rehabilitation randomized controlled trials (RCTs) by countries and regions.

Objective: To systematically assess the percentage of female participants in RCTs of post stroke rehabilitation of upper extremity (UE) motor disorders in low-middle-income (LMICs) and high-income countries (HICs) in different world regions.

Materials & methods: CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to April 1, 2021. Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English (2) ≥50% of participants were diagnosed with stroke, 3) included adults ≥18 years old, and (4) applied an intervention to the hemiparetic UE as the primary objective of the study. Countries were divided into HICs and LMICs based of their growth national incomes. The HICs further divided into 3 regions of North America, Europe, and Asia & Pacific. Data analyses were performed using SPSS (V29.0).

Results: 1,276 RCTs met inclusion criteria. 298 RCTs were in LMICs and 978 were in HICs. The percentage of female participants was significantly higher in HICs (39.5%) than LMICs (36.9%). Comparing the regions in HICs, there was a significant difference between HICs in Europe and LMICs but not North America or HIC Asia/Oceania. The regression analysis showed a small decrease of female participation over time in all countries and regions., with no interaction between the groups.

Conclusions: Sufficient female representation in clinical trials is required for the generalizability of results. There are some small regional differences with a higher percentage of females in Europe, followed by North America, Asia/Oceania and finally LMICs.

P-461

Female enrollment in randomized controlled trials of post stroke lower extremity rehabilitation over 50 years

R. Teasell¹, S. Mehrabi¹, J. Fleet¹, S. Peters², M. Payne¹, R. Viana¹, S. Mehta¹, M. Safaei Qomi¹

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

²Western University, Physical Therapy, London, Ontario, Canada

Introduction: Historically, females have been underrepresented in randomized controlled trials (RCTs) across areas of medical research. Ensuring sufficient inclusion of both sexes in clinical trials evaluating stroke is essential to determining the generalizability of the research.

Objective: To systematically assess the reporting of sex, and the percentage of female participants in RCTs examining interventions for the post-stroke rehabilitation of lower extremity (LE) motor disorders.

Materials & methods: CINAHL, Embase, PubMed, Scopus and Web of Science were searched from 1960 to April 30, 2022. Additional articles were identified using the Evidence-Based Review of Stroke Rehabilitation. Studies were eligible for inclusion if they (1) were RCTs or crossovers published in English (2) ≥50% of participants were diagnosed with stroke, 3) included adults ≥18 years old, and (4) applied an intervention designed to rehabilitate the hemiparetic LE motor disorders as the primary objective of the study. Study characteristics and variables were summarized using standard descriptive statistics. Data analyses were performed using SPSS (V29.0).

Results: 1,296 RCTs met inclusion criteria, and of these, 4.5% did not report results on sex. Females have been underrepresented in stroke RCTs, accounting for 39.4±12.7% of participants, with a small but significant decrease over time. While more than half of RCTs were done in the chronic post stroke phase, female participation was greater in acute and subacute phases than chronic phase (p=0.001, p=0.03 respectively). Female participation was comparable between the groups of RCTs with fair and good qualities (PEDro 4-8) but was lower in the high quality (PEDro>8) RCTs.

Conclusions: Female participants have been underrepresented in post stroke LE rehabilitation RCTs with a slight decline over time. Policies should be taken to encourage researchers to enrol enough of both sexes and to report any sex differences in RCTs.

P-463

The fear of falling between disability and psychology in stroke patients: observational study

M. Filippetti¹, V. Varalta^1,2, E. Evangelista¹, Y. Gallinaro¹, C. Fonte², R. Di Censo¹, M. Treccani¹, A. Picelli^1,2, N. Smania^1,2

¹University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy

²Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy

Introduction: Fear Of Falling (FOF) refers to a psychological condition characterized by insecurity during walking with a high incidence in patients with stroke with a reduction in autonomy and social isolation.

Objectives: Evaluate the possible relationships between FOF and psychological, personological, cognitive, motor and disability aspects in patients with stroke.

Materials & methods: Patients with FAC≥1 were included and patients with concurrent other neurological or orthopedic pathologies interfering with walking ability, presence of dementia, language disorders, visual or auditory such as to preclude the administration of the stairs were excluded. Patients were assessed for the presence of FOF (Falls Efficacy Scale-International, FES-I), anxious and depressive symptoms, social anxiety, cognitive disorders such as attention deficits and executive functions, and motor skills (Berg Balance Scale, BBS) and the level of disability (Barthel Index, BI).

Results: 52 patients (54%) showed a high degree of FOF, 19 moderate (20%) and 25 absent/mild (26%). On the basis of the FES-I score and the risk of falls (absent BBS=56; mild BBS 55-45 without falls; high BBS <45 or BBS between 51 and 45 with associated previous fall) 4 categories of patients were identified: "vigorous" (n=23): low physiological and perceived risk; "anxious" (n=35): low physiological risk and moderate/high perceived risk; "stoic" (n=9): high physiological risk and low perceived risk; "aware" (n=29): high physiological risk and moderate/high perceived risk. None of the groups present anxiety and depression. The "vigorous" group demonstrate the least disability, while the "conscious" the greatest. The "Stoic" group highlight the lowest balance function.

Conclusion: The present study is the first to classify stroke patients by relating FOF to personological traits. This could guide in choosing the most appropriate approach (physiotherapy +/- psychotherapy) from a personalized medicine perspective.

P-464

Gait and Balance Recovery Study (GABARES), a proposal of a new predictive algorithm on stroke recovery: single-centre prospective observational study

M. Filippetti¹, V. Varalta^1,2, A. Righetti¹, R. Di Censo¹, L. Linde¹, N. Mattiuz³, M. Treccani¹, A. Picelli^1,2, N. Smania^1,2

¹University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Verona, Italy

²Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy

³IRCCS Sacro Cuore Don Calabria, Rehabilitation, Negrar, Italy

Introduction: The relevance of the prediction in stroke recovery is crucial.

Objectives: This single-centre prospective observational study aimed to develop a new bedside predictive algorithm on gait and balance recovery of stroke patients.

Materials & methods: Consecutive patients with a radiological diagnosis of first-ever unilaterally ischemic cerebral stroke, a physiological balance and gait ability pre-stroke, and absence of neglect or severe aphasia, were evaluated within the first 2-5 days after stroke (T0) through possible predictive factors (NIHSS, BMI; Trunk Control Test; lower limb muscle strength: ankle dorsiflexion, hip extension and abduction; pallesthesia of the lower limb; thrombolysis). At 1 (T1), 3 (T2) and 6 (T3) months the patients were evaluated with functional outcome measures (Functional Ambulation Category, FAC; Motricity Index, MI; Berg Balance Scale, BBS; Time Up and Go test, TUG; 10-Meter Walking Test, 6MWT; Barthel Index, BI). A Classification and Regression Tree (CART) analysis was performed to predict the gait and balance recovery. Statistical analyses and partitioning for trees generation were conducted in the statistical environment R (version 4.3.1). Classification trees were achieved and visualised using rpart (version 4.1.19) and rpart.plot (version 3.1.1) packages respectively.

Results: Data on 77 patients (36 female and 41 males; median age: 71 years old) were included in a Classification and Regression Tree (CART) analysis. MRC>4 in ankle dorsiflexion, age<76 and pallesthesia at first metatarsal>6 demonstrates, among all predictors investigated, the best recovery rate at T1.

Conclusion: Our data highlight the role of a new predictor, the pallesthesia at first metatarsal, that to the best of our knowledge was never tested before. Being able to have a bedside tool in predicting the balance and gait recovery in patients with stroke from the first days would have a significant impact on neurorehabilitation clinical practice.

P-466

Quantifying movement in moderate intensity multimodal circuit training for stroke individuals

A. F. Silveira¹, M. Feltrin¹, P. Nepomuceno Araujo¹, N. Ribeiro Uliam¹, P. Bettyni Fray¹, A. Quintanilha Brandao¹, C. Fernandes de Aguiar¹, S. R. Sita Junior¹, L. B. Farias¹, T. Aguiar de Oliveira¹, T. L. Russo¹

¹Federal University of Sao Carlos, Physiotherapy, Sao Carlos, Brazil

Background: In post-stroke rehabilitation, repeated functional movements in therapy sessions enhance motor learning, and aerobic exercise improves mobility.

Objective: Quantify repetitions during moderate multimodal circuit training in post-stroke individuals.

Methods: This is a descriptive cross-sectional study conducted in Brazil. Inclusion criteria: individuals ≥40≤80 years old; who had experienced stroke ≥6 months ≤5 years; medical permission to participate; functional ambulation classification ≥3; and who were insufficiently active. The Fugl-Meyer sensory-motor assessment scale was used to assess the level of sensory impairment. Multimodal circuit training was developed based on the main guidelines to increase lower limb strength, balance, and function. A typical training week included the performance of three different circuits (A on Monday, B on Wednesday, and C on Friday). Each circuit had five functional exercises/day. The training occurred 3x/week for 40 minutes/session (intensity set to 40-60% of the heart rate reserve, determined by a maximal exercise test). Exercises were monitored by a digital camera for a week. The statistical analysis was based on minimal, maximum, and mean (standard deviation) by the software SPSS.

Results: Our sample comprised three men (45-62 years old; with time since stroke: 8-31 months). Two used gait aids. Each of them had different categories in sensory-motor assessment (mild, moderate, and severe). For Circuit A the mean movement repetitions was 409±155. The lowest number of repetitions was in the sit-to-stand exercise (140) and the highest was in the sidestep (409). For Circuit B: 228±221 [fast-gait (84) and pill-blocks (372)]. For Circuit C: 349±200 [gait-eighth (38) and put objects from side-to-side (406)].

Conclusion: Multimodal circuit training with moderate intensity may facilitate high numbers of movement repetitions. It is important to note that these results are preliminary and must be interpreted with caution.

P-467

Interventions to change movement behaviors after stroke: a systematic review and meta-analysis

S. Garcia Oliveira¹, J. A. Matos Ribeiro¹, E. S. Moreira Silva¹, N. Ribeiro Uliam¹, A. F. Silveira¹, P. Nepomuceno Araujo¹, A. I. Camargo¹, V. R. Rocha Urruchia¹, S. Lourenco Nogueira¹, T. L. Russo¹

¹Federal University of Sao Carlos, Physiotherapy, Sao Carlos, Brazil

Introduction: Approximately 74.2% of the global burden of stroke is attributable to behavioral factors.

Objective: This systematic review aimed to determine which interventions increase physical activity (PA) and decrease sedentary behavior (SB) based on objective measures of movement behavior in post-stroke individuals.

Methods: The PubMed, EMBASE, Scopus, CINAHL, and Web of Science databases were consulted for articles published up to January 2023. Inclusion criteria: randomized controlled trial designs; post-stroke adult individuals; interventions aimed to increase PA or decrease SB; and used objective measurement instruments. The data extraction was standardized, considering participants and assessments of interest. The risk of bias and quality of evidence of the included studies were assessed.

Results: Twenty-eight studies involving 1855 patients were included. Post-stroke acute/subacute phase: Meta-analyses revealed that exercise interventions combined with behavior change techniques (BCTs) increased both daily steps (standardized mean difference [SMD]=0.65, P=.0002) and time spent on moderate-to-vigorous intensity physical activities (MVPAs) duration of PA (SMD=.68, P=.0004) with moderate-quality evidence. In addition, interventions based only on BCTs increased PA levels with very low-quality evidence (low-intensity physical activity SMD= 0.36, P=.02; MVPA SMD= 0.56, P=.0004) and decreased SB with low-quality evidence (SMD=0.48, P=.03). Post-stroke chronic phase: there is statistical significance in favor of exercise-only interventions in PA frequency (steps/day) with moderate-quality evidence (SMD=0.68, P=.002). In general, the risk of bias in the included studies was low.

Conclusions: In the acute/subacute phase after stroke, the use of BCTs combined with exercise can increase the number of daily steps and time spent on MVPA. In contrast, in the post-stroke chronic phase, exercise-only interventions resulted in a significant increase in daily steps.

P-468

Upper limb rehabilitation in (sub)acute stroke in West African low-income countries: an observational prospective study focusing on dose and content

J. Dembele¹, L. Tedesco Triccas¹, O. Kossi¹, R. Amenzonwe¹, A. Spooren¹

¹Hasselt University, REVAL, Hasselt, Belgium

Introduction: Improving upper limb function should be a core element of stroke rehabilitation to reduce disability and to enable persons to perform meaningful activities. The content and dose of upper limb training, the main components of rehabilitation after a stroke, are not known in low-resource income countries.

Objective: To identify the content and dose of upper limb rehabilitation in early phase poststroke in Burkina Faso and Benin.

Methods & patients: An observational prospective study was conducted in hospitals and rehabilitation centers in Ouagadougou in Burkina Faso and at the University Hospital of Parakou in Benin. Sessions of patients in the acute and subacute phase of stroke were observed for 4 weeks by recording the content and dose of upper limb rehabilitation using a standardized taxonomy of activities form.

Results: Eighty-one patients (Burkina Faso n=59 and Benin n=22) and 35 physiotherapists were observed. The median number of sessions during 4 weeks was 8 with 30 minutes median session length and a median duration of upper limb training of 15 minutes per session. The dose of therapy (number of sessions, session length and upper limb session time) is significantly higher in Benin than in Burkina Faso (P< 0.001). The upper limb training consists on performing pre-functional activities for 85% of the time.

Conclusion: Upper limb rehabilitation in the early phase poststroke in low income countries was focused mainly on pre-functional activities and provided at a low dose. Future research should investigate how higher dose and involving more functional training could be provided in countries such as Burkina Faso and Benin taking into account the importance of improving upper limb in daily activities with the limited resources available.

P-469

Implementation of goal setting in rehabilitation in people with stroke

L. Thijs¹, J. Bergs¹, I. Lamers¹, S. Meyer¹, N. Gijbels¹, H. Meermans¹, M. Van Durme¹, T. Lejeune¹, R. Alaerts¹, R. Lemmens¹, A. Spooren¹

¹Hasselt University, REVAL, Hasselt, Belgium

Introduction: In clinical practice there is an evidence-to-practice gap in post-stroke care where patient-centered goal setting is underutilized. A program theory is crucial to guide goal-setting processes and overcome implementation barriers.

Objectives: to investigate experiences of different stakeholders in the context of implementing goal-setting strategies post-stroke.

Methods & participants: Qualitative study in which healthcare professionals, stroke patients and family members participated in semi-structured focus groups and interviews.

Results: Communication with patients and family members is critical. Challenges include varying family involvement, difficulties in organizing family-patient discussions and differing perceptions of predictive screenings. Issues in transmural care persist, emphasizing the need for standardized transfer documents and procedures. Action plan development faces obstacles related to patient comprehension, timing and time investment, and healthcare professionals’ involvement. Patient experiences reveal high trust in the team, limited goal awareness, varying desires for an active role, and insufficient explanations for prescribed exercises.

Conclusion: This study reveals persistent challenges in communication, transmural care and interdisciplinary collaboration to implement goal-setting in post-stroke care.

P-470

Adrift in space: gaps in assessing proprioception after stroke

D. Kennedy¹, G. Fisher², C. Quel de Oliveira³, A. Rochette⁴, S. Gandevia⁵

¹University of Victoria, Motion and Mobility Rehabilitation Laboratory, School of Exercise Science, Physical and Health Education, Victoria, Canada

²Australian Institute of Health Innovation, Macquarie University, Centre for Healthcare Resilience and Implementation Science, Sydney, Australia

³University of Technology Sydney, Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, Sydney, Australia

⁴University of Montreal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada

⁵University of New South Wales, Neuroscience Research Australia, Sydney, Australia

Introduction: Proprioception is a critical somatosensory impairment to assess in stroke rehabilitation as it provides awareness of the position, movement, and muscular force generated by our bodies so that we can interact with the world. Although clinicians often report to assess proprioception, it is less clear how frequently they do so in practice or the type of assessments they use.

Objectives: We aimed to provide a preliminary description of the frequency and types of proprioception assessments used by clinicians in stroke rehabilitation and clinician knowledge about proprioception.

Materials & methods: We conducted a mixed-methods study with an online survey of Australian physiotherapists and occupational therapists working in stroke rehabilitation. The survey presented a patient case study and asked clinicians to identify impairments and appropriate assessments. Cues of proprioceptive impairment were embedded in the case. Then, we asked questions about knowledge and attitudes toward proprioception. We analyzed qualitative data with a framework analysis and quantitative data with descriptive statistics.

Results: Of 165 survey responses, 58 complete datasets were analyzed. In the patient case, 55% (n=32) of clinicians selected a proprioception assessment as part of their initial clinical assessment, and 36% selected an assessment tool specific to proprioception. Most respondents defined proprioception as the sense of limb or body position (65.5%, n=38; 46.6%, n=27, respectively) and described using either a judgement of passive limb movement (40%, n=23) or a limb position-matching task (53%, n=31). For limb position-matching, 47% (n=27) of respondents reported ’eyeballing’ the match (47%, n=27), and 28% (n=16) reported using an unclear method of measurement.

Conclusion: These data suggest proprioception is likely under-assessed. While most respondents could define proprioception conceptually, their descriptions of assessment methods lacked standardization.

P-471

Revealing the unseen: clinician perceptions on improving spatial neglect assessment for stroke survivors

D. Kennedy¹, G. Fisher², C. Quel de Oliveira³, P. Stubbs³, E. Power⁴, M. Checketts⁵, A. Porter-Armstrong⁶

¹University of Victoria, Motion and Mobility Rehabilitation Laboratory, School of Exercise Science, Physical and Health Education, Victoria, Canada

²Australian Institute of Health Innovation, Macquarie University, Centre for Healthcare Resilience and Implementation Science, Sydney, Australia

³University of Technology Sydney, Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, Sydney, Australia

⁴University of Technology Sydney, Discipline of Speech Pathology, Graduate School of Health, Faculty of Health, Sydney, Australia

⁵University of Manchester, Psychology and Mental Health, Manchester, United Kingdom

⁶Edinburgh Napier University, Department: Healthcare Technology Innovation and Assessment in the School of Health and Social Care, Edinburgh, United Kingdom

Introduction: Spatial neglect is a common neurological disorder after stroke, affecting 30-40% of survivors, and significantly hinders rehabilitation progress and outcomes. Despite multiple assessment tools available, spatial neglect and its diverse impairments may be overlooked and underdiagnosed.

Objectives: This study explored determinants influencing assessment practices, ideal tools, and strategies that influence the clinical assessment and, ultimately, the rehabilitation of spatial neglect.

Materials & methods: Focus groups (n = 8) with 27 allied health professionals attending an online stroke rehabilitation bootcamp identified key factors impacting assessment. A deductive framework analysis of focus group data with the Theoretical Domains Framework (TDF) was used to describe perceived determinants of clinical behaviour. An inductive thematic analysis was used to describe perceptions of an ideal assessment tool and practice change strategies.

Results: Using the TDF, we found that several domains shaped clinical behaviour. Participants acknowledged that better assessment of spatial neglect could improve functional outcomes. However, limited knowledge of neglect and how best to assess it was a consistent issue, which resulted in the infrequent use of standardized tools. Occupational therapists were viewed as the profession most likely to assess neglect, although there was recognition that a multidisciplinary approach may allow for more opportunities to assess patients and better distribute workload. Open-access online education incorporating live skills practice was proposed necessary to change behaviours.

Conclusion: Our findings suggest that multidisciplinary training and practice-change strategies are key to enhancing neglect assessment using standardized tools. Targeting knowledge gaps and offering opportunities for skills development through team-based learning may increase assessment rates and improve outcomes for stroke survivors with spatial neglect.

P-472

Effect of a sensorimotor exercise regime for upper limb deficits in the in-hospital phase after a supratentorial stroke (SMULS)

D. Gandhi¹, N. Chawla², S. Zarreen¹, P. Vijayanand¹

¹Christian Medical College & Hospital, Neurology & Physiotherapy, Ludhiana, India

²MAHE, Manipal, India

Background: Somatosensory impairments in the upper limb are a common occurrence in >50% of post stroke individuals. Although deficits of different somatosensory modalities have varied prevalence rates, it is important to note that, patients encounter an impairment in >1 modality post stroke. Somatosensory function plays an important role in all stages of movement production. Integration of several sensory inputs has a significant role in motor performance. The effects of a combined sensorimotor therapy program on improving functional outcomes have not been studied extensively. A recent study by Bruyn et al reported that sensorimotor therapy may not improve somatosensory function.9 However, the patients recruited for this study were beyond 1 month post-stroke onset.

Objective: To evaluate the effectiveness of a sensorimotor program on motor outcomes of upper extremity deficits in the in-hospital phase post stroke.

Methods: Through a randomized controlled trial of PROBE design, based on a pre-set selection criteria, participants either received the structured regime of sensorimotor therapy in addition to routine care or only routine care for up to 14 days or until discharge in the hospital, Action reserahc Arm test (ARAT) at 3rd month is the primary outcome while ARAT at 6th month and Erasmus modified Nottingham Sensory Assesment Scale (Em-NSA) are secondary outcome measures.

Results: The interim results have been presented in this paper. Nine patients have been enrolled thus, 4 females and 5 males, in different groups according to the stratification of stroke severity & impairment levels. A normal distribution was seen for the data of ARAT and EmNSA using Kolmogorov-Smirnov Test. 3rd month follow up was completed for 8 patient and showed statistically significant improvement on grip (p=0.001) and pinch subscales (p=0.0001) of ARAT. 6th month follow up is completed in 5 patients. Intervention is found to be safe and feasible so far.

P-473

Assessing stroke rehabilitation guidelines in LMICs – a systematic review of quality and scope

D. Gandhi¹, S. Kamalakannan², G. Urimubenshi³, I. Sebastian⁴, V. Montanaro⁵, N. Chawla⁶

¹Christian Medical College & Hospital, Neurology & Physiotherapy, Ludhiana, India

²Northumbria University, Newcastle upon Tyne, United Kingdom

³University of Rwanda, Physiotherapy, Kigali, Rwanda

⁴St Stephens Hospital, New Delhi, India

⁵Sarah Rehabiliation Hospital, Brazil, Brazil

⁶MAHE, Manipal, India

Background: A significant amount of the stroke burden is borne by low and middle-income countries. However, efforts towards reducing the stroke burden in this context have been an immense challenge. One of the important reasons could be the scope and quality of clinical,practice gudielines (CPGs) developed for stroke rehabilitations in the Low-and-middle-Inclone countries (LMICs) which restricts its translation to clinical practice.

Objective: This systematic review intends to assess the availability, scope and quality of clinical practice guidelines for stroke rehabilitation in low and middle-income countries.

Methods: This review was conducted following the CPGs related to stroke rehabilitation developed specifically for the context of LMIC Four electronic databases were searched using relevant search strategy. Grey literature and hand search were also completed. Availability and the content of the CPGs were narratively summarised. The quality of the included guidelines, developed de novo, was analysed using AGREE REX and AGREE II tools.

Results: 11 CPGs from 9 countries were included. 3 were developed de novo, rest were contextualized from high income country CPGs. Most contextualizations had limited stakeholder involvement or local healthsystems or patient pathway analysis. Overall, all nine countries have included recommendations for physiotherapy, seven for communication & swallowing, and five for occupational therapy services post-stroke, only 2 for fatigue & nutrition. Quality assessment using AGREE REX and AGREE II for the included de novo guidelines was very low showing poor methodological rigor & clinical implementablity. Generally, the guidelines scored poorly on rigor of development & applicability. Stakeholder involvement was bare minimum for CPG development and targeted health professionals like PTs and OTs mainly. COuntry health systems, patient pathways, implementation & dissemination plans, cost of care were not considered in all CPGs.

P-474

Motor rehabilitation after stroke: European Stroke Organisation (ESO) consensus-based definition

G. Kwakkel^1,2,3, C. Stinear⁴, B. Essers⁵, M. Munoz-Novoa⁶, M. Branscheidt^7,8, R. Cabanas-Valdés⁹, S. Lakičević¹⁰, S. Lampropoulou¹¹, A. Luft^7,8, P. Marque¹², S. A. Moore^13,14, J. M. Solomon^15,16, E. Swinnen¹⁷, A. Turolla^18,19, M. Alt Murphy^6,20, G. Verheyden⁵

¹Amsterdam University Medical Center, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands

²Northwestern University, Department of Physical Therapy and Human Movement Sciences, Chicago, IL, United States

³Amsterdam Rehabilitation Research Centre, Reade, Department Acquired Brain Injuries, Amsterdam, Netherlands

⁴University of Auckland, Medicine, Aotearoa, New Zealand

⁵KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

⁶University of Gothenburg, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg, Sweden

⁷University Hospital of Zurich, Neurology, Zurich, Switzerland

⁸cereneo Foundation, Vitznau, Switzerland

⁹International University of Catalonia, Physiotherapy, Barcelona, Spain

¹⁰University Hospital Mostar, Department of Neurology, Stroke Unit, Mostar, Bosnia And Herzegovina

¹¹University of Patras, Physiotherapy Department, School of Health Rehabilitation Sciences, Patras, Greece

¹²CHU de Toulouse, Service de médecine physique et réadaptation, Toulouse, France

¹³Northumbria University, Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Science, Newcastle upon Tyne, United Kingdom

¹⁴Newcastle University, Stroke Research Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle upon Tyne, United Kingdom

¹⁵Manipal Academy of Higher Education, Centre for Comprehensive Stroke Rehabilitation and Research, Manipal, India

¹⁶Manipal Academy of Higher education, Department of Physiotherapy, Manipal College of Health Professions, Manipal, India

¹⁷Vrije University (VUB), Rehabilitation Research Group, Faculty of Physical Education and Physiotherapy, Brussels, Belgium

¹⁸Alma Mater University of Bologna, Department of Biomedical and Neuromotor Sciences, Bologna, Italy

¹⁹IRCCS Azienda Ospedaliero-Universitaria di Bologna, Occupational Therapy, Bologna, Italy

²⁰Sahlgrenska University Hospital, Physical and Occupational Therapy, Gothenburg, Sweden

Introduction: Definitions for rehabilitation and stroke rehabilitation exist, but for the domain of motor rehabilitation after stroke, this is lacking. A consensus on this topic would advance the field by presenting an agreed description for all professionals involved.

Objective: To propose a consensus-based definition for motor rehabilitation after stroke.

Materials & methods: An expert working group built a definition paragraph through a structured process including online surveys, voting, and group discussion. Each element of the definition required at least 75% agreement and internal consensus was reached, integrating external feedback from clinicians.

Results: Motor rehabilitation is defined as a process that engages people with stroke to benefit their motor function, activity capacity and performance in daily life. It is necessary for people with residual motor disability whose goal is to enhance their functioning, independence and participation. Motor rehabilitation operates through learning- and use-dependent mechanisms. The trajectory of motor recovery varies across patients and stages of recovery. Early behavioural restitution of motor function depends on spontaneous biological mechanisms. Further improvements in activities of daily living are achieved by compensations. Motor rehabilitation is guided by regular assessment of motor function and activity using consensus-based measures, including patient-reported outcomes. Results are discussed with the patient and their carers to set personal goals. During motor rehabilitation patients learn to optimize and adapt their motor, sensory and cognitive functioning through appropriately dosed repetitive, goal-oriented, progressive, task- and context-specific training. Motor rehabilitation supports people with stroke to maximise health, well-being and quality of life.

Conclusion: This definition may guide clinical educators, inform clinicians and advise researchers to advance the motor rehabilitation domain.

P-475

A 4-week Home GRASP program including sensor-based feedback enhances perceived and actual upper limb performance in the chronic phase after stroke

B. Essers¹, G. Verheyden¹, J. Veerbeek², A. Luft^3,4

¹KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

²Luzerner Kantonsspital, Neurocenter, Lucerne, Switzerland

³University of Zurich and University Hospital Zurich, Department of Neurology and clinical Neuroscience Center, Zurich, Switzerland

⁴Center for Neurology and Rehabilitation, Cereneo, Vitznau, Switzerland

Background: Chronic stroke survivors struggle to regain upper limb (UL) activity in daily life. Limited research on the Home-Graded Repetitive Arm Supplementary Program (H-GRASP) in chronic individuals has primarily addressed perceived performance, leaving a gap in understanding its impact on actual performance.

Objectives: To explore the preliminary effect of H-GRASP with sensor-based feedback in enhancing both actual and perceived daily-life UL performance.

Method: A pre-post double baseline repeated measures design was employed. Participants completed a 4-week (48-hour) home exercise program, incorporating weekly accelerometer-based feedback on actual UL performance. The intervention included behavioral strategies to encourage greater use of the affected UL. Participants were monitored bi-weekly by therapists over the phone. Actual performance was measured using wrist-worn accelerometry, and perceived performance was assessed through the Motor Activity Log (MAL-AOU and MAL-QOM) and the Hand Subscale of the Stroke Impact Scale (SIS-Hand).

Results: Participants were stable across the baseline period. Seventeen individuals with chronic stroke completed the program and practiced between 12 and 56 hours. Post-treatment effect sizes for greater perceived performance were observed in MAL-AOU (0.64, p<0.001), MAL-QOM (0.41, p<0.001), and SIS-Hand (0.57, p=0.004). Actual performance demonstrated enhancements in activity ratio (1.16, p=0.015), unilateral affected UL activity (0.32, p=0.040), and median magnitude ratio (0.85, p=0.046).

Conclusion: Our feasibility study suggests that H-GRASP, combined with sensor-based feedback and behavioral strategies, holds promise for enhancing both perceived and actual daily-life UL performance in chronic stroke survivors. Caution is advised in interpreting results due to the study’s feasibility nature. Preliminary results support further exploration in a larger trial to establish program efficacy.

P-476

Characterization and understanding of the mechanisms of balance disorders in a seated position following a stroke

I. Bonan¹, S. Cordillet¹, F. Bidet¹, A. Veisingler¹, S. Leplaideur¹, K. Jamal¹

¹University Hospital Rennes, Physical Therapy and Rehabilitation, Rennes, France

Introduction: One of the causes of disability in stroke patients is postural disturbance, which can result in a disturbance of balance in the sitting position. To date, the mechanisms of these postural disturbances in the seated position in patients with stroke have not been fully elucidated. The objective of this study was to characterize the disorders of a patient’s sitting posture and to relate the results obtained to the characteristics of hemiplegia.

Methods: Sixteen stroke patients (8 right and 8 left) with less than 3 months of post-stroke delay were tested alongside 16 age-matched healthy subjects. The positions of the head, trunk, and pelvis were assessed using three-dimensional motion capture. The evaluation was composed of four tests: two with open eyes and two with closed eyes, each with a duration of 30s. The data on sitting balance disorders were associated with the characteristics of hemiplegia and perception of the spatial representation of the bodyby multivariate variance analysis.

Results: The preliminary data in the first condition showed that the stroke patients were more forward than the healthy subjects (p=0.03), whereas the right stroke patients were more on their left side compared to the left stroke patients who were more tilted towards their right side (p=0.006). Other analyses are currently underway, and the results will be presented at the Congress.

Discussion: A diverse typology of sitting posture disorders following a stroke is expected, with more pronounced disorders observed in patients with rightstroke, partly attributable to spatial representation deficits. This enhanced understanding aims to improve sitting posture disorders and, consequently, has a direct impact on the risk of falls, a source of loss of autonomy.

Reference

Van Nes IJW, Nienhuis B, Latour H, Geurts ACH. Posturographic assessment of sittingbalance recovery in the subacute phase of stroke. Gait Posture. oct 2008;28(3):507-12.

P-477

Contribution of Hemineglect, lateropulsion and motor impairment on balance disturbance in a right stroke population with acquired standing: a cross-sectional study

I. Bonan¹, E. Foussat¹, C. Rousseau¹, S. Leplaideur¹, K. Jamal¹

¹University Hospital Rennes, Physical Therapy and Rehabilitation, Rennes, France

Background: One of the consequences of the aftermath of a stroke is balance disturbance that leads to an increased risk of falls and loss of autonomy. To date, the factors involved in this balance impairment, particularly in patients with right stroke, remain a subject of discussion, including the implications of spatial cognition disorders. The objective of this study was to identify factors related to balance disturbances in a cohort of patients with right-sided stroke.

Methods: A cross-sectional multicenter randomized trial involving patients with right stroke in the subacute phase was conducted. This study assessed lower limb motor function, spasticity, sensitivity, lateropulsion, and spatial cognition (hemineglect test, straight ahead, and longitudinal body axis). Balance was evaluated using the Berg Balance Scale (BBS), with a threshold of less than 45/56 chosen to signify balance disturbance. Factors at the initial time point were analyzed using both univariate and multivariate logistic regression techniques.

Results: 82 patients were analyzed (mean age (years):59.3 (10.3); time post-stroke (days):91.3 (59.6)), of whom 61 had a BBS score <45. Multivariate analysis revealed a significant association between BBS and lower limb motor function (odds ratio [OR] =0.8; p=0.002), lateropulsion (OR= 6 ; p=0.03), and hemineglect tests (OR = 19 ; p=0.02).

Discussion: The presence of lower limb motor function, hemineglect, and lateropulsion induce a loss of balance capacity and should be taken into account in rehabilitation.

References

Tyson SF, Hanley M, Chillala J, Selley A, Tallis RC. Balance disability after stroke. Phys Ther. janv 2006;86(1):30-8.

Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. mars 1995;27(1):27-36.

P-478

Feasibility and benefit of early vocational rehabilitation for people with stroke: a randomized controlled trial

N. A. Lannin^1,2, S. O’Keefe¹, A. Farrin³, L. Marsden³, S. Alves-Stein^1,2, G. C. Cloud^1,2, M. Stanley⁴, K. Radford⁵

¹Monash University, Neuroscience, Melbourne, Australia

²Alfred Health, Melbourne, Australia

³University of Leeds, Leeds Institute for Clinical Trials Research, Leeds, United Kingdom

⁴Edith Cowan University, Perth, Australia

⁵University of Nottingham, Nottingham, United Kingdom

Introduction: Returning to the workplace after first stroke is acknowledged to be challenging. Vocational rehabilitation programs, traditionally delivered following the completion of medical rehabilitation, are designed to support work-specific skills. It remains unknown whether such vocational rehabilitation can be delivered alongside medical rehabilitation (i.e. early).

Objectives: To assess the feasibility and acceptance of an early vocational rehabilitation intervention for adults with stroke to improve work participation.

Patients & methods: Stroke survivors with an unmet need related to work, were recruited within 4mo of stroke from a single tertiary hospital in Melbourne, Australia. A prospective, randomized controlled trial compared two groups: Work group received a 12wk vocational rehabilitation program in addition to usual medical rehabilitation, control group received usual medical rehabilitation only. Assessments were taken prior to randomization and at 12wks and 6mos. Primary outcome was work participation (days worked per month); secondary outcomes of participant ratings of health-related quality of life and social functioning, alongside acceptability were collected and reported descriptively.

Results: 34 stroke survivors (male 20 (59%), mean age 49.7(SD12.7) years) were recruited an average of 1.1 (SD1.2) month post-stroke (median NIHSS 2 (0.0, 14.0)) between 2019 and 2022. At 12wks and 6mos more participants in the Work group had returned to paid employment (65% and 71%) compared to the control group (47% and 64%). Average days worked in the past month showed Work group participants worked 3.06 days/month more (95%CI-3.34 to 9.46) than the control group at 12wks.

Conclusion: Vocational rehabilitation delivered during the early-subacute phase of recovery is feasible. Further clinical trials are warranted to define the most comprehensive approach to integrating vocational rehabilitation interventions early within post-stroke rehabilitation.

P-479

A study on genetic polymorphism affecting short-term functional outcomes in acute stroke patients

M. W. Kim¹, J. Kim¹

¹Catholic University, Rehabilitation, Seoul, South Korea

Introduction & objectives: Genome-wide association studies (GWAS) have revealed genetic variants associated with strokes. Numerous studies indicate a correlation between genetic factors and the functional outcomes of stroke patients. This study aims to investigate the association between genetic variants and short-term functional outcomes in acute stroke patients.

Patients & methods: Subjects with first-ever acute stroke, transferred to the rehabilitation department, and undergoing intensive rehabilitation intervention for four weeks, were enrolled. Functional assessments, including [specify assessments], were conducted before and four weeks after rehabilitation. Thirteen single-nucleotide polymorphisms (SNPs) were genotyped (PTGS2 [rs20417, rs5275], COMT [rs4680], CRP [rs1130864], APOE [rs429358, rs7412], BDNF [rs6265], XRCC1 [rs25487], IGF1 [rs7136446], PTCH1 [rs2236406], PLAA [rs13299556], NTN4 [rs78734480], LOC105372028 [rs1842681]).

Results: A total of 23 subjects were enrolled. The CRP-CT polymorphisms were associated with better Fugl-Meyer assessment of Upper Extremity (FMA-UE) motor function compared to the CC variant (p = 0.032). The APOE (rs7412)-CT variant was associated with poorer FMA-UE motor function compared to the CC variant (p = 0.019). The BDNF-GG polymorphism was associated with better hand function test (grip strength and 3-point pinch) results compared to the GA variant (p = 0.032 and p = 0.03, respectively).

Conclusion: This study investigated differences in short-term functional improvement among acute stroke patients in relation to SNPs of several genes. Genetic variants, particularly the CRP (rs1130864), APOE (rs7412), and BDNF (rs6265) polymorphisms, were found to be associated with functional outcomes after stroke.

P-480

Feedback-based mall-walking program for improving community ambulation post-stroke: a case series

K. Bansal¹, T. Barrett²

¹University of Mount Union, Department of Physical Therapy, Alliance, Ohio, United States

²University of Mount Union, Department of Exercise Science, Alliance, Ohio, Canada

Introduction: Despite advancements in gait rehabilitation, stroke survivors express dissatisfaction with their community ambulation levels beyond home safety. The dearth of freely accessible, community-based, behavior-change interventions targeting sustained post-stroke community ambulation improvement is evident.

Objective: This case series aimed to evaluate the feasibility and efficacy of a feedback-based, mall-walking program in enhancing community ambulation post-stroke.

Materials & methods: Seven ambulatory adults (3 males, mean age: 60±14 years, mean time post-stroke: 8±10 years) participated. The intervention comprised of biweekly 40-minute student-led mall-walking sessions for six weeks, feedback on daily steps from the Fitbit Sense and weekly goals to increase stepping activity. Baseline and post-intervention outcomes included the six-minute walk test (6MWT), and a 7-day recording of daily home and community steps. A user perception questionnaire evaluated feasibility.

Results: All participants exhibited 100% compliance with no adverse events and agreed that the mall-walking program was easy and enjoyable to participate. The 6MWT improved in four participants (median change: 34.5±44.5 meters). All participants increased total daily walking activity by augmenting community steps (Pre-intervention: 2046±1250 steps/day; post-intervention: 3543±1606 steps/day; p<0.05) while maintaining their home steps (Pre-intervention: 1708±1953 steps/day; post-intervention: 1609±1992 steps/day). Post-study, three individuals continued community-based walking programs, and two acquired Fitbit watches to sustain daily activity tracking.

Conclusion: The feedback-based mall-walking program is deemed safe, feasible, sustainable, and exhibits promising enhancements in post-stroke community ambulation. This case series will inform the subsequent phase of our larger randomized controlled trial.

P-482

Exploring the feasibility of speed as an intensity measure in post-stroke high-intensity treadmill training

A. Doshi^1,2, B. Cleland³, F. Testai⁴, S. Madhavan²

¹University of Illinois, Neuroscience, Chicago, IL, United States

²University of Illinois, Physical Therapy, Chicago, IL, United States

³University of Illinois, Rehabilitation, Chicago, IL, United States

⁴University of Illinois, Neurology and Rehabilitation, Chicago, IL, United States

Background: High-intensity interval training (HIIT) is effective for post-stroke gait rehabilitation. The protocol typically uses age-predicted maximal heart rate to measure intensity, but this may not work for many stroke survivors on medications like ß-blockers. Speed-based HIIT (HISTT) has demonstrated superior outcomes in power and fatigue resistance compared to traditional HIIT after stroke. However, there is a gap in our understanding of the relationship between treadmill belt speed (Speed_t) and peak heart rate (HR_peak) during HISTT. It remains uncertain whether Speed_t can be a valid surrogate for HR_peak in assessing exercise intensity.

Objectives: To determine the association between Speed_t and HR_peak during long-term HISTT training. To examine whether lower limb measures of function and ß-blocker medication usage affect this relationship.

Methods: Data were collected as part of a larger clinical trial where participants with stroke performed 12 sessions of HISTT. The variables of interest in this research were Speed_t, HR_peak, ß-blocker usage, self-selected and fast walking speeds, walking endurance, maximal dorsiflexion force, and the Fugl Meyer Lower Extremity Assessment.

Results: The study analyzed 36 chronic stroke participants. Using a longitudinal linear mixed-effects model, we found that a 0.16 m/s (minimal clinically important difference) increase in Speed_t led to an increase of 3.83 bpm in HR_peak (p=0.018). Notably, ß-blocker non-users exhibited greater HR_peak increases with Speed_t than users. Additionally, individuals with higher non-paretic dorsiflexion force experienced more substantial HR_peak increases with Speed_t.

Conclusion: These results demonstrate an association between heart rate and treadmill belt speed during HISTT with the caveat that ß-blocker medication usage and non-paretic dorsiflexion force may influence this relationship. These findings suggest the potential feasibility of speed as a measure of intensity during HISTT.

P-483

Clinician perspectives on wearable sensor use to guide activity counselling during stroke rehabilitation at home

A. Shenoy¹, S. Thomson², K. Van Ooteghem², K. S. Weber², K. B. Beyer², W. E. McIlroy², J. Eng¹, C. L. Pollock¹

¹University of British Columbia, Physical Therapy, Vancouver, Canada

²University of Waterloo, Kinesiology, Waterloo, Canada

Introduction: Activity data (i.e. step count, sleep time, arm use) can be remotely collected with wearable sensors and used to aid activity counselling during stroke rehabilitation. Clinicians’ perception of the utility of sensor-derived metrics has not been explored as extensively as use of the devices themselves.

Methods & Materials: We created a patient report for use during activity counselling including sensor-derived metrics obtained from bilateral wrist and ankle data from a 1-week wear period capturing:1)Physical Activity 2)Upper Extremity Activity 3)Sleep and 4)Walking. Two focus groups with 7 physiotherapists (PTs) were conducted. PTs were asked about their current approaches to activity monitoring and counselling during stroke rehabilitation and then provided feedback on the proposed patient report as a counselling tool. Thematic analysis of transcripts was conducted.

Results: PTs worked in hospital stroke rehab units (inpatient=4, outpatient=3) and had >1 yr of experience. The following themes emerged:1)Accessibility 2)Individualized Progress Tracking and 3)Volume of Information. For current approaches to activity monitoring, PTs were in favour of using wearable sensors to track activity levels only if they were easily accessible (e.g. within patients’ budget or currently own device). For the patient report as a counselling tool, PTs highlighted the importance of tracking individualized progress over time to support patients’ goals. Lastly, having the option to adjust amount of information in the report was identified as important. Specifically, PTs felt some patients would benefit from streamlined summary information for counselling while detailed feedback would be more beneficial and engaging for others.

Conclusion: For clinical use, wearable sensors must not be exclusive, sensor-derived metrics must be relevant and sensitive to change, and reports must be adaptable to meet individual needs and activity counselling goals during stroke rehabilitation.

P-484

Transformation but not generation of motor images is disrupted following stimulation over the inferior parietal lobe: implications for motor imagery in stroke rehabilitation

A. Davis¹, A. Hurst², A. Pond³, T. Yousef¹, S. Kraeutner¹

¹University of British Columbia, Psychology, Kelowna, Canada

²Dalhousie University, Physiotherapy, Halifax, Canada

³University of British Columbia, Kinesiology, Vancouver, Canada

Introduction: Motor imagery (MI; mental rehearsal of an action) shows promise as an adjunct intervention for upper limb stroke recovery. Stroke-related damage to posterior parietal areas may hinder the effectiveness of MI as it is thought these areas, specifically the inferior parietal lobule (IPL), may be critical for generating motor images. Yet, the specific role of the IPL in MI is unknown.

Objectives: We aimed to examine the role of the IPL in MI as it relates to the stages of MI (generation, maintenance, or manipulation of a motor image) to expand understanding of how stroke-related damage to this region may impact the use of MI for stroke recovery.

Methods: Healthy participants (N=15) were recruited for a 2-day study. Each day, participants engaged in a MI task (a laterality judgement task where participants determined via keypress response if hands presented on a screen in various orientations were a left or right hand). During the task, TMS was delivered to the IPL on 50% of the trials. Stimulation occurred at three time points: 250, 500, or 750ms after trial onset. Day A involved active TMS (delivered at 120% resting motor threshold), and Day B involved sham (placebo) TMS (15% over the vertex). Order of Days A/B were randomized across participants. Reaction time (RT) was recorded and averaged across trials. Effect sizes (Cohen"s d; 6 total) were calculated: RTs for each TMS time point were compared to the no stimulation condition (control) for both active and sham.

Results: RTs were increased when TMS was delivered at the 750ms time point (M_750active = 1.28s±0.29, M_750sham = 1.19s±0.23) and to a greater extent during active vs. sham as evidenced by a large vs. medium effect size (d_750active=0.62 vs d_750sham=0.33). No other meaningful effects were observed (d < 0.2).

Conclusions: Applying TMS to the IPL later (750ms) hinders MI performance, suggesting that the IPL contributes to image transformation. Overall, findings inform the use of MI after stroke.

P-485

SocialBit: A novel smartwatch sensor to detect social interaction frequency in stroke survivors

G. Cooke¹, O. Adeboye¹, S. Tate², K. White³, V. Dhongade¹, R. Zafonte⁴, S. Narayanan⁵, M. R. Mehl⁶, M. Shin², A. Dhand¹

¹Brigham and Women’s Hospital, Neurology, Boston, MA, United States

²University of North Carolina at Charlotte, Charlotte, NC, United States

³University of Connecticut, Farmington, CT, United States

⁴Spaulding Rehabilitation Network, Boston, MA, United States

⁵University of Southern California, Los Angeles, CA, United States

⁶University of Arizona, Tucson, AZ, United States

Introduction: Stroke survivors experience high levels of social isolation which hinder their rehabilitation and well-being. A gap in the field that impedes intervention is a lack of real-time social interaction measurement tailored for this population. In response, we developed SocialBit, a smartwatch-based machine learning algorithm to unobtrusively detect social interactions through privacy-preserving acoustic analysis.

Objectives: For the purpose of this observational study we aimed to determine the accuracy of SocialBit to detect social interactions of stroke survivors.

Patients & methods: SocialBit was built as a neural network machine learning algorithm using features from YAMNet and a Transformer classifier. It was trained and tested in ischemic stroke survivors for up to 8 days in hospital while human observers tallied the presence or absence of social interactions every minute to establish the ground truth. SocialBit performance was compared against the ground truth for 96 patients. 15% of patients had aphasia, 26% reported symptoms of clinical depression, and 27% reported moderate to severe loneliness.

Results: SocialBit had an accuracy of 0.84 (SD = 0.02), sensitivity of 0.87 (SD = 0.04), specificity of 0.81 (SD = 0.04), and an area under the curve of 0.90 (SD = 0.02). For patients with aphasia, SocialBit had an accuracy of 0.81.

Conclusions: SocialBit detected the frequency of social interactions in stroke survivors in a hospital setting with high levels of accuracy. These results will drive future planned studies to examine SocialBit’s performance in patients" communities. SocialBit shows the potential to be the first real-time social sensor to quantify social interactions and social isolation in stroke survivors.

P-486

Investigating the acceptability of modified constraint-induced movement therapy among stroke survivors and carers: a qualitative study

A. Weerakkody^1,2, E. Godecke^1,3, B. Singer¹

¹Edith Cowan University, Health Science, Joondalup, Australia

²South Metropolitan Health Service, Rehabilitation in the Home, Fremantle, Australia

³North Metropolitan Health Service, Sir Charles Gaidner Osborne Park Health Group, Nedlands, Australia

Introduction: Modified constraint-induced movement therapy (mCIMT) is an effective intervention to improve upper limb function after stroke, yet few stroke survivors receive this therapy. A behaviour change intervention to increase provision of mCIMT within an early-supported discharge (ESD) rehabilitation service identified clinician concerns regarding the acceptability of mCIMT among stroke survivors and carers, consistent with findings published internationally.

Objective: To explore the acceptability of mCIMT among stroke survivors and carers within an ESD service and inform further adaptations to the program to enhance acceptability.

Materials & methods: Qualitative study within a mixed methods process evaluation of mCIMT implementation. Semi-structured interviews were analysed using reflexive thematic analysis and mapped to the Capability, Opportunity, Motivation- Behaviour model.

Results: Fifteen stroke survivors and ten carers participated. Five themes were generated and mapped to the COM-B. Participants attributed functional improvements to the program whilst also encountering several challenges with returning home after stroke (Capability- physical); the importance of education (Capability- psychological); the benefits afforded by the structured nature of the program (Opportunity- physical); the challenges for carers to support mCIMT programs whilst navigating new relationship roles (Opportunity- social); the desire to improve (Motivation- automatic); and the influence each of the mCIMT program"s components had in facilitating long term upper limb use (Motivation- reflective).

Conclusion: mCIMT was an acceptable intervention for stroke survivors and carers within the ESD service, offering considerable benefits compared to other therapies. The findings suggest that multifaceted education strategies could increase stroke survivor preparedness. Extending the mCIMT program duration may maximise functional improvements.

P-487

Exploring the views of people with stroke regarding aerobic exercise participation during inpatient and outpatient rehabilitation: a qualitative study

A. Barzideh^1,2, A. J. Devasahayam^2,3, A. Tang⁴, E. Inness^1,2,5, S. Marzolini^1,2,5, S. Munce^1,2, K. Sibley⁶, A. Mansfield^2,5,3

¹University of Toronto, Rehabilitation, Toronto, Canada

²KITE-Toronto Rehabilitation Institute, Toronto, Canada

³Sunnybrook Research Institute, Evaluative Clinical Sciences, Toronto, Canada

⁴McMaster University, Rehabilitation, Hamilton, Canada

⁵University of Toronto, Physical Therapy, Toronto, Canada

⁶University of Manitoba, Public Health, Winnipeg, Canada

Introduction: Although aerobic exercise is a critical component of stroke rehabilitation, the number of people participating in aerobic exercise during rehabilitation is low. Previous studies have aimed to better understand the reason for this by exploring physiotherapists’ perspectives. Only one study explored the views of people with stroke using a survey and this study included a small number of participants and did not examine patient perspectives in-depth.

Objective: in depth exploration of the views of people with stroke regarding participation in aerobic exercise during stroke rehabilitation.

Patients & methods: We conducted a qualitative descriptive study using thematic analysis informed by a pragmatic worldview. People with stroke who were able to communicate from three urban rehabilitation hospitals in Canada were invited to attend semi-structured interviews. Both deductive and inductive coding were used for analysis.

Results: Fourteen people with stroke participated. Participants reported participating in any exercise prescribed by their physiotherapist, with none declining, even if the exercises were difficult or fatiguing. Four themes were identified: 1) having a structured program run by a physiotherapist during sub-acute phase of stroke recovery to promote aerobic exercise (subthemes: whether aerobic exercise is prescribed, access to resources, and having a routine); 2) psychological and social factors (subthemes: motivation and support, and emotions); 3) belief about capabilities (subthemes: competence and confidence, and empowerment); and 4) knowledge and attitude about exercise.

Conclusion: Our findings suggest that patients" beliefs about their own capabilities, their motivation and emotions, and their knowledge and attitude toward exercise are not significant barriers to aerobic exercise participation during rehabilitation. Instead, prescription of aerobic exercise provided by physiotherapists is the sole predictor of participation.

P-488

Measuring flow experience during therapy in neurorehabilitation – the flow state scale for rehabilitation tasks: a new flow experience questionnaire for stroke patients

B. Ottiger¹, J. Veerbeek¹, D. Cazzoli^1,2, T. Nyffeler^1,3,4, T. Vanbellingen^1,3

¹Luzerner Kantonsspital, Neurozentrum, Lucerne, Switzerland

²University of Bern, Psychology, Bern, Switzerland

³University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Switzerland

⁴Bern University Hospital, Neurology, Bern, Switzerland

Introduction: Flow is a subjective psychological state that people report when they are fully involved in an activity to the point of forgetting time and their surrounding except the activity itself. Flow experience is measured to determine the extent to which patients engage in therapy activities. Several flow questionnaires are used in neurorehabilitation. However, none have been validated for patients with (sub)acute stroke.

Objectives: To develop and validate a new flow questionnaire for patients with (sub)acute stroke.

Patients & methods: A single-center prospective cohort study was conducted at one neurorehabilitation unit in 50 patients with (sub)acute stroke. The first phase consisted of the development of the Flow State Scale for Rehabilitation Tasks (FSSRT). In the second phase, the psychometric properties of the FSSRT (internal consistency, test-retest reliability, structural and construct validity) were determined in (sub)acute stroke patients.

Results: The FSSRT showed good internal consistency and excellent test-retest reliability. The FSSRT is composed of four components: concentration, pleasure, movement control, and absorption. Construct validity showed that the FSSRT correlates significantly negatively with the Hospital Anxiety and Depression Scale.

Conclusion: Measuring flow experience in the context of occupational therapy and physical therapy is a new approach. The FSSRT is a reliable and valid questionnaire measuring flow experience in patients with (sub)acute stroke. This questionnaire can be easily used in occupational therapy as well as in physical therapy. Therapists can use the FSSRT to optimally adapt the therapy program to increase the patient’s engagement during therapy.

Manuscript accepted by American Journal of Occupational Therapy AJOT

P-489

Characterizing arm recovery in people with severe stroke (CARPSS): a project update

K. Hayward^1,2, B. C. Larssen³, J. Ferris^3,4, J. Dahlby³, S. Peters⁵, K. R. Lohse⁶, J. Bernhardt², C. E. Lang⁶, L. A. Boyd³

¹University of Melbourne, Physiotherapy, Melbourne, Australia

²Florey Institute of Neuroscience, Melbourne, Australia

³University of British Columbia, Physical Therapy, Vancouver, Canada

⁴Gerontology Research Centre, Simon Fraser University, Department of Gerontology, Vancouver, Canada

⁵University of Western Ontario, Physical Therapy, London, Ontario, Canada

⁶Washington University School of Medicine in St. Louis, Program in Physical Therapy and Neurology, St. Louis, MO, United States

Background & objectives: Participants with early (<7 days post-stroke) and severe upper limb paresis (SAFE score <5; Shoulder Abduction and Finger Extension strength) after their first ever clinically diagnosed stroke, are followed for 12 months to 1) determine if biomarkers of brain structure and function collected at <1 month post-stroke explain who will experience clinically important recovery over the first 12 months; 2) compare stroke survivors’ perceptions of meaningful recovery to clinically important recovery; and 3) characterise the trajectory of change in measures of motor function, brain structure and function.

Methods: Participants for this ongoing observational study are recruited from a single site (Canadian tertiary stroke referral centre) and assessed at 4 timepoints: 1, 3, 6 and 12 months post-stroke. We define clinically important recovery as improvement on 2 of 3 measures spanning ICF domains of impairment (Fugl-Meyer Upper Limb, change ≥10 pts), activity (Motor Assessment Scale item 6, change ≥1 pt) and participation (Rating of Everyday Arm-use in the Community and Home, change ≥1 pt). Brain biomarkers related to corpus callosum and corticospinal tract structure and function are assessed with MRI and transcranial magnetic stimulation. Stroke survivors’ perception of recovery (3 questions) and real-world arm use (assessed with accelerometry) are also collected.

Results: Forty-nine participants (21 Female, 28 Male; Median Age 65 years, IQR 57-72) have been recruited. The median SAFE score within 7 days post-stroke of recruited participants is 2/10 (IQR 0-3). Median days to first assessment is 15.5 (IQR 8-23). The study experienced significant recruitment delays owing to the COVID pandemic. Projected enrollment is 60 participants by May 2025.

Conclusion: This work will provide a comprehensive characterization of the 12 month upper limb recovery trajectory in people who present with severe upper limb paresis early after stroke.

P-490

Bilateral performance of a drinking task improves movement kinematics of the affected arm after stroke

B. Perry¹, J. Sivak¹, K. Horne¹, J. Chow¹, D. Stokic¹

¹Methodist Rehabilitation Center, Jackson, MS, United States

Introduction: Daily activities require coordinated movements of both arms yet previous kinematic studies mainly focused on the affected arm after a stroke. Thus, we asked whether kinematics of a drinking task differ when performed only with the affected arm or both arms together.

Objectives: To determine kinematic differences in the arm affected by stroke between the unilateral (UNI) and bilateral (BIL) drinking task under the fast and accurate condition (FAST+ACCR) and fast only condition (FAST).

Patients & methods: We recruited participants with unilateral arm weakness due to a recent ischemic or hemorrhagic stroke while admitted to post-acute inpatient rehabilitation. Impairment of the affected arm was evaluated by the Upper Extremity Fugl-Meyer Assessment (FMA, 0-66). 3D motion capture was used to collect kinematic data. Twenty markers were placed on anatomical landmarks of the head, trunk, and both arms. FAST+ACCR condition was performed first. Within each condition, the drinking task was performed first with the nonaffected arm, the affected arm, then bilaterally.

Results: FMA scores ranged from 44-60. Compared to UNI task, total movement time was shorter, peak velocity was higher, and movement units were fewer when the affected arm performed BIL task, regardless of FAST+ACCR or FAST condition. In FAST condition, arm-trunk slope was lower in BIL task. Within task comparison showed shorter total movement time, higher peak velocity, and fewer movement units in FAST condition compared to FAST+ACCR condition for both UNI and BIL tasks. Arm-trunk slope was also lower in FAST condition but only in BIL task.

Conclusion: The affected arm moves faster and smoother when the drinking task is performed with both arms together. Faster and smoother movements of the affected arm can be achieved when accuracy is not required, however, trading accuracy for speed in the bilateral task comes at the cost of increased trunk compensation.

P-491

The association of interlimb coordination and temporal symmetry with walking function and motor impairment after stroke

B. Cleland¹, S. Madhavan¹

¹University of Illinois, Physical Therapy, Chicago, IL, United States

Introduction: Interlimb coordination during walking is important for effective movement, stability, and response to perturbation, but is impaired after stroke. It is still unclear how impaired interlimb coordination impacts overall walking function after stroke.

Objectives: This cross-sectional study aimed to determine the associations of interlimb coordination and temporal symmetry with walking function and motor impairment.

Patients & methods: 56 individuals with chronic stroke were tested. During walking tests, participants wore wireless wearable sensors to detect the timing of heel strikes. We calculated interlimb coordination as the phase coordination index (accuracy and consistency of interlimb phasing) and temporal symmetry as the ratio of paretic to non-paretic leg stance times. Associations with walking speed and motor impairment were assessed.

Results: Worse interlimb coordination was correlated with slower comfortable (R=-0.38, p=0.004) and maximal (R=-0.36, p=0.006) walking speed and worse motor function (R=-0.45, p=0.001). Worse temporal symmetry was correlated with worse motor function (R=0.39, p=0.004) but not walking speeds. Interlimb coordination had stronger associations than temporal symmetry with comfortable (R: -0.38 vs. 0.08) and maximal walking speeds (R: -0.36 vs. 0.12).

Conclusion: Poor interlimb coordination was associated with slow walking speed and motor impairment in individuals with chronic stroke. In contrast, temporal asymmetry was associated with motor impairment but not walking speed. Overall, interlimb coordination had stronger associations with walking speeds than temporal symmetry did and may provide unique insights into walking function after stroke.

P-492

Change leadership: fostering effective change in an existing community stroke program to better align with Canadian stroke best practice guidelines

C. Tremblay¹, K. Smith¹

¹Winnipeg Regional Health Authority, Community Stroke Care Service, Winnipeg, Canada

Introduction: Change can be challenging to facilitate. As part of a quality improvement initiative, a community stroke rehab program that follows an Early Supported Discharge (ESD) model, set out to review practice alignment with evidenced-based Canadian Stroke Best Practice Guidelines (CSBPG). Consensus was reached among team members that processes developed 18 years earlier needed updating. This presentation describes the peer-facilitated change process that was used.

Objectives: To engage team members in the change process by promoting an understanding of the need for change, fostering collaboration in implementing changes, and facilitating achievement of identified outcomes.

Methods: A review of current literature on ESD and CSBPG, with a focus on in-home community rehab, was completed. All stroke team members were asked to review key articles. A peer-facilitated focus group was conducted to discuss best practice, vocalize challenges, and identify areas for improvement. Content themes from the focus group were identified. A small working group was established to facilitate change-actions related to themes. Change-actions included: developing new strategies based on discipline specific challenges, gathering and collating feedback, updating practice guidelines to meet targeted goals, and evaluation of changes implemented.

Results: The presentation will discuss achievement of targeted outcomes related to 6 identified themes, deliverables created, and evaluation of the change process. The community stroke program noted improved access to care, client flow, and interdisciplinary communication.

Conclusion: There is value in peer-led team engagement when fostering change, rather than a top-down approach. Using an iterative process as part of the quality improvement initiative, with regular follow ups at team meetings, guided service delivery change, made for a more gradual process shift, and may have fostered the feeling of a greater locus of control.

P-493

Exercise beliefs, barriers and facilitators: a survey of community-dwelling people after stroke involved in the Falls After Stroke Trial

I. Lin¹, C. Dean¹, J. Glinsky¹, E. Preston², L. Clemson³, K. Scrivener¹

¹Macquarie University, Macquarie Park, Australia

²University of Canberra, Canberra, Australia

³University of Sydney, Sydney, Australia

Introduction: High levels of sedentary behaviour are observed in people after stroke. The Falls After Stroke Trial (FAST)¹ is using a habit-forming exercise program (LiFE) as part of a multi-component falls prevention intervention which may support a long-term, daily increase in physical activity.

Objectives: To understand the perspectives of FAST participants about overall physical activity and specific exercise program participation. In particular, if exercise beliefs differ between the control (usual care) and intervention groups.

Patients & methods: Participants were community-dwelling people after stroke who had completed formal rehabilitation. Forty-nine participants were invited to participate in a survey at the 6-month assessment. It consisted of 43 items administered to all participants and an additional five items administered to intervention participants. The survey was either completed independently by the participant or with a researcher over the phone.

Results: Thirty-eight participants completed the survey. Only 14 participants (37%) reported meeting the physical activity guidelines of which 11 were from the intervention group. Intervention participants were more satisfied with their physical activity levels compared to control participants. On average, participants reported two barriers to completing regular exercise with the most common barriers being poor balance (45%), being too tired (37%) and poor weather (32%). Intervention participants reported that the LiFE program increased their desire (87%) and made it easier for them (91%) to be more physically active.

Conclusion: Although most participants agreed that physical activity is beneficial for health and wellbeing, less than half were meeting the physical activity guidelines. Intervention participants reported that a habit-forming exercise intervention made them want to be more active and made it easier for them to do so.

Reference

1. Dean C, et al. Int J Stroke. 2021 Dec;16(9):1053-8

P-494

Vagus nerve stimulation paired with upper limb rehabilitation using the Vivistim System® in a home environment: preliminary findings from a post-market study

C. Prudente¹, R. Patel², L. Guglielmo³, S. Zera⁴, A. Parkman⁵, W. B. Tarver¹, N. Engineer¹

¹MicroTransponder, Austin, TX, United States

²Consultant, Mooresville, NC, United States

³Concierge Neurologic Therapy, Mamaroneck, NY, United States

⁴Moxie OT, Chicago, IL, United States

⁵Collage Rehabiliation Partners, Haslet, TX, United States

Introduction: Upper limb (UL) rehabilitation paired with vagus nerve stimulation (VNS) with Vivistim (ie, Paired VNS) was FDA approved in 2021. Previous studies were based on Paired VNS therapy in outpatient settings, where the therapist delivered VNS during functional movements, followed by at-home therapy involving VNS self-activation prior to a home exercise program (HEP) or daily activities. Here we describe early findings from a post-market study of Vivistim’s Paired VNS therapy implementation in the home environment.

Objectives: To assess feasibility of Paired VNS provided by a therapist in the home environment.

Methods: A sample of 20 participants is expected. Individuals implanted with Vivistim receive 36 hours of UL Paired VNS provided in the home by a therapist within 18 weeks. On days without supervised sessions, subjects use self-activated VNS during a HEP or daily activities. Outcomes include Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Action Research Arm Test (ARAT), Box and Block Test (BBT), Nine-Hole Peg Test (NHPT), Stroke Impact Scale (SIS), and other self-reported measures. Assessments occur at baseline and after completion of 12, 24, and 36 hours of supervised sessions, and at 3, 12, and 24 months thereafter.

Results: Six participants have enrolled, with one having completed the supervised therapy to date. This subject completed 36 hours of supervised and 116 hours of self-activated therapy in ~14 weeks and showed improvements on: FMA-UE (+15), ARAT (+8), BBT (+8), SIS-Hand (+30). The subject was unable to complete the NHPT. Data for all enrolled subjects will be presented.

Conclusions: The early findings suggest feasibility and benefits of Paired VNS when delivered in the home. The study design utilizes a more convenient therapy delivery paradigm for patients, potentially increasing access to Vivistim therapy for chronic stroke survivors.

P-495

Development and evaluation of robot-assisted serious games for upper limb sensorimotor impairments after stroke

L. Saenen¹, C. Heremans¹, L. Micca¹, J. J. Orban de Xivry², G. Verheyden¹

¹KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

²KU Leuven - University of Leuven, Movement Control & Neuroplasticity, Leuven, Belgium

Introduction: Upper limb somatosensory (ULSS) function is crucial for daily living in chronic stroke, but evidence on rehabilitation therapies is scarce. SENSe therapy is a sensory training program involving learning principles, which stimulate learning-dependent neuroplasticity by requiring therapy to be repetitive, intensive, goal-directed, and task-specific and to deliver feedback. Therefore, SENSe therapy could target ULSS function.

Objectives: We aimed to investigate the conversion of SENSe principles in a 10-hour robot-based ULSS serious games training program.

Materials & methods: Chronic stroke survivors received 10 one-hour ULSS training sessions over 4 weeks on four serious games developed on the Kinarm End-Point robot (BKIN Technologies Ltd., Canada). Changes in pre- and post-interventional assessments including Erasmus modified Nottingham sensory assessment (EmNSA), Fugl-Meyer upper extremity assessment (FM-UE), (sensorimotor) Action Research Arm Test ((s)ARAT), and novel robot-based passive and active sensorimotor processing assessment, were evaluated by Wilcoxon signed-rank tests.

Results: Ten chronic stroke survivors with mild-moderate ULSS and motor impairments at baseline (median EmNSA 25/40 (IQR 18-34); median FM-UE 43/66 (IQR 32-49)) were included. After 4 weeks, performance improved on therapy tasks (p<0.001). We found a median increase of 4 points on FM-UE (p=0.015), and decreased assessment times of -7.85s on ARAT (p=0.039) and -76.36s on sARAT (p=0.030). Median changes on EmNSA (+1), and passive (+0.89) and active (+0.16) sensory processing were not significant (p=0.061-0.717).

Conclusions: The robot-based ULSS training program using SENSe principles can improve mild-moderate ULSS, motor function and activity. The motor function improved probably due to the nature of the task. Future research should define subgroups that could benefit most from this therapy program and should focus on how to target relevant function.

P-496

Effects of mirror therapy proceeding augmented reality in stroke rehabilitation: a study protocol

C. J. Lin¹, Y. H. Wu², K. C. Lin^1,2

¹National Taiwan University, Occupational Therapy, Taipei, Taiwan

²National Taiwan University Hospital, Physical Therapy and Rehabilitation, Taipei, Taiwan

Introduction: Mirror therapy (MT) and augmented reality (AR) are gaining popularity in stroke rehabilitation. MT utilizes mirror visual feedback to promote bilateral brain coupling and increase primary motor cortex excitability. AR offers an interactive context of practice for promoting motor and cognitive recovery. MT and AR may complement each other for hybrid interventions in stroke rehabilitation. This poster presented a study protocol for examining the effects of the hybrid regimen.

Objectives: This study protocol aims at examining the effects of the hybrid regimen of MT preceding AR, relative to the monotherapy of AR and conventional therapy (CT) in stroke rehabilitation. Our hypothesis states that the MT-primed AR regimen will be more effective than the AR and CT program in patients with stroke.

Methods: This study will be a single-blind, three-arm parallel randomized controlled trial (RCT). Sixty participants who are eligible for participation in this RCT will be randomized into three groups: the MT-primed AR group, the AR group, or the CT group for 90 minutes/day, 3 days/week, over 6 weeks. Additional home practices for 30 minutes/day, 5 days/week will be provided to all participants. Outcome measures will include the Fugl-Meyer Assessment, Motor Activity Log, Functional Independence Measure, and Stroke Impact Scale Version 3. All assessments will be administered before, immediately after, and 3 months after treatment.

Anticipated Results: To our knowledge, this proposed study will be the first to investigate the effects of MT preceding AR in stroke rehabilitation. Our pilot study showed that MT-primed AR may improve motor impairment and functional outcomes more than the monotherapies. The preliminaries are encouraging for further study. This proposed research will verify our study hypothesis based on a larger sample. The findings may inform the selection of combinatory regimens in stroke rehabilitation.

P-497

The effect of robot-assisted therapy combined with mirror therapy on motor and daily functions, and self-efficacy in stroke

C. Y. Wu¹, Y. W. Chen¹, K. H. Su¹

¹Chang Gung University, Department of Occupational Therapy & Graduate Institute of Behavioral Science, Taoyuan, Taiwan

Introduction: Robot-assisted therapy promotes upper limb function in stroke survivors through intense, repetitive practice. Mirror therapy improves motor function of the upper limb after stroke by mirror-induced visual illusion to facilitate neuroplasticity. Combining these two interventions might yield greater therapeutic effects.

Objectives: We aimed to examine whether mirror therapy would augment the therapeutic effects of robot-assisted therapy on motor function, daily function, and self-efficacy in chronic stroke survivors.

Materials & methods: A single-blinded randomized controlled trial was conducted in this study. Thirty-seven individuals with chronic stroke were randomly assigned to the experimental group receiving mirror therapy prior to robot-assisted therapy and the control group receiving sham mirror therapy prior to robot-assisted therapy during an intervention session. All participants received 18 intervention sessions (60 min/session, 3 sessions/ week). Outcome measures were evaluated at baseline and after the 18-session intervention. Motor function was assessed using the Fugl-Meyer Assessment. The daily function was assessed using the Nottingham Extended Activities of Daily Living Scale. Self-efficacy was assessed using Stroke Self-Efficacy Questionnaires and the Daily Living Self-Efficacy Scale. Data was analyzed using mixed model analysis of variance.

Results: Both groups showed significant improvements in motor and daily function, but there were no significant differences between the two groups. Participants receiving mirror therapy prior to robot-assisted therapy experienced greater improvements in self-efficacy measures compared to those receiving sham mirror therapy.

Conclusion: Our findings suggest that robot-assisted therapy improved upper limb function and daily independence in chronic stroke survivors. Combining mirror therapy with robot-assisted therapy could further enhance self-efficacy post-stroke.

P-498

A case-series evaluation in the development of an exposure-based cognitive behavioral therapy based intervention for the rehabilitation of walking post-stroke

C. L. Pollock¹, A. Kasapi¹, S. Mehta², N. Silverberg³, N. Badke⁴, A. Harris⁴, D. Caves⁴, B. Mortenson⁵, J. Schmidt⁵, K. Yoshida¹

¹University of British Columbia, Physical Therapy, Vancouver, Canada

²Western University, London, Ontario, Canada

³University of British Columbia, Psychology, Vancouver, Canada

⁴GF Strong Rehabilitation Centre, Vancouver, Canada

⁵University of British Columbia, Occupational Therapy, Vancouver, Canada

Introduction: After stroke, achieving independent walking is a rehabilitation priority, however, health outcomes associated with walking remain poor. One in 4 people with stroke experience anxiety, and significantly more struggle with activity avoidance and sedentary lifestyles. These psychosocial factors are strongly impacted by decreased balance confidence, regardless of walking ability. We propose to proactively treat balance confidence while actively rehabilitating walking post-stroke. This study used a mixed-methods case-series to evaluate a novel Exposure-based Cognitive Behavioral Therapy based intervention for rehabilitation of walking post-stroke.

Patients & methods: Two treating physiotherapists (PT) were members of the study team developing the intervention. The study followed a pragmatic approach such that the intervention was integrated into usual PT care and individualized for patients over 8-12 sessions. Seven people with stroke referred to outpatient PT participated (median age: 46 years, range 32-63; 2 females; median time since stroke: 4 months, range 2-8). Primary outcome was the Activities-specific Balance Confidence (ABC) scale. Fast walking speed (FWS) and Timed Up and Go (TUG) were measured to explore functional change associated with increased walking balance post-stroke. Post-treatment qualitative interviews were conducted.

Results: All participants demonstrated improvement on the ABC with five participants demonstrating increase beyond the minimal detectable change of 14 points (median 28.6, range 4.4 – 40.9 points). FWS and TUG scores also showed improvement (FWS 0.3 m/s, -0.1-0.6; TUG -2.8 s, -6.4-1.1). Patients reported positive experiences with exposure-based CBT components of their treatment and progression to participation in activities reflective of community reintegration.

Conclusion: The findings highlight potential benefits of an exposure-based CBT approach to rehabilitation of walking function post-stroke.

P-499

Virtual reality and cognitive rehabilitation: an experimental study

D. Sundareswaran ¹

¹Meenakshi Academy of Higher Education & Research, Occupational Therapy, Chennai, India

Introduction: Virtual Reality (VR) can be viewed as an advanced form of computer interface that allows the user to interact with and become immersed in a computer generated environment.

Aims & objectives: The study aimed at identifying the effect of specific virtual reality in improving cognitive skills and functional performance of persons with cerebro vascular accident .

Methodology: Experimental study design where persons with neurological disorders who had cognitive impairment were included for this study . Ethical consent and institutional review board approval was sought . The study was undertaken after receiving informed consent

Tools: Lowenstein Occupational Therapy Cognitive Assessment Tool and Occupational Performance measure.

Pre test was administered .Intervention protocol included specific functional tasks and exer games through use of immersive technology. Each session lasted for 45 minutes. The duration Of training was 3 months. The sessions were held every alternate days of a week by a trained clinical therapist.

Results: A total of 60 participants took part in the study. There were 35 men and 25 women in the study.There was significant improvement in areas of Praxis , Visuo spatial skills and thinking operations. Improvement in thinking operations was better in younger age group than higher age group. There was minimal improvement in visuo spatial abilities.

Overall improvement was noticed in functional performance following training using VR.

Conclusion: Virtual reality facilitates significant interest and motivation in persons with stroke .Specific training using virtual reality improves cognitive functioning and functional performance .

Virtual reality serves as a promising technology in cognitive rehabilitation by occupational therapists.

Keywords: Virtual Reality, Cognitive Rehabilitation, Occupational Therapy, Functional Performance.

P-500

Can 3DfUS reliably measure Tibialis Anterior Muscle Echo-intensity in stroke patients and healthy controls?

F. Schillebeeckx¹, B. Hanssen², G. Verheyden², K. Desloovere², K. Peers¹

¹University Hospitals Leuven, Leuven, Belgium

²KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

Introduction: Drop foot is common in stroke patients for which various rehabilitation treatments are used. With increasing use of ultrasound (US), also echo intensity (EI) of a muscle is more often used as outcome parameter after treatment. In stroke, EI values at proximal third of tibialis anterior (TA) muscle have been reported1. However, EI evaluations are currently based on 2D evaluations of 1 US image.

Objectives: To define the reliability of defining TA EI based on 1 and multiple US images.

Patients & methods: Nine stroke patients and 9 age-matched healthy subjects were included. Two operators performed 3D US collections, combining cross-sectional 2D US with probe position data. Next, 2 processors made 3D reconstructions of the whole TA muscle and defined the proximal, mid and distal third. At these locations, EI was calculated from 1 US image and from the average of 2 and 3 US images. Inter- and intra-rater reliability was defined by intra-class correlation coefficients (ICC) and relative standard errors of measurement (SEM%).

Results: Overall, reliability increased as multiple images were included. Based on 1 image, ICCs ranged from 0.441 (-0.059-0.674) to 0.998 (0.996-0.999) with SEM% from 0.7% to 9% in stroke patients and from 0.667 (0.291-0.842) to 0.978 (0.955-0.990) with SEM% from 1.9% to 9% in healthy subjects. Based on 2 images, ICCs were 0.920 (0.259-0.985) to 0.970 (0.869-0.993) with SEM% from 0.4% to 4.3% in stroke patients and ICC"s from 0.820 (0.290-0.960) to 0.980 (0.910-0.990) with SEM% from 1.5% to 6.8% in healthy subjects. Finally, based on 3 images, ICCs ranged from 0.874 (0.190-0.974) to 1 (0.999-1) with SEM% from 0.3% to 4.3% in stroke patients and ICC"s from 0.832 (0.326-0.961) to 0.986 (0.928-0.997)with SEM% from 1.3% to 6.4% in healthy subjects.

Conclusion: This 3DUS reliability study suggests determining EI on multiple US images instead of 1 image as is currently done in clinical practice.

1. DOI: 10.1002/mus.25716

P-501

Experiences of family caregivers of stroke survivors in Burkina Faso: a qualitative study protocol

F. Ouédraogo^1,2, G. M. Kiki^3,4, O. L. Atigossou^3,4

¹University of Montreal, Rehabilitation, Montreal, Canada

²Sainte-Justine University Hospital Research Center, Marie Enfant Rehabilitation Center, Montreal, Canada

³Laval University, Rehabilitation, Québec, Canada

⁴Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada

Background: Stroke survivors in sub-Saharan Africa often need ongoing help from their relatives with daily tasks and personal hygiene. However, in Burkina Faso, the experiences of these caregivers are not well known.

Objective: This protocol outlines a research project which aims to comprehensively examine the experiences of family caregivers of stroke survivors in this country. The objective is to achieve a more thorough understanding of the true effects of their caregiving responsibilities on their overall quality of life.

Method: A sample of twenty family caregivers, recruited from both urban and semi-urban regions, will be used to conduct a qualitative study. Participants will engage in individual semi-structured online interviews using a pre-designed interview guide. The interviews will be recorded, transcribed verbatim, and subject to abductive thematic analysis guided by the International Classification of Functioning, Disability, and Health (ICF) framework.

Expected results: Four potential themes could eventually emerge: a) Health and well-being of family caregivers (e.g., physical, psychological, and social impacts, health management, conflicts, and priorities); b) Balancing caregiving responsibilities and personal life (e.g., daily caregiving management and the impact of caregiving role on social participation); c) Impact of environment on the caregiving role (e.g., social and physical environment factors); d) Personal experience and perceptions of the caregiving role (e.g., self-assessment as a caregiver, expectations and needs).

Conclusion: This study is the first of its kind to be carried out in this country. It therefore has the potential to make a significant contribution to the field of stroke research in sub-Saharan Africa, with particular relevance to Burkina Faso.

P-503

The setting of high intensity targets results in improved functional and locomotor outcomes for inpatient stroke rehabilitation

F. Bronstein ^1,2

¹NYU Langone Health, Physical Therapy, New York, NY, United States

²New York University Langone Health Orthopedic Hospital

Rusk Institute of Rehabilitation, Physical Therapy-Inpatient Rehabilitation, New York, NY, United States

Background & purpose: There is emerging research to support functional improvements in subacute stroke following high intensity training (HIT). Despite studies demonstrating its feasibility, its application can be challenging due to the lack of direct guidelines. The purpose of this study is to evaluate the comparative effectiveness of a HIT stepping program using time and intensity targets as a measure of adherence in subacute stroke in the inpatient rehabilitation (IR) setting.

Methods: All subjects received HIT during IR, defined as stepping training at 60-80% of heart rate reserve and/or a rate of perceived exertion rating of 15 to 18 at least 4 out of 7 days a week. Outcomes included the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI): admission quality indicator scores for transfers, combined ambulation and stairs, Berg Balance Scale (BBS), 10 Meter Walk Test (10MWT), 6 Minute Walk Test (6MWT), and discharge destination. Changes in functional and locomotor outcomes were compared between the adherent and non-adherent to target groups.

Results: Outcome data was collected for 128 patients (adherent n=67, non-adherent n=61). Significantly greater gains in BBS (p=<.001), 10MWT (p= <.001), 6MWT (p=<.001) and IRF-PAI transfer (p<0.001), walking (p<0.001), and stair scores (p=<0.001) were observed in the adherent vs. non-adherent groups. A higher proportion of subjects in the adherent group (88%) were discharged to home compared with the non-adherent (65%) group (p=.002).

Discussion and Conclusions: HIT was attempted on all patients admitted to IR following stroke. Greater locomotor gains and an increased likelihood to discharge home were observed in patients who were adherent to set targets.

P-504

Muscle activation in body weight transition during gait using functional electrostimulation in people with stroke

F. Covarrubias Escudero^1,2, J. P. Appelgren Gonzalez^1,3, G. Varas⁴

¹Trainfes, Translational Research Unit, Santiago, Chile

²Metropolitan University of Science Education, Kinesiology, Santiago, Chile

³Catholic University of Chile, Biomedical Imaging Center, Santiago, Chile

⁴Catholic University of Chile, Kinesiology, Santiago, Chile

Background: Falls are common in people with stroke (PwS), occurring in 73% of the cases within the first year. One critical moment is during the transfer of body weight between legs. Active weight transfer involves shifting weight from the back leg to the front leg, primarily using the triceps suralis muscle. This occurs just before the front foot makes contact with the ground correlating precisely when the CoM reaches its minimal vertical velocity (Vv_min), resulting in a balanced transition of the center of mass and forward movement. In contrast, a passive weight transfer is observed when the back leg does not initiate the transfer of weight.

Rehabilitation goal: There are several therapeutic alternatives to improve gait pattern. However, one of the main limitations in the implementation lies in the altered voluntary control of the muscles involved in the weight transfer. In this study, a functional electrical stimulation (FES) system driven by a closed-loop IMU-based algorithm, was used to activate plantar and dorsiflexors.

Objectives: (i) Categorize the transition of body weight during walking in PwS and (ii) describe if there are immediate changes when using FES on the paretic lower extremity to correct the weight-bearing transition.

Methods: An analytical study has been carried out that measured cadence, gait speed, stride length, percentage of the gait cycle in double support, force ratio, Vv_min with and without FES facilitation in a single session.

Preliminary results: A total of 8 PwS were analyzed so far. There were significant differences in force ratio (p=0.014) and Vv_min (p=0.017). Tendence to change with no significant differences for the temporal-spatial variables.

Ongoing activities: Users with different chronicity times continue to be recruited; a training plan with an extended period, will be carried out to explore dose-response effects; individualized assessments to detect which muscle activation setup facilitates better each condition.

P-505

Pre-exercise training upregulates irisin to promote the transmission of astrocyte mitochondrias to neurons to alleviate neurological dysfunction in mice with cerebral infarction

F. Yifeng¹, X. Yang¹, Z. Liying¹

¹Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, China

Introduction: Stroke is the leading cause of adult death and disability in China. Pre-exercise was proved to effectively protect stroke, through its unclear mechanism.

Objectives: To clarify the protective effect of preexercise training on neurological function in mice with cerebral infarction, and to explore the role and mechanism of exercise in the transmission of mitochondria from astrocytes to neurons in the peri-infarction area.

Materials & methods: 14 5-week-old C57BL/6J male mice were randomly divided into control group (CON, n=7) and preexercise training group (PE, n=7). Both groups received intracranial injection of GFAP-Mito-GFP-AAV to mark the mitochondria in astrocytes. The PE group was given 4 weeks of autonomous running training, and the CON group was not. Four weeks later, the left MCAO model was established by thread ocIrisinsion method. At 24h after MCAO, the mNSS was used to evaluate neurological function, MRI for the cerebral infarction volume, WB and qPCR for Irisin expression. Immunofluorescence was used to detect the transmission of mitochondria from astrocytes to neurons in the peri-infarct zone.

Results: PE mice mNSS score is superior to the CON group mice (P < 0.05), cerebral infarction volume significantly decreased (P < 0.05). Compared with the CON group, the brain Irisin and its mRNA levels were significantly increased in PE group (P < 0.05). There are more Neu N+ cells in the peri-infarct of PE group than the CON group (P < 0.05). The average number of mitochondria per neuron in the PE group was higher than that in the CON group (P < 0.05).

Conclusions: Preexercise training can promote the transmission of mitochondria from astrocytes to neurons in the peri-infarct zone of mice with cerebral infarction by up-regulating brain Irisin, promote the survival of neurons, and alleviate neurological dysfunction in mice with cerebral infarction.

P-506

Effects of Robot-assistED rehabIlitation vs occupational therapy on the Recovery of funCTion of the upper limb after a Stroke (REDIRECT): a randomized controlled study protocol and preliminary data

M. A. Szczepanska^1,2, C. Castagnoli², S. Doronzio^1,2, D. Longo^1,2, M. Cannobio², A. Politi², J. Giacani¹, G. Santini¹, L. Chiari¹, M. Baccini^1,2, F. Cecchi^1,2

¹University of Florence, Experimental Science, Florence, Italy

²IRCCS Carlo Gnocchi Foundation, Florence, Italy

Background: Manual dexterity (MD) and upper limb (UL) functioning are often chronically impaired after a stroke, significantly reducing functioning and quality of life of the affected persons. Physiotherapy (PT) and Occupational Therapy (OT) are widely adopted to enhance UL function; robotic devices also claim promising results. Gloreha Sinfonia (GS), equipped with a robotic glove that allow passive/active movements and functional tasks, is one of the most advanced devices for UL rehabilitation.

Objective: To provide evidence on the effects of robotic rehabilitation by GS compared to OT.

Patients & Methods: RCT designed according to the CONSORT guidelines. Participants: adults with chronic stroke and UL motor impairment (Motriciy Index 18-77); exclusion criteria: severe UL spasticity, other musculoskeletal/neurological conditions, severe cognitive disorders impairing comprehension/participation. A sample of 72 patients will be randomized to three groups:2 intervention groups (15 one-hour sessions for 5 weeks), i.e. a physiotherapist-supervised robotic therapy with GS (A) and OT promoting UL recovery with 1:4 therapist/patients ratio (B), and a control group undergoing a customized home exercise program (C). Primary outcome: 9 Hole Peg Test (NHPT); secondary outcomes: Wolf Motor Function Test (WMFT), ABILHAND, Frenchay Activity Index (FAI), and neuropsychological tests. Assessments: baseline (T0), after 5 weeks (T1) and after 3 months from T1 (T2).

Results: 12 patients (5 men, median age 60) were randomly assigned to the groups (4 for each group). Preliminar results T0-T1: NHPT: (A)= +9,1%, (B)= -18%, (C)= -115%; WMFT: (A)= +31,3%, (B)= +75,4%, (C)= -26,3%; ABILHAND: (A)= +8,43%, (B)= +47,17%, (C)= +19,56%; FAI: (A)= +18,2%, (B)= +22,9%, (C)= +6,9%.

Conclusion: The results obtained aren"t significant due to the small sample. The evaluation at T2 has not yet been carried out. By the time of the congress we expect to analyse at least 50% of the planned sample.

P-507

Fitness training for non-ambulatory stroke survivors living at home: intervention development and feasibility testing

F. van Wijck¹, M. Lloyd¹, D. A. Skelton¹, B. Williams², J. Booth¹, G. Mead³

¹Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, United Kingdom

²University of the HIghlands and Islands, Inverness, United Kingdom

³University of Edinburgh, Edinburgh, United Kingdom

Background: Clinical guidelines recommend fitness training after stroke, but evidence-based interventions for non-ambulatory stroke survivors are lacking.

Objectives: To develop, deliver and evaluate a novel fitness training programme for non-ambulatory stroke survivors living at home, and explore its feasibility, acceptability, safety and preliminary effects.

Method: Mixed-methods feasibility study in 3 stages. Stage 1: Interviews with non-ambulatory stroke survivors, carers and professionals to identify barriers, motivators, needs and goals. Stage 2: Intervention development. Stage 3: Feasibility testing, with stroke survivor input. Outcomes (self-efficacy, goal attainment, physical function, mood, independence, participation, carer burden) were measured by a blinded assessor before, after the 12-week intervention and at 3-months. Acceptability was explored in exit interviews, analysed thematically.

Results: Stage 1: Stroke survivors (N=14) and carers (N=7) expressed low confidence and mood, lack of independence and social isolation. Professionals (N=8) recommended tailored solutions to engage non-ambulatory stroke survivors in fitness training, prioritising safety. Goals prioritised confidence, self-care, physical function and participation. Stage 2: The intervention integrated personal goals with progressive chair-based training and behaviour change strategies. Stage 3: 9 stroke survivors (4 carers) completed baseline, 7 stroke survivors completed the intervention, 6 stroke survivors (3 carers) completed follow-up assessment. Post-intervention outcomes suggested small improvements in self-efficacy, goal attainment, anxiety and carer burden; some of which were sustained. None of the 4 Serious Adverse Events were intervention-related. Participants enjoyed the intervention, reporting benefits in mood, confidence, physical function and activity.

Conclusions: Findings suggest the intervention was enjoyable, feasible, acceptable and safe, warranting a future RCT.

P-508

Effects of swing timing differences between a cane and a paretic lower limb on walking speed in hemiplegic patients

F. Matsuda¹, M. Mukaino², K. Ohtsuka¹, J. Yamada³, Y. Wada⁴, E. Saitoh⁴, Y. Otaka⁴

¹Fujita Health University, Rehabilitation, Toyoake, Japan

²Hokkaido University Hospital, Rehabilitation, Sapporo, Japan

³Fujita Health University Hospital, Rehabilitation, Toyoake, Japan

⁴Fujita Health University, Rehabilitation, Toyoake, Japan

Introduction: Many hemiplegic patients use a cane to stabilize the paretic stance phase and assist with balance while walking. Most hemiplegic patients hold a cane using the non-paretic upper limb and swing it forward during the paretic swing phase. However, there are often differences in swing timings between the cane and paretic lower limb. Although this difference may affect the walking speed of these patients, there have been limited reports to date regarding this effect.

Objectives: This study aims to elucidate the effect of variations in swing phase timing between the cane and paretic lower limb on walking speed among hemiplegic patients.

Patients & methods: Sixty-three hemiplegic patients in the subacute or recovery stage who were able to walk with a cane were included in this study. For gait measurement, each patient was asked to walk with a cane at a comfortable speed on level ground. A three-dimensional motion analysis system, KinemaTracer, was used for all measurements. The outcomes of the differences in swing phase timing between the cane and paretic lower limb (where a positive value indicated that the cane touched ground earlier than the paretic foot), walking speed, and spatio-temporal parameters were calculated. The relationships between walking speed and other indices were also examined.

Results: The difference in swing phase timing between the cane and paretic limb was 0.80 ± 0.62 s. This difference showed a strong negative correlation with walking speed, cadence, and stride length (r = −0.84, −0.86, −0.56, respectively) and a strong positive correlation with the double support phase before the paretic swing (r = 0.90).

Conclusion: This study revealed that the cane swings forward before the paretic lower limb in the cane gaits of hemiplegic patients. Furthermore, as the timing difference increases, the double support time before the paretic swing increases, and the walking speed decreases.

P-509

The lifetime of a walk: survival curve analysis of walking patterns after stroke

G. Fulk¹, K. Klingman², J. Skufca³

¹Emory University, Physical Therapy and Rehabilitation, Atlanta, GA, United States

²Upstate Medical University, Nursing, Syracuse, NY, United States

³Clarkson University, Mathematics, Potsdam, NY, United States

Introduction: Activity monitors (AM) provide a way to explore movement behavior in the real world. Typical analyses use summary statistics of steps/day. However, these data may not be normally distributed and characterization by summary statistics may be too simplified.

Objective: This study explores patterns of post-stroke walking activity using a survival curve framework for both research and clinical applications.

Patients & methods: 6 participants wore an ActivPal (AP) and carried a GPS device for 5-7 days at 60 and 90 days post-stroke. We post-processed the AP data to contiguous intervals in upright posture, which we call a walklet, and the time spend "stepping" during that walket as its duration. GPS data identified walklets in the home vs. out of the home. By treating duration as an observed lifetime, we applied survival curve analysis to the "cohort" of durations on a per-subject basis, with a goal of identifying patterns.

Results: Survival curve analysis revealed varying patterns of stepping behavior. The distribution of durations was typically log normal or exponential, but never normal. Pattern analysis revealed that "in-home" or "out of home" and time (60 vs. 90 days) were interesting covariates.

Conclusion: This framework revealed patterns of stepping behavior well beyond those available in summary statistics. Participants with "exponential" patterns tended to walk less, with durations likely governed by external factors, while "log-normal" patterns indicated walks of longer duration, likely the result of internal factors (such as purposeful effort to extend walking durations). We believe this approach provides robust and novel insight into "in-situ" mobility and provides a rich set of existing techniques to analyze data sets involving "durations."

P-510

Knowledge, attitude and practice (KAP) of neurologists towards stroke neuro-rehabilitation in India

G. Ramamurthy¹, J. Maria Daniub¹, N. Surya², A. Srivastava³, A. Shivaraman⁴

¹BG Hospital, Neuroscience, Tiruchendur, India

²Surya Neuro Centre, Mumbai, India

³Kokilaben Hospital, Rehabilitation, Mumbai, India

⁴NG Hospital, Department of Neurology & Neurorehab, Coimbatore, India

Introduction: The number of rehabilitation centers and services for the rehabilitation of neurological disorders is far from requirements. The number of Rehabilitation centers are not proportionate enough to provide services to those requiring Neurorehabilitation.

Objectives: This study was carried to assess potential reason for exiguous number of Neuro-rehabilitation centers in India. This was perfomed by assessing the knowledge, attitude and practice of neurologists towards neurorehabilitation in India.

Method: A cross sectional 25-item online Knowledge, Attitude & Practice (KAP) questionnaire survey was conducted on Neurologist in South India. Convenience sampling method was used.

Results:83 Neurologists completed the survey. Overall knowledge of Stroke-Rehabilitation was 63%.The option of neurorehabilitation discussed with the stroke patients during acute and discharge was 75% and 59% respectively. Only, 29%Neuro-rehab centers are adequately equipped with techniques of Neural Repair.Two session of rehab per day for 6 months was reported 34% and 62% respectively.50% agree that it is necessary for health care workers to work as a team rather than separate unit.40% reports patients from remote regions are unable to reach for Neuro-rehabilitation services.Only,39% patients maximally adhere to regular Neurorehabilitation.78% reported that financial reason contributes to poor adherence of patients to neuro rehabilitation.

Conclusion: Despite sound knowledge of neurologists in Neurorehabilitation, the connect between neurologists and the neurorehabilitation centers needs to be strengthened. Further cost-effective Neuro-Rehabilitation services and insurance coverage could assist in continued care.

P-511

Repeated Transcranial Magnetic Stimulation (rTMS) combined with human umbilical cord mesenchymal stem cell therapy improves neurological outcomes in ischemic rats by reducing the panoptosis of neurons in the subacute phase of cerebral infarction

H. Zheng¹, S. Cheng¹, Q. Lu¹, J. Chen¹, M. Huang¹

¹Third Affiliated Hospital of Sun Yat-Sen University, Rehabilitation, Guangzhou City, China

Introduction: Repetitive transcranial magnetic stimulation (rTMS) and human umbilical cord mesenchymal stem cells (hUCMSCs) transplantation have proven therapeutic in rats with transient middle cerebral artery occlusion (tMCAO). However, both treatments have limitations. Whether these two therapies have synergistic effects and the underlying mechanisms remains unclear.

Objectives: This study purposed to evaluate the synergistic effect of rTMS combined with hUCMSCs treatment in rats with cerebral infarction and elucidate the underlying mechanism.

Materials & methods: Rats were divided into five groups: sham, tMCAO, rTMS, hUCMSCs and rTMS+hUCMSCs groups. We evaluated the effects of hUCMSCs+rTMS treatment on functional recovery and neuroprotective effects in tMCAO rats while addressing the mechanism via in vitro experiments.

Results: Our results showed that the nerve prognosis of all the treatment groups was better than those of the tMCAO, while the rTMS+hUCMSCs group was the most significant. The levels of panoptosis indicators including Bax, Caspase3, NLRP3, Caspaese1, RIPK1and RIPK3 were the lowest in the rTMS+hUCMSCs group, accompanied by decreased production of IL-1β, IL-6, and TNF-α. To further explore the role of the two therapies, we found that hUCMSCs contributed to decreasing the activation of the spleen and reducing the inflammatory infiltration in the central nervous system. Meanwhile, the OGD/R model in vitro confirmed that rTMS significantly induced neurotrophic factor secretion in hUCMSCs-inhibited inflammatory conditions.

Conclusion: Our findings demonstrate that rTMS combined with hUCMSCs transplantation could synergistically alleviate panoptosis of neurons in the subacute phase of cerebral infarction, thus improving neurological outcomes. The neuroprotective effects are attributed to the anti-inflammatory effect of hUCMSCs and the secretion of neurotrophic factors such as BDNF induced by rTMS.

P-512

Self-reported sleep disturbances more than one year after stroke and its determinants

H. Nilsson¹, L. Rosengren¹, L. Jacobsson¹, J. Lexell¹

¹Lund Univeristy, Health Science, Lund, Sweden

Introduction: A common impairment after stroke is sleep disturbances. Studies of sleep disturbances after stroke are mostly performed in the acute phase. An increased knowledge of sleep disturbances a longer time after stroke and its determinants are needed to improve treatment and rehabilitation.

Objectives: The objective of this study were (i) to describe self-reported sleep disturbances more than one year after stroke onset, and (ii) to investigate the association between sleep disturbances, gender, age, time since stroke, other stroke characteristics and sociodemographics.

Materials & methods: Data were collected with a study specific questionnaire, the self-assessment tool Pittsburgh Sleep Quality Index (PSQI) and review of medical records. A total of 160 stroke survivors from northern Sweden participated. To investigate the association between sleep disturbances and gender, age, time since stroke, stroke characteristics and sociodemographics a hierarchical multiple regression analysis was conducted with PSQI as the dependent variable.

Results: Of the included participants, 86 (54%) were men and 74 (46%) were woman. The mean age was 73 years (SD ±11; 30-91) and mean time since stroke onset was 35 months (SD ±26; 18-61). Most participants walked independently (n=113; 71%) and less than a third (n=47; 29%) needed a mobility device. A total of 98 participants (61%) rated 5 points or more on PSQI and the mean score was 6.5 points (SD ±4.2; min-max 0-18). Gender and use of mobility devices were the only significant contributors and explained 9.5% of the variance in PSQI.

Conclusion: Sleep disturbances occur to a large extent several years after stroke onset. Being female and being less recovered from the stroke (i.e., need mobility devices) are more likely to report sleep disturbances, regardless of age, time since stroke onset, stroke characteristics and sociodemographics. Further studies are needed to identify determinants of sleep disturbances after stroke.

P-513

Effects of a 6-week lateral treadmill oscillation walking (TOW) training on balance and gait functions in chronic stroke survivors

H. Y. Hsiao¹, K. H. Shen¹, J. Tsai¹, R. Lee²

¹University of Texas, Kinesiology and Health Education, Austin, TX, United States

²St. David’s Medical Center, Austin, TX, United States

Introduction: Individuals post-stroke commonly have difficulty transferring bodyweight to their hemiparetic limb. Delayed and impaired weight transfer during gait contributes to greater energy expenditure and increased fall risk. Because standing surface translation engages hip and knee muscle activities that are important for weight transfer, a new approach that applies lateral treadmill oscillation during walking has been developed to enhance balance control and weight transfer during dynamic gait.

Objectives: This study aims to determine the short-term effects of a 6-week treadmill oscillation walking (TOW) training on clinical balance and gait outcomes.

Patients & methods: Five chronic stroke survivors (age: 58±16 yr; 3 male; time since stroke onset: 110±74 months; 3 left paretic) participated in 18 training sessions (three times a week for 6 weeks). Each session consisted of six 6-minute bouts of treadmill walking at baseline self-selected walking speed with treadmill oscillation. The lateral oscillation was a continuous sinusoidal pattern with a 1-cm amplitude and a frequency tailored to the individual"s self-selected stride frequency determined pretraining. Treadmill oscillation frequency was increased by 5% each week to promote progressive adaptive changes (25% over 6 weeks). BERG balance scale, Dynamic Gait Index (DGI), 6-minute walk test (6MWT), and self-selected (SS) and maximal walking speeds (MWS) during 10-meter walk test were measured pre- and post-training.

Results: On average, BERG increased 29±16%, DGI increased 31±22%., 6MWT decreased 3±14%, SS speed increased 14±16%, and MWS increased 9±14% from pre- to post-training.

Conclusions: TOW training appeared to improve balance measures and walking speed for individuals with chronic stroke. However, TOW does not show a positive effect on endurance. Ongoing investigations include identifying baseline predictors of responders and comparing muscle activation patterns before and after training.

P-514

Examining the effects of dance on physical and psychosocial function in chronic stroke

H. Ng^1,2, Y. Sharma^1,2, W. Michaelchuk^1,2, K. Patterson^1,2

¹University of Toronto, Toronto, Canada

²Toronto Rehabilitation Institute, Toronto, Canada

Background: Stroke affects physical and psychosocial function (e.g. balance, gait, social connection, confidence). Preliminary evidence suggests dance benefits both these domains but a randomized controlled trial (RCT) is needed to confirm this.

Objectives: Primary; Determine the effects of dance on physical and psychosocial function in chronic stroke with an RCT. Secondary; describe individual change with dance and potential mediating factors.

Methods: People post-stroke were randomized to dance or exercise and attended classes 2x/week for 12 weeks. Mini BESTest, gait speed, Friendship Scale, and Activities Specific Balance Confidence (ABC) Scale were assessed. The COVID pandemic ended the RCT early, and the target sample size was not met. Within and between group differences were investigated with t-tests. Individual change was explored by identifying those who improved on each outcome [(post – pre) > MDC] and comparing their attendance, perceived exertion, and baseline Fugl-Meyer, Mini BESTest and gait speed to non-improvers on each outcome with unpaired t-tests.

Results: Twenty-six people (11 women, mean (sd) age: 64.5 (10.1) yrs) participated. There were no within or between group differences. Within dance, compared to the non improvers, 3 people who improved on Mini BEST had lower baseline arm motor function (46 (18) vs. 55 (7); p=0.02); 2 who improved in gait speed had lower baseline arm (39 (19) vs. 56 (7); p=0.02) and leg (16 (0) vs. 26 (4); p=0.02) motor function; and 1 who improved in ABC had higher baseline MiniBEST (22 vs. 14.5 (6.3); p=0.003) and faster gait speed (116 vs. 80.8 (40.1); p = 0.01).

Conclusion: Preliminary results suggest some people with more baseline impairment improve in balance and gait speed with dance. Lessons from pandemic-related challenges can inform future studies on virtual delivery methods. Future work should explore what dance content is most effective and confirm features of those with chronic stroke most likely to benefit.

P-516

Safety and feasibility of high-intensity interval training in post-stroke individuals: a systematic review

H. Blatgé¹, L. Paul¹, F. van Wijck¹

¹Glasgow Caledonian University, School of Health and Life Sciences, Glasgow, United Kingdom

Introduction: High-intensity interval training (HIIT) has shown to be beneficial in stroke rehabilitation however its feasibility and safety remain unclear, hampering implementation in practice.

Objectives: This systematic review aimed to synthesize evidence regarding the feasibility and safety of HIIT in poststroke individuals.

Materials & methods: A systematic literature search according to the PRISMA guidelines was conducted in nine major databases to retrieve any type of design. Inclusion criteria were defined using PICO elements. Methodology quality was assessed using published tools. Narrative synthesis was used because of study heterogeneity.

Results: Of 5,247 records, 15 studies (14 quantitative, 1 mixed methods) involving 397 participants met inclusion criteria. Half the studies were of strong quality, half were moderate. Most studies included participants in the chronic stage of stroke with mild impairments. HIIT was mainly conducted in clinical settings with supervision from trained staff. There was a low incidence of dropouts and adverse events in both intervention and control groups, however 43% of adverse events in the intervention groups were exercise-related. One case fatality was reported in the HIIT intervention, but this was not exercise-related. Attendance to HIIT was 96% across intervention groups. There were insufficient qualitative data to draw conclusions on participants" perception on acceptability of HIIT, and scarce reporting of compliance. Adherence to the appropriate intensity for HIIT was variable with inconsistency in reporting physiological variables.

Conclusion: HIIT may be considered safe and feasible for carefully screened chronic stroke individuals when being supervised by trained staff. Further research should address the feasibility and safety of HIIT in subacute stroke individuals and its implementation in community settings. Moreover, future studies need to explore the overall acceptability of HIIT.

P-518

Effect of chronic physical exercise prior a stroke on acquired morphological damage and functional impairments in an animal model

J. Silva-García^1,2, R. Fuentes-Flores², J. L. Valdés²

¹University of Chile, Medicine, Santiago, Chile

²University of Chile, Faculty of Medicine, Dept of Neuroscience, Santiago, Chile

Stroke is one of the leading causes of death and disability worldwide, with 1/3 of the survivors suffering different degrees of disability, and the lack of effective treatments. On the other side, brain activity and plasticity, attention, learning, and memory can be improved with physical exercise, which is known to increase brain-derived neurotrophic factor levels (BDNF), suggesting a potential role in motor function recovery after stroke. Nevertheless, it is still unclear the specific role of physical exercise in preventing ischemic brain damage and, at the same time, facilitating motor recovery. Therefore, we propose that chronic physical exercise (4 weeks) before an ischemic insult protects against acquired morphological and functional damage.

Sprague-Dawley adult rats will perform voluntary physical exercise for 28 days on a running wheel. Afterward, a stroke will be induced by ET-1 administration on M1 of the preferred forelimb. Motor behaviour and acquired neurological impairments will be analysed and correlated with histological and immunohistochemical analysis. It is expected that physical exercise will reduce lesion size and neurological impairments after stroke, along with a reduced neuroinflammation, and an augmented angiogenesis and plasticity on M1, assessed by Iba-1, CD31 and BDNF immunoreactivity respectively.

The results provided by this research will help us to broaden our knowledge about the role of physical exercise over cerebral function, providing evidence about its potential protecting role against ischemic damage. All of this will help promote even further physical exercise programs and a better understanding of how specific effects of exercise could help to develop new therapeutic approaches to ameliorate ischemic damage and promote motor rehabilitation.

P-519

Exploring white matter tract involvement in alien hand syndrome following stroke: diffusion tensor imaging study

J. Park¹, S. Lee¹, J. I. Lee¹, W. S. Tae², S. B. Pyun^1,3,2

¹Korea University Anam Hospital, Physical Therapy and Rehabilitation, Seoul, South Korea

²Korea University College of Medicine, Brain Convergence Research Center, Seoul, South Korea

³Korea University College of Medicine, Biomedical Sciences, Seoul, South Korea

Introduction: Alien Hand Syndrome (AHS) causes loss of hand control and involuntary movements, often attributed to damage to the corpus callosum (CC), which connects the two brain hemispheres. AHS can also result from damage to the medial frontal cortex, parietal lobe, or thalamus, but its precise causes remain unclear.

Objectives: This study aimed to identify the white matter tracts associated with AHS development using the automated reconstruction of 42 tracts from diffusion tensor imaging (DTI) data.

Patients & methods: We included three female AHS patients with anterior cerebral arterial infarctions. Additionally, we enrolled 20 age-matched control subjects and six patients with cerebral infarctions in the anterior cerebral arterial region but without AHS symptoms (N-AHS group) for comparison. DTI was conducted in AHS, N-AHS, and control groups. Fractional anisotropy (FA) and volume values were extracted from the DTI datasets of participants using TRActs Constrained by UnderLying Anatomy (TRACULA) technique. The Kruskal-Wallis test with post hoc analysis compared these values among the groups.

Results: The AHS group showed lower FA values of the CC body (parietal and temporal section), right arcuate fasciculus, corticospinal tract, extreme capsule, inferior longitudinal fasciculus, and superior longitudinal fasciculus than the control group (p<0.05). However, these tracts exhibited no significant difference between N-AHS and control groups. Similarly, the volume value in the genu of CC in the AHS group was lower than the control group (p = 0.04).

Conclusion: Our study revealed the extensive corpus callosum and multiple white matter tract involvement in the development of AHS. These findings provide insights into the neural mechanisms behind AHS and highlight the importance of considering other white matter tracts beyond the CC in understanding this intriguing phenomenon.

P-521

Factors related to prognosis after rehabilitation for stroke following cardiac surgery

J. H. Lee¹, S. H. Lee¹, S. Cha¹

¹Asan Medical Center, Rehabilitation, Seoul, South Korea

Objective: Stroke is one of major complication of cardiac surgery. The aim of this study is to investigate the factors related to the prognosis of stroke following cardiac surgery and to investigate predictive factors for discharge after rehabilitation.

Method: The study was a retrospective chart review. Patients who had undergone cardiac surgery and were transferred to inpatient department of rehabilitation medicine from March 2018 to March 2023 were included. Patients who had developed acute stroke before surgery or those with spinal cord injury were excluded. Demographic data, past medical history, radiologic findings including brain MR and baseline laboratory test results were collected. Functional evaluations including Manual Muscle Test (MMT) sum of bilateral shoulder, eblow, wrist, hip, knee and ankle, Berg Balance Scale (BBS), Functional Ambulatory Category (FAC) and Modified Barthel Index (BMI) at the time of transfer and discharge were investigated as well.

Results: A total of 94 patients were enrolled in the study, with 55 patients having developed new stroke after cardiac surgery. Comparison between groups with and without stroke did not show significant differences in baseline characteristics except hemoglobin and creatinine. Stroke patients showed lower MBI and FAC at the time of transfer, received longer sessions of rehabilitation, and showed lower MBI at the time of discharge. Analysis in terms of discharge location showed that patients who discharged to home showed higher MBI, FAC, and MMT sum at the time of transfer and discharge. Logistic regression analysis showed that MBI at the time of transfer was a significant factor in predicting home discharge.

Conclusion: Post-cardiac surgery stroke is a major complication of cardiac surgery, with stroke patients showing lower functional status. MBI showed to be a predictive factor in predicting home discharge.

P-522

A new reflex-based treatment of the claw hand in chronic stroke patients. A proposal for a new rehabilitation robot design

J. Van Vaerenbegrh ¹

¹Luzerner Höhenklinik Montana AG, Rehabilitation, Crans Montana, Switzerland

Introduction: Impaired hand function is one of the most frequently persisting consequences of stroke. Advanced rehabilitation techniques may improve hand function in stroke survivors, however, many of these techniques, including robot therapy, require some residual movement of the impaired arm or hand and therefore are not applicable to severely disabled stroke survivors.

Patients & methods: Electrical stimulation at discrete skin locations on the foot soles of stroke patients with a Babinski sign has been shown to inhibit the plantar grasp reflex and to modulate topographically discrete cutaneous reflexes, with gait-related mechanical properties. Since spinal reflexes during rhythmic upper limb movements present similar phase-dependent modulations, we postulate that an analog, state-dependent condition, with topographically discrete cutaneous reflexes, exists for the clawing hand, during quadrupedal walking and can be considered as a temporary status of human devolution-based on neurological damage and a start for treating a claw hand.

Results: Using a stimulus of rectangular pulses (1 ms duration, 200 Hz frequency) through a constant current stimulator, kinematical correlates to crawling could be generated in the upper limb of 3 stroke patients with a nonfunctional, spastic, claw hand.

Conclusion: On this basis we propose a completely new robot design for upper limb rehabilitation, supporting different types of quadrupedal walking and initiated through palmar hand skin stimulation with the aim of developing gross motor control of a severely spastic hand.

P-523

Exploring new ways of defining risk and determinants of post-stroke cognitive decline

J. P. Saa¹, C. Chen², M. Springer³, S. Pendlebury⁴, D. Levine³, A. Brodtmann⁵

¹Florey Institute of Neuroscience, Melbourne, Australia

²National University of Singapore, Singapore, Singapore

³University of Michigan, Ann Arbor, MI, United States

⁴University of Oxford, Oxford, United Kingdom

⁵Monash University, Medicine, Melbourne, Australia

Cognitive impairment following stroke occurs in up to 80% of patients and contributes to post-stroke disability. Stroke is associated with accelerated rates of structural brain-aging which precedes cognitive decline and dementia. Despite recent evidence describing cognition after stroke, the longer-term trajectories of cognition remain unclear, as do the risk and determinants of post-stroke cognitive decline. Processing speed, attentional impairment and executive dysfunction are common in the acute post-stroke period, with some evidence of improvement at 3-months post-stroke. Stroke survivors are also reported to have reduced spatial, attention, and processing abilities; and greater declines in memory, attention/processing speed, orientation and executive ability following recurrent stroke. Older age, fewer years of education, history of vascular and cardiac events, mood dysfunction, race and sociodemographic factors may modify the risk of post stroke cognitive decline.

The purpose of this session is to describe the risk and determinants of cognitive changes post-stroke, from an imaging, neuropsychological and sociodemographic perspective. In addition, we aim to describe methods of prediction and characterization of individual cognitive trajectory after stroke, and the factors associated with these trajectories. Findings from these areas may aid us in identifying potential mechanisms of post-stroke cognitive decline and have implications for high-risk groups to target with current or new interventions.

P-524

Examining sex differences in relationships between subjective and objective measures of upper extremity motor impairment in a sample of stroke survivors

J. Dahlby¹, B. C. Larssen¹, L. A. Boyd^1,2

¹University of British Columbia, Physical Therapy, Vancouver, Canada

²University of British Columbia, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada

Background & purpose: Females are underrepresented in stroke research. How this impacts physical therapy clinical care is not fully known. Increased efforts toward disentangling the differences between the sexes are crucial to providing personalized care for those living with stroke. Rehabilitation professionals use subjective and objective outcome measures to assess stroke-related impact and impairment. Understanding if subjective and objective findings correlate among stroke survivors, especially if these associations differ between females and males, can inform care decisions.

Methods: A retrospective cross-sectional design was used, with data selected from subacute to chronic stroke survivors on age, time since stroke, the hand domain from the Stroke Impact Scale version 3.0 (SIS-H), and the Fugl-Meyer Upper Extremity Assessment (FMUE). Group differences were assessed for all outcomes based on sex and time post-stroke. Separate correlations for females and males were performed between the subjective (SIS-H) and objective measures (FMUE) of upper limb function and impairment.

Results: Data from 148 participants (44 females) were included in this study. SIS-H was significantly correlated with FMUE in both females and males (Ps≤0.001). No significant differences were found between the groups" mean SIS-H or FMUE scores based on sex or time post-stroke.

Discussion & conclusions: Subjective and objective measures of physical functioning were correlated in both females and males. Although we found no sex differences in our primary outcomes, the sample size of females was disproportionately lower than the males. This is consistent with an ongoing problem in the stroke recovery research field, where females are often underrepresented and understudied. Continued efforts to balance sample sizes and perform sex-based analyses will help to address the gap that lingers in our knowledge regarding females and stroke rehabilitation.

P-525

Development and feasibility of first- and third-person motor imagery for people with stroke living in the community

K. P. Y. Liu^1,2, N. Welage^2,3, M. Bissett⁴, K. Coxon², K. Fong¹

¹Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

²University of Western Sydney, Health Science, Penrith, Australia

³University of Kelaniya, Ragama, Sri Lanka

⁴Southern Cross University, Health Science, Gold Coast, Australia

Background: Research show that mental imagery effectively enhances hand function in people with stroke. It can be performed when people imagine themselves as the first person completing the movement or imagine a third person doing it. However, there is no report on the specific use of first-person and third-person imagery in stroke rehabilitation.

Aims: To develop and assess the feasibility of a First-Person Mental Imagery (FPMI) and a Third-Person Mental Imagery (TPMI) programs to address the hand function of people with stroke.

Methods: This study started with the development of the FPMI and TPMI programs through an expert panel review. It then went through a feasibility testing with six participants with stroke participated in the FPMI and TPMI programs for two weeks. Feedback collected included the suitability of the eligibility criteria, therapist"s and participant"s adherence to intervention and instructions, appropriateness of the outcome measures, and completion of the intervention sessions within the specified time.

Results: The FPMI and TPMI programs were developed based on previously established programs and included 12 hand tasks. The participants completed four 45-minute sessions in two weeks. The treating therapist adhered to the program protocol and completed all the steps within the specified time frame. Participants followed the instructions given and engaged in mental imagery. The outcome measures selected were appropriate for the participants. Both programs showed a positive trend towards improvement in participants" upper extremity and hand function and self-perceived performance in activities of daily living.

Conclusions: The study provides preliminary evidence that these programs and outcome measures are feasible for implementation with adults with stroke. This study outlines a realistic plan for future trials in relation to participant recruitment, training of therapists on the intervention delivery, and the use of outcome measures.

P-526

Prevalence of people presenting with upper limb weakness within the first week post-stroke is shifting

E. Dalton¹, H. Johns², S. Newton¹, K. Hayward^1,2,3

¹University of Melbourne, Physiotherapy, Carlton, Australia

²University of Melbourne, Medicine, Carlton, Australia

³Florey Institute of Neuroscience, Stroke, Heidelberg, Australia

Introduction: The prevalence of upper limb motor weakness early post-stroke is hypothesised to be shifting over time.

Objective: To investigate cross-sectional observational studies for a shift over time in the number of people presenting with upper limb motor weakness within the first 7-days post-stroke.

Methods: Studies that reported the proportion of people presenting with upper limb weakness within the first 7-days post-stroke (acute stroke phase of recovery) were examined. The 95% confidence interval (95% CI) was calculated for each study based on the proportion of people presenting with upper limb weakness. We visually inspected the results for trends over time.

Results: Seven studies were identified (n=3,620 people with stroke) that collected prevalence data between 1978 and 2022. Two clusters were visually observed. An earlier cluster (3 studies, n=1,049 people with stroke) collected data between 1978-1997. Reported upper limb weakness ranged from 69% (95% CI 64-73%) to 76% (95% CI 72-79%). A later cluster (4 studies, n=2,571 people with stroke) collected data between 2009-2022. Reported upper limb weakness ranged from 35% (95%CI 30-39%) to 48% (95% CI 44-52%). No studies in the earlier cluster reported on use of acute interventions (i.e., thrombolysis and thrombectomy) as it was not part of routine stroke care. All studies in the later cluster reported on use of acute interventions, which ranged from 14% to 52% of people with stroke.

Conclusion: These findings support the hypothesis that there has been a decline in the percentage of people presenting with upper limb weakness early post-stroke over the last 40+ years. Acute interventions, along with a stronger focus on primary stroke prevention, and improved imaging to detect small strokes are possible factors contributing to the observed decline. Further research is warranted to unpack this finding to inform prioritisation of research questions and clinical care pathways.

P-527

Effects of handrail use during treadmill walking on abnormal gait patterns and spatiotemporal parameters in patients with hemiparesis

K. Ohtsuka¹, M. Mukaino², J. Yamada³, F. Matsuda¹, H. Tanikawa¹, K. Tuchiyama¹, Y. Wada⁴, E. Saitoh⁵, Y. Otaka⁴

¹Fujita Health University, Rehabilitation, Aichi, Japan

²Hokkaido University Hospital, Rehabilitation, Hokkaido, Japan

³Fujita Health University hospital, Rehabilitation, Aichi, Japan

⁴Fujita Health University, Rehabilitation, Aichi, Japan

⁵Fujita Health University, Aichi, Japan

Introduction: Patients with hemiparesis who use a cane use a handrail instead of a cane during treadmill walking. Canes and handrails are similar; however, different structures mean that they could have different influences on gait parameters.

Objectives: The purpose of this study was to investigate the effects of handrail use on spatiotemporal parameters and abnormal gait patterns during treadmill walking in patients with hemiplegic stroke.

Participants & measurement: Twenty-seven patients with hemiparesis who used a cane to walk on a level surface and could walk on a treadmill without a handrail participated in this study. A three-dimensional motion analysis system (KinemaTracer) was used for all measurements. The outcome measures included 12 abnormal gait indices and spatiotemporal indices calculated using kinematic data. The Wilcoxon signed-rank test was used to compare walking with and without the handrail for each index. The significance level was set at p < .05.

Results: Forefoot contact, flexed-knee gait, medial whip, insufficient knee flexion during the swing phase, and hip hiking significantly decreased, whereas circumduction gait significantly increased during handrail walking. The stride length and both step lengths significantly increased, and the cadence decreased during walking with a handrail.

Conclusion: This study revealed that the use of a handrail during treadmill walking decreased abnormal gait patterns, whereas circumduction gait increased. It has been suggested that the increase in circumduction gait may be due to longer stride and step lengths.

P-528

Power training for Stroke Recovery (POWER): an interim analysis of a feasibility trial

K. S. Noguchi¹, J. Abreu², Z. Sanvido², P. Bochnak³, A. McQuarrie³, B. Elliott⁴, S. M. Phillips², M. Beauchamp¹, L. Thabane^5,1,6,7, A. Tang¹

¹McMaster University, Rehabilitation, Hamilton, Canada

²McMaster University, Kinesiology, Hamilton, Canada

³McMaster University, Physical Activity Centre of Excellence, Hamilton, Canada

⁴Community Member, Hamilton, Canada

⁵McMaster University, Health Research Methods, Evidence & Impact, Hamilton, Canada

⁶St Joseph’s Healthcare Hamilton, Hamilton, Canada

⁷University of Johannesburg, Health Science, Johannesburg, South Africa

Introduction: Resistance training (RT) is recommended after stroke to improve or retain muscle strength. Muscle power accounts for a higher proportion of the variance in physical function compared to muscle strength in people with stroke, presenting an opportunity for power-focused RT programs to promote stroke recovery.

Objectives: To examine the feasibility of power-focused RT in people with chronic stroke.

Materials & methods: Participants >6 months post-stroke participated in a 10-week progressive RT program in a community exercise gym delivered over 3 phases: familiarization (Week 1), traditional strength-focused RT (Weeks 2-5), power-focused RT where repetitions were performed as quickly as possible (Weeks 6-10). Feasibility of recruitment, sex and gender distribution, attendance, attrition, safety, exercise tolerance and adherence were measured throughout the study process with pre-established criteria for success.

Results: Seven participants (62.9±4.2 years old, 6.3±3.1 years post-stroke) were recruited over 4 months (1.8/month; target: ≥1.0/month), of which 43% were female and women (target: ≤60% of any sex/gender). Participants attended 178 of 186 (96%) possible exercise sessions (target: ≥85%). There has been no loss to follow-up (target: ≤10%). Across 2,931 exercise sets, there were 7 instances (0.2%) of pain or discomfort during exercise and no serious adverse events (target: 0). There were no abnormal blood pressure responses to exercise (0%; target: <25%). Participants adhered to 74% of sets at the correct prescribed exercise intensities, based on a 10-point rating of perceived exertion scale (target: ≥85%).

Conclusion: A progressive power-focused RT program may be feasible in people with chronic stroke. However, using a subjective rating of perceived exertion scale, fewer than expected sets were at the prescribed intensity.

P-529

How does the therapeutic alliance relate to self-management in community stroke rehabilitation? Exploring the views of healthcare professionals

L. Lucas¹, S. Peters², S. Cotterill³, A. Bowen¹

¹University of Manchester, Psychology and Mental Health, Manchester, United Kingdom

²University of Manchester, Psychology and Mental Health, Manchester, United Kingdom

³University of Manchester, Centre for Biostatistics, Division of Population Health, Health Services Research & Primary Care (SHS | FBMH), Manchester, United Kingdom

Background: The therapeutic alliance constitutes one-of-five core self-management skills but is not well understood in community stroke settings and has not been explored in relation to stroke self-management.

Objectives: The aim of the study, focusing on healthcare professionals, is to understand (i) how self-management is perceived in community stroke rehabilitation, (ii) how alliances with stroke survivors are developed, maintained and repaired, and (iii) which aspects of the alliance are perceived to help or hinder self-management.

Methods: Qualitative, semi-structured interviews were conducted with healthcare professionals from four community stroke services in the UK. A group of 7 people with lived experience of stroke helped develop the interview schedule and contributed to analysis. Inductive thematic analysis, using Braun and Clarke’s 6-stages and NVivo, was used to develop themes.

Results: Analysis of 19 interviews produced three themes and ten subthemes. "Confusion about what self-management is" leads to impairment-focused self-management support, missing opportunities to support emotional management. Alliances are complex and developed on the premiss that "we’re not going to be here forever". Buy-in and managing expectations contribute to developing and maintaining alliances. In the context of rehabilitation, alliances are considered important for rehab success. "Unpicking the magic but muddying the waters" highlights where confusion remains about transitioning to alliances conducive to self-management success, as well as rehab success.

Conclusion: Staff training and education about what self-management is, beyond focusing on impairments, may address the complex psychosocial consequences of stroke and introduce co-production opportunities within services. Organisational approaches to self-management, embedding evidence-based interventions in community teams, may enhance working relationships to be conducive for both rehab and self-management success.

P-530

Capacity of the paretic upper extremity in unimanual vs. bimanual tasks and its relationship with daily life use after stroke

L. Gagné-Pelletier^1,2, I. Poitras^1,2, M. Roig^3,4, C. Mercier^1,2

¹Laval University, Rehabilitation, Québec, Canada

²Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Québec, Canada

³McGill University, Physical and Occupational Therapy, Montreal, Canada

⁴Center for Interdisciplinary Research in Rehabilitation, Montreal, Canada

Introduction: Improvement in motor capacity of the paretic upper extremity (UE) after stroke does not always translate into an increased use in daily life activities, which might be explained by the fact that most of these activities require cooperative use of both hands. While some argue that bimanual tasks can facilitate paretic UE movements, others claim that unimanual movements are better preserved after stroke.

Objectives: This study aimed to compare the relative capacity of the paretic UE between unimanual and bimanual tasks in subacute stroke survivors and to assess its relationship with the relative use of paretic UE in daily life. We hypothesised that capacity during the performance of a bimanual task would be lower than during the unimanual version of the task, but more closely associated to use in daily life.

Patients & methods: Nineteen hemiparetic participants underwent a robotic task assessing sensorimotor capacity and wore wrist accelerometers measuring relative use of each UE over seven days. Robotic assessment consisted of a visuomotor task requiring hitting as many virtual balls as possible, either freely using both hands (bimanual asymmetric task) or only one hand (unimanual task). Ratios of the number of hits (paretic/non-paretic) were compared across tasks, and association with use ratios derived from accelerometry was assessed.

Results: Hit ratios did not differ between unimanual and bimanual tasks (mean±SD: 0.76±0.29 and 0.80±0.28, respectively; p=0.25), both being much higher than use ratios in daily life (0.52±0.37; p<0.001). Nevertheless, both unimanual and bimanual hit ratios were strongly associated with use ratios in daily life (R2=0.67 and 0.61, respectively; p<0.001).

Conclusion: Performing an asymmetric bimanual task neither improved nor decreased the paretic UE relative capacity compared to a similar unimanual task. Capacities in unimanual and bimanual tasks predict the level of use of the paretic UE in daily life in a similar way.

P-531

Arm-hand BOOST therapy to enhance upper limb recovery after stroke: clinical, health economic and process evaluation

L. Cornelis¹, S. Meyer^2,1, M. Michielsen², M. Vander Plaetse², K. Putman³, M. Fobelets³, L. Cruycke³, A. De Smedt⁴, G. Verheyden¹

¹KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

²Jessa Hospital, Physical Therapy and Rehabilitation, Herk-de-Stad, Belgium

³Vrije University (VUB), Public Health, Brussels, Belgium

⁴Vrije University (VUB), STIMULUS research group, Brussels, Belgium

Introduction: Our proof-of-concept showed the feasibility, safety and potential efficacy of the arm-hand BOOST program, which is now tested in a phase III RCT.

Objectives: The overall aim of this study is to establish the clinical- and cost-effectiveness of the arm-hand BOOST therapy when delivered on top of the usual care program in the sub-acute phase post stroke and to perform a process evaluation.

Patients & methods: In this phase III RCT, 80 patients with stroke will be recruited from two inpatient stroke rehabilitation wards in Belgium and randomized to the experimental group receiving arm-hand BOOST therapy or the control group receiving the CONTROL intervention, on top of their usual inpatient care program. The arm-hand BOOST program (1 hour/day, 5x/week, 4 weeks) consists of group exercises including scapula-setting, core-stability, shoulder external rotation and elbow extension, manipulation and dexterity, and ADL tasks. Additionally, technology-supported upper limb therapy will be provided one hour per week. The CONTROL intervention comprises a dose-matched program of lower limb exercises and general reconditioning. At baseline, after 4 weeks of training, 3 months after the intervention and at 12 months post stroke, outcome assessment will be performed. The primary outcome measure is the action research arm test (ARAT). Secondary outcomes include measures in the domain of upper limb function and capacity, independence, participation and quality of life. Multivariate ANOVA and sensitivity analyses will be used to compare change from baseline between groups. Information on medical costs will be collected to allow a health economic evaluation. Finally, a process evaluation will be performed to assist in identifying why arm-hand BOOST succeeds or fails unexpectedly or has unanticipated consequences, and how it can be optimised.

Results & conclusion: Recruitment is planned between April 2024 and April 2026, with last follow-up measures planned in April 2027.

P-532

Cardiac source of ischemic stroke may be associated with worse patient outcome upon discharge: a pilot study from southern Armenia

L. Avetisyan^1,2, S. Khachatryan^1,3, N. Yeghiazaryan^1,4, L. Manutsyan⁵

¹National Institute of Health, Neurosurgery, Yerevan, Armenia

²"Davidyants Polyclinics" Primary Healthcare Center, Yerevan, Armenia

³"Somnus" Sleep and Movement Disorders Center, Yerevan, Armenia

⁴Erebouni Medical Center, Department of General Neurology and Stroke, Yerevan, Armenia

⁵Goris Medical Center, Department of Internal Medicine, Goris, Armenia

Introduction: Ischemic stroke is associated with variable frequently poor outcomes depending on many factors.Stroke etiology may be one of the factors with different prevalences between populations. Goris Medical Center(GMC) is located in the southeast Syunik region in Armenia.Stroke patients living far from the comprehensive centers in Armenia have difficulty accessing timely and quality stroke treatment.We aimed to study the relationship between stroke etiology and patient outcome upon discharge.

Methods: Patients who had ischemic stroke(IS)and were admitted to GMC in Summer 2022 were included in the study.They were categorized based on the IS subtype into the cardiac source (CS) and non-cardiac source(NCS) groups.The latter included other subtypes of TOAST classification such as atherothrombotic large vessel occlusions, small vessel disease, etc. Glasgow Coma Scale(GCS) and National Institute of Health Stroke Scale(NIHSS) were used for neurological deficit and level of consciousness assessments at admission and at 24 hours after admission. The Modified Rankin Scale(mRS) was used for stroke outcome evaluation at discharge.Mann-Whitney U test was used for analysis.

Results: Descriptives:n=23,mean age=68.8 years,F/M=56/44%,CS/NCS= 26/74%.There were statistically significant differences between NCS/CS:INR at admission=1/1.12 (p=0.03), Glasgow Coma Scale at admission-9.3/13.25 (p<0.05), NIHSS score at admission 9.6/23.7(p=0.01),GCS-24-hr-13.9/10.3 (p<0.05),NIHSS-24-hr-7.4/22(p=0.02),mRS score at discharge:2.17/4.33 (p=0.013).The CS patients had higher severity on GCS and NIHSS for both admission and 24-hour measurements. Patients in the CS group were mobilized later as compared to patients in the NCS group-1.12/1.75, however, this did not reach statistical significance.

Conclusion: Patients with IS due to CS had worse neurological deficits and level of consciousness initially, than patients with other subtypes of stroke and had worse outcomes upon discharge.

P-533

Self-reported physical activity and determinants in people after mild to moderate stroke

M. Kähler¹, L. Rosengren¹, L. Jacobsson¹, J. Lexell¹

¹Lund University, Health Science, Lund, Sweden

Introduction: Physical activity (PA) leads to significant health benefits for people after stroke when conducted regularly and with sufficient intensity and duration. Increased knowledge of PA after stroke may help us to identify those at risk not meeting the World Health Organization (WHO) recommended level of PA.

Objectives: To assess stroke survivors at least one year after stroke onset and (i) describe their self-reported level of PA, (ii) explore the association between PA and sociodemographics and stroke characteristics, and iii) determine the characteristics of those below the WHO recommended level of PA (150 min/week of moderate PA).

Materials & methods: A total of 160 stroke survivors at least one year after stroke onset participated. Data were collected with a study specific questionnaire, the Swedish National Board of Health and Welfare Physical Activity Questionnaire and review of medical records. A hierarchical regression analysis was performed to explore the association with PA, and chi-square test and Mann-Whitney U-test to identify the characteristics of those below the WHO recommended level of PA.

Results: There were 86 men (54%) and 74 women (46%), mean age 73 years (SD ±11; 30-91), mean time since stroke onset 35 months (SD ±26; 18-61). A total of 66.3% of the participants were below the WHO recommendations of PA. The need of home assistance explained 13% of the variance in PA, and those who were older, lived alone, needed home assistance and mobility devices, and had some comorbidity did not reach the WHO recommended level of PA.

Conclusion: This study confirms that a majority of stroke survivors are not physically active enough. In particular, those who are less recovered from their stroke (i.e., need home assistance and mobility devices), are older, live alone and have some comorbidity, regardless of gender, time since stroke onset or current stroke characteristics, are at risk of not meeting the WHO recommended level of PA.

P-534

Myoelectric pattern recognition combined with virtual reality and serious gaming for upper limb rehabilitation in stroke: a qualitative study

M. Munoz-Novoa^1,2, C. Andersson¹, M. Ortiz-Catalan³, K. Stibrant Sunnerhagen^1,4, M. Alt Murphy^1,5

¹University of Gothenburg, Neuroscience, Gothenburg, Sweden

²Center for Bionics and Pain Research, Gothenburg, Sweden

³Bionics Institute, Melbourne, Australia

⁴Sahlgrenska University Hospital, Section of Neurocare, Gothenburg, Sweden

⁵Sahlgrenska University Hospital, Physical and Occupational Therapy, Gothenburg, Sweden

Background: User-centered design is essential for developing novel rehabilitation interventions. The present study employs a qualitative approach within an intervention study examining the preliminary effectiveness and feasibility of a combined intervention involving myoelectric pattern recognition (MPR), virtual reality (VR), and serious gaming to enhance upper limb function in stroke.

Objectives: To explore the perceptions and experiences of persons with chronic stroke undergoing upper limb training with a novel intervention combining MPR, VR, and serious gaming in order to refine the design and applicability of the intervention.

Method: Six individuals with chronic stroke (average age :55 years; 33% females; moderate to severe upper limb impairment) were interviewed after 6 weeks of training (18, two-hour sessions). The semi-structured interviews were transcribed verbatim and analyzed using content analysis.

Result: The overall experience of the participants was reflected in the overreaching theme "Many factors come into play to make it work", which reflected the three main actors of the intervention: "The Player", "The Program", and "The Supporter". While participants found the training rewarding and worthwhile, their performance varied depending on their day-to-day physical form. Participants emphasized their role as "players" and perceived an increased awareness and use of their paretic arm in daily life activities. The feedback on the "program" was overall positive, although participants described the visual synchronization between the real and virtual arm could even be more intuitive. The guidance and "support" from the therapist was found crucial and provided extra motivation.

Conclusion: The participants describe the intervention as positive and meaningful, highlighting its role in improving awareness of their paretic arm. Participants feedback and proposed improvements offered valuable insights in refining both current and future MPR-based training systems.

P-535

Stroke rehabilitation. A mixed method study evaluating a novel physiotherapy intervention and patients’ experiences

M. Sivertsen^1,2, K. B. Alstadhaug^1,3, E. C. Arntzen⁴, B. Normann^1,4

¹Nordlandssykehuset HF, Physiotherapy, Bodoe, Norway

²UiT The Arctic University of Norway, Health Science, Tromsø, Norway

³UiT The Arctic University of Norway, Medicine, Tromsø, Norway

⁴Nord University, Nursing and Health, Bodø, Norway

Background: This study addresses benefits and challenges of a new physiotherapy (PT) intervention (I-CoreDIST) and usual care (UC) PT after a stroke and patient perceptions of participation in rehabilitation.

Methods: This mixed method study consists of a randomized controlled trial (RCT) and an interview study. Sixty participants with acute strokes were recruited for the RCT and received I-CoreDIST or UC PT for 12. Assessments of trunk control, physical activity, balance, gait and health related quality of life (HRQOL) were undertaken at baseline and at 12 weeks. A sample of 19 participants were interviewed, data were transcribed and analysed. The quantitative and qualitative findings were integrated resulting in three categories.

Results: 1) Transitions-enablers and challenges for participation: Transitions characterize the continuum through shifts from being able, becoming unable and re-enablement, and transfers through levels of health care. We found discrepancies between measured and experienced disability at baseline. Measurements aligned with experiences of becoming able, and imply that PT was beneficial in both groups. There were no significant differences at 12 weeks, except for gains in HRQOL in the UC group. 2) Structures and traditions in institutions and municipalities shape delivery of care; Structures and cultures of institutions and municipality care shape practices of communication, decision-making and delivery of clinical practice, including PT. 3) Meaning, progress and embodiment; Positive bodily changes, individualization and intensity in training link to development of meaning and motivation in PT. Levels of physical activity remained low.

Conclusion: Transitions and variations in organisational structures and cultures shape active patient participation in post-stroke rehabilitation. Meaning and motivation is connected to experiencing bodily changes and tailored treatment. Despite improved function, sustained inactivity is a challenge.

P-536

Motor and neurophysiological changes after ischemic conditioning in individuals with chronic stroke: a pilot trial

M. Cummings¹, S. Madhavan¹

¹University of Illinois, Physical Therapy, Chicago, IL, United States

Introduction: Ischemic conditioning (IC), a procedure where the limb is exposed to recurrent bouts of blood flow occlusion followed by reperfusion, is clinically relevant for stroke rehabilitation as a neuromodulatory adjunct. Similar modalities (i.e., ischemic nerve block) revealed that peripheral blood flow restriction initiated neuroplastic changes in the motor cortex. Yet, this is unconfirmed with IC.

Objectives: To quantify changes in corticomotor excitability (CME), intracortical inhibition (SICI) and transcallosal inhibition (TCI) of the paretic and nonparetic tibialis anterior (TA) muscle representations alongside changes in motor performance after one session of IC compared to sham-IC and aerobic exercise (AE).

Methods: 15 people with stroke will participate in one IC, sham-IC and AE session (1wk washout). IC involves 10min cycles, totaling 30min: 5min occlusion with cuff pressure at 225mmHg (IC) or 25mmHg (sham-IC) and 5min reperfusion at 0mmHg. AE entails 30min of moderate intensity recumbent stepper cycling. Before (pre), after (post) and 30min after (post-30), CME, TCI and SICI will be assessed using transcranial magnetic stimulation in addition to paretic ankle strength and reaction time (RT).

Results: Pilot data from 5 males (avg±SD: age=62.4±9.9yrs.; yrs. since stroke=8.4±4.6) showed that after IC, CME increased 31% (post) and 15% (post-30), SICI decreased 10% (post) and 11% (post-30) and TCI increased 12% (post) and 13% (post-30). After AE, CME decreased 8% (post) and increased 5% (post-30), SICI decreased 3% and TCI increased 14% (post) and 16% (post-30). Sham-IC had negligible results. Strength improved 19% (post) and 25% (post-30) after IC and 16% (post) and 15% (post-30) after AE. RT increased 11% after IC but only 2% after AE and <1% after sham-IC.

Conclusion: Initial results reveal IC is superior to sham-IC and AE for enhancing corticomotor and behavioral outcomes in chronic stroke. We expect to confirm these results with full data collection.

P-537

The role of the insula in emotional processing – data from patients following stroke

M. Lotze ¹

¹University Medicine Greifswald, Diagnostic Radiology and Neuroradiology, Greifswald, Germany

Introduction: The human insula serves as a hub for monitoring bodily states and integrating those in an adjusted behaviour which can be most roughly described as avoidance and approach. Since functional imaging has proven a contribution of the insula to a vast number of paradigms, lesion studies investigating patients with insula damage following stroke might help us to better understand the role of insula processing circuits and their interconnections to other brain areas.

Objectives: This review provides an overview on studies testing emotional processing deficits in participants with insula damage following strokes. It is overviewing studies on (A) emotional testing (pictures/sounds) and psychophysiology response and (B) social interaction related emotional processing such as facial expression recognition, empathizing and gaming behaviour.

Materials & methods: Concepts and models about the functional contribution of the human insula and on their anatomical and functional subdivisions. Systematic meta-analysis using PUBMed references for the following keywords: emotional processing, stroke, insula.

Results: Beside their clinical importance, these studies highlight the role of different parts of the insula and their interconnections with other brain areas not only for emotional processing, but also for the decoupling of bodily and brain responses on emotionally relevant stimuli.

Conclusion: Damage of the insula and its white matter tracts of both hemispheres can result in distinct emotional and socially relevant disturbances which should be considered early in neurorehabilitation because they can substantially impact social interaction and quality of life.

Reference

Klepzig et al., 2023; Brain communications, 5(3), fcad144

Witt et al., 2023; European Journal of Neurology, 30(6), 1706-1711.

P-538

Vision rehabilitation: case reports on 2 subacute stroke patients presenting with diplopia

M. Lim¹, E. Chong¹

¹Alexandra Hospital, Rehabilitation, Singapore, Singapore

Introduction: Ocular motor deficits are common resultants of brain injury, resulting in debilitating symptoms such as diplopia impeding on independence. In a study by Fowler, it was found that 36% of patients admitted into a neurological rehabilitation unit experienced diplopia post brain injury.

Objective: To present outcomes of 2 sub-acute-stroke patients with neuro-ophthalmic deficits undergoing vision rehabilitation by an Occupational Therapist in an inpatient rehabilitation setting.

Patients: Subject 1 is a 27-year-old female with a pontine bleed, experiencing diplopia with a right one and a half syndrome. She complains of moderate-severe giddiness impeding on her independence in daily living. Subject 2 is a 58-year-old gentleman who suffered a left thalamic bleed resulting in ipsilesional eye hypertropia and vertical diplopia. Jerky movements were observed during upward, downward and outward eye movements. Both patients were prescribed customized bedside vision exercises and underwent occupational therapy sessions that incorporated vision exercises targeting identified specific muscles requiring intervention

Results: For subject 1, there was increased oculomotor range in adduction for both her eyes. Subject 1 was able to read short paragraphs with font size 10 to12 and use her electronic devices (handphone and laptop) for 15 minutes. She was unable to do these during admission. Subject 2 reported improvements in diplopia frequency from “all the time” to “some of the time”. In the Canadian Occupational Performance Measure (COPM), for which his 3 vision-related tasks were greatly impacted, overall performance and satisfaction scores improved from 1.3 to 8, and 1.67 to 7.67, respectively. The Visual Functioning Questionnaire showed significant improvements.

Conclusion: These 2 case studies highlight the important roles an occupational therapist can play in vision assessment and interventions post-stroke for improvements in their daily living function

P-539

Intravenous cerebrolysin concentrate for post-stroke oral apraxia: case reports

M. Kim¹, D. Y. Kim¹

¹International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Rehabilitation, Incheon, South Korea

Introduction: Cerebrolysin concentrate, containing brain-derived neurotrophic factor, is an intravenous pharmacotherapy known for stimulating nerve tissue regeneration and aiding recovery following brain injuries. We present two cases demonstrating positive outcomes using cerebrolysin concentrate for post-stroke oral apraxia.

Objectives: Our objective is to document the effects of cerebrolysin concentrate on severe oral apraxia in patients with acute strokes involving the left insula.

Patients & methods: We present two cases: Case 1, a 72-year-old male, and Case 2, a 67-year-old male, both diagnosed with severe oral apraxia after left insula strokes. Initially, both patients couldn’t imitate oral or limb movements, with a Limb and Oral Apraxia Test (LOAT) score of 0. Both cases initially required nasogastric tube feeding due to severe oral apraxia-induced dysphagia. In both cases, cerebrolysin was administered in conjunction with intensive inpatient rehabilitation. Case 1 received 20 ml/day of intravenous cerebrolysin concentrate for 14 days, starting on the 14th day post-onset. Case 2 had a 29-day regimen, starting on the 12th day post-onset, with an initial 16 days of 30ml/day, followed by 13 days of 40ml/day.

Results: Case 1 resumed spontaneous speech within 5 days of completing cerebrolysin treatment, and oral dietary intake was restored by the 6th day. By the 22nd day after treatment completion, LOAT oral scores improved to 24. In Case 2, speech abilities returned on the 2nd day after the completion of treatment, with oral dietary intake restored by the 16th day. LOAT oral scores improved to 8 by the 22nd day post-treatment.

Conclusion: These cases highlight the potential benefits of intravenous cerebrolysin concentrate used in conjunction with rehabilitation in treating severe oral apraxia after strokes involving the left insula. Although further research is needed, this treatment may play a promising role and offer hope for similar patients.

P-540

Developing best practice statements for orthotic intervention supporting mobility recovery following stroke: the OTIS study

M. Golding-Day¹, S. Thomas¹, J. Horne¹, P. Whitehead², M. Walker¹

¹University of Nottingham, Centre for Rehabilitation and Ageing Research, Nottingham, United Kingdom

²University of Newcastle, Population Health Sciences Institute, Newcastle upon Tyne, United Kingdom

Background: Whilst orthotic intervention following stroke is often considered an important element of rehabilitation for motor deficit, the optimum content, timing and method of intervention is not known. There are currently no agreed guidelines of best practice for orthotic intervention following stroke for clinicians to reference and services to adhere to.

Objectives: Lack of guidelines for orthotic intervention post-stroke means there is no consistency in the treatment stroke survivors can expect to receive both in the UK and worldwide. The aim of this study was to develop clinical best practice statements for orthotic intervention supporting walking recovery after stroke.

Method: This mixed methods study sought to explore the optimum content, timing and delivery of specialist orthotic intervention after stroke via consensus methods of a national survey, targeted focus groups with clinician and patient experts, and a national eDelphi to develop proposed best practice statements. Participants were recruited from the membership of the British Association of Prosthetists and Orthotists (BAPO) and via the network of NHS Orthotic Managers Group (NOMaG).

Results: Proposed clinical statements of best practice have been developed from this three-stage mixed methods study. These statements were constructed directly from the themes and recommendations identified within the results of the concluding national eDelphi exercise which returned a mean average 94% consensus, with participants representative of approximately 5% of the national orthotic expert workforce within the UK (Health & Care Professions Council, 2023).

Conclusions: The developed clinical best practice statements returned a high level of consensus and satisfy a paucity of guidance for the therapeutic use of orthotic intervention within mobility rehabilitation post-stroke. The effectiveness and validity of these statements within the applied healthcare setting will be tested in a future evaluative trial.

P-541

Stakeholder engagement in codesign of stroke interventions is perceived as valuable and worthwhile

N. Fini¹, E. Ramage^2,3, J. Bernhardt³, E. Bicknell⁴, C. Tzefronis⁵, P. Fink⁵, E. Godecke⁶, C. English⁷, J. Francis⁸, C. Said^1,2

¹University of Melbourne, Physiotherapy, Parkville, Australia

²Western Health, Physiotherapy, Melbourne, Australia

³Florey Institute of Neuroscience, Stroke Theme, Heidelberg, Australia

⁴The Royal Melbourne Hospital, Physiotherapy, Parkville, Australia

⁵Consumer Representative, Melbourne, Australia

⁶Edith Cowan University, Health Science, Perth, Australia

⁷University of Newcastle, School of Health Sciences, College of Health, Medicine and Wellbeing, Newcastle, Australia

⁸University of Melbourne, Melbourne School of Health Sciences, Parkville, Australia

Introduction: Involving stakeholders in intervention development is thought to improve engagement, feasibility and clinical translation.

Objectives: To evaluate the codesign process from the perspective of stakeholders: people with lived experience, clinicians and researchers.

Methods: A four-stage integrated knowledge translation approach was applied to codesign a post-stroke physical activity intervention. Stakeholder participants (stroke survivors, carers (n=13) and clinicians (n=12)) were recruited. All participants and the research team (n=13) were invited to participate in an evaluation of the codesign process using the Ways of Engaging-ENgagement ACtivity Tool.

Quantitative survey responses were analysed descriptively. Open-ended responses to survey questions were thematically analysed by two researchers following Braun & Clarke"s approach to thematic analysis.

Results: Most survey respondents (>80%) felt a great deal of trust, transparency and shared learning in the process; >70% reported that they had at least a moderate influence on the project; >80% felt prepared to contribute.

Four main themes were generated from the data. 1) All respondents valued codesign and the lived experience perspective, including learning from others, collaboration and teamwork. 2) All respondents wanted to improve outcomes for stroke survivors and produce an intervention that was clinically useful and feasible. 3) The codesign workshops provided a respectful atmosphere with opportunity for open discussion. 4) All respondents valued participation in the process – it provided the opportunity to a) reflect on their own physical activity participation/clinical practice, b) "give back" and share knowledge, and was an enjoyable experience.

Conclusions: In the context of a post-stroke physical activity intervention, codesign, both the concept and the process, was valued by people with lived experience, clinicians and researchers and is an important element of research.

P-542

Standardized assessment tools in clinical practice guidelines for stroke rehabilitation worldwide: a scoping review

R. Barbosa dos Santos^1,2, A. Fiedler³, A. Badwal¹, J. M. Legasto-Mulvale^1,2, K. Sibley⁴, O. A. Olaleye⁵, G. Diermayr³, N. Salbach^1,2

¹University of Toronto, Physical Therapy, Toronto, Canada

²University of Toronto, Rehabilitation, Toronto, Canada

³University of Heidelberg, School for Therapeutic Sciences, Heidelberg, Germany

⁴University of Manitoba, Public Health, Winnipeg, Canada

⁵University of Ibadan, Physiotherapy, Ibadan, Nigeria

Introduction: Use of standardized assessment tools (SATs) is a recommended practice in stroke rehabilitation. A first step towards harmonizing recommendations for using SATs across geographical regions is to understand which tools are recommended across clinical practice guidelines (CPGs). We conducted a scoping review that included 19 CPGs published between 2014 and 2021, written in English, French, German, Portuguese or Spanish, with recommendations on the delivery of stroke rehabilitation to address balance and mobility limitation. As part of this review, we abstracted information on all SATs recommended or suggested in each CPG.

Objectives: We aimed to describe the SATs recommended or suggested in the 19 CPGs included in our scoping review.

Materials & methods: In our scoping review, we searched seven electronic databases and grey literature. Pairs of reviewers reviewed abstracts and full texts in duplicate. We abstracted data about CPGs, SATs, the method of tool selection, and resources to support implementation.

Results: We included 19 CPGs from 7 middle- and 12 high-income countries. Eleven CPGs (58%) recommended or suggested 115 unique tools. The most commonly recommended measures were: Berg Balance Scale (9 CPGs, 82%), Timed Up and Go Test (8 CPGs, 73%), 6-Minute Walk Test (8 CPGs, 73%), 10-meter Walk Test (8 CPGs, 73%), Fugl-Meyer Assessment of Motor Recovery (7 CPGs, 64%), Action Research Arm Test (7 CPGs, 64%), Barthel Index (7 CPGs, 64%). Five CPGs provided information in variable detail on the method of tool selection. Seven CPGs provided resources to support clinical implementation; one CPG from a middle-income country included a resource available in a CPG from a high-income country.

Conclusion: Review findings can be used to inform international efforts to harmonize recommendations and resources for using SATs in stroke rehabilitation across geographical regions.

P-543

Effect of higher walking doses on post-stroke physical activity: a secondary analysis

P. Mackie^1,2, T. Klassen¹, M. Bayley³, S. P. Dukelow⁴, M. Hill⁴, S. Pooyania⁵, M. Poulin⁶, J. Yao⁷, J. Eng^1,2

¹University of British Columbia, Physical Therapy, Vancouver, Canada

²Vancouver Coastal Health, Centre for Aging SMART, Vancouver, Canada

³University of Toronto, Medicine, Toronto, Canada

⁴University of Calgary, Department of Clinical Neurosciences and Hotchkiss Brain Institute, Calgary, Canada

⁵University of Manitoba, Department of Internal Medicine, Winnipeg, Canada

⁶University of Calgary, Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Calgary, Canada

⁷University of British Columbia, Medicine, Vancouver, Canada

Introduction: Regular engagement in physical activity interventions have been found to decrease the risk of future vascular events. Higher doses of walking at inpatient rehabilitation have been shown to improve mobility (gait speed and endurance) 1 year after stroke, but the impact of higher doses on physical activity have not been well established.

Objectives: The objective of this secondary analysis is to determine 1. the effect of higher walking doses at inpatient rehabilitation on total step count at 6 months post-stroke; and 2. the impact of time post-stroke (6 and 12 months) on total step count.

Materials & methods: A secondary analysis of the Determing Optimal Post-Stroke Exercise (DOSE) trial, a multi-site, assessor blinded, randomized controlled trial. Participants were randomized to 3 groups: 1. Control (4 weeks usual therapy), 2. DOSE 1, 4 weeks walking and aerobic exercise (5 hours/week), or 3. DOSE 2, receiving double DOSE 1. Secondary analysis included daily steps from StepWatch worn for a minimum of 2 days at 6-months and 12-months post-stroke, baseline 5 metre walking speed, and Berg Balance Scale (BBS).

Results: Of the 75 participants included in DOSE, step data were available for 65 participants (87%) at 6-months and 58 (77%) participants at 12-months. Participants had mean age of 56.63 (11.65), were predominately male (63%), and had impaired balance (BBS = 33 ± 14) and mobility (gait speed = 0.41 ± 0.23). There were no group effects on physical activity at 6 months post-stroke. Combining all groups, there was no significant difference between steps at 6-months (7866 steps; 95% Confidence Interval [CI], 6659 to 9186) and 12-months (7883; 95% CI, 6767 to 9134).

Conclusion: This secondary analysis found no impact of higher walking doses at inpatient rehabilitation on 6-month physical activity in those with stroke. Further, total steps did not change between 6-months and 12-months post-stroke.

P-544

Advancing stroke rehabilitation: adding home exercises with functional electrical stimulation on off-clinical days to boost functional gains

R. Purohit¹, J. P. Appelgren Gonzalez², M. Hosiasson², F. Covarrubias Escudero², G. Varas-Diaz³, T. Bhatt⁴

¹University of Illinois, Rehabilitation, Chicago, IL, United States

²TRAINFES Center, Physical Therapy, Metropolitana, Chile

³Pontificia Universidad Católica, Departamento de Cs. de la Salud, Santiago, Chile

⁴University of Illinois, Physical Therapy, Chicago, IL, United States

Introduction: Clinic-based physical therapy (PT) alone might be insufficient for maintaining functional health status among chronic stroke patients. Hence, incorporating exercise components that can be independently practiced at home might enhance patient adherence. Pairing exercises with functional electrical stimulation (FES) is recognized for its superior impact on mobility and walking performance compared to traditional PT. Hence, supplementing home exercises with FES could induce greater functional gains among stroke patients.

Objective: We compared the effect of clinic-based FES training with and without home training among chronic stroke patients.

Patients and Methods: 23 individuals were divided into clinic + home (n=13) and clinic-only (n=10) group. There were no group differences in age, stroke onset and ambulatory status. Participants underwent 6 weeks of multicomponent exercises (balance, aerobic, strength) with FES in clinic. FES was delivered to paretic lower limb muscles using a portable stimulator and a software application. In addition, the home + clinic group were provided with the equipment and encouraged to perform exercises at home for twice per week. Before and after training, we assessed functional performance on the 10-Meter Walk Test, 30-second chair stand and Mini-BESTest. A Kruskal-Wallis test was used to test the effect of group and time on the outcomes.

Results: No adverse events were reported in both groups. Pre-training, there were no group differences in clinical functional outcomes between groups (p>0.05). Both groups showed improvements on all outcomes (p<0.05). However, only the clinic + home group surpassed the established minimal clinically important difference threshold on the 10-Meter Walk and Mini-BESTest.

Conclusion: Incorporating exercises in a real-life environment on off-clinical days could promote self-practice and increase self-efficacy compared to clinic-based PT alone, thus resulting in greater functional gains.

P-545

Testing the association between upper-limb motor impairment and motor imagery-related brain activation after stroke

S. Klick¹, L. Penko², L. A. Boyd², S. Kraeutner¹

¹University of British Columbia, Kelowna, Canada

²University of British Columbia, Vancouver, Canada

Introduction: Motor imagery (MI), the mental rehearsal of a movement, shows promise as an adjunct to physical therapy that may improve recovery after stroke by activating similar brain regions as physical practice. Yet, the impact of stroke-related factors such as upper-limb motor impairment on MI-related brain activity is largely unexplored.

Objective: This study aims to test the association between MI-related brain activity and upper-limb motor impairment after stroke.

Methods: Participants (N = 5; target N = 10; aged 40-75 years, 2 female, middle cerebral artery stroke, 2 left hemisphere stroke) underwent a single functional magnetic resonance imaging (fMRI; Phillips 3.0T MRI) session. During the fMRI, participants engaged in a MI task where they imagined opening a door using their affected arm/hand. Participants performed one run (three 30sec task blocks alternating with 30sec rest). Prior to the fMRI session, participants" upper-limb motor impairment was characterized via the Upper Limb Extremity scale of the Fugl-Meyer Assessment (FMA). Individual statistical activation maps were calculated for each run with a fixed effects model (group-level) conducted to assess MI-related activity. FMA scores were correlated with resultant MI-related activation to determine how MI-related activity was modulated by motor impairment.

Results: MI-related activation was localized to sensorimotor regions (including inferior frontal gyrus and left primary somatosensory cortex). Positive correlations between FMA score and MI-related activity was found in regions including the middle cingulum bundle, middle frontal gyrus, and parahippocampal gyrus.

Conclusions: Findings show that greater upper limb motor impairment is associated with activation in regions that are required to produce a vivid motor image. Overall, this study improves understanding of the use of MI in individuals with stroke.

P-546

Personalizing brain stimulation for stroke recovery with individual brain dynamics

S. Kraeutner¹, L. Penko², S. Klick^1,2, J. Andrushko^2,3, L. A. Boyd²

¹University of British Columbia, Psychology, Kelowna, Canada

²University of British Columbia, Physical Therapy, Vancouver, Canada

³Northumbria University, Sport, Exercise and Rehabilitation, Newcastle upon Tyne, United Kingdom

Pairing contralesional motor cortex repetitive transcranial magnetic stimulation (M1-rTMS) with rehabilitation shows promise to improve stroke recovery by enhancing motor learning associated plasticity. Yet, response to this intervention is varied, in part because no work has tested how M1-rTMS modulates brain connectivity at an individual level, nor assessed individual changes in network characteristics.

Objectives: To determine how M1-rTMS modulates group-level brain connectivity and quantify individual changes in network characteristics.

Methods: Participants (N = 5; aged 40-75 yrs, 2 female, middle cerebral artery stroke), underwent 2 sessions of M1-rTMS (sham, active; order randomized). Before and after M1-rTMS, resting state functional magnetic resonance imaging (rsfMRI) was captured. Group-level changes in rsfMRI were assessed across a cortical-cerebellar network. To quantify changes in network characteristics at the subject-level, graph theoretical analyses were applied to extract changes in node degree (brain regions of high interconnectivity; pre/post M1-rTMS).

Results: At the group-level, a decrease in rsfMRI connectivity was observed between the left and right cerebellum (crus 1-lobule 6) following active M1-rTMS (pFDR = 0.011). No changes were observed pre/post sham M1-rTMS. At the subject-level, key changes in node degree (≥5 degrees) following M1-rTMS was highly varied and related to cerebellar (n=2), parietal (n=1), temporal and frontal nodes (n=1), and no nodes (n=1).

Conclusion: Group-level modulations were consistent with theories suggesting M1-rTMS enhances plasticity associated with motor learning. Yet, M1-rTMS led to diverse changes in network characteristics within individuals. This work highlights the variance of brain dynamics post-stroke and illustrates the limitations of group-level inference. Our data suggest that personalizing the location of rTMS after stroke may enhance outcomes; this idea is being tested in ongoing work.

P-547

Arm-hand boost therapy during inpatient stroke rehabilitation: results from a phase II randomized controlled trial

S. Meyer^1,2, G. Verheyden², K. Kempeneers¹, M. Vander Plaetse¹, M. Michielsen¹

¹Jessa Hospital, Physical Therapy and Rehabilitation, Herk-de-Stad, Belgium

²KU Leuven - University of Leuven, Rehabilitation, Leuven, Belgium

Introduction: Difficulty in using the upper limb remains a major contributor to activity limitations post-stroke. A focused arm-hand intervention in the sub-acute phase post-stroke can target this.

Objectives: It was the aim to assess feasibility, safety and efficacy of a new, focused arm-hand BOOST program during inpatient stroke rehabilitation.

Patients & methods: In this phase II RCT, patients with stroke were randomized to the experimental group (EG) receiving arm-hand BOOST or the control group (CG) receiving the CONTROL intervention, on top of their usual inpatient care program. The arm-hand BOOST program (1 hour/day, 5x/week, 4 weeks) consisted of group exercises including scapula-setting, core-stability, shoulder external rotation and elbow extension, manipulation and dexterity, and ADL tasks. Additionally, the Armeo®Power (Hocoma AG, Switzerland) was used one hour/week. The CONTROL intervention comprised a dose-matched program of lower limb exercises and general reconditioning. At baseline and after 4 weeks of training, the Fugl-Meyer assessment upper extremity (FMA-UE), action research arm test (ARAT) and stroke upper limb capacity scale (SULCS) were administered.

Results: Eighteen participants (EG: n=10, CG: n=8) were included at a median (IQR) time post stroke of 8.6 weeks (5-12). No adverse events were reported. Significant between-group differences in favor of arm-hand BOOST were found after 4 weeks of training for FMA-UE (p=0.003) and SULCS (p=0.033) and a trend for ARAT (p=0.075) with median (IQR) change scores for the EG of 9 (7-16), 2 (1-3) and 12.5 (1-18) points respectively, and for the CG of 0.5 (-3-3), 1 (0-1) and 1.5 (-1-9) points, respectively. In the EG, 80% of patients improved beyond the minimal clinical important difference of FMA-UE, compared to none in the CG.

Conclusion: Arm-hand BOOST is feasible and safe and suggests positive, clinical meaningful effects for upper limb function and activity. It is now tested in a phase III RCT.

P-548

Value-based partnering with consumers and clinicians to co-design a cardiorespiratory exercise program for non-ambulatory stroke survivors: a qualitative study

S. Kramer¹, R. Lipson-Smith², N. A. Lannin^1,3, G. C. Cloud^1,3, T. Bucknall^3,4

¹Monash University, Neuroscience, Melbourne, Australia

²University of Western Sydney, MARCS Institute for Brain, Behaviour and Development, Penrith, Australia

³Alfred Health, Melbourne, Australia

⁴Deakin University, Melbourne, Australia

Introduction: Clinical practice guidelines recommend cardiorespiratory fitness (CRF) training to improve post-stroke health. Despite this, CRF training is rarely part of routine clinical care. Additionally, non-ambulatory stroke survivors are often excluded from community exercise programs. It is important to understand the views and concerns on CRF training from the perspective of key stakeholders to develop implementable programs.

Objectives: To determine the program inclusions and better understand barriers and enablers for non-ambulatory stroke survivors to participate in a CRF training program from the perspectives of consumers and physiotherapists.

Materials & methods: Qualitative study using Value Focused Thinking (VFT), which first establishes clear objectives (what is valued) before considering how it can be achieved. Fundamental and mean objectives were identified during individual and small-group interviews with non-ambulatory stroke survivors and experienced stroke physiotherapists.

Results: 14 non-ambulatory stroke survivors (8 males) and 15 physiotherapists (14 female) identified four fundamental objectives for a program: to maximize an active lifestyle, health, quality of life, and safety. Active lifestyle including changing long-term behaviour; safety including ensuring cardiac safety and physical safety; quality of life including improving engagement and autonomy; health including improving fitness, physical and mental health. Additional means objectives were identified which are aimed to achieve the fundamental objectives.

Conclusion: Fundamental objectives, driven by the values of participating stakeholders, were identified and a comprehensive list of objectives were included in the final framework. Understanding the needs and wants of stroke survivors and clinicians provides a guide to co-designing a tailored CRF training intervention for non-ambulatory stroke survivors. Future testing of the program"s feasibility and acceptance is now warranted.

P-549

Examining longitudinal changes in spatiotemporal characteristics of preferred- and fast-paced walking in chronic stroke up to 24 months

S. Thomson¹, B. F. Cornish¹, K. B. Beyer¹, F. E. Godkin¹, K. Van Ooteghem¹, W. E. McIlroy¹

¹University Of Waterloo, Kinesiology, Waterloo, Canada

Introduction: Common gait impairments after stroke, such as slow walking speed and asymmetry, impact overall recovery. While gait assessment often evaluates preferred gait speed, fast-paced walking may provide insight into gait control and recovery after stroke. However, few studies examine fast paced walking in chronic stroke and longitudinal studies beyond 12 months are limited.

Objectives: This longitudinal study seeks to evaluate whether clinically meaningful changes in preferred- and fast-paced gait occur from 6 to 24 months post stroke. Further, we examine the relationship between fast-paced and preferred gait and the importance of the strategy used to increase speed.

Materials & methods: Thirty-eight individuals with first ever stroke (61+12 yrs, 71% male) walked at preferred pace (n=38) and fast pace (n=28) on an instrumented walkway, at 6, 12, and 24 months post stroke. Gait speed, symmetry, and gait speed reserve (fast-preferred speed) were calculated to characterize gait. Outcomes were compared between timepoints (repeated measure comparisons) and against minimal clinically important differences (MCID) and impairment thresholds to describe meaningful differences in recovery.

Results: Preferred and fast gait speed and symmetry ratios did not differ between time points (p>. 05). However, important individual level changes occurred from 6 to 24 months, with 50% and 43% of individuals exceeding MCID in preferred and fast gait speed, respectively, and 32-61% of individuals transitioning between symmetric and asymmetric gait classifications. Ongoing work is examining changes in gait speed reserve and the strategies used to achieve fast gait over time.

Conclusion: Important changes in gait during chronic stroke suggest a need for continued monitoring and intervention to maximize recovery potential and minimize functional decline. Improved understanding of the implications of fast gait in chronic stroke may inform such intervention strategies.

P-550

AI (Artificial Intelligence) determination of functional ambulatory category of stroke patients

J. H. Kim¹, S. H. Lee², J. Kwak³, S. U. Lee⁴, S. H. Jang⁵

¹Seoul Metropolitan Government Boramae Medical Center, Rehabilitation, Seoul, South Korea

²Medi-in Hospital, Paju-si, South Korea

³SASANG Smart Hospital, Busan, South Korea

⁴Seoul National University, Rehabilitation, Seoul, South Korea

⁵Hanyang University, Rehabilitation, Seoul, South Korea

Background: Gait assessment is vital for predicting the ambulatory status, societal participation, and prognosis of stroke patients. FAC is a simple subjective evaluation tool. AI can be used for objective evaluations. We used AI to classify gait functions by analyzing coordinate data from gait performance videos of stroke patients.

Method: We collected gait videos (1 million pixels, 30fps, mp4) of normal people and stroke patients from 6 medical institutions to learn the AI model for gait function classification of stroke. Time series joint coordinate data was extracted from 2D JSON and this was pre-processed. The pre-processed data were randomly divided into a training set (80%) and a test set (20%) for performance verification. The AI model was deep-learned to classify it into 4 stages according to gait function, and 5-fold cross-validation was performed. The accuracy of the model was verified with the test set. The classification was based on the scores of FAC evaluated by physiatrists.

Result: The subjects were normal 278 (male:52, female:226), mean age 64.9, stroke 218 (male:134, female:84), mean age 62.2. Stroke type was ischemic in 135 patients and hemorrhagic in 83 patients. Injury region of brain was cortical in 156 patients and subcortical in 35 patients. As a result of verifying the performance of the AI model based on gait video, the accuracy of stroke classification for normal persons was 95.09%, and Area Under the Curve (AUC) was 0.94. The functional gait classification accuracy of stroke patients was 83.44% and AUC was 0.95.

Conclusion: AI-based gait function classification was confirmed by utilizing video files of gait performance in stroke patients. This tool served as support data for functional gait evaluation and diagnosis performed by physiatrists. The AI model achieved over 80% accuracy, suggesting potential for remote care and patient monitoring technologies. Future research will focus on analyzing gait videos from different perspectives.

P-551

Exploring the link between post-stroke depression and walking speed in adults with chronic stroke

S. Deshmukh¹, H. Raleigh¹, S. Madhavan¹

¹University of Illinois, Chicago, IL, United States

Introduction: In stroke survivors, lower limb impairments frequently accompany reduced mobility, necessitating rehabilitation for improved ambulation, and independence. Assessing walking speed serves as a key indicator for lower-limb impairment recovery. Post-stroke depression (PSD) affects 18-33% of these stroke survivors, impacting quality of life, and potentially delaying rehabilitation progress. Investigating the interaction between walking speed and depression is crucial for its potential effect on patient quality of life.

Objectives: The study aims to investigate the interaction of walking speed and PSD in adults with chronic stroke.

Materials & methods: Data from thirty subjects with chronic stroke were included. Inclusion consisted of monohemispheric stroke > 6 months, ankle range of motion > 5 degrees, presence of hemiparesis, and absence of conditions affecting balance. Primary outcomes included the 10-Meter Walking Test (10MWT) at comfortable and maximal walking speeds, and the Patient Health Questionnaire-9 (PHQ9) for depressive symptom severity. Statistical analyses included coefficient of determination (R2) and the Wilcoxon signed-ranked test.

Results: Thirty stroke participants (mean age 61±9.24 years) were included in this analysis. No significant correlation was found between the PHQ9 and comfortable walking speed (R2= 0.0099) or maximal walking speed (R2= 0.034). The Wilcoxon test showed statistical significance for the PHQ9 and comfortable walking speed (Z-score of 56) and the PHQ9 and maximal walking speed (Z-score of 115). Notably, we found an association between PHQ9 scores and both comfortable walking speed (R2= 0.622) and maximal walking speed (R2= 0.627) specifically in individuals using assistive devices.

Conclusion: This study suggests that fewer depressive symptoms could be associated with higher walking speeds in post-stroke patients using assistive devices and no relationships between the two in those not using assistive devices.

P-552

Exploratory investigation into cognitive fatigue following a stroke: a study on patients’ experiences

S. Askari¹, K. Harvey¹, M. Sam Odutola¹

¹Dalhousie University, Halifax, Canada

Purpose: Cognitive fatigue is commonly reported and described as disabling by patients recovering from neurological conditions including stroke. However, cognitive fatigue is usually underdiagnosed among stroke survivors which leads to a lack of specific treatments for this condition. Therefore, the aim of this study was to explore post-stroke cognitive fatigue as it is experienced by stroke survivors.

Methods: This qualitative research followed the principles of descriptive phenomenology within a constructivist paradigm. Individual semi-structured interviews were conducted with stroke survivors experiencing post-stroke cognitive fatigue recruited through the Heart and Stroke Foundation, the Canadian Partnership for Stroke Recovery, and social media posts. Data were analyzed through inductive content analysis.

Results: Eleven stroke survivors participated. The analysis revealed five themes illustrating the experience and descriptions of post-stroke cognitive fatigue: 1) characteristics, 2) aggravating factors, 3) management, 4) effect of cognitive fatigue on daily life, and 5) social awareness and support.

Conclusion: This study highlights the complexity of post-stroke cognitive fatigue. Cognitive fatigue becomes more evident after discharge; therefore, clinicians should consistently screen for it and provide proper education to the patients and their carers.

P-553

Feasibility of high intensity gait training in subacute stroke during inpatient rehabilitation: results from a pilot quality improvement project

S. Paquin¹, M. Robidas¹

¹Villa Medica Rehabilitation Hospital, Montreal, Canada

Background: Regaining walking function is one of the main goals expressed by stroke patients during inpatient rehabilitation. A growing body of evidence recommends high intensity gait training (HIGT) to optimize gains in walking function.

Purpose: The goals of this quality improvement project are to evaluate the feasibility, acceptability, and efficacy of implementing a HIGT protocol during physical therapy in subacute stroke patients admitted to an inpatient rehabilitation center in Montreal, Canada.

Methods: The project followed a pilot pragmatic trial design. Data was collected from the patient medical records of two trained physical therapists over a 6 month period. HIGT consists of prioritizing stepping training in variable contexts during physical therapy sessions, at a target cardiovascular intensity of 75-85% of the age-predicted heart rate max. Feasibility, acceptability, and efficacy were measured by the ratio of included versus excluded stroke patients, patient questionnaires at discharge, and pre-post standardized walking (6MWT, 10mWT) and balance (Berg) outcome measures respectively.

Results: 10 stroke patients completed the HIGT protocol, corresponding to a 33% inclusion rate. Reasons for exclusion included lack of medical authorization for high intensity training, short lengths of stay, severe cognitive impairments, or patient refusal. The intervention demonstrated significant gains in walking distance, balance, walking speed and level of autonomy at discharge. Patient questionnaires demonstrated a high level of acceptability and appreciability of the intervention.

Conclusions: HIGT is a feasible and efficient way to improve walking function and balance in subacute stroke during inpatient rehabilitation and is appreciated by patients.

Implications: Results from this pilot trial will inform widespread implementation of HIGT in the aforementioned inpatient rehabilitation hospital. HIGT should be considered to optimize walking function in subacute stroke

P-554

Case study to demonstrate that significant progress can be achieved in movement rehabilitation in brain injury patients in the chronic phase of recovery and up to 12 years post injury

S. Cairns ¹

¹Reset Rehab, Bristol, United Kingdom

Introduction: Challenge the accepted belief that significant progress is not possible in brain injury patients 6+ months post injury.

Objective: Demonstrate that the techniques used by the author to rehabilitate himself post haemorrhagic stroke & surgery would be successful with non ambulatory brain injury patients in the chronic phase of recovery.

Methods: Participants comprised of 7 brainstem stroke & surgery patients and a meningioma resection patient, all in the chronic recovery phase. Methods employed were to sequentially acquire competence in the hierarchy of movement milestones expressed in the initial 21 months of life, when infants learn to walk. Rehabilitation began at the lowest level in the sequence at which competence was absent. Block Practice of movement drills was avoided and Random Practice employed using a continuum of evermore complex implementations of the desired movement pattern. Subsequent movements were only attempted once a subject had gained sufficient range of movement to enable authentic execution and competence had been achieved in all prior movements in the development sequence.

Results: Qualitative results were recorded for each participant against the motor development milestones used in the WHO Motor Development Study 1997-2003.

	Significant Deterioration	Some Deterioration	No Change	Some Progress	Significant Progress
Sitting without support			2	3	2
Standing with assistance			1	3	3
Hands-and-knees crawling				4	3
Walking with assistance				2	5
Standing alone				2	5
Walking alone			1	3	3
Overall movement quality					7

Conclusion: Significant progress can be achieved in brain injury patients up to 12 years post injury, as long as musculo-skeletal range of motion is restored and rehabilitation sequentially honours competence in the developmental skills upon which walking depends.

P-555

The long-term retention and transfer effects of single session of overground perturbation training on functional domains among patients with chronic stroke

T. Bhatt¹, R. Purohit²

¹University of Illinois, Physical Therapy, Chicago, IL, United States

²University of Illinois, Rehabilitation, Chicago, IL, United States

Introduction: Perturbation-based balance training (PBT), involving repeated exposure to perturbations (e.g. slips), is known to enhance fall-resisting skills among chronic stroke patients. However, whether PBT can induce retainable changes and transfer to improvements in untrained functional domains remains unexplored.

Objectives: We examined the retention effect of PBT on trained domains of balance control and transfer effect on untrained domains of impairment, gait and balance, and community integration over 1 year.

Patients & methods: 60 people with hemiparesis were randomized to PBT or control group. The PBT group received one session of 30 walking slips (a block of non-paretic slips, then a block of paretic slips and a block of mixed slips), whereas the control group received equal walking trials. Assessments included trained domains of reactive balance (laboratory falls, reactive stability) and untrained domains of impairment (sensorimotor), walking performance (speed, endurance), dynamic balance (functional mobility, balance confidence), and community integration at baseline, 6-month and 1-year retests.

Results: Statistical analysis showed main effect of slip-side and time × group interaction on trained domains (p<0.05). The PBT group demonstrated greater reductions in falls and improvements in reactive stability at 6-month retest and no differences between 6-month and 1-year retest compared to control group (p<0.02). In addition, there was a time × group interaction on some of the untrained domains (p<0.02). The PBT group demonstrated greater enhancements in functional mobility, walking speed, balance confidence from baseline to 6-month retest, and improvement in community integration from 6-month to 1-year retest compared to the control group (p>0.02).

Conclusion: A single session of gait PBT resulted in retainable improvements in training-specific domains and partial transfer to untrained functional domains over 6 months, which can be retained upto 1 year.

P-556

Feasibility and effects of a novel game-based biofeedback interface for stroke gait retraining

T. Kesar¹, A. Slusarenko¹, M. Kim¹, Z. Alam¹

¹Emory University, Rehabilitation, Atlanta, GA, United States

Introduction: Reduced paretic propulsion during terminal stance is an important post-stroke gait deficit that negatively impacts walking function. There is a paucity of gait training approaches that target specific paretic leg deficits and leverage motor learning principles to optimize walking. Previous work from our lab demonstrated that real-time AGRF biofeedback training improves stroke gait biomechanics, but our biofeedback interface was simple, 2-dimensional, and non-engaging.

Objective: Here, our objective was to evaluate the feasibility and effects of an engaging, game-based system specifically designed for post-stroke gait training. We also obtained iterative feedback from key stakeholders (rehabilitation clients and healthcare providers).

Methods: We collected data on 10 able bodied controls (6 females; age: 27.6± 4.01) and 6 stroke survivors (3 females; age: 65.5± 5.54 years; 5.17 ± 3.66 years since stroke). Study participants completed one session comprising three bouts of walking with no bio-feedback, a conventional non-gamified biofeedback, our newly developed, game-based "RockWalk" biofeedback. To measure physiological engagement and intensity, rate of perceived exertion, heart rate, and galvanic skin resistance were collected during each walking bout. Gait biomechanics variables were obtained before and after each trial. To obtain user feedback and perceptions, 3 user surveys were implemented after each type of biofeedback.

Results & conclusions: Our preliminary results related to user feedback provide insights regarding stroke survivors’ perceptions related to sophisticated game-based gait retraining feedback systems. We show the feasibility of and biomechanical improvements induced by game-based feedback in context of clinically-relevant gait rehabilitation. Ongoing and future work will investigate neural mechanisms, compare immersive (via virtual reality headsets) versus non-immersive feedback, and multiple sessions of game-based biofeedback.

P-557

A novel threshold matrix framework to quantify post-stroke neurophysiological recovery

W. Byblow¹, M. Shanks¹, C. Stinear¹, J. Cirillo¹

¹University of Auckland, Auckland, New Zealand

Introduction: After stroke, transcranial magnetic stimulation (TMS) of human motor cortex can be used to evaluate functional corticomotor integrity from motor evoked potentials (MEPs). Although stimulus-response curves can be used to depict the gain of the corticomotor pathway, early after stroke curve-fitting can be inaccurate. A novel threshold matrix is an alternative framework to analyse MEPs across a wide range of stimulation intensities and upper limb muscles to better quantify post-stroke recovery. Objectives. To assess neurophysiological upper limb recovery in a cohort of stroke patients across the sub-acute phase using a novel threshold matrix framework.

Methods: Participants were screened and recruited from consecutive patients admitted to the Auckland hospital as part of an ongoing RCT (ACTRN12620000871943). All participants had monohemispheric stroke with upper limb involvement, and MEPs in the paretic upper limb within 5 days of stroke. Threshold matrices were constructed from MEPs obtained from four upper limb muscles distal to the elbow across ten stimulation intensities for both the paretic and non-paretic side, at 1, 3, and 6 months post stroke. Compositional analyses were used to quantify the absence of MEPs, the presence of subthreshold MEPs and the presence of suprathreshold MEPs. Clinical assessments were also obtained.

Results: Threshold matrix elements obtained from the paretic side were indicative of functional recovery. Non-paretic side matrices were stable and similar to those obtained from age-similar healthy controls. Linear regression and compositional analyses were used to explore associations between threshold matrix elements and clinical outcomes.

Conclusion: The threshold matrix concept provides a compositional analysis framework for assessing the corticomotor pathway function after stroke. Further studies are warranted within the first month after stroke to more completely characterise mechanisms of spontaneous recovery.

P-558

Occupational engagement, arm use, environmental features and its relationship amongst stroke survivors in an acute stroke unit

X. Y. Wu¹, W. X. Tan¹, H. Y. E. Ong¹, S. K. S. Hou¹, K. Teh¹, H. R. J. Lam¹, K. T. M. Lau¹, Y. Q. T. Wu¹, X. S. Choo¹

¹Singapore General Hospital, Occupational Therapy, Singapore, Singapore

Background: Occupational engagement significantly impacts functional recovery in acute stroke. Hospitalised stroke patients often spend their waking hours alone, inactive and with minimal paretic arm use, leading to poorer outcomes. The hospital environment can influence a patient’s recovery and well-being, with occupational therapists (OTs) playing a crucial role in identifying related factors.

Objectives: To understand stroke patients’ 1) occupation engagement and paretic arm use, 2) their immediate ward environment in the acute stroke unit and 3) the relationship between these variables.

Methods: Trained OTs observed hospitalised stroke patients for a day, with occupational engagement, paretic arm use, and ward environmental factors measured using behavioural mapping. Data were analysed with descriptive statistics and associations explored with Spearman Rank Correlation.

Results: Fifteen participants were recruited with a total of 720 10-minute interval observations completed. The mean (SD) percentage time engaged in active occupations, such as therapy, self-care and self-exercise was 40.8 (20.9); while median (IQR) percentage time of paretic arm use was 12.5 (7.3-34.4). Participants were in bed 83.3 (IQR:64.6–95.9)% of the time. The immediate ward environment was assessed by the percentage time [median (IQR)] participants had within arm’s reach a geriatric chair [66.7 (8.3-100)], cardiac table [100 (100-100)] and iPad [100 (100-100)]. Correlation analysis revealed that the environment does not significantly influence occupational engagement or paretic arm use.

Conclusion: The current ward environment with its availability of geriatric chair, cardiac table and iPad is insufficient to stimulate stroke patients’ occupational engagement and paretic arm use. OTs need to play a greater role in supporting and motivating patients to actively engage in occupations and increase paretic arm use along with environmental facilitators for optimal functional recovery.

P-559

Enhancing occupational therapists’ and interns’ perceptions of GRASP for upper-extremity hemiparesis: an implementation science study using an educational module

Y. W. Pan¹, C. L. Yang^1,2

¹Chang Gung University, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Taoyuan, Taiwan

²Chang Gung Memorial Hospital, Physical Therapy and Rehabilitation, Chiayi, Taiwan

Introduction: Implementation science is a scientific approach aimed at promoting the application of research findings into practice. In knowledge translation, education is the most used way to enhance clinical knowledge. Therefore, this study adopted an evidence-based teaching model known as the BOPPPS model (Bridge in, Objective, Pre-assessment, Participatory learning, Post-assessment, and Summary). The Graded Repetitive Arm Supplementary Program (GRASP) is an evidence-based program for upper limb rehabilitation for stroke.

Objectives: This study examines the changes in knowledge, confidence, and willingness to use GRASP among occupational therapists and interns after a one-hour educational course.

Methods: Convenience sampling was used to recruit occupational therapists and interns from four hospitals in Taiwan. This study used a single-group quasi-experimental pre–post design. Participants received 1-2 hours of GRASP educational course, and participants completed a questionnaire that assessed knowledge, confidence, and willingness to use GRASP before and after the course. The Wilcoxon signed rank test was used to examine the differences between the pre- and post-tests.

Results: A total of 30 occupational therapists (n=21) and interns (n=9) participated in this study. The results showed significant improvement in knowledge (P < .001), confidence (P < .001), willingness (P < .001), and total scores (P < .001) between pre-and post-tests.

Conclusion: One to two hours of education courses improved occupational therapists’ and interns’ knowledge, confidence, and willingness to use GRASP. Future research is needed to explore therapists’ and interns" perspectives about facilitators and barriers to implementing GRASP in clinical through qualitative studies.

P-560

One year evaluation of functional results of intensive day rehabilitation programme using CIMT

Y. Angerová¹, M. Krivošíková¹, N. Sebkova¹, S. Klimošova¹

¹Charles University, Rehabilitation, Prague, Czech Republic

Introduction: CIMT (Constraint Induced Movement Therapy) is based on two basic principles. Forced used of the affected arm by restraining the unaffected arm and massed practice of the affected arm through so called shaping activities. Our Department of Rehabilitation Medicine uses this concept during intensive outpatient day program. The program is for four weeks, five days a week from the morning until the afternoon. Patients have individual as well as group activities using CIMT principles.

Objectives: We wanted to know how long the results achieved during the programme will last.

Method: 20 patients (10 men and 10 women) with hemiparesis due to stroke age 18 and older were involved during the years 2020-2023. They had ischemic as well as hemorrhagic stroke more than 6 months before starting the programme. They had good cognitive functions to understand and follow the tasks. Neuropsychological assessment was necessary before the program. They had paresis of upper limb and were able to extend wrist at least 20 degrees and fingers in metacarpophalangeal joints extend at least 10 degrees.

The functional evaluation of upper limb (MFS - Modified Frenchay scale, Jebsen Taylor test and Motor activity log) as well as FIM were done at the beginning and at the end of the programme. After finishing the programme patients were controlled 1, 3,6 months and 1 year using the same tests.

Results: Almost all patients improved their dexterity during the programme. The improvement achieved was outworn even after one year. There was no statistical significance of improvement in FIM but in Jebsen Taylor and MFS.

The results are very promising and confirm the effectiveness of the program, but very precise indication is necessary.

KWAKKEL, Gert, et al. Constraint-induced movement therapy after stroke. The Lancet Neurology, 2015, 14.2: 224-234

P-561

REMOBI & AIDEAL innovations for improving eye movements, functional visual field, reading and quality of life following a stroke

Z. Kapoula¹, M. Favrat¹, N. Badet¹, C. Ailleo¹

¹ORASIS - EAR, Eye Analytics & Rehabilitation, Paris, France

Objectives: Visual and oculomotor disorders are highly prevalent following a stroke (>73%, Rowe et al., PLOS ONE 2019). Eye movements possess neuroplasticity. This study investigates the effectiveness of an eye movement training protocol for stroke rehabilitation.

Material & methods: The REMOBI device, equipped with LEDs and adjacent buzzers, was positioned horizontally at eye level to evaluate horizontal saccades at three depths, vergence, and the Visuo Motor Attentional field. Eye movements were recorded with the Pupil Core, analyzed with the AIDEAL (www.orasis-ear.com). Six patients, three males, aged 41 to 66 years old, experienced a stroke 2 to 10 years ago, except for one patient who had a stroke six months ago. One patient presented moderate left neglect, three had right lateral homonymous hemianopsia, one left hemianopsia, and the last one a left-down scotoma due to multi-territorial stroke. Patients underwent six eye movement training sessions with the REMOBI, using audiovisual targets to promote multisensory facilitation. Recordings before and after training were conducted with LED targets only.

Results: All patients showed a significant improvement in saccade latency and precision, particularly in the affected field and for far distances. Vergence latency and amplitude improved. The visual field improved for all patients except one. Reading eye movements and speed improved. Star cancellation test scores improved, visual stress decreased (CISS scale), Bergego’s scale scores improved. Two patients returned to their professional activities (road driver, counting).

Discussion & conclusion: The REMOBI & AIDEAL protocol represents a comprehensive integrative approach to stroke rehabilitation by harnessing the neuroplasticity of eye movements and incorporating multisensory audio-visual cognitive stimulation

P-562

Examining the relationship between upper extremity motor recovery and unilateral changes in arterial and intramuscular blood flow among people with chronic stroke: a cross-sectional study

T. Miller^1,2,3, H. Ouyang³, C. Tsang³, M. Calderón-Juárez^1,2, M. Ying⁴, M. Pang³

¹University of British Columbia, Medicine, Vancouver, Canada

²International Collaboration on Repair Discoveries (ICORD), Medicine, Vancouver, Canada

³Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

⁴Polytechnic University, Health Technology and Informatics, Hong Kong, Hong Kong

Background: Peripheral vascular changes have been shown to be more pronounced in paretic limbs after stroke. However, comparisons of intramuscular blood perfusion in stroke-affected upper extremity muscles relative to their healthy counterparts have not been examined. Moreover, associations between the vascular changes and measures functional recovery after stroke remain understudied.

Objectives: (1) To compare arterial and intramuscular blood flow between non-paretic and paretic upper limbs of people with stroke and healthy controls and (2) examine the association between vascular parameters and motor impairment.

Methods: Participants with chronic stroke (n=64, age=60.8±7.7 years, stroke duration=5.7±3.9 years) and age- and sex-matched controls (n=64, 59.4±7.8 years) completed this cross-sectional study. Brachial artery diameter (AD) and blood flow volume (Vflow) were assessed with Doppler ultrasound. The vascularity index (VI) was used to estimate biceps brachii intramuscular blood perfusion. Paretic arm impairment was assessed using the Fugl-Meyer Assessment (FMA), and Motor Activity Log (MAL).

Results: Interaction effects were found for VI and AD (p≤0.048) but not Vflow (p=0.324). Post hoc tests showed reduced VI and AD for paretic limbs (stroke), greater Vflow for dominant limbs (control), and greater side-to-side difference (%SSD) in AD and VI for the group with stroke (p≤0.017). The %SSD in VI, AD, and Vflow all demonstrated an association with stroke-related impairment (MAL, FMA) (p≤0.05). FMA was an independent predictor of both %SSD in AD (R2=0.280, p=0.018) and %SSD in VI (R2=0.259, p=0.008). MAL was also an independent predictor of %SSD in Vflow (R2=0.158, p=0.046).

Conclusions: Compared to non-paretic sides and bilateral limbs of controls, paretic artery size and muscle blood flow were significantly reduced. Paretic arm motor impairment and disuse were also predictors of all vascular measures.

P-563

Effect of physical exercise on falls in people with stroke: a systematic review and meta-analysis

X. Li¹, Y. K. Chan¹, Y. L. Tong¹, J. Zhuang¹, H. Y. Wan¹, C. H. Wong¹, K. Y. Wong¹, A. C. F. Li¹, M. Pang¹

¹Polytechnic University, Rehabilitation, Hong Kong, Hong Kong

Introduction: Falls are a common complication after stroke. Physical exercise training could be a potential approach to reduce falls.

Objectives: To evaluate the effect of physical exercise on falls in people with stroke, and to examine the characteristics of exercise protocols that may affect fall outcomes.

Patients & methods: Randomized controlled trials that involved physical exercise as an intervention and measured fall-related outcomes (e.g., number of falls, fallers, and injurious falls) in people with stroke were searched in PubMed, CINAHL, Cochrane Database, PsycINFO, and MEDLINE databases. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the quality of studies. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system was adopted to appraise the quality of evidence for each outcome.

Results: Seventeen studies (1477 subjects) were included in this review and for meta-analysis. The primary analysis showed that physical exercise tended to reduce the number of fallers (incident risk ratio (IRR)=0.88, 95% CI [0.71, 1.09]), but there was a small chance that the control group had better outcome. The primary analysis also revealed that physical exercise was effective in reducing the number of falls (IRR=0.73, 95% CI [0.56, 0.94]). In sensitivity analysis involving only those trials that studied physical exercise with cognitive components (i.e., dual-task, mind-body exercise), the effect on reduction of number of fallers (IRR)=0.54, 95% CI [0.35, 0.82]), and number of falls (IRR=0.55, 95% CI [0.36, 0.83]) seemed to be more pronounced.

Conclusion: Low to moderate quality evidence supports that physical exercise has beneficial effects on reducing number of falls and fallers among people with stroke. Potentially greater benefit may be obtained by incorporating cognitive training components into the overall physical exercise program for fall prevention post-stroke.

P-564

EEG connectivity as a marker of motor recovery after stroke

R. Garrido-Baquedano¹, T. Bruna-Melo¹, F. Aleitte-Leyton¹, J. Becerra Caroca¹, J. Carrasco Plaza¹, P. Burgos¹

¹University of Chile, Physical Therapy, Santiago, Chile

Introduction: A current challenge after stroke is understanding if interventions promote true recovery or compensation at behavioral and brain levels. At the behavioral level, recovery is usually assessed using clinical scales such as the Fugl Meyer Assessment (FMA). However, at the brain level, most techniques are oriented to assess the structural damage, not the brain dynamics.

Objectives: To identify the characteristics of cortical connectivity recorded with EEG that are related to motor recovery after stroke. We hypothesized that motor interhemispheric and parietal-motor connectivity would be associated with motor recovery.

Methods: 22 individuals with stroke in the early subacute phase (age=67±7, FMA=31±13) were assessed in 4 sessions: first week(0M), first month (1M), third (3M), and sixth(6M). In each session, we assessed the FMA (upper extremity) and the EEG (64 channels) during a functional task (water-glass task repeated 40 times). After source analysis, we calculated functional connectivity (FC) and effective connectivity (EC) metrics between the motor and parietal cortex.

Results: The FMA values show a motor recovery of the participants (31±13, 50±11, 55±13 and 56±13, in 0M, 1M, 3M and 6M respectively). There were significant differences between 0M and all records (p=0.000). We observed a significant correlation between motor recovery (all sessions) and alpha FC between R-L primary motor cortices (r=-0.29, p=0.02) and alpha EC from the ipsilesional motor cortex to the contralesional (r=-0.39, p=0.002), between -0.25 and 0s. A significant correlation was identified in alpha EC from the parietal cortex to the primary motor cortex (r=-0.33, p=0.01) between 0.5 and 0.75s in the ipsilesional hemisphere.

Conclusions: In the first semester after stroke, a significant negative correlation exists between upper extremity motor recovery and functional and effective connectivity between motor and parietal-motor areas.

P-565

Lunch date versus peg tube procedure

N. Singh¹, J. Woo¹

¹Baylor College of Medicine, Physical Therapy and Rehabilitation, Houston, TX, United States

Purpose: Altered taste perception following a stroke predisposes patient to malnutrition affecting overall recovery. Yet, there are no established interventions

Case: We present a case of a 57-year old patient who developed aversion to food and fluid following a left middle cerebral artery infarct. As her swallowing was intact, she was admitted to inpatient rehabilitation unit on a thin liquid diet. However, she could not tolerate anything by mouth and would make facial expressions and gestures of disgust with any oral intake. Assessment was significantly limited due to global aphasia. After unsuccessful trials with mirtazapine and carbamazepine, a nasogastric (NG) tube was eventually placed for supplemental nutrition. Folate and zinc were added to the regimen followed by dronabinol. But with no improvement, they were discontinued, and gabapentin was added. Laryngoscope was performed which revealed mild inflammatory changes, for which proton pump inhibitor was added. Simultaneously, lunch sessions were initiated, in which patient was joined by the rehabilitation team members to eat together in a common area in the unit to promote a pleasant dining experience. Patient was being prepared for percutaneous endoscopic gastrostomy (PEG) tube placement, aspirin & clopidogrel were held. While waiting for the procedure to be scheduled, patient"s oral intake gradually improved to the point where she was eating at least half of her meals consistently. PEG tube procedure was cancelled and NG tube was removed. The patient was provided with consistent support, encouragement, and positive nonverbal cues during mealtime by the staff and family members to maintain adequate oral intake.

Conclusion: In this case, it is difficult to identify which intervention improved her oral intake. However, through this case report, authors would like to emphasize upon the use of environmental factors along with pharmacological interventions to manage dysgeusia and improve patient"s quality of life.

P-566

Understanding the prevalence of and factors influencing fatigue in stroke survivors in Singapore

P. L. Choo¹, Y. J. Huang¹, J. E. Kam¹

¹Singapore Institute of Technology, Health and Social Sciences, Singapore, Singapore

Introduction: Post-stroke fatigue is one of the most prevalent post-stroke complications. Prevalence of and factors associated with post-stroke fatigue in stroke survivors in Singapore has not been established.

Objectives: To determine the prevalence of and the factors associated with post-stroke fatigue in stroke survivors in Singapore and to examine the differences in fatigue between residential and community-dwelling stroke survivors.

Methods: A cross-sectional, observational study recruiting 146 residential and community-dwelling stroke survivors. Fatigue was measured using the Fatigue Assessment Scale (FAS). Secondary assessments such as the Multidimensional State Boredom Scale (MSBS), Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were used to measure state boredom, daytime sleepiness, and sleep quality respectively. Associations between baseline characteristics, secondary assessments and fatigue were calculated.

Results: Prevalence of fatigue in stroke survivors in Singapore was found to be 42.5%, with most of them experiencing mild-moderate levels of fatigue (37.0%). Physical fatigue was found to contribute greater than mental fatigue (p<0.001). There were no significant between-group differences in fatigue levels between community and residential stroke survivors (p=0.144). Significant correlation was found between MSBS scores (p<0.001), ESS scores (p=0.005), PSQI scores (p<0.001) and FAS scores. No significant correlation was found between baseline characteristics (p>0.05), neurological factors (p>0.05) and FAS scores.

Conclusions: Post-stroke fatigue is highly prevalent in Singapore stroke survivors, and they mostly suffer mild-moderate fatigue. Boredom, daytime sleepiness, and sleep quality were found to be associated to post-stroke fatigue.

P-567

Use of bilateral upper limb outcome measures in stroke survivors: a systematic review

P. L. Choo¹, W. K. J. Sim¹, W. T. M. Yee¹

¹Singapore Institute of Technology, Health and Social Sciences, Singapore, Singapore

Introduction: The use of bilateral upper limb (UL) outcome measures allows clinicians to better understand stroke survivors’ bilateral UL function after stroke.

Objectives: To summarise UL outcome measures’ psychometric properties, identify the type of movements involved in each outcome measure, and identify validated outcome measures to be used in the various stages after stroke.

Methods: Four electronic databases, PubMed, Cochrane Library, CINAHL and Web of Science, were used to identify journal articles published from inception.

Results: Thirteen included studies met the inclusion criteria. Bilateral UL outcome measures included: ABILHAND, Ad-AHA (Adult Assisting Hand Assessment Stroke), BAM (Bimanual Assessment Measure), CAHAI (Chedoke Arm and Hand Activity Inventory), EMORY (Emory Motor Function Test), ILC2 (Interlimb Coordination Test), SAL (Stroke Arm Ladder), TEMPA (Test d’Evaluation de la performance des Membres Supérieurs des Personnes Agées), Y-BAT (Yonsei-Bilateral Activity Test), and AMULA (Activities Measure for Upper Limb Amputees). In terms of the type of movements assessed, six involved bilaterally different movements, 1 involved bilaterally similar movements while three had a combination. Seven assessed impairments at an activity level, one assessed bodily functional impairment, one assessed activity and bodily functional impairments and one assessed impairments across all three domains. Only the ABILHAND, BAM and ILC2 outcome measures were studied among chronic stroke survivors; the rest were done among acute and chronic stroke survivors. Only six measures included movement quality as part of their scoring criteria. In terms of incorporating ADLs as part of the assessment components, all but ILC2 and EMORY did so.

Conclusions: Majority of the outcome measures displayed good psychometric properties. However, future investigation is required on the differences in their properties, suitability, and feasibility of use in clinical settings.

P-568

Physical exercise recovers the FUNDC1-dependent MAMs after ischemic stroke

X. Yang¹, F. Yifeng¹, F. Zheng¹, Z. Liying¹, X. Hu¹

¹Third Affiliated Hospital of Sun Yat-Sen University, Rehabilitation, Guangzhou City, China

Introduction: The FUN14 domain-containing protein 1 (FUNDC1) mediated mitochondria-associated endoplasmic reticulum membranes (MAMs) are sensitive to energy stresses and critical in mitochondrial functions.

Objective: In this study, we determined to figure out whether and how physical exercise manipulates the FUNDC1-dependent MAMs after ischemic stroke.

Method: Magnetic resonance imaging was used to examine the penumbra volumes. The structure of MAMs and the process of mitophagy was observed by electron microscopy, immunofluorescence. Western blotting was performed to qualify the MAMs protein from high-speed centrifugation. Immunoprecipitation was utilized to demonstrate the connection between Pak2 and FUNDC1. AAV-mediated circAnks1b knockdown in animal level and lentivirus-mediated circAnks1b overexpression in primary neuron were applied to determine the regulation of circAnks1b-miR-130b-5p-Pak2.

Result: In this study, we identified physical exercise improved functional recovery and reduced infarct volume, as well as restored the damaged MAMs in the peri-infarct cortex. The repairment of MAMs is correlated with the aggregation of FUNDC1, whose activity is potentiated to promote neuronal mitophagy. The up-regulation of FUNDC1 in MAMs interacted with the endoplasmic reticulum Pak2. Furthermore, neuronal Pak2 was regulated by circAnks1b-miR-130b-5p, and disruption of cirAnks1b-miR-130b-5p-Pak2 axis in peri-infarct cortex effectively interrupted the rehabilitation effect of physical exercise.

Conclusion: Our results indicated that physical exercise recovered the FUNDC1-dependent MAMs and promotes stroke rehabilitation. Approaches targeting Pak2 and modulating this signaling pathway might be a potential therapeutic strategy for ischemic stroke.

Key words: Physical Exercise; ischemic stroke; mitophagy

P-569

Exercise preconditioning protects autophagy-lysosomal pathway via lung-derived FNIP1 in acute ischemic stroke

X. Yang¹, F. Yifeng¹, Z. Liying¹, X. Hu¹

¹Third Affiliated Hospital of Sun Yat-Sen University, Rehabilitation, Guangzhou City, China

Objective: The Autophagy-Lysosomal Pathway (ALP) plays an important role in nerve injury and repair. TFEB nuclear transport is key to ALP function, and FNIP1 has recently been reported regulating TFEB nuclear transport. However, the mechanism by which exercise preconditioning regulates autophagy after ischemic stroke remains unclear.

Methods: MRI was used to determine the infarction volume, and modified Neurological Severity Scores and Cylinder test were used to evaluate neurological function after ischemic stroke. The level of neuronal autophagy, autophagic flux, and signaling pathway proteins were determined using western blotting, RT-qPCR and immunofluorescence. The Pseudorabies virus was injected in lung and see the connections between the lung and cortex, besides, intranasal AAV6-EGFP-shFNIP1 was was used to silence the pulmonary FNIP1and verify its effect after ischemic stroke.

Results: Our study found that ① Exercise Preconditioning improved neurological functions and defective autophagy, and reduced the infarct volume; ② Exercise Preconditioning decreased TFEB phosphorylation in peri-infarct cortex, increased TFEB nucleus transfer, and improved damaged ALP pathway; ③ Proteomics analyses showed that exercise preconditioning up-regulated FNIP1 expression; ④ FNIP1 was highly expressed in lung, and its expression level was positively correlated with the level of FNIP1 in cortex.

Conclusion: Exercise Preconditioning can up-regulate FNIP1 in lung, increase FNIP1 expression in per-infarct cortex, promote FLCN-FNIP1 turn to "Gap off", therefore inhibit TFEB phosphorylation and increase TFEB nuclear transfer, thus improve ALP pathway. Our study provides a potential molecular targer to treating patients with stroke injury.

Key words: Exercise Preconditioning; ischemic stroke; Autophagy-Lysosomal Pathway

P-570

Profiling speech, language, and feeding impairments in a young child with Phelan Mcdermid Syndrome – a case study

S. Shah¹, T. Motiwala¹

¹NMC & BYL Nair Charitable Hospital, Audiology and Speech Therapy, Mumbai, India

Introduction: Phelan-McDermid Syndrome (PMS) or 22q13.3 deletion syndrome is a rare genetic disorder compromising SHANK3 gene. It includes speech and language deficits, feeding issues, neonatal hypotonia, motor skill delays, sensory issues, attention problems, medical comorbidities, intellectual disability, unique physical features and autism-like traits.

Objective: This study explores and highlights communication and feeding impairments in a case of PMS.

Methods: We employed standardized tests to evaluate speech, language, feeding and sensory domains, gaining a comprehensive analysis of child’s abilities and challenges.

Results: Child exhibited significant delay in motor and speech development, encompassing semantics, syntax, phonology, morphology, and pragmatics. Apraxia of speech compounded her challenges. Feeding issues included food pocketing, spills, and open-mouth chewing making mealtimes complex. Sensory sensitivities involved sound hypersensitivity, object and hand mouthing, and repetitive banging.

Conclusion: This case analysis informs clinical management and interventions for PMS cases. Understanding their speech-language and feeding profiles is crucial for tailored support and enhancing their quality of life. This research contributes to PMS knowledge and informs strategies for improving affected children’s development.

References

Speech and language phenotype in Phelan-McDermid (22q13.3) syndrome. Brignell, A., Gu, C., Holm, A. et al. 8th December 2020, European Journal of Human Genetics.

Consensus recommendations on communication, language and speech in Phelan-McDermid syndrome. Monica Burdeus-Olavarrieta, Julián Nevado, Sabrina van Weering-Scholten, Susanne Parker, the European Phelan-McDermid syndrome consortium, Ann Swillen. 2023, European Journal of Medical Genetics.

Characterisation of the clinical phenotype in Phelan-McDermid syndrome. Burdeus-Olavarrieta, M., San José-Cáceres, A., García-Alcón, A. et al. 2021, Journal of Neurodevelop Disorders.

P-571

Assessment and intervention of speech and swallowing in a young adult with lateral medullary syndrome – a case study

T. Motiwala ¹

¹NMC & BYL Nair Charitable Hospital, Audiology and Speech Therapy, Mumbai, India

Introduction: Lateral Medullary Syndrome (LMS), also known as Wallenberg’s syndrome, results from ischemia in the lateral part of the medulla oblongata due to occlusion in a vertebral or posterior inferior cerebellar artery. It primarily causes sensory deficits in the opposite trunk and limbs and on the same side, affecting the face and cranial nerves. LMS symptoms include swallowing issues, hiccups, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner’s syndrome, diplopia, and possibly palatal myoclonus.

Objective: To study the clinical course and outcome of severe dysphagia and speech difficulties in a young LMS patient.

Methods: A 26-year-old with LMS underwent comprehensive management for speech and swallowing issues, using assessments and therapeutic techniques.

Results: Evidence-based therapy improved speech and swallowing in young adults within 3 months, allowing the patient to resume an oral diet.

Conclusion: This article highlights the holistic rehabilitation of impaired speech and swallowing in Lateral Medullary Syndrome.

References

2. Ji R, Schwamm LH, Pervez MA, Singhal AB. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis. JAMA Neurol. 2013 Jan;70(1):51–7.

Fonarow GC, Reeves MJ, Zhao X, Olson DM, Smith EE, Saver JL, et al. Age-related differences in characteristics, performance measures, treatment trends, and outcomes in patients with ischemic stroke. Circulation. 2010 Feb 23;121(7):879–91.

Jang SH, Kim MS. Dysphagia in Lateral Medullary Syndrome: A Narrative Review. Dysphagia. 2021 Jun;36(3):329–38.

Norrving B, Cronqvist S. Lateral medullary infarction: prognosis in an unselected series. Neurology. 1991 Feb;41(2 (Pt 1)):244–8.

P-572

Effect of neuromuscular electrical stimulation along with traditional swallowing therapy in a young patient with lateral medullary syndrome: a case study

T. Motiwala ¹

¹NMC & BYL Nair Charitable Hospital, Audiology and Speech Therapy, Mumbai, India

Introduction: Lateral Medullary syndrome (LMS) results from medulla oblongata damage, often causing speech and swallowing difficulties. Therapy includes traditional and Neuromuscular Electrical Stimulation (NMES). NMES benefits swallowing, voice, muscle strength, and more, especially in young patients.

Objective: To assess the effects of NMES combined with traditional therapy in a young LMS patient with severe dysphagia.

Methods: The patient underwent 60 cycles of NMES along with traditional swallowing therapy for a month.

Results: NMES and traditional therapy effectively improve swallowing and speech function in stroke rehabilitation.

Conclusion: NMES and traditional therapy aid swallowing and speech recovery in young adults with LMS, often leading to faster progress.

References

Banik, A. A., &Hattiangadi, G. A. (2020). Transcutaneous electrical neuromuscular stimulation (TENS) along with traditional dysphagia therapy in patients with posterior stroke: A case study. Indian Journal of Otolaryngology and Head and Neck Surgery: Official Publication of the Association of Otolaryngologists of India, 72(3), 279–283.

Howard, M. M., Block, E. S., Mishreki, D., Kim, T., & Rosario, E. R. (2023). The effect of sensory level versus motor level electrical stimulation of pharyngeal muscles in acute stroke patients with dysphagia: A randomized trial. Dysphagia, 38(3),943–953.

Zhang, M., Tao, T., Zhang, Z.-B., Zhu, X., Fan, W.-G., Pu, L.-J., Chu, L., & Yue, S.-W. (2016). Effectiveness of neuromuscular electrical stimulation on patients with dysphagia with medullary infarction. Archives of Physical Medicine and Rehabilitation, 97(3), 355–362.

P-573

Development and validation of FEES tutorial for students of speech-language pathology in India

T. Sanghavi¹, J. Dave²

¹All India Institute of Speech and Hearing, Mysuru, India

²Terna Physiotherapy College, Navi Mumbai, India

Introduction: Difficulty swallowing, also called dysphagia, is a common condition in India due to various reasons such as pneumonia, head and neck cancers, and cardiovascular diseases. FEES is a procedure to evaluate pharyngeal dysphagia by inserting an endoscope into the nasal cavity. There is a lack of educational materials to learn about FEES in the Indian context for students of speech-language pathology. The present study outlines the development of a tutorial, which would help develop competency and knowledge about FEES among students.

Objectives: To develop a tutorial which would include information about basic knowledge of FEES equipment, procedure and its implementation. To establish its content validity; To assess the efficacy of the tutorial by administering it on students of speech-language pathology.

Method: Information about relevant aspects of FEES was collected from various sources and was organized into six chapters. The chapters were validated for contents by one ENT physician and three speech-language pathologists. User validation was done by administering the tutorial on ten postgraduate students of speech-language pathology. All ethical procedures were followed. The total pre and post-test scores obtained from all the participants were averaged. Non parametric test Wilcoxon Signed Rank Test was used to compare the pretest and posttest average scores using SPSS software version 26.

Results: The outcome of the study was a tutorial to assess pharyngeal dysphagia using FEES. A significantly higher post-test scores (Z=2.03, p < 0.04) indicated that the tutorial was effective in increasing the understanding about FEES procedure among the students. A chapter wise analysis revealed that there was a significant difference in the scores of all chapters, except for chapter IV.

Conclusion: The tutorial developed was effective in enhancing the understanding pertaining to the FEES procedure.

P-574

Use of rTMS and tDCS improves swallowing in a brainstem stroke patient with cricopharyngeal spasm: a case study

T. Sanghavi¹, J. Dave²

¹All India Institute of Speech and Hearing, Mysuru, India

²Terna Physiotherapy College, Navi Mumbai, India

Introduction: Post-stroke dysphagia affects between 37 and 78 percent of people in India. In recent years, research into repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) has explored the possibility of using it for swallowing rehabilitation, however, there is a paucity of literature on the effects of combined rTMS and tDCS on swallowing.

Objectives: To study the combined effects of transcranial magnetic stimulation and transcranial direct current stimulation in combination with standard swallowing training on swallowing function in brainstem stroke patient with cricopharyngeal spasms.

Materials & methods: A 38-year-old male and engineer by profession was admitted to the hospital following acute lateral medullary infarct and lacunar infarct in the left gangliocapsular region on 30 October 2021. A research protocol was formulated that combined rtMS and tDCS with conventional swallowing therapy. Following this, the patient received both tDCS and rTMS sessions. SWAL-QOL was administered before and after implementing the treatment protocol simultaneously first 6 sessions a week, and later 3 sessions a week for two weeks.

Results: Statistical analysis was done using Wilcoxon signed rank test to compare the effects of treatment pre and post-test as per domains of SWAL QOL. It was found that the maximum difference was noted for food selection and social functioning and the minimum difference was found for fatigue.

Conclusion: This study combines the usage of both rTMS and tDCS along with traditional swallowing therapy to help a patient recover from oropharyngeal dysphagia with cricopharyngeal spasm.

P-575

Systematic review of behavioral swallowing interventions in persons with ataxic etiologies

A. Memarian^1,2, D. Grimes^3,4, H. Flowers^1,2

¹University of Ottawa, Rehabilitation, Ottawa, Canada

²Bruyère Research Institute, Ottawa, Canada

³The Ottawa Hospital Research Institute, Neurology, Ottawa, Canada

⁴University of Ottawa, Brain and Mind Research Institute, Ottawa, Canada

Introduction: Ataxic etiologies can cause dysphagia, which has a variety of negative effects such as malnutrition,aspiration pneumonia,extended hospital stays, and psychosocial difficulties like mealtime anxiety and social withdrawal. Despite these impacts, there’s a lack of empirical, population-specific evidence elucidating the benefits of swallowing therapy for individuals with ataxia. Given the potential for dysphagia to manifest in this population,coupled with a poor understanding of what therapies are most robust to address it,a systematic review is badly needed to extend the evidence and inform best practices.

Objectives: The main aim is to conduct a thorough review of the literature on behavioural interventions for dysphagia in adults with ataxia. The goal is to provide a current, detailed overview and identify research gaps for evidence-based recommendations to aid clinicians and researchers.

Materials & methods: We will systematically review and analyze swallowing interventions for adults with ataxia, considering oropharyngeal physiology, diet, and respiratory indicators. A comprehensive search will be conducted in MEDLINE, EMBASE, CINAHL, AMED, the Cochrane Library, Web of Science,and Scopus,along with various grey literature databases. The included studies will focus on adults with ataxia-related dysphagia, with two assessors independently evaluating abstracts and articles. Exclusions involve studies on gastroesophageal reflux,esophageal dysphagia, or pediatrics. A risk of bias assessment will be conducted, and findings will be presented categorically based on ataxic etiologies, either narratively or through meta-analysis if heterogeneity is low.

Conclusion: Researchers will present findings on effective behavioural interventions for dysphagia in adults with ataxia at the conference. The results aim to guide clinicians in developing protocols, informing future research,and improving the well-being of those facing dysphagia challenges linked to ataxia.

P-576

Comparing the use of the Munich dysphagia test for Parkinson’s disease (MDT-PD) in an inpatient neurorehabilitation and an outpatient neurologist setting

A. Tautscher-Basnett¹, V. Tomantschger¹, C. Hohenwarter¹

¹Gailtal-Klinik Hermagor, Neurorehabilitation, Hermagor, Austria

Objectives: To evaluate if by using the MDT-PD more patients with dysphagia can be identified and referred to a speech and language therapist (SLT) so as to enhance the management of dysphagia in PwPD in an inpatient neurorehabilitation and outpatient neurologist setting.

Patients & methods: We compared four groups of PwPD (tab. 1) in terms of dysphagia management during 3-months periods:

group 1: inpatients without MDT-PD screening, 16.04.-16.07.23

group 2: inpatients with MDT-PD screening, 17.07-17.10.23

group 3: outpatients without MDT-PD screening, 04.04.-04.07.23

group 4: outpatients with MDT-PD screening, 05.07.-05.10.23

Tab. 1.

Demographic data.

	number of PwP	m %	w %	average age	years since PD diagnosis: average (range)
group 1:	44	64	36	73,3	8,4 (0-26)
group 2:	34	59	41	74,6	7,6 (1-22)
group 3:	30	63	37	72,2	11,3 (0-41)
group 4:	22	73	27	72,6	7,8 (1-25)

A total of 130 PwPD participated. Hoehn & Yahr stages were very variable in all groups and ranged from 1 to 4.

All questionnaires were analysed on the web application www.mdt-parkinson.de (1), which provides advice on the interpretation of the results and offers different recommendations for management.

Results:	% of PwPD with SLT dysphagia management
group 1: Inpatients, without	45,5
group 2: Inpatients, with	59,8
group 3: Outpatients, without	3,3
group 4: Outpatients with	31,8

SLT dysphagia management included clinical investigation, training the structures related to swallowing, giving advice to PwPD and their carers on managing swallowing difficulties.

Conclusions: The MDT-PD is an easy to use screening tool for early detection of potential problems with swallowing in PwPD both in inpatient and outpatient settings. Additionally, it raises awareness in PwPD and their carers.

Reference:

(1) Web application for analysis: mdt-parkinson.de

P-577

Understanding the Implications of Single-use Rhinolaryngoscopes for FEES Procedures on SLP Workflow

I. Haislip¹, C. Cool¹

¹Ambu USA, Health Economics & Outcomes Research, Market Access, Columbia, MD, United States

Introduction: Flexible endoscopic evaluation of swallowing (FEES) requires the use of a flexible rhinolaryngoscope to evaluate the swallowing function and are performed by speech language pathologists (SLP) across many settings, which means equipment needs to be readily available. Single-use (SU) rhinolaryngoscopes are an alternative to traditional reusable equipment and do not require reprocessing or repairs, which means there is no extensive downtime.

Objective: The objective of the study was to understand the potential impact of SU rhinolaryngoscopes on FEES caseloads and SLP productivity from the user perspective.

Materials & methods: A 23-question survey was administered to SLPs between November 16-18, 2023. Proportions were calculated using each question"s applicable respondents.

Results: A total of 24 certified SLPs completed the survey. Nearly half (46%) of respondents believed they could perform FEES more regularly/efficiently with the elimination of scope availability issues while only 29% of respondents did not, and 25% were unsure. Furthermore, 58% thought they could perform more FEES Procedures with the use of SU (which includes some of those previously unsure), 38% estimated they could add between 1-3 FEES cases per week, 13% estimating 4-6 cases, and 8% estimated 7 to 9 cases. Many respondents believed there would be a benefit in being able to discharge patients sooner with SU (33%), with only 21% of respondents not believing they could discharge patients sooner (46% were unsure). Lastly, only 13% of respondents felt they would not be able to spend more time on direct patient care if SU was utilized (33% indicated they could, 54% were unsure).

Conclusion: Respondents felt that they would be able to perform FEES more regularly/efficiently with readily available endoscopy equipment but indicated uncertainty as to how SU scopes would impact their overall workflow (likely due to inexperience with SU), signaling the need for further research.

P-578

Delayed cough reflex and cough effectiveness in patients with significant dysphagia: an observational study

J. K. Lee¹, J. Y. Kim¹

¹Gachon University Gil Hospital, Rehabilitation, Incheon, South Korea

Introduction: Laryngeal sensory function is crucial for swallowing and cough reflex, and its impairment in dysphagic patients increases aspiration pneumonia risk in post-stroke patients.

Objectives: We investigated the relationship of the onset timing of cough reflexes and the effectiveness of coughs in patients with significant aspiration, using video fluoroscopic swallowing studies (VFSS)

Methods: From March to June 2023, patients with Penetration Aspiration Score (PAS) grades 7 and 8 during the VFSS were enrolled for the study. The onset timing and the effectiveness of the cough after aspiration were investigated using the VFSS. Delayed cough reflex was defined as a cough occurred after more than 1 second of aspirated food passing through the vocal cord. The effective cough was defined as the cough that expels any amount of the aspirated material out above the vocal cord.

Results: A total of 111 patients were enrolled in the study, of which 90(81%) had PAS grade 7 and 21(19%) had PAS grade 8. The patients with effective cough among PAS 7 was 5/90(5.56%). Among the 90 patients with PAS 7, 30 patients (33%) showed delayed cough reflex, and 1 of them (1/30, 3.3%) showed effective cough. 60 patients (67%) showed immediate cough (< 1 second after aspiration), and 4 of them showed effective cough (4/60, 6.6%). The ratio of effective cough was not different between delayed cough group and immediate cough group.(p>0.05) Delayed cough reflex and the cough effectiveness showed no significant correlation with diagnosis and consciousness level. (p>0.05)

Conclusion: The low rate of effective cough suggests that aspiration itself is dangerous in dysphagia patient with PAS 7/8, regardless of cough timing.

P-581

The relationship between swallowing oral hesitation and cognition in frontal lobe stroke

Y. J. Yun¹, S. H. Han²

¹Department of Rehabilitation Medicine, Seoul National University Hospital, Rehabilitation, Seoul, South Korea

²Hanyang Guri Hospital, Rehabilitation, Guri, South Korea

Introduction: Dysphagia of oral stage problem mostly caused by frontal lobe lesions. We investigated the relationship between oral hesitation and cognitive impairment after frontal lobe stroke.

Objective: To confirm the relationship between oral hesitation and frontal lobe stroke

Patients & methods: We consecutively collected 946 patients with stroke from January 2016 to December 2020. Among them 38 patients had only frontal lobe lesions. Video fluoroscopic swallowing study(VFSS) was performed in a total of 5 stages from water to solid food in step. Patients who progressed to solid food are very rare, so we focused on liquid and soft food. Diagnosis of stroke was limited to cases in which cerebral infarction or hemorrhage had been verified by magnetic resonance imaging (MRI). Cognitive impairment was evaluated by MMSE in patients with frontal lobe lesions.

Results: Of the total 946 patients, 35 patients with frontal lobe lesions were enrolled in the study. Of them, 22 were judged to have cognitive impairment. The oral hesitation of the liquid component was analyzed, and a conclusion was drawn that the group with cognitive impairment showed significant oral hesitation than the group without cognitive impairment. On the other hand, in the case of soft food, it was found that there was no correlation between cognition and oral hesitation.

Conclusion: It was confirmed that oral hesitation during swallowing in patients with frontal lobe stroke had a meaningful relationship with cognition, and oral hesitation during swallowing was significantly higher in liquid swallowing rather than soft food.

P-582

iSpeak: a digital companion for speech assessment

S. Giovanoli^1,2, T. Menard^1,2, K. H. Beck³, C. Easthope Awai^1,2

¹Lake Lucerne Institute, DARTLab, Vitznau, Switzerland

²cereneo Foundation, Vitznau, Switzerland

³cereneo Foundation, Weggis, Switzerland

Introduction: Speech and language assessments during recovery from neurological diseases are highly relevant, however also highly time-consuming, and usually based on perceptual scoring and manual documentation. Objective and automated methods of scoring can enhance reliability and reduce time requirements. To address this, we designed a digital scoring program to facilitate traditional voice and speech assessment in a user-centered design approach (iSpeak).

Objectives: We here test the iSpeak digital companion in terms of usability and feasibility in a clinical setting.

Methods & patients: We target an intake of 10 patients with speech and language impairments caused by neurological disease in the period Feb 2024 – May 2024. In a crossover trial design with randomized sequence, patients will perform a traditional speech assessment using the Bogenhausener Dysarthria Scale with and without the iSpeak digital companion for scoring with one week washout between. The assessment will be performed by one highly experienced speech and language therapist. Feasibility is tested by measuring the time to conduct, score and document the assessment. Usability is measured quantitatively with the system usability score and qualitatively through the analysis of therapist feedback.

Results: Preliminary results from trial sessions with the prototype indicate feasibility of the application in a clinical setting.

Conclusion: Speech and language assessments require substantial resources in clinical routine and can potentially be digitized. Our preliminary results indicate promising feasibility of our user-centered application to be used in a standard clinical setting. Digitized speech assessments also hold potential to build up databases of contextualized voice and speech recordings which can form the basis for training automated classifiers of clinical decision support.

P-583

Integrating artificial intelligence for enhanced data management in neurological patient care

H. Someshwar¹, N. Surya², J. Someshwar³

¹NMC & BYL Nair Charitable Hospital, Physiotherapy, Mumbai, India

²Bombay Hospital & Medical Research Center, Mumbai, India

³NMC & BYL Nair Charitable Hospital, Occupational Therapy, Mumbai, India

The Study explores the integration of Artificial Intelligence (AI) techniques in the field of data management for neurological patients, aiming to improve diagnostic accuracy, treatment planning, and overall patient outcomes. Neurological disorders encompass a diverse range of conditions, each presenting unique challenges in data acquisition, processing, and interpretation. Traditional methods of data management often struggle to handle the complexity and volume of information generated from various imaging modalities, genetic studies, and clinical assessments.

This research investigates the application of AI algorithms, including machine learning, deep learning, and natural language processing, in streamlining the processing and analysis of neurological patient data. By leveraging AI-driven approaches, healthcare providers can enhance their ability to accurately diagnose conditions, predict disease progression, and tailor treatment strategies to individual patient profiles. Moreover, AI-powered tools facilitate the integration of diverse data sources, allowing for a holistic understanding of the patient’s condition.

The study highlights several key applications of AI in neurological data management, including automated image analysis for radiological studies, predictive modeling for disease progression, and personalized treatment recommendations based on genetic and clinical data. Additionally, the implementation of AI-driven decision support systems shows promise in optimizing clinical workflows, reducing diagnostic uncertainties, and improving resource allocation in healthcare settings.

In conclusion, this research underscores the transformative potential of integrating AI in the data management of neurological patients. The adoption of AI-driven solutions has the potential to revolutionize clinical practice, enabling more precise diagnoses, personalized treatment plans, and improved patient outcomes in the realm of neurological care. The findings of this study offer valuable insights for healthcare practitioners, researchers, and policymakers seeking to harness the full potential of AI in neurology.

P-584

How to increase the dosage and quality of exercise at home? Retrospective real world analysis of a neurorehabilitation digital-based protocol for people with stroke

J. P. Appelgren Gonzalez^1,2, F. Covarrubias Escudero^1,3, M. V. Covarrubias Valdés¹, V. Hernandez Fuentes¹, M. Montero Reyes¹, B. Urzúa Soler¹, M. Muñoz Cicarelli¹

¹Trainfes, Translational Research Unit, Santiago, Chile

²Catholic University of Chile, Biomedical Imaging Center, Santiago, Chile

³Metropolitan University of Science Education, Kinesiology, Santiago, Chile

Clinical relevance: The rehabilitation transition from hospital to home is a challenge in many ways for people with stroke (PwS) and their communities. The clinicians have to transfer part of the treatment to the caregivers and the patient itself. They, for their side, must assume part of the responsibility for the process and execute the exercises as well as possible without supervision. This can also be seen as an unparalleled opportunity, where we can take advantage of the time off therapy to maximize the amount of exercise and at the same time take care that its execution is the most efficient and with the least amount of compensation.

Method: In this study, we evaluated retrospectively a novel digital-based protocol for PwS, delivered through a mobile app from August 2022 to May 2023. The user or patient can access their own account, where the clinician can upload different types of daily unsupervised exercises. Those related to re-acquisition of motor abilities were facilitated by an easy-to-use functional electrical stimulation (FES) system. The stimulation could be delivered as a preconfigured pattern or can be triggered by an Inertial Sensor in different functional patterns such as walking, jumping, grasping, reaching, among others.

Patients: A total of 62 PwS, who meet the inclusion criteria (aged 18 years or older, with a stroke of more than 6 months of evolution), were classified by their functional status in three different groups. Individual exercise prescription depends on three main domains: (1) Functional Status, (2) Digitalization level and (3) Environmental Fitness, as measured by, safeness, space and time available for therapy.

Preliminary results: User Experience, Satisfaction, Compliance and Adherence to treatment, as well as MiniBEST, Timed Up and Go and Five Sit to Stand were measured at the beginning and ten weeks after, showing a positive effect, with no difference in gender and no negative correlation related to age.

P-585

Teleneurorehabilitation program (virtual reality) for patients with balance disorders: descriptive study

M. Maldonado ^1,2

¹Clinica Alemana, Physical Therapy and Rehabilitation, Santiago, Chile

²Universidad del Desarrollo, Physical Therapy, Santiago, Chile

Background and aims: This study seeks to present the training selection methodology and a clinical protocol for patients with balance disorders inserted in a Telerehabilitation Program based on Virtual Reality since it can help to physiotherapists to make clinical decisions more efficiently.

Methods: Descriptive study where is eight physiotherapists were trained to use RehaMetrics®. To evaluate the level of agreement among physiotherapists in the selection of the exercise clusters developed, the Interobserver Reliability was measured through the kappa statistic. To evaluate the application of the clinical protocol, 16 patients in total.

Results: The percentage of agreement among the expert physiotherapists irrespective of the cluster exceeds 80%, which indicates a very good strength of agreement, while the novices reached a level of agreement of 45%, which suggests a moderate strength of agreement. All clinical outcomes showed statistically significant differences between the median times, as did the Maximum Width Left Side (MWLS) (cm). The minutes of training was 485.81 minutes (SD 246.49 minutes), and the number of sessions performed during the 4 weeks of intervention was 17 sessions (SD 7.15 sessions).

Conclusion: Telerehabilitation Program based on Virtual Reality is an excellent alternative to provide continuity of treatment to patients with balance disorders.

References

Alcock L, O"Brien TD, Health Care Women Int (2018) 39:1366–1380. doi:10.1080/07399332.2018.1499106

Mileti I, Taborri Sensors (Switzerland) (2020) 20: doi:10.3390/s20010063

Agrawal Y, Ward BK. J Vestib Res Equilib Orientat (2013) 23:113–117. doi:10.3233/VES-130498

P-586

Effect of sociodemographic variables on functional recovery of the paretic arm after applying constraint induced movement therapy in remote versus face-to-face modality

A. Doussoulin¹, C. Rivas¹, M. Obreque^1,2, J. L. Saiz¹, K. Castro¹

¹Frontera University, Rehabilitation, Temuco, Chile

²Catholic University, Temuco, Chile

Background: Evidence suggests that there may be interaction between sociodemographic and clinical variables, influencing the results of the rehabilitation process affecting the health and well-being of users after brain injury.

Objective: To determine the effects of sociodemographic variables on the functional recovery of the paretic arm when applying Constraint Induced Movement Therapy in remote versus face-to-face modality.

Material & methods: Randomized clinical trial, composed of 48 subjects divided into 2 standardized intervention modalities (n=22 remote and n=26 face-to-face). Participants were evaluated at baseline (T1), final (T2) and 1 month after the intervention (T3), applying a registration form (demographic and clinical data), a survey regarding user experience with the remote modality and upper extremity function through the Motor Activity Log-30 (MAL-30) scale.

Results: According to an ANOVA, the main effect of treatment modality on change scores between T1 and T2 was not significant, F(1, 44) = 0.301, p = 0.86, revealing that both modalities were equivalent in increasing amount of use between these two times. The main effect of sex was significant, F(1, 44) = 8.884, p = .005, η2p= .168: males (M = +1.24) improved more than females (M = +0.49). Finally, the interactive effect treatment x sex was also significant F(1, 44) = 9.395, p = .004, η2p= .176.

Conclusion: Both intervention modalities equivalently increased the amount of weak arm use between pre-test and post-test. This effect was moderated by the sex of the patients: in the TeleCIMT group, men improved more than women, whereas in the CIMT group, men and women improved in a non-significantly different way.

P-587

What do therapists think about data from wearable technology for stroke rehabilitation?

M. Demers^1,2, H. D Asli^1,2, C. Perron^1,2, M. Tamara^3,2, C. Auger^1,2, D. Barthelemy^1,2, D. Kairy^1,2, J. Higgins^1,2

¹University of Montreal, Rehabilitation, Montreal, Canada

²Center for Interdisciplinary Research in Rehabilitation, IURDPM, Montreal, Canada

³University of Montreal, Medicine, Montreal, Canada

Background: Wearable technology can be used to provide timely, meaningful feedback on activity performed in the home and community environment to induce paretic arm/hand use and increase walking behavior. Since therapists play a crucial role in the adoption of wearable technology in clinical practice, it is key to gather their perspective on sensor-derived data.

Objectives: To understand the perspectives of therapists towards sensor-derived feedback data from wearable technology to complement ambulatory stroke care.

Method: Using a qualitative descriptive design, two 90-min focus group were conducted with three clinicians each (total: 2 occupational therapists and 4 physical therapists, mean years of clinical experience: 20.5). A brief overview of sensor-derived metrics was presented and then, a semi-structured interview was organized around two topics: 1) satisfaction with sensor-derived feedback metrics, and 2) characteristic of sensor-derived metrics to encourage behavior change. The focus group interviews were transcribed verbatim and analyzed using inductive thematic analysis by two independent researchers.

Results: Three main themes emerged: 1) Need to personalized sensor-derived metrics, 2) High clinical relevance of wearable technology to complement rehabilitation care, and 3) Opportunities enabled by real-time feedback provision to encourage behavior change. Therapists had positive attitudes towards wearable technology. Wearable technology was perceived as useful to guide clinical decisions, encourage self-management and provide objective measure of real-life functioning. Since stroke is heterogeneous, therapists stressed the importance to offer a variety of graphics, types, and frequencies of feedback. This work will guide the development of personalized interventions leveraging wearable technology. Future work should investigate how wearable technology is implemented in stroke rehabilitation.

P-590

Remote assessment and interventions of bilingual and multilingual people with primary progressive aphasia (PPA): a mini review of literature

M. Taiebine¹, L. Keegan², A. Marfak¹, W. Al Hassani¹, C. Nejjari¹

¹Euro Mediterranean University of Fez (UEMF), Fez, Morocco; ²Moravian University, Philadelphia, PA, United States

Primary progressive aphasia (PPA) as a neurodegenerative disease with linguistic presentation has been described extensively in mono-lingual and English-speaking patients. However due to the heterogeneity of clinical presentations of PPA as well as the neurotypical underpinnings of its variants, there is a need to investigate the culturally and linguistically diverse (CALD) population for whom there is no consensus on care or asessment. To address this gap, the current review aims to identify the assessment and intervention protocols used remotely for this population.

A literature review was conducted between September and October 2023. A literature search was conducted for articles published in English that addressed tele-assessment and tele-rehabilitation for multilingual people with primary progressive aphasia (MPW-PPA) in the field of Speech Language Therapy or Pathology.

A total of 21 full-text studies were assessed for eligibility. Based on the inclusion and exclusion criteria, six articles were included in this scoping review. Factors that contributed to the successful delivery of remote-based assessment and interventions were described in terms of technological medium and modality of intervention. This scoping review has demonstrated an urgent need for setting up telerehabilitation for the benefit of MPW-PPA. However, the selected studies used mostly single case or survey, which limits the generalizability and comparability of the findings.

This review maps the current paucity of literature on remote-based assessment and therapy in MPW-PPA. There is a huge need for future research to include people from CALD population and to describe them in terms of demographic, socio-linguistic, neuropsycho-linguistic, socio-cultural and clinical variables. In order to bridge the digital gap, technological devices should be made available to diverse MPW-PPA as well as their caregivers in order to optimize the therapeutic alliance and outcomes.

P-591

A review of tools for telerehabilitation of acquired neurogenic language disorders in Arabic

M. Taiebine¹, L. Keegan², A. Marfak¹, W. Al Hassani¹, C. Nejjari¹

¹Euro Mediterranean University of Fez (UEMF), Fez, Morocco

²Moravian University, Philadelphia, PA, United States

Aphasia is an acquired neurogenic language disorder that typically occurs following stroke. While the majority of evidence-based interventions has been widely tailored for English-speakers, there has been a growing interest in implementing empirical studies about non-pharmacological therapies in non-Indo-European languages including Arabic-speakers with aphasia (ASWA). Recently, the standardization of these approaches in Western languages follow the Rehabilitation Treatment Specification System (RTSS). Thus, this scoping review aimed to map a comprehensive characterization of RTSS in ASWA.

A literature review was conducted in August 2023. We searched articles published in English from 2000 to 2023 in PubMed, Web of Science and Scopus databases that addressed the telerehabilitation of acquired neurogenic language disorders in ASWA. A total of 89 articles has been identified. Based on the inclusion criteria, 5 suitable studies were selected. Factors that contributed to the successful delivery of rehabilitation were described in terms of treatment targets, ingredients and mechanism of action (MOA) per the rehabilitation treatment specification system (RTSS).

There are a number of intrinsic and extrinsic factors to take into account when delivering and tailoring specific rehabilitation approaches for ASWA, including lack of theoretical framework and evidence-based approaches; restricted availability and accessibility of technological medium; limited literacy and numeracy prior to stroke and lack of RTSS core components. Despite the paucity of selected studies, they focused on neuromodulation techniques using TDCs (n=1) and telerehabilitation (n=2).

This review showed the urgent need to implement an evidence-based approaches in telerehabilitation of acquired neurogenic language disorders in Arabic. In this cotext, RTSS framework should be used in developing, comparing, delivering and tailoring specific non-pharmacological therapies in people with aphasia.

P-592

Balance telerehabilitation for people with Parkinson’s disease: the TelePD trial

C. Silva-Batista¹, J. Wilhelm¹, K. Scanlan¹, M. Stojak¹, P. Carlson-Kuhta¹, W. Liu¹, F. Horak¹, M. Mancini¹, L. King¹

¹Oregon Health Science University, Portland, OR, United States

Introduction: Balance impairments that lead to falls are one of the main symptoms of Parkinson"s disease (PD). Telerehabilitation by videoconferencing is becoming more common for people with PD; however, balance telerehabilitation for PD lacks strong evidence-based trials. The Clinical Practice Guideline recommends implementing aspects of task specificity that target specific impairments in PD such as anticipatory postural adjustments, sensory integration, and challenging gait to improve balance. It is unknown if these recommendations can be safely implemented into balance telerehabilitation.

Objective: To evaluate the feasibility of the adapted Agility Boot Camp (ABC) for balance telerehabilitation (Tele-ABC) in people with mild-to-moderate PD.

Methods: The TelePD Trial is a prospective, single-center, parallel-group, single-blind, and RCT. This trial will enroll 80 eligible people with PD who will be randomized into receiving either Tele-ABC by videoconferencing (n=40) or unsupervised-ABC (n=40). Both groups will perform 12 sessions of exercise at home (60 minutes long).

Results: TelePD is ongoing and enrolled 16 participants with mild to moderate PD (age 69.5[6.8] yrs, disease duration 9.1[6.2] yrs, MoCA 26.5[2.1], Mini-BEST 19.2[3.8]). Of these, 37% are female, 38% are freezers, 31% are fallers, and 25% live alone. Currently, 6 falls have been reported during the study (1 during virtual assessment, 1 during Tele-ABC exercises, and 4 unrelated to the study). The fallers were more likely to report freezing of gait (75% vs 25%) and had a lower Mini-BEST score (15.5[3.3] vs 20.7[1.7]). The compliance is high for both training groups (Tele-ABC=98.8% and unsupervised-ABC= 98.6%), and the patient"s global impression of change is higher for Tele-ABC (5.4[1.0]) than unsupervised-ABC (4.0[1.8]).

Conclusion: Our preliminary data show that the Tele-ABC is feasible and safe for people with mild-to-moderate PD and may potentially improve their balance.

P-593

Added value of telerehabilitation to provide intensive upper limb training during the chronic phase of stroke recovery: the stroke survivor’s perspective

D. Kairy¹, D. Allegue², K. V. Rodrigues Soares Menezes¹

¹University of Montreal, École de réadaptation, Montreal, Canada

²McGill University, Montreal, Canada

Introduction: Intensity of training has emerged as a critical parameter impacting on post-stroke recovery. Digital health technologies can play an important role in achieving higher intensities. In previous studies, we found that greatest improvements in arm recovery of chronic stroke survivors were in those who used serious games at least at the recommend intensity. The aim of the study embedded in a randomized controlled trial was to better understand the stroke survivors" experience when using telerehabilitation (TR) as a supplement to serious games.

Patients & methods: Interviews were conducted with 7 participants who sustained a stroke, had residual arm hemiplegia and were no longer receiving rehabilitation services. Study participants had participated in the intervention-arm of a randomized controlled trial assessing the use of a 2-month upper limb training using TR with the OpenTera application and serious games with the Jintronix games. A thematic analysis was conducted, guided by the Unified Theory of Acceptance and Use of Technology model.

Results: Preliminary findings suggest that interspersed remote interactions with a physiotherapist throughout the 2-month intervention increased motivation and adherence to the recommended intervention intensity and helped them identify opportunities to use the upper extremity in activities of choice identified online. Participants noted the relevance of personal interactions and demonstrations. Technological issues primarily related to internet stability occurred when the two systems were used together which caused some frustration. Participants found the system intuitive and user friendly.

Conclusion: TR could play an important role in achieving recommended intensity guidelines for stroke rehabilitation, including in the chronic stages of recovery. Factors related to individuals, the technology and the context are important to consider and understand when implementing complex digital health interventions.

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Preferred technology-based solutions for meeting the needs of young adults with stroke in australia: a cross-sectional study

D. Amoah¹, M. Schmidt¹, S. Prior², C. Mather³, M. L. Bird^1,4

¹University of Tasmania, Health Science, Launceston, Australia

²University of Tasmania, Medicine, Burnie, Australia

³University of Tasmania, Nursing, Launceston, Australia

⁴University of British Columbia, Physical Therapy, Vancouver, Canada

Introduction: Many post-stroke needs for young adults are currently unmet, as available resources are tailored to older stroke survivors. Technology is gaining prominence in stroke rehabilitation, and young stroke survivors use it ubiquitously. There is limited evidence on how technology can specifically reach and support the unique needs of young (18-30 years) adults in Australia.

Objectives: To identify the technology-based priorities of young adults (18-30 years) with stroke in Australia.

Materials & methods: A cross-sectional study was conducted in Australia between June and October 2023. The study employed self-administered online surveys to collect data from young adults with stroke consisting of structured multiple choice and Likert scale questions. This study included demographic characteristics, stroke-related information and the use of potential technology-based solutions grouped as: support for recovery, access to support, care continuity, adjustment to life and education. Descriptive statistics and frequencies were used to present findings.

Results: Sixty-two young adults with stroke participated (74.2% males, mean age: 26.5 ± 2.37 years old, Ischaemic stroke - 62.9%). All technology-based solutions presented were found to be potentially useful (mean ≥ 3 on Likert scale). Technology to assist with the movement of limbs, speech development/communication, reminders for medications, continuity of therapy sessions, follow-up and mentorship were reported to be the most useful (mean ≥ 4 on Likert scale). Apps, social media and websites were the easiest ways young adults with stroke wanted to access support.

Conclusion: Given the range of unmet needs and technological preferences, providing diverse solutions is imperative to address the individual needs of young adults with stroke. As the needs of young adults with stroke may change, more research would benefit from evaluating preferences for technology-based tools over time.

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A qualitative study of individuals with acquired brain injury and program facilitators experiences in virtual ABI community support programs

J. Grewal¹, S. Vu Nguyen², N. Nonis², H. Singh³

¹University of British Columbia, Vancouver, Canada

²Brain Injury Association of Peel and Halton (BIAPH), Mississauga, Canada

³University of Toronto, Toronto, Canada

Introduction: After acquired brain injury (ABI), community reintegration is a common goal. The purpose of community support programs is to help support the ongoing needs of individuals with ABI by providing psychosocial support. During the COVID-19 pandemic, community support programs began virtual program delivery. However, there is limited research exploring the experiences of facilitators and individuals with ABI who participate in virtual support programs.

Objective: To illuminate the experiences of individuals with ABI and program facilitators who are respectively attending and facilitating virtual support programs.

Patients & methods: Semi-structured interviews were conducted with 16 individuals who attended or facilitated virtual support programs. Of the 16 participants, 14 were attendees with ABI (three of whom were also program faciliators) and 2 were program faciliators without ABI. Thematic analysis was used to analyze the transcripts.

Results: Three themes were identified. Theme one described the perceived benefits of joining virtual support programs, including connecting with peers and enhanced access to information about ABI. Theme two described the perceived challenges of virtual support programs, including interpersonal (i.e., communication barriers amongst attendees), intrapersonal (i.e., heightened ABI side effects), and environmental and contextual (i.e., privacy concerns) challenges. Theme three described the considerations to facilitate participation in virtual support programs such as creating a safe and respectful environment, fostering engagement, and enhancing inclusivity and accessibility.

Conclusion: This study described the experiences of individuals with ABI and facilitators who respectively attended and facilitated virtual ABI support programs. The results may be used to improve the quality of virtual programs, ensuring programs are accessible, engaging, safe and inclusive.

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Tele-assessments for upper extremity motor function in stroke rehabilitation – a systematic review

L. Sauerzopf^1,2, A. Luft³, S. Frey¹, A. Baldissera⁴, V. Klamroth-Marganska⁵, M. Spiess¹

¹ZHAW Zurich University of Applied Sciences, School of Health Sciences, Institute of Occupational Therapy, Winterthur, Switzerland

²University of Zurich, Medicine, Zurich, Switzerland

³University of Zurich, Neurology, Zurich, Switzerland

⁴Care Home City of Winterthur, Winterthur, Switzerland

⁵Klinik Adelheid, Zug, Switzerland

Introduction: Telerehabilitation complements traditional therapy, but tele-assessments in stroke rehabilitation remain underexplored. While many reports and recommendations on tele-interventions are available, little is known about the use of tele-assessments after stroke.¹ However, high-quality assessments are essential, whether in-person or remote.

Objectives: This systematic review² aims to identify tele-assessments for post-stroke upper extremity motor impairments and to evaluate the quality criteria and clinical utility.

Materials & methods: We conducted a systematic search² across seven databases, from inception to July 2023. To assess study quality and psychometric properties, we conducted the COSMIN Risk of Bias Checklist for systematic reviews of patient-reported outcome measures. Clinical utility was critically appraised according to Fawcett and using the 10-point utility scale by Tyson and Connell.

Results: Out of 3519 hits, we identified a total of eleven articles, describing ten distinct tele-assessment that met our predetermined inclusion criteria.The quality and psychometric properties of these tele-assessments varied from low to high. None of them currently meet the criteria for clinical utility to be recommended for clinical practice.²

Conclusion: The results underline the existence of individual tele-assessments with good quality, which are likely to gain relevance in clinical practice once barriers such as costs, time to administer, need for additional equipment are addressed.

References

1. Sharififar S, Ghasemi H, Geis C, et al. Telerehabilitation service impact on physical function and adherence compared to face-to-face rehabilitation in patients with stroke: A Systematic Review and Meta-Analysis. PM&R 2023; pmrj.12988.

2. Sauerzopf L, Luft A, Frey S, et al. Remotely Assessing Motor Function of the Upper Extremity after Stroke: A Systematic Review of Validity and Clinical Utility of Tele-Assessments [Unpublished manuscript].

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Clinical efficacy of cognitive stimulation in aged subjects with mild and moderate cognitive impairment

L. Pignolo¹, M. Contrada¹, C. Pucci¹, G. Torchia², P. Tonin¹, M. Vatrano¹, I. Mantia¹, G. Arabia²

¹S. Anna Institute, Research, Crotone, Italy; ²University of Catanzaro "Magna Graecia", Nurology, Catanzaro, Italy

Introduction: In this study, a cognitive treatment was delivered by means of Tele Rehabilitation to a sample of Parkinson"s Disease (PD) and chronic stroke patients, with mild to moderate cognitive impairment. The main objective was to verify the effectiveness of TR cognitive intervention compared with conventional rehabilitation.

Materials & methods: The enrollment criteria were:MMSE between 24 and 18; Clinical Dementia Rating score ranging from 0.5 to 1. Until June 2023, 20 SP(10 M/10 F; mean age: 58.1), and 20 PD (14 M/6 F; mean age: 66), were enrolled.

All remote treatments (TR) provide a direct, bidirectional, online connection; the therapist at the rehabilitation center sets up exercises in the virtual environment on the patient’s computer and can always check and modify the exercises as they are performed. Cognitive stimulation (CS) was delivered for 1 h/d, 5 t/w, for 4 consecutive weeks. The Cognitive Module enables activities related to the treatment of neurological disorders afferent to the cognitive sphere.

Cognitive assessment: MDB; TMT; B.A.D.A.; 15 Rey words; BDI-II; STAI; SF-36; CBI. Clinical assessments were administered blinded, before and after treatments.

Results: Preliminary results in both groups of patients showed improvement in cognitive performance and mood after the TR protocol administration. Specifically, the improvements were observed in a constructive praxis task from programming items; learning of short- and long-term memory of verbal information; visual attention and task change. Data collection is still ongoing.

Conclusions: The role that CS plays in cognitive function of post-stroke patients and PD was highlighted, suggesting that cognitive training may also serve to optimize cognitive functioning of people with mild/moderate cognitive impairment.

Reference

Contrada, M., Arcuri, F., Tonin, P., Pignolo, L. Cerasa, A. (2021). Stroke Telerehabilitation in Calabria: A Health Technology Assessment. Frontiers in Neurology, 12.

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NeuroRehabilitation OnLine (NROL): description of a multidisciplinary group telerehabilitation innovation for stroke and neurological conditions using the TIDieR checklist

L. A. Connell^1,2, S. Ackerley^1,3, N. Wilson³, P. Boland³, R. Peel⁴

¹East Lancashire Hospitals NHS Trust, Burnley, United Kingdom

²Lancaster University/ East Lancashire Hospitals NHS Trust, Lancaster, United Kingdom

³University of Central Lancashire, Preston, United Kingdom

⁴Cambridge University Hospital NHS Foundation Trust, Lancaster, United Kingdom

Introduction: Providing recommended amounts of rehabilitation for stroke and neurological patients is challenging. Telerehabilitation is viable for delivering rehabilitation and an acceptable adjunct to in-person therapy. NROL was developed as a pilot and subsequently operationalised as a regional innovation embedded across four National Health Service sites.

Objective: To describe the NROL innovation to assist future implementation and replication efforts.

Method: The Template for Intervention Description and Replication (TIDieR) checklist, with guidance from the TIDieR-Telehealth extension, was used to describe NROL. The description was developed collaboratively by clinical academics, therapists, managers, and researchers. Updated Consolidated Framework for Implementation Research (CFIR) domains were used to describe the context in which the innovation was delivered.

Results: NROL delivers online group-based real-time neurorehabilitation with technology assistance, incorporating multidisciplinary targeted therapy and peer support. Procedures, materials and structure are detailed to demonstrate how NROL is embedded within a healthcare system. NROL uses existing therapy workforce alongside dedicated NROL roles, including an essential technology support role. Selection of NROL groups is dependent on patient need. The NROL innovation is modified over time in response to patient and staff feedback. NROL described here is situated within a regional stroke and neurorehabilitation network in North-West England, aligns with local and national strategies, and capitalises on an existing clinical-academic partnership.

Conclusion: This description of a regional NROL innovation, and clarification of core components, should facilitate other healthcare settings to adapt and implement NROL for their context. Continuous evaluation alongside implementation will ensure maximal impact for neurorehabilitation.

P-601

Understanding physical therapists’ perspectives and attitudes towards artificial intelligence in healthcare and rehabilitation: qualitative study

M. Alsobhi¹, F. Khan¹, M. Faisal Chevidikunnan¹, L. Shawli², S. Rosewilliam³, R. Basuodan⁴

¹King Abdulaziz University, Physical Therapy, Jeddah, Saudi Arabia

²King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

³University of Birmingham, Birmingham, United Kingdom

⁴Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

Background: The adoption and acceptance of artificial intelligence (AI) by physical therapists (PTs) is essential for its effective and successful application. Despite the growing interest in technologies, PTs’ attitudes and perceptions regarding AI use need to be further investigated.

Objectives: This study aims to have an in-depth understanding of PTs" perspectives and attitudes toward AI utilization in healthcare and rehabilitation.

Methods: This study is an exploratory, qualitative research design, and it was conducted using in-depth semi-structured interviews with PTs (N=15). The transcribed interviews were thematically analyzed to identify the themes.

Results: During the thematic analysis, four main themes were identified, namely: (i) perceptions of AI and its applications in healthcare services; (ii) Rehabilitation professionals are not easily replaced: the impact on the workforce; (iii) Considerations around implementing AI within rehabilitation; and (iv) AI and its fast-approaching future.

Conclusion: PTs shared views on the potential impact of AI applications on healthcare and rehabilitation practices, such as assisting the decision-making process, and saving time and effort for both therapist and patients. Also, therapists had voiced concerns about potential pitfalls that must still be considered, such as patient data privacy, loss of patient-healthcare practitioner relationships, and ethical issues related to reliance on these applications, which could hinder effective patient care.

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Developing ROSIA (Remote Rehabilitation Services For Isolated Areas): the EU ROSIA pre-commercial procurement project, results of phase 1 and 2

R. Mamgain¹, A. Carroll¹

¹National Rehabilitation Hospital, Dublin, Ireland

Introduction: Rehabilitation is an essential part of modern healthcare systems; it improves health outcomes, reduces disability and costs by reducing hospital stays. WHO Rehabilitation 2030 calls for global action to scale-up rehabilitation. Technology has the potential to alter rehabilitation by revolutionising service delivery. ROSIA, an EU funded PCP project, is ready to deploy a complete digital solution set for scale-up.

Objectives: ROSIA will design, validate and assess a scalable disruptive technological solution, a value-based virtual rehabilitation care model to address the challenge of access to rehabilitation for people living remotely.

Methods & materials: ROSIA comprises 3 co-designed phases. Design of ROSIA"s model based on evidence informed iterative work of co-creation, including all stakeholders (complete). Prototype Development of three proposed solutions selected from Phase 1 (in progress). Validation of the best prototype solution from phase 2.

Results: State-of-the Art Analysis, literature reviews, maturity assessment, telehealth capacity and readiness assessment were completed. Stakeholder needs assessment, Open Market Consultation and open-Tender processes have been completed. The successful developers are creating an innovative digital Ecosystem enabling clinicians to prescribe certified 3rd party solutions from a catalogue. Applications and devices will connect to an open platform allowing the integration of community supported self-care into the care plan. It will integrate seamlessly with any health service in Europe, allowing a model shift from hospital-based rehabilitation to telerehabilitation under follow-up of clinicians and self-management at home.

Conclusion: Redesigning rehabilitation services to be more person centred, co-ordinated and continuous is the ambition of all systems. ROSIA is one mechanism for delivering a tailored integrated care pathway supported by technology.

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Improving neuro telerehabilitation accessibility and features: OpenTera, an open-source software platform

S. Briere¹, D. Létourneau², F. Michaud², K. Lebel^1,2

¹Research Center on Aging - CIUSSS de l’Estrie-CHUS, Sherbrooke, Canada

²Sherbrooke University, Sherbrooke, Canada

Introduction: Use of telerehabilitation (TR) for neurorehabilitation has increased over the last few years, especially in the COVID-19 context. Providing TR sessions between clinicians and in-home patients, using both real-time (audio, video & data) and asynchronous (sensors, exercises videos, questions) modalities requires specific features that are usually limited, not available or not adapted for telehealth in commercial platforms. Moreover, raw data and data storage location may be issues in such platforms.

Objective: To develop an open-source TR platform addressing constant evolution of clinical & research needs.

Methods: Engineers and clinicians teamed up to identify features for each of the clinical needs. Engineering team developed the software platform with maintainability, expandability, and security in mind. Clinicians are involved, providing feedback and new features suggestions as the platform is deployed through research and external projects.

Results: OpenTera platform was built considering those constraints. In addition to basic features (audio, video, screen sharing), the ability to display countdown or chronometer for both clinicians and patients, measure on-screen angles and share music were implemented as clinical tools for real-time sessions. On-demand exercises videos specific to each patient, pre & post sessions short questions assessment, and long-term biometric data recordings (e.g. smart watches) were implemented as features for asynchronous sessions. Software was developed with a micro-service architecture, which allows flexibility to cope with future needs. Current version of OpenTera is used in > 13 research projects involving > 112 participants and > 51 clinicians and in 4 general practice clinics (25 clinicians). Patients" pathologies included Parkinson, neuromuscular issues and long-term COVID.

Conclusion: OpenTera is an expandable open source telerehabilitation platform focused on the clinician needs and improving TR patients" care.

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Benefits and challenges of a regional NeuroRehabilitation OnLine (NROL) innovation

L. A. Connell^1,2, S. Ackerley^1,3, A. Partington¹

¹East Lancashire Hospitals NHS Trust, Burnley, United Kingdom

²Lancaster University/ East Lancashire Hospitals NHS Trust, Lancaster, United Kingdom

³University of Central Lancashire, Preston, United Kingdom

Introduction: NROL is an innovation providing online group multidisciplinary rehabilitation to community-based patients with neurological conditions, complementing existing therapy. In 2022, NROL expanded across North-West England with four different organisations working together.

Objectives: To identify the challenges and benefits of providing NROL at a regional level.

Methods: Evaluation using routine service data along with patient and staff feedback.

Results: Over 300 patients participated in ten 6-week "NROL blocks", involving physical, talking and community groups. Over 50 therapists and support staff were involved.

Patient outcomes and feedback were positive, with benefits of peer support reported. Service data indicate increased access and capacity for therapy, allowing patients with similar presentations to receive more targeted group-based interventions. Staff benefits include professional development and networking opportunities. Organisational advantages include staff delivery efficiencies (staff:patient ratio=0.4) and reduced travel time and costs (saved >40,000 driving-miles). NROL does not suit everyone (withdrawal rate~18%).

Challenges exist around staff capacity for session delivery, referrer engagement, cross-organisation communication, and differences in infrastructure and governance across provider organisations.

Conclusion: With the growing demand for rehabilitation services and workforce constraints, current rehabilitation provision needs to be future-proofed and capitalise on technological advances. NROL provides an exemplar of a digital health innovation provided across organisations at a systems-level. Evaluation indicates benefits out-weigh the efforts and challenges needed for implementation. Learnings can be used for adoption of NROL, and for rehabilitation provision at a systems-level more widely.

P-606

Digital therapeutics for knee joint recovery after total knee replacement surgery: a reliability and validity study

Y. G. Nam ^1,2

¹Sunmoon University, Asan-si, South Korea

²University, Physiotherapy, Asan-si, South Korea

Background & objectives: Digital Therapeutics (DTx) is an evidence-based behavioral therapy provided online through software and other means, which can enhance the accessibility and efficiency of healthcare for the prevention, management, and treatment of medical disorders or diseases. This study aims to verify the clinical effectiveness of an app-based digital therapeutic linked with a device developed to extend treatment sessions at home after Total Knee Replacement (TKR) surgery and to facilitate from early rehabilitation to subsequent stages. The objective is also to confirm the reliability and validity between Range of Motion (ROM) measurements for the knee.

Methods & statistical analysis: Total of 20 participants involved. Joint angles for knee flexion were measured twice each using a developed digital therapeutic apparatus by two experienced physical therapists and a goniometer. Intra-class correlation coefficients were used to calculate intra-rater reliability and inter-rater reliability, while validity was calculated through Pearson correlation. All statistical significance levels were set at 0.05.

Findings: Intra-rater reliability was excellent for the DTx (ICC>0.90), with a statistically significant difference (p=0.000), and excellent (ICC>0.90) and good reliability (ICC=0.86) for the goniometer, with a statistically significant difference (p=0.000). Inter-rater reliability was good for almost all measures (ICC>0.80) and excellent for the goniometer pre-measurement (ICC>0.90), all with statistically significant differences (p=0.000). The validity of the two instruments showed a strong positive correlation (r=0.75) with a statistically significant difference (p=0.000).

Improvements & applications: In this study, the DTx ultimately showed reliability and validity as good as the goniometer used by conventional physical therapists to measure joint angles and can be used to measure knee joint angles.

P-607

An automated assessment based on deep learning pose estimation technology for upper extremity motor function following stroke

Y. H. Chang¹, Y. P. Wang², Y. P. Chao², Y. C. Weng³, C. L. Yang^1,4

¹Chang Gung University, Occupational Therapy and Graduate Institute of Behavioral Sciences, Taoyuan, Taiwan

²Chang Gung University, Computer Science, Taoyuan, Taiwan

³New Taipei Municipal Tucheng Hospital, Neurology, New Taipei, Taiwan

⁴Chang Gung Memorial Hospital, Physical Therapy and Rehabilitation, Chiayi, Taiwan

Background: With the development of telerehabilitation, there has been an increasing demand for automated assessment.

Objectives: To develop and test an automated assessment based on deep learning pose estimation technology to assess upper extremity motor function poststroke.

Patients & methods: We designed an automated version of the Arm Capacity and Movement Test (ArmCAM) using Google Mediapipe and YoloV4 for AI skeleton posture detection and object detection. The automated ArmCAM was administered to 23 stroke participants and assessed twice within a week. Other outcome measures included the Wolf Motor Function Test(WMFT), Action Reach Arm Test(ARAT), Grip Strength, Fugl-Meyer Assessment-Upper Extremity(FMA-UE), Motor Activity Log(MAL), Stroke Impact Scale(SIS) Hand Function Domain and Rating of Everyday Arm-use in the Community and Home(REACH) Scale. Intraclass correlation coefficients(ICCs) and Cohen"s κ were used to evaluate the test-retest reliability of the automated ArmCAM scores and the interrater reliability between the automated ArmCAM score and the score given by the therapist. The validity was examined with Spearman rank correlation coefficients.

Result: The ICCs for test-retest reliability was 0.978. Individual items" test-retest reliability ranged from 0.259 to 0.661. The inter-rater reliabilities between the automated ArmCAM and therapist in two sessions were 0.978 and 0.998, respectively. Individual items" interrater levels of agreement ranged from 0.337 to 0.932. There were good to excellent correlations between the automated ArmCAM score and the WMFT (r=0.933), ARAT (r=0.965), grip strength (r=0.827), FMA-UE (r =0.951), MAL Amount of Use Scale(r=0.844), MAL Quality of Movement (r=0.901), SIS Hand Function Domain (r=0.654), REACH (r=0.916).

Conclusion: The automated ArmCAM total score has good reliability and validity.

P-608

Ballistic resistance training improves mobility more than usual physiotherapy intervention following traumatic brain injury: a randomised controlled trial

G. Williams¹, L. Hassett^1,2,3, R. Clark⁴, A. Bryant⁵, M. Morris⁶, J. Olver⁷, L. Ada⁸

¹University of Melbourne, Physiotherapy, Richmond, Australia

²Sydney School of Health Sciences, Medicine, Sydney, Australia

³Institute for Musculoskeletal Health, The University of Sydney, Sydney, Australia

⁴School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia

⁵University of Melbourne, Melbourne, Australia

⁶La Trobe University, Melbourne, Australia

⁷Epworth Healthcare, Melbourne, Australia

⁸University of Sydney, Sydney, Australia

Background: Ballistic resistance training, targeted to the primary lower-limb muscle groups responsible for forward propulsion, implemented in accordance with the American College of Sports Medicine guidelines for resistance training, is a promising new intervention for people with mobility limitations.

Aim: To determine, in people recovering from traumatic brain injury (TBI), is a 3-month ballistic resistance training program targeting three lower-limb muscle groups more effective than usual physiotherapy care for improving mobility?

Design: A prospective, multi-centre, randomised controlled trial conducted according to the CONSORT guidelines. ACTRN12611001098921.

Participants: 144 people with TBI.

Intervention: For 12 weeks, the experimental group had three 60-minute sessions of usual physiotherapy care per week replaced by ballistic resistance training. The control group had usual physiotherapy care of equivalent time consisting of balance exercises, lower limb stretching, conventional strengthening exercises and cardiovascular fitness training. Both groups received gait training.

Outcome measures: The primary outcome measure was mobility quantified using the HiMAT. Secondary outcomes were walking speed, strength, balance and quality of life. Outcomes were measured at baseline (0 weeks), after completion of the 12-week intervention (12 weeks), and 12 weeks after the cessation of the intervention (24 weeks).

Results: After 12 weeks of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the HiMAT than the control group and they remained 3 points (95% CI –1 to 6) higher at 24 weeks. Participants with a baseline HiMAT <27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT.

Conclusion: This RCT shows that ballistic resistance training has a better effect on mobility than usual physiotherapy care in people with TBI. It may be better targeted towards those with more severe mobility limitations.

P-609

Evidence-based review of randomized controlled trials of interventions for mental health management post moderate to severe traumatic brain injury

R. Teasell¹, H. MacKenzie¹, E. A. Bateman¹, S. Mehta¹, A. McIntyre², U. Barua¹, C. Flores-Sandoval¹, M. Bayley³

¹Parkwood Institute, Physical Therapy and Rehabilitation, London, Ontario, Canada

²Western University, Nursing, London, Ontario, Canada

³University of Toronto, Toronto, Canada

Introduction: Individuals with Traumatic Brain Injury (TBI), regardless of severity, frequently present with affective disorders as a result of their injury.

Objectives: This review examined randomized controlled trials of interventions addressing mental health disorders in individuals with moderate to severe TBI. The studies presented in this review are part of a larger database of randomized TBI RCTs.

Materials & methods: Systematic searches were conducted for articles published in the English language in MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO, up to and including December 2022, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they met the following criteria: (1) mean age of ≥18yrs; (2) ≥50% of the sample had moderate to severe TBI; and, (3) the study design was a RCT.

Results: 87 RCTs, published from 1988 to 2022, that examined interventions and outcome measures that addressed mental health post moderate to severe TBI were included. Mental health issues which were addressed included depression, anxiety, PTSD and drug and substance abuse but not behavioural disorders. Collectively these studies enrolled 6,471 participants, with sample sizes ranging from 7 to 433. Almost half of RCTs (47.1%) were conducted in the United States and 64.4% were conducted after 2010. Of these, 62 RCTs examined non-pharmacological interventions and 25 RCTs examined pharmacological interventions.

Conclusion: Treatments that were most effective were psychotherapy interventions, in particular CBT as well as other forms of supportive psychotherapy, with combinations of different forms of psychotherapy even more effective. Less effective were cognitive and neuropsychological interventions but these showed some limited promise. Unexpectedly, antidepressants and other pharmacological interventions showed limited effectiveness.

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Are you doing the best to care for people after they have sustained a traumatic brain injury (TBI)? How Living Clinical Practice Guidelines ensure best practice care and resources are at your fingertips

P. Akbari¹, A. Nair¹, J. Gargaro¹, M. Bayley¹

¹University Health Network, Toronto Rehabilitation Institute, Toronto, Canada

Introduction: Through ongoing comprehensive review of research and clinical evidence, the Canadian Clinical Practice Guideline (CPG) for the Rehabilitation of Adults with Moderate to Severe Traumatic Brain Injury (TBI) produces best-practice TBI care recommendations for an international audience to improve: 1) the quality and consistency of care provided by healthcare professionals, and 2) patient health outcomes.

Objectives: to increase understanding of the clinical value of the CPG and Ideal Care Pathways, and to guide application of its up-to-date best-practice recommendations, resources, and clinical tools.

Methods: Using the principles of adult learning (self-concept, adult learner experience, readiness to learn, orientation to learning, motivation to learn, and active learning), knowledge translation (KT) activities were designed for asynchronous learning and developed in partnership with Regulated Health Professional (RHP) Organizations and key partners. The KT activities promoted the relevance of the CPG by using clinical data, partnering with relevant practicing clinicians, and addressing current clinical issues in TBI care. The primary target audience of the KT activities was healthcare professionals who may not routinely encounter TBI patients and/or who may not be aware of current TBI best care practices.

Results: The KT activities used were dependent on the specific preference of the RHP Organizations (e.g., newsletter articles, blog posts, website links, all-member emails, and interactive webinars), and in many cases, multiple methods were used. There has been excellent engagement in these activities, which have been ongoing since June 2023. Data will be presented on engagement, follow-up activities, and Google Analytics for the online resources.

Conclusion: Our multi-faceted and collaborative KT strategy for the CPG is critical in helping healthcare professionals make scientifically informed and up to date TBI clinical care decisions.

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Development of the first clinical practice guideline for intimacy and sexuality following moderate to severe traumatic brain injury (INTIMASY-TBI)

E. Patsakos¹, S. Backhaus², K. Farris³, M. King⁴, A. Moreno⁵, D. Neumann⁶, A. Sander⁷, M. Bayley¹

¹University Health Network, Toronto Rehabilitation Institute, Toronto, Canada

²Rehabilitation Hospital of Indiana, Indianapolis, IN, United States

³University of Illinois, Chicago, IL, United States

⁴University of Pennsylvania, Philadelphia, PA, United States

⁵University of Montreal, Montreal, Canada

⁶Indiana University, Indianapolis, IN, United States

⁷Baylor College of Medicine, Houston, TX, United States

Introduction: Moderate-to-severe traumatic brain injury (MS-TBI) can negatively impact intimacy, relationships, and sexual function. However, these concerns have not been typically discussed during rehabilitation and discharge planning. The INTIMASY-TBI Guideline aims to provide strategies for clinicians to discuss the physical, psychosocial, behavioural and emotional aspects of sexuality and intimacy with individuals with MS-TBI.

Methods: A systematic search was conducted to identify relevant evidence published from 2010 to 2020. An Expert Panel of North American clinicians and researchers was formed to review and develop recommendations for integrating discussions related to intimacy and sexuality within MS-TBI rehabilitation and community-based programs.

Results: Ten recommendations were developed that address the following topic areas: 1) interprofessional team training, 2) providing early education on the effects of MS-TBI on intimacy, relationships, and sexuality, 3) creating individualized interventions on intimacy and sexuality, 4) education, assessment and management of the causes of sexual dysfunction, and 5) providing written materials on sexuality, relationships and intimacy, and relationship coaching. A decision algorithm was developed to assist clinicians in navigating through the recommendations.

Conclusion: The INTIMASY-TBI Guideline is one of the first comprehensive clinical practice guidelines to assist clinicians with promoting the maintenance of healthy relationships, intimacy, and sexuality for persons with TBI and their partners.

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What is the impact of living with a traumatic brain injury and how can co-production of a resource with traumatic brain injury survivors be achieved?

K. Saunders¹, M. Sakel², R. Faruqui³

¹University of Kent, Health Service Research, Canterburry, United Kingdom

²East Kent Hospitals University NHS Foundation Trust, Neurorehabilitation, Canterburry, United Kingdom

³Kent and Medway NHS and Social Care Partnership Trust, Psychiatry, Maidstone Kent, United Kingdom

Data collected regionally by the Kent Public Health Observatory shows that the number of hospital in-patient admissions for traumatic brain injury (TBI) in Kent and Medway (K&M) increased from 3645 in 2016 to 4295 in 2019 and the latest national data figures published by a UK charity show that Head Injury hospital admissions have increased by 3%, which suggests that this is a public health issue.The regional increase in incidence of TBI is a driver for this research because an increased number of admissions for head injury in K&M means that there will be more survivors, confronted by long term health challenges, who may need to access health and care services as a direct result of TBI exposure.Stage 1-To identify what are the long-term health issues experienced by survivors of moderate TBI (mTBI) and severe TBI (sTBI)?What do we know about how mTBI and sTBI survivors experience and manage their recovery journeys?Stage 2-To identify what kinds of resources are used and might be of value to access by survivors of mTBI and sTBI?How do mTBI and sTBI survivors experience taking part in a "co-production" process? Stage 1-Qualitative study with semi-structured interviews by telephone.10 interviews with survivors & 5 with primary care-givers.University of Kent Ethical Committee approval on 21/1/2022.Data analysis used the One Sheet of Paper thematic approach.Results:16 themes identified in TBI survivor data:Survivorship, life changes, long term health impacts,impact on family,relationships, employment,education,hobbies, resources and coping strategies, recovery journeys, broken care system, non-visible disabilities,achievements, ongoing challenges, beyond survivorship, ideas for resource co-design.10 themes identified from care-giver data.Conclusion:Survivors and their care givers identified complex diverse impacts on health and their social lives, alongside of describing resources used to alleviate and improve specific challenges.These findings will enable Stage 2 in 2024

P-613

Recovery from paroxysmal sympathetic hyperactivity after severe traumatic brain injury following the administration of bromocriptine medication: a case report

S. Hwang¹, H. S. Kim²

¹Daejeon Eulji Medical Center, Eulji University, Rehabilitation, Daejeon, South Korea

²National Health Insurance Service Ilsan Hospital, Physical Therapy and Rehabilitation, Goyang, South Korea

Background: Paroxysmal sympathetic hyperactivity (PSH), which can be caused by traumatic brain injury, is a potentially life-threatening condition characterized by both autonomic dysfunction and increased muscle tone. No standard treatment for this condition has yet been reported, save for the recommendation to avoid noxious stimuli. Among the various available management options, the most widely used approach involves sedative agents intended to alleviate the patient"s hypermetabolic status, although such agents have several side effects. Dantrolene, a blocking agent of sarcoplasmic Ca2+, and bromocriptine, a dopaminergic agonist, were chosen as the treatment agents for our patient.

Objectives: This report presents the case of a patient with severe TBI. He did not significantly improve following the administration of dantrolene. However, he gradually recovered from life-threatening PSH following the administration of bromocriptine and the resultant neurologic improvement.

Case presentation: An 18-old-man had a car accident and referred to our hospital after traumatic brain injury. Six days after the onset, he presented tachycardia, hypertension, hyperthermia, diaphoresis, and rigidity. Through various examinations, we excluded other diagnoses and we concluded that his symptoms were PSH. Although he showed no decrease in symptoms when the dantrolene was first administrated, his symptoms improved following the prescription of bromocriptine, leading to neurologic recovery.

Conclusions: This case report suggests that bromocriptine may be a helpful option for the treatment of PSH. When paroxysmal hyperthermia and increased extensor tones are present in patients with acute TBI, the administration of bromocriptine could be considered a valuable treatment option due to the injury to the dopaminergic pathway.

P-614

Demonstrating that inpatient rehabilitation following acquired brain injury provides value for money. Adaptation of the UK cost-efficiency model for Australia

N. A. Lannin^1,2, J. Ratcliffe³, I. D. Cameron⁴, M. Crotty³, P. Hunter², J. Morarty², L. Turner-Stokes⁵

¹Monash University, Neuroscience, Melbourne, Australia

²Alfred Health, Melbourne, Australia

³Flinders University, Adelaide, Australia

⁴University of Sydney, Sydney, Australia

⁵King’s College London, Cicely Saunders Institute, London, United Kingdom

Background: With increasing financial pressure, rehabilitation services are increasingly required to demonstrate value for money. In the UK, cost efficiency is measured by computing the cost of rehabilitation against savings in projected costs of ongoing care in the community. In this abstract, we adapt this UK cost-efficiency model for use in Australia.

Objectives: To examine the cost-efficiency of a specialist inpatient brain injury rehabilitation programme.

Method: On observational cohort study of prospectively collected clinical data from consecutive inpatients with acquired brain injury (ABI) admitted over 2 years (2016-17) was completed. Patients with complete Northwick Park Dependency and Care Needs Assessment (NPCNA) data on admission and discharge were included (n=196) and analysed in three groups of dependency. The NPCNA uses a computerised algorithm to estimate ongoing care costs in the community. This algorithm was adjusted using Australian costings. Cost-efficiency was estimated by calculating both time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of on-going care, and net projected lifetime savings.

Results: Mean age 44.6 years, males:females 72:28%. Aetiology: Trauma 63%, Stroke 21%, diffuse 9%. Mean length of stay 118.4 (95%CI 102.9,136.2) days; mean episode costs AUD$147,043 (126,861, 1,689,427). The mean reduction in weekly care costs of AUD$8275 (7736, 9713) p<0.001, offset the cost of rehabilitation within 5.5 months (2.4,9.0). Mean projected net lifetime savings were AUD$13.4 million (11.4,15.4) per patient. Savings were greatest in the high-dependency group. For $1 spent on rehabilitation in this cohort, approximately $91 was saved in ongoing care costs alone.

Conclusion: This study provides further evidence that specialist rehabilitation for patients with complex disabilities following ABI represents value for money.

P-616

Naturalistic psychedelic use for TBI symptom management: findings from the global psychedelic survey

B. VanderZwaag^1,2, M. Schaeffer^1,2, J. VanderZwaag³, S. Lake⁴, P. Lucas⁵

¹University of Victoria, Psychology, Victoria, Canada

²Institute on Aging and Lifelong Health, Victoria, Canada

³University of Victoria, Medicine, Victoria, Canada

⁴University of California, UCLA Center for Cannabis and Cannabinoids, Department of Psychiatry and Biobehavioral Sciences,, Los Angeles, CA, United States

⁵SABI Mind, Calgary, Canada

Introduction: Traumatic brain injury (TBI) is a prevalent and concerning neurological disorder with devastating symptoms [1]. Psychedelics such as psilocybin may reduce symptoms of anxiety and depression in various clinical populations [2]. It is worthwhile to examine naturalistic psychedelic use for the purpose of managing TBI symptoms.

Objectives: We examined naturalistic use of psychedelics for managing TBI recovery and self-reported effectiveness of use for this purpose.

Methods: The Global Psychedelic Survey (GPS) was an online survey available to adults 21 years or older who had used psychedelics at least once in their life. We report descriptive statistics from a component of the survey that was distributed only to respondents who indicated therapeutic use of psychedelics for TBI.

Results: 205 respondents from the GPS reported using psychedelics to help manage their TBI. TBI was primarily acquired via a fall (18.0%) and sports involvement (13.7%). Respondents who managed TBI with psychedelics reported using psychedelics to aid with stress relief (11.7%), mood (11.5%), and cognitive impairments (11.5%). Psilocybin was the most used psychedelic (75.6%) and 36.8% found psilocybin effective in managing their TBI symptoms. LSD was the next most common (60.0%) and 14.9% found it effective. On average, respondents rated their TBI symptom relief with psychedelics as 54 on a scale from 0 (not at all effective) to 100 (very effective). 10.2% of respondents found that their use of psychedelic(s) were ineffective in treating their TBI symptoms.

Conclusions: Some TBI patients are engaging in naturalistic psychedelic use to assist the management of their symptoms. Psychedelic researchers should engage with TBI patients to better examine the effects and role of psychedelics in TBI recovery through clinical trials.

References

[1] Osmond et al. (2023). https://doi.org/10.1001/jamanetworkopen.2023.16383

[2] Ross et al. (2016). https://doi.org/10.1177/0269881116675512

P-617

Post-traumatic brain injury psychosis and the role of an interdisciplinary brain medicine clinic: a case report

C. F. Leochico¹, A. Espiritu¹, S. Levitt², M. Guo¹, S. Mitchell¹

¹University of Toronto, Medicine, Toronto, Canada

²University of Toronto, Department of Psychiatry, Toronto, Canada

Background: Schizophrenia-like psychosis is a rare and functionally impairing sequela of TBI. As complex brain disorders may be multifactorial, patients often require consultations from different specialties, depending on their individual needs. The traditional siloed medical approach to evaluating patients, however, may create several barriers to care, such as long wait times, delays in management, lack of care coordination, service duplication, poor resource allocation, and patient/caregiver fatigue.

Objective: To present the Brain Medicine Clinic (BMC), a transdisciplinary one-stop shop aimed to eliminate barriers to care and provide holistic patient management through neurobiopsychosocial formulations.

Method: We report an elderly with early-life psychological traumas presenting with delusions post-mild TBI.

Results: The BMC established at the University of Toronto, Canada in 2019 is a novel service delivery model leveraging shared healthcare in approaching patients with complex brain disorders by integrating "knowledge across disciplines." Our patient was a 74-year-old lady with new-onset psychosis 6 months after a closed head trauma. She was referred to determine the etiology of her psychosis (primary psychiatric disorder, post-TBI psychosis, or neurodegeneration). She was evaluated by a clinical fellow and presented to a neurologist, psychiatrist, and physiatrist, who gave interdisciplinary recommendations. As the management of brain disorders is transforming, it is indeed "time for Brain Medicine." Given their potentially overlapping diagnostics and treatments for complex neurologic disorders, brain-related specialties can come together following the innovative BMC model to arrive at an integrated approach to care, while creating efficiencies for the different stakeholders (patients, families, healthcare system). In our case, we were able to provide diagnostic clarifications and appropriate treatment plan for an elderly with rare TBI-associated psychosis.

P-618

Combined pharmacologic and nonpharmacologic interventions for sexually disinhibited behaviors following traumatic brain injury: a case series

C. Falco^1,2, I. Herrin³, L. Harik⁴

¹McGovern Medical School at UT Health, Houston, TX, United States

²TIRR Memorial Hermann, PM&R, Houston, TX, United States

³Memorial Hermann Health System, Houston, TX, United States

⁴TIRR Memorial Hermann, Neuropsychology, Houston, TX, United States

Introduction: Challenging behavior (CB), including sexually disinhibited behavior (SDB) following traumatic brain injury (TBI) can have significant implications on rehabilitation and recovery. Previous medical management of SDB focusing on hormonal therapies, "chemical castration", and electrical aversion therapy carries ethical considerations. Nonpharmacologic behavior management techniques proven successful include environmental modifications and reframing techniques. There is a dearth of literature discussing a combined approach to management of SDB.

Objective: Three cases examining the benefits of an interdisciplinary framework for reducing SDB following TBI in an inpatient rehabilitation (IPR) facility will be presented.

Method: Descriptive analysis of medical and behavior management plans and assessment data of three individuals with TBI will be reviewed. All plans were implemented by an interdisciplinary team that specializes in management of CB.

Results: All three cases demonstrated SDB including self-stimulation and sexual talk with additional CB (e.g., aggression). Neurostimulants were trialed in all three cases and discontinued in two due to worsening CB. A selective serotonin reuptake inhibitor (SSRI) was used for all three cases. All cases benefited from behavior management techniques including environmental modifications, planned ignoring, and allowance of socially acceptable sexual behaviors based on context. Total functional outcomes (mobility, activity of daily living, and cognition) improved in all three cases.

Discussion: Due to the frequency and severity of CB, all three cases had longer than average lengths of stay in IPR. In agreement with the current literature, medical and behavior management is the most effective when individualized to particular needs and genetic make-up. Preliminary data suggests the benefits of pharmacologic management combined with a behavior management techniques.

P-621

Influence of off-hour hospital admission on short-term mortality after traumatic brain injury according to age group

H. Ryu ¹

¹Chonnam National University Hospital, Department of Emergency Medicine, Dong-gu, Gwangju, South Korea

Background: Traumatic brain injury (TBI) is a time sensitive and life-threatening surgical emergency. We hypothesized that off-hour, which includes night time, weekends, and holidays, may affect the mortality of TBI. Our study aimed to evaluate that off-hour effect influence the mortality of TBI patients, and whether this effect is depending on the age group.

Methods: This study included patients who experience TBI and were admitted to Chonnam National University Hospital (CNUH) between 2017 to 2020. The main exposure was arrival time of emergency department (ED) admission (off-hour vs. working-hour). The main outcome was mortality at hospital discharge. Multivariable logistic regression analysis was conducted to estimate the effect sizes of off-hour on mortality compared to working-hour. We performed interaction analysis between ED admission time and age group on study outcomes.

Results: In the multivariable logistic regression analysis, patient visiting ED at off-hours had no significant difference on mortality (AOR, 95% CI (1.05 (0.58—1.89)). In the interaction analysis, the effect measure of ED admission on mortality at off-hours was significant in younger age of 0—17 years-old (1.17 (1.04—1.30)), whereas it was not significant in other age group.

Conclusions: In young patients under 18 years old, admitted at off-hours is associated increasing mortality at hospital discharge compared to admitted at working-hours in TBI patients with intracranial hemorrhage. ED should be designed that can expect the same quality of emergency care regardless of admission time.

P-622

Predictors of return to work in the first year after severe traumatic brain injury: a prospective, observational cohort study

I. Manhoni Baiense¹, J. Vaz Gonçalves¹, P. Henrique Cassaro Lirio¹, T. S. Rodrigues¹, H. S. Almeida¹, L. C. S. Ramos¹, C. B. Louzada¹, H. S. Vasconcellos¹, J. C. Souza Alves¹, Y. Rodrigues Antunes¹, M. Barçante¹, G. Campos Santana¹, F. Zanela da Silva Arêas¹

¹Universidade Federal do Espirito Santo, Center for Health Sciences (Centro de Ciências da Saúde), Vitória, Brazil

Survivors of severe Traumatic Brain Injuries (sTBI) encounter challenges returning to work (RTW), considered a primary goal by the World Health Organization in the TBI rehabilitation.¹ There are approximately 5.5 million sTBI cases annually², and 50% of these individuals fail to RTW in long term. Several studies have explored predictors of employment status after sTBI, but the investigations have only taken place in High-Income Countries. Studies assessing the trajectory of RTW and its predictive factors at Low/Middle-Income Countries as Brazil are limited. The objective of this study is to investigate clinical and sociodemographic factors associated with RTW 6 and 12 months after sTBI. Individuals with sTBI admitted to the reference trauma hospital in 1 year period were considered, and the inclusion criteria were sTBI diagnosis, age >18 years old and an employed status before trauma. 135 individuals were included, and 97 individuals completed the 12-month follow-up. RTW was observed in 23.7% of the participants, 6 months after sTBI, and 32.9% at 12 months. Physical aggression (PA) as the cause of injury, length of Mechanical Ventilatory Support, and high level of education (HLE) were associated with a higher probability of RTW 6 months after sTBI. At 12 months after trauma, PA as the cause of injury, ISS score, performance of decompressive craniectomy, job security, and a HLE were associated with a higher probability of RTW. According to this study, most patients with sTBI don"t return to work one year after the injury. Disability and cognitive impairments are the primary factors that contribute to the challenges faced by these individuals in reintegration at social life. Reference: ¹ Yue JK, et al. Predictors of six-month inability to return to work in previously employed subjects after mild traumatic brain injury: A TRACKTBI pilot study. J Concussion. 2021. ² Dewan MC, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2018;1-18.

P-623

Predictor of long-term functional outcome after severe traumatic brain injury

M. Barçante¹, J. Vaz Gonçalves¹, P. Henrique Cassaro Lirio¹, L. R. Nascimento¹, C. B. Louzada¹, H. S. Almeida¹, T. S. Rodrigues¹, L. C. S. Ramos¹, A. G.Carvalho¹, I. Manhoni Baiense¹, J. C. Souza Alves¹, Y. Rodrigues Antunes¹, G. Campos Santana¹, F. Zanela da Silva Arêas¹

¹Universidade Federal do Espírito Santo, Vitória, Brazil

Traumatic brain injury (TBI) is the main cause of disability worldwide1-2, leading to long-term (L-T) incapacities or limitations in social life. Most prediction models for functional outcome after TBI come from developed countries. But sociocultural and clinical factors may differ in Low/Middle-income countries, leading to variations in recovery rates and predictive factors. There are no studies that have followed these individuals and assessed the L-T trajectory of functional recovery after hospital discharge in Brazil. Our goal was to investigate clinical and sociodemographic factors associated with functional outcome 1 year after severe TBI (sTBI). 172 individuals with sTBI admitted to the reference trauma hospital in Brazil, between May/21 to May/22 were enrolled. Only 145 patients completed 1 year follow-up. In this study, patients with sTBI presented a high level of disability at hospital discharge, wich may be explained by the high in-hospital mortality rate (>50%). After 12 months, 26% of the individuals achieved full recovery and 22% achieved good recovery. Although, disability and mortality were still considerably high in this population 1 year after the injury. In multivariate analyses, independent predictive factors for an unfavorable L-T outcome were advanced age, length of stay on mechanical ventilation, education level and ISS scores. Our findings suggest that while clinical and physiological parameters appear to be associated with short-term hospital mortality, socioeconomic factors such as age and education play a significant role in long-term functional recovery after hospital discharge. ¹Areas FZ, et al. Predictors of Hospital Mortality and the Related Burden of Disease in Severe Traumatic Brain Injury: A Prospective Multicentric Study in Brazil. Front Neurol. 2019; ²Carteri, RBK; Silva, RA. Traumatic brain injury hospital incidence in Brazil: an analysis of the past 10 years. Rev Bras Ter Intensiva. 2021.

P-624

Success is a journey: pilot implementation of the Ideal Care Pathway for traumatic brain injuries

M. Wiest¹, J. Gargaro¹, C. Halovanic², M. Lye³, C. Coburn⁴, D. Boileau⁵, E. Foster⁶, J. Osbelt⁷, M. Bayley¹

¹University Health Network, KITE Research Institute, Toronto Rehabilitation Institute, Toronto, Canada

²Central Acquired Brain Injury Collaborative, Toronto, Canada

³Community Networks of Specialized Care – Central East, Toronto, Canada

⁴Home and Community Care Support Services, Ontario, Canada

⁵Vista Centre Brain Injury Services, Ottawa, Canada

⁶Hull-Ellis Concussion and Research Clinic, Toronto, Canada

⁷Toronto ABI Network, Toronto, Canada

Introduction: Engaging diverse key partners, the Neurotrauma Care Pathways developed Ideal Care Pathways for mild traumatic brain injuries (TBI-concussions) and for moderate to severe TBIs. The TBI Care Pathways address known gaps in care related to, for example, unclear expectations during patient journeys, non-standardized concussion identification, and the much-needed lifelong community supports, especially related to mental health. With the Pathways at hand, it is time to start the journey to address these gaps.

Objective: to describe implementation projects addressing key elements of the TBI Care Pathways in Ontario, Canada.

Methods: Provincial Working Groups composed of people with lived experience and their families, clinicians, healthcare administrators, community service providers, policymakers and researchers set implementation priorities: education for persons with lived experience and their families, and care coordination and navigation. We identified regional teams to champion the implementation of three projects. Each team received a grant to co-design with persons with lived experience and their families a care map and implementation manual related to the implementation priorities. The projects had to implement an ongoing sustainability plan and evaluation strategies.

Results: The three pilot implementation projects include: 1) a large urban concussion care clinic partnering with the TBI system navigator to optimize referral services; 2) a justice-involved support organization and a TBI system navigator creating a resource list for those living with complex needs, and 3) a community base provider facilitating post-traumatic stress disorder training after TBI.

Conclusion: These implementation projects are initial steps of the journey towards the success of the TBI Care Pathways. Success will be represented by all Ontarians living with a TBI and their families receiving equitable care and supports to address their chronic needs over the lifespan.

P-625

Attentional blink post-concussion: association with fear-avoidance constructs and implications for intervention

M. Amarnath Nair¹, M. Cairncross¹

¹Simon Fraser University, Psychology, Burnaby, Canada

Introduction: Fear avoidance behaviour, defined as avoidance of activities and/or stimuli that might trigger or worsen symptoms, is associated with prolonged recovery from concussion. Fear-avoidance behaviour results from a cycle of catastrophic beliefs about symptoms, resulting in increased anxiety, and subsequent avoidance. Difficulty disengaging attention is associated with anxiety vulnerability and avoidance behaviour in similar conditions, but its role post-concussion is unclear.

Objectives: This study assessed if individuals with persistent post-concussion symptoms (PPCS) experience greater difficulty disengaging attention from symptom-relevant stimuli compared to individuals who have recovered from their concussion, and if difficulty disengaging was associated with heightened anxiety, catastrophizing, and avoidance behaviour.

Patients & methods: In this study, concussed adults with PPCS (n = 81) and without PPCS (n = 72) completed self-report measures of symptom severity, anxiety, pain-catastrophizing, and fear avoidance behaviour, and an attentional blink task, which provided a measure of difficulty disengaging attention from neutral and symptom-relevant stimuli.

Results & conclusion: In a 2x2 ANOVA, a main effect of group on difficulty disengaging from neutral and symptom-relevant stimuli was observed (F = 3.993, p = .047, η_p² = .02), with greater difficulty disengaging from both types of stimuli in the PPCS group. Difficulty disengaging from symptom-relevant stimuli was weakly associated with heightened anxiety (r = -.142, p = .040) and symptom severity (r = -.135, p = .048). There were no significant associations between difficulty disengaging from symptom-relevant stimuli and pain-catastrophizing (p = .403) or fear-avoidance behaviour (p = .439). Results provide support for development of psychological interventions which target disrupted attentional processes (e.g., mindfulness) to reduce anxiety and symptom severity among individuals with PPCS.

P-626

Hemispheric hyperfunction syndromes post traumatic brain injury

M. Hoffmann ¹

¹University of Central Florida, Neurology, Orlando, FL, United States

Background: Hemispheric hyperfunction syndromes post brain injury occurs frequently and may manifest with a myriad of symptoms.

Aims: Examples of hyperfunction or superlative brain function were analyzed using a dedicated FTD registry.

Methodology: Behavioral neurological syndromes were analyzed from a frontotemporal disorders (FTD) registry diagnosed with the DAPHNE criteria. Evaluations included a comprehensive, cognitive and behavioral screening evaluation (COCONUTS), MOCA test, computerized cognitive testing (CNS-VS), Frontal Systems Behavioral Evaluation testing (FRSBE), Frontal Behavioral Inventory (FBI), Boston Naming Test (BNT,), Bear-Fedio Inventory, standard laboratory, multimodal MRI neuroimaging and PET brain scan imaging and 4 etiological categories were delineated.

Results: In the FTD registry (n=67), the 4 etiological groups comprised of TBI (n=37), neurotoxicological (14), vascular (10) and other (6). All patients had abnormal FRSBE scores for the 3 principal frontal presentations and abnormal FBI scores. The most common associated subsyndrome was GGS (n=25) attributed to left hemisphere hyperfunction with TBI (21/37;57%) as the most significant etiological. Comparisons with the three principal frontal lobe syndrome clusters of abulia, disinhibition, executive dysfunction, revealed a significant association of GGS and abnormal disinhibition FRSBE T-scores. Less common subsyndrome were characterized into 16 separate conditions including 6 persons with superlative abilities comprising of acquired savant abilities including visual art, musical, literary, architectural brilliance and precognition, all attributed to right hemisphere hyperfunction.

Conclusions: By deconstructing FTD into the multiple subsyndromes, including hyperfunction and superlative function categories, a more targeted precision medicine approach is enabled. Cerebral connectional diaschisis and paradoxical functional facilitation theories best explain these syndromes.

P-627

Rapid, Accurate, and Cost-Effective (RACE) analysis of blood biomarkers for concussion diagnosis and prognosis: prior traumatic life events correlate to initial symptom severity

S. McIntosh^1,2, L. Penner¹, K. Crowder³, A. Sanati-Nezhad⁴, C. Debert^1,2

¹University of Calgary, Neuroscience, Calgary, Canada

²University of Calgary, Hotchkiss Brain Institute (HBI), Calgary, Canada

³University of Calgary, Emergency Medicine, Calgary, Canada

⁴University of Calgary, Biomedical Engineering, Calgary, Canada

Background: Most adults recover from a concussion in 2 weeks, but up to 30% experience symptoms beyond 1-month post-injury, termed persistent post-concussive symptoms (PPCS). One previously reported predictor of PPCS is post-traumatic stress.

Objectives: In this study, we aimed to examine the relationship between exposure to traumatic life events and post-concussion symptom (PCS) severity and recovery.

Methods: We recruited 35 adults diagnosed with concussion from Foothills Medical Centre Emergency Department (ED) within 2 days post-injury. During their ED visit, participants completed questionnaires about exposure to traumatic life events (Life Event Checklist [LEC]) and severity of 22 common PCSs. Participants completed daily PCS surveys until they indicated 100% recovery. Descriptive statistics, independent sample t-tests, and chi-squared tests were used to describe and compare 2 groups: those who recovered before 6 weeks (Recovered) and those experiencing PCS at 6 weeks post-injury (PPCS). Spearman"s rank correlation was used to examine the correlation between LEC and PCS.

Results: Of the participants recruited, 16 were lost to follow-up. The recovered group (n=11, 41.6±10.7 years old, 54.5% female) did not differ from the PPCS group (n=8, 33.9±12.7 years old, 62.5% female) in age, sex, or injury characteristics. PCSs were significantly higher in the PPCS group at baseline (PPCS; 67.9±35.7, R; 35.3±28.4, p=0.040), 2- (PPCS; 56.9±39.0, R; 11.2±12.9, p=0.013), and 6-weeks post-injury (PPCS; 46.3±40.2, R; 0.5±0.8, p=0.015). Though LEC scores were not significantly different between the PPCS (10.6±2.7) and R group (10.0±2.1, p=0.853), LEC scores were positively correlated to PCS scores at baseline (r=0.339, p=0.032), but not at 2- (r=0.161, p=0.404) or 6-weeks (r=0.055, p=0.824) post-injury.

Conclusion: Traumatic life events and initial severity of PCS were positively correlated, suggesting pre-injury traumas may contribute to recovery following concussion.

P-628

Upper limb pointing movement performance in individuals with concussions

S. Subramanian^1,2, M. Verduzco-Gutierrez²

¹University of Texas, Physical Therapy, San Antonio, TX, United States

²University of Texas, Rehabilitation, San Antonio, TX, United States

Introduction: Motor impairments after concussions include co-ordination issues and weakness in extremities. Individuals with concussions report some difficulties in using their upper limbs (ULs) to perform daily life activities. Little information is available on the types of UL movement patterns (joint ranges) used in this population. Such information can be obtained using kinematic analyses.

Objective: To investigate the upper limb movement patterns used during appointing task in individuals with a concussion/s

Materials & methods: Individuals with concussions (n=10) and controls (n=7) were seated. They pointed at a target placed in front of them at arm’s length with eyes closed. Eight reflective markers were placed at the following anatomical landmarks: right and left acromion processes, sternal notch, lateral epicondyle of the elbow, radial styloid process, index fingertip, greater trochanter and on the target. Recording frequency was 100Hz and trial duration was 3-5 sec. Times at which the movement velocity exceeded and continued to increase above or decreased and remained below 10% peak velocity denoted movement onset and offset. Ranges of wrist movement, elbow extension, and shoulder flexion and shoulder horizontal adduction (in degrees) and the amount of trunk displacement (in mm) were quantified using markers. Kinematic variables at movement offset were considered for analysis. Significance was set at p<0.05

Results: Compared to controls, individuals with concussions had significantly (p<0.05) lower ranges of motion in wrist extension (24.8±3.8° vs.17.3±3.4°), elbow extension (156.3±8.7° vs.140.6±3.6°), shoulder flexion (66.6±9.9° vs.58.5±5.1°), shoulder horizontal adduction (88.7±9.0 vs.77.2±5.2°) and used more trunk displacement (13.3±1 mm vs.10.2±0.8).

Conclusions: Individuals sustaining concussions have deficits in UL movement patterns. Assessment of movement patterns can help present a more complete picture of latent UL deficits in this population.

P-629

Fingolimod protects against inflammation by inhibiting NF-ƘB signaling pathway after traumatic brain injury in mice

S. Seok Young¹, L. Hoo Young¹, L. Jinju¹, B. M. Oh¹

¹Seoul National University Hospital, Rehabilitation, Seoul, South Korea

Traumatic brain injury is one of the leading causes of morbidity and mortality throughout the world. Its increasing incidence, and its fundamental role in the development of neurodegenerative disease, proves that TBI is especially concerning disease. Despite extensive preclinical and clinical studies, researchers have yet to identify a safe and effective neuroprotective strategy. FTY720 acts as a functional antagonist of S1P1 receptors. A total of 52 adult mice were subjected to controlled cortical impact, CCI, or sham injury which underwent craniotomy only. And CCI mice were subjected to high dose fingolimod, low dose fingolimod, or normal saline for control.In the behavioral assessments, fingolimod treated mice showed significantly improved motor performances in Neurological severity score, rotarod tests, cylinder tests, and openfield tests, compared with control mice. Particularly, MSD multiplex immunoassay showed a trend for pro-inflammatory cytokines IL-1B and IL-6 to decrease and anti-inflammatory cytokine IL-10 in high dose fingolimod treated group compared with the control group in the hippocampus. The levels of NF-ĸB, quantified by WB, was significantly decreased in the high dose fingolimod treated group in the cerebral cortex compared with the control group.

In this study, both high and low dose fingolimod exhibited immunomodulatory effects on neuroinflammation in experimental TBI. Since the safety was approved previously by FDA, Exploring new therapeutic uses of fingolimod for TBI treatment could lead to safe, affordable and timely new treatment options And The dose and therapeutic window should be considered before using fingolimod to treat clinical TBI.

P-630

Extended reality-based exposure and cognitive behavioral therapy (CBT) for job interview skill and anxiety management of autistic adults: a pilot and feasibility study protocol

P. Parchini¹, M. Ferguson-Pell¹, L. Zwaigenbaum²

¹University of Alberta, Rehabilitation, Edmonton, Canada

²University of Alberta, Medicine & Dentistry - Pediatrics, Edmonton, Canada

Introduction: Worldwide, there are estimated to be 50,000 people turning 18 with autism annually. Autistic adults are more likely to experience difficulties with independent living and lack of well-paid employment due to a wide range of challenges in social communication, sensory sensitivities, and repetitive behaviors. Designing a low-cost, accessible intervention is crucial for autistic adults to express their skills through verbal and non-verbal methods.

Objective: The prospective pilot study aims to develop personalized low-cost XR simulations with a 360-3D camera and the EON-XR platform to investigate the feasibility of XR-based exposure therapy with Cognitive Behavioral Therapy (CBT) to improve job interview skills and anxiety management in autistic adults.

Methodology: Eight autistic adults (18-30 years) with the ability to use smartphones and learn new technology without severe generalized anxiety disorders and functional impairment such as hearing problems will be recruited. Pre- and post-treatment levels of anxiety, job interview skills, rate of participation, and feasibility of the XR simulations will be compared using the Beck Anxiety Inventory, Social Interaction Anxiety Scale, Generalized Anxiety Disorder 7, and the Marino Interview Assessment Scale. Qualitative insights and attendance rates will be collected using a Participant Experience Tool. Each adult will have seven sessions in total; one session will introduce them to XR technology and also teach them CBT-based anxiety management techniques, and six sessions of job interview scenarios developed by both 360-3D cameras and the EON-XR platform.

Discussion: This study highlights the potential of XR-based interventions in enhancing job interview skills and anxiety management in autistic adults. The specially designed simulations with CBT will show promise for future research and utilization in the adult autism community, offering a transformative and accessible approach.

P-631

Older drivers with cognitive impairment show slower take-over performance during automated driving

H. Devos¹, P. Ahmadnezhad¹, J. Burns², A. Akinwuntan¹

¹University of Kansas Medical Center, Physical Therapy and Rehabilitation, Kansas City, KS, United States

²University of Kansas Medical Center, Kansas City, KS, United States

Introduction: Older drivers with cogntiive impairment (CI) exhibit changes in driving performance. The impact of CI on take-over performance during automated driving is unclear.

Objectives: To compare take-over performance between drivers with CI and control drivers during conditional automated driving.

Patients & methods: This cross-sectional, observational pilot study included 14 participants with CI (average age of 72.71 ± 5.82 and Montreal Cognitive Assessment (MOCA) score of 23.43 ± 4.97) and 21 controls (average age of 73.81 ± 5.62 and MOCA score of 28.24 ± 1.67). All participants completed two driving scenarios. Scenario 1 included conditional automated driving with a sudden emergency event that required manual take-over; scenario 2 comprised the same events but with an additional cognitive distractor task (2-back test). Response time to the emergency event was the main driving outcome. Two sample independent t-tests were used to compare differences between groups.

Results: Drivers with CI took longer to respond to the emergency event during conditional automated driving with 2-back compared to controls (17.2s ± 7.04 vs. 13.45s ± 10.43; p=0.046). No statistical differences were found in take-over performance between drivers with CI compared to the controls in the automated driving scenario without the 2-back (21.73s ± 11.2 vs. 20.52s ± 3.18, p = 0.31).

Conclusion: Our pilot study suggests that distracted drivers with CI may not have the prerequisite skills to safely take over control during conditional automated driving. Future studies are needed to investigate take-over performance in simulated and real-world traffic conditions in drivers with CI.

P-632

Bilateral parietal cortex activation in stroke patients with unilateral spatial neglect during virtual prism adaptation

A. Kim^1,2, W. K. Chang³, S. Cho⁴, J. Lee³, N. J. Paik³, H. J. Hwang^1,2, W. S. Kim³

¹Korea University, Department of Electronics and Information, Sejong, South Korea

²Korea University, Interdisciplinary Graduate Program for Artificial Intelligence Smart Convergence Technology, Sejong, South Korea

³Seoul National University Bundang Hospital, Rehabilitation, Seongnam-si, South Korea

⁴Delvine Inc., Seoul, South Korea

Objectives: Prism adaptation has been considered as a potential evidence-based therapy for patients with unilateral spatial neglect (USN). To address the limitations of traditional prism therapy, a novel system has been developed utilizing immersive virtual reality technology and a depth-sensing camera, creating a virtual prism adaptation therapy (VPAT) paradigm. Our study aims to investigate the brain regions activated by the VPAT system and validate these regions using functional near-infrared spectroscopy (fNIRS) to measure cortical activation.

Methods: Six stroke patients with left USN participated in the paradigm, which comprised four stages: Pre-VPAT, VPAT-10°, VPAT-20°, and post-VPAT. During the task, fNIRS signals were recorded using thirty-nine channels covering the frontoparietal cortices based on the international 10-20 system. The region of interest (ROI) was divided into four areas based on the Brodmann area, including the bilateral hemispheres of the dorsolateral prefrontal (DLPF), and parietal association (PA) areas. The fNIRS data were preprocessed using the NIRSlab software, and the data was epoched for each of the four VPAT conditions. Statistical analysis was conducted by calculating the change in oxy-hemoglobin (oxy-Hb) concentration for all combinations of eight ROIs and four experimental conditions.

Results: Significant decreases in oxy-HB concentration were observed in the left DLPF during VPAT-10° and VPAT-20° conditions, compared to the pre-VPAT condition (Bonferroni corrected p < 0.05). In the partial associate area, bilateral increases in oxy-HB concentration were observed during the post-VPAT condition compared to pre-VPAT condition (Bonferroni corrected p < 0.05).

Conclusions: We observed a significant increase in activation in the bilateral parietal cortex during the post-VPAT condition compared to pre-VAPT condition, which aligns with previous research findings with conventional rightward prism adaptation. Further studies using functional imaging techniques with high spatial resolution, such as fMRI, are needed to pinpoint the exact activation areas within the parietal cortex.

P-633

Exploring perspectives of occupational therapists and people with traumatic brain injury on the potential use of virtual reality in practice for occupation-based cognitive intervention

E. Doig^1,2, H. Gullo^1,3,2, J. Sampson¹, R. Brimelow¹, F. Patterson^1,2, G. Tornatore^1,2, J. Griffin⁴, C. Casey⁵, J. Fleming^1,2, T. Russell^1,2

¹University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia

²Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, Brisbane, Australia

³Prince Charles Hospital, Allied Health Research Collaborative, Brisbane, Australia

⁴Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Australia

⁵Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, Australia

Introduction: Virtual reality (VR) may enhance cognitive rehabilitation satisfaction and intensity of practice, with potential for early task practice, and transfer of skills to the real-world. Co-design of suitable VR applications is needed to understand priorities, meet clinical needs and appropriate design for users, to ultimately improve uptake in practice.

Objectives: To explore i) perspectives of people with TBI about VR technology, their rehabilitation goals and views on potential usefulness of VR to address goals, and ii) perspectives of experienced occupational therapists about VR technology (usefulness, acceptability, barriers and facilitators to uptake) and views about the most useful scenarios to simulate in VR to facilitate occupation-based rehabilitation.

Methods: Semi-structured qualitative interviews were conducted with seven people with recent lived experience of rehabilitation after TBI and focus groups with 21 specialist neurorehabilitation occupational therapists across three health services. All were given an introduction to VR technology (set up process, features and capabilities) and the opportunity to experience and explore immersion and interaction in a 3D simulated kitchen scenario using VR. Audiotaped data was transcribed verbatim and thematically analysed.

Results: Three main themes emerged: i) VR is novel and can be engaging for use in cognitive rehabilitation with people with TBI; ii) VR needs to be individualized for therapeutic benefit to be possible; and iii) Factors and considerations influencing the use of VR with people with TBI. There were also several sub-themes identified.

Conclusion: Clinicians and people with TBI identified a range of key priority areas and essential design features that will be used to inform the next phase, which involves the development of occupation-based VR applications with gradable scenarios and environments for trial then implementation with people with cognitive impairment after TBI.

P-634

Identifying key stakeholder goals and priorities for cognitive neurorehabilitation using virtual reality to inform co-design of future applications

H. Gullo^1,2,3, E. Doig^1,3, J. Sampson¹, R. Brimelow¹, F. Patterson^1,3,4, G. Tornatore^1,4, G. Janelle⁵, C. Casey⁶, J. Fleming^1,3, T. Russell^3,7

¹University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia

²Prince Charles Hospital, Allied Health Research Collaborative, Brisbane, Australia

³Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, Brisbane, Australia

⁴Surgical Treatment and Rehabilitation Service, Metro North Health, Brisbane, Australia

⁵Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Australia

⁶Royal Brisbane and Women’s Hospital, Metro North Health, Brisbane, Australia

⁷University of Queensland, Recover Injury Research Centre, Brisbane, Australia

Introduction: Virtual reality (VR) has potential to enhance cognitive rehabilitation through engagement in simulated meaningful everyday activities in more realistic environments than is possible in rehabilitation settings due to safety issues, feasibility or cost.

Objectives: To determine key priority areas to inform development of VR technology for use with people with cognitive impairment after traumatic brain injury (TBI). We explored perspectives of (i) occupational therapists about the most important occupations to address in rehabilitation and (ii) patients regarding their top ranked rehabilitation goals; with both parties rating the most useful therapeutic scenarios to simulate in VR for rehabilitation.

Methods: A human-centred design approach was utilized with a) four focus groups (1.5 hours each) with clinicians from three hospital sites, and b) patient interviews. Participants (n=28) included 21 occupational therapists with specialized experience (m=6.05, 0.5-26 years) providing cognitive rehabilitation to people with TBI, and seven patients with moderate to severe TBI. Clinicians within each focus group generated a priority list for design of future VR, and individuals rated each priority from 1 (not useful) to 10 (extremely useful), which were collated across groups. Patients ranked their top ten goals for rehabilitation and rated the potential usefulness of VR, from 1 to 10, for addressing the highest priority goals identified.

Results: Top three areas rated most relevant and useful for VR application development by clinicians were: i) using public transport; ii) shopping; and iii) navigating in the community. For patients, the top ranked rehabilitation goals deemed most relevant for addressing using VR were i) cognitive skill components; ii) cooking; and iii) shopping.

Conclusion: Clinicians and patients identified key priority areas that will inform development of tailored VR applications for use with people with cognitive impairment after TBI.

P-635

Development of a behavioural biomarker for cognitive impairment through navigation experiments

A. Gharib Mombeini^1,2, A. Sadek¹, I. Morgan³, A. Lester¹, H. Nguyen⁴, M. Madhav^1,2

¹University of British Columbia, Biomedical Engineering, Vancouver, Canada

²University of British Columbia, Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada

³University of British Columbia, Vancouver, Canada

⁴McGill University, Montreal, Canada

Introduction: Alzheimer’s disease (AD) in its early stages damages brain regions involved in spatial navigation and route planning, reducing performance in spatial navigation using both egocentric and allocentric strategies.

Objectives: We aim to create a behavioral test in a virtual reality (VR) environment to assess navigation performance and compare the performance of participants with preclinical AD to a defined normative aging profile. This research aims to identify specific impairments related to early AD-related neurodegeneration.

Methods: We designed a corridor maze in an immersive VR environment. Participants (young healthy adults, older healthy adults, diagnosed with preclinical AD) will navigate this space using a joystick and a VR headset and perform orienting tasks with graded complexity. We will quantify their egocentric and allocentric errors as a function of complexity, parameterized by the length and turns of the route. We will quantify a boundary in the error-complexity space at which the performance drops. This will help us obtain a characteristic profile that we will compare between young and older healthy participants. Once we define the profile for normative aging, we will test participants with preclinical AD to identify specific impairments that may be indicative of early AD-related neurodegeneration.

Expected results: Based on previous research, we expect to see that older healthy adults have a better performance (higher error boundaries) in egocentric navigation. On the other hand, preclinical AD participants will show lower performance (lower error boundaries) compared to healthy aged adults in both egocentric and allocentric navigation.

Conclusion: Our study introduces a promising and innovative approach to address the critical need for non-invasive, inexpensive, and reliable methods for detecting early-stage Alzheimer’s disease. This research may lead to more effective interventions and support for individuals with preclinical AD.

P-636

Improvement of active elbow extension with short-term error augmentation training in stroke survivors

C. Rajda¹, S. Berman², S. Levy-Tzedek³, P. Archambault⁴, M. Levin⁴

¹McGill University, Neuroscience, Montreal, Canada

²Ben-Gurion University, Industrial Engineering and Management, Beer Shiva, Israel

³Ben-Gurion University, Physical Therapy, Beer Shiva, Israel

⁴McGill University, Physical and Occupational Therapy, Montreal, Canada

Stroke leads to lasting problems using the upper limb (UL) in everyday activities. While rehabilitation depends on motor learning, UL recovery remains less than ideal. Implicit learning may lead to better outcomes than explicit learning. Error augmentation (EA) is a feedback modality based on implicit learning, which has been used in patients with stroke resulting in improved precision and speed of UL reaching movements. However, accompanying changes in UL movement patterns were not reported. Post-stroke patients may use compensatory shoulder and trunk movements to improve reaching success. To achieve better UL motor recovery, emphasis can be placed on training movement patterns that were present before the stroke. The study objective is to increase the range of active elbow extension during a functional reaching task in patients with stroke with short-term training using EA feedback of the elbow extension range.

A reaching training program was created in virtual reality to provide a challenging and motivating environment promoting implicit motor learning. Adults with chronic stroke (n = 24) trained reaching 3x in 1 wk (150 trials/30 min x 3) with or without EA feedback. EA encouraged greater elbow extension during reaching by making the elbow appear to move less than in reality. Pre- and post-training outcomes were assessed clinically and kinematically using a standardized test reaching task. These included UL joint and trunk kinematics, endpoint precision, speed, smoothness and straightness as well as the size of the active reaching zone during training. Results show that both groups improved UL, trunk and endpoint kinematics. Subjects who trained with EA feedback had greater changes in the size of the active reaching zone compared to those who trained without EA feedback. Results will inform the design of effective personalized training protocols using EA feedback for people with post-stroke UL deficits.

P-638

Effects of virtual reality game-based exercise on functional fitness in community-dwelling elderly adults

C. H. Lin¹, Y. C. Tseng²

¹National Health Research Institutes, National Center for Geriatrics and Welfare Research, Yunlin, Taiwan

²Taipei Medical University, Taipei, Taiwan

Introduction: Integrating virtual reality games into exercises could enhance motivation for regular physical activity and improve physical well-being among elderly community members. However, the effects of virtual reality game-based exercises on functional fitness in this demographic have not been extensively researched.

Objectives: To investigate the effects of virtual reality game-based exercise on functional fitness in community-dwelling older adults.

Materials & methods: Twenty community-dwelling elderly adults (18 females, 2 males; aged 79.1 ± 6.9 years) were recruited and divided into a virtual reality game group (VRG, n=10) and a control group (CG, n=10). Each participant engaged in a 1-hour exercise program three times weekly for 12 weeks. The VRG utilized a system combining inertial measurement units (IMUs) with a video game, where participants wore a soft waist corset embedded with an IMU to control a small rocket in the game, facilitating activities such as catching stars or avoiding meteorites. Conversely, the CG engaged in traditional physical exercises, including 10 minutes of warm-up and cool-down stretches and 50 minutes focusing on muscle strength, endurance, mobility, and balance. Functional fitness measures (chair stand, arm curl, body flexibility, 8-ft up-and-go, and 2-minute step test) were evaluated before and after the intervention. Data analysis was conducted, with the alpha level for statistical significance set at 0.05.

Results: In the VRG, comparisons of pre- and post-intervention measures showed significant improvements (p < 0.05) in arm circumference, which increased by 17.6%; body flexibility, which improved 2.75-fold; and the 2-minute step test, which saw a 27.9% increase. Furthermore, the VRG demonstrated a significantly greater improvement in the 2-minute step test (p = 0.019) compared to the CG.

Conclusion: Game-based virtual reality exercises significantly improve functional fitness in elderly adults living in communities.

P-639

Clinical potential of virtual reality based task for post-stroke neuro-rehabilitation of distal upper extremities: a pilot study

D. Nath¹, N. Singh¹, O. Banduni¹, V. Y. Vishnu², N. Kumar³, M. V. P. Srivastava², A. Mehndiratta^1,4

¹Indian Institute of Technology Delhi, Biomedical Engineering, New Delhi, India

²All India Institute of Medical Sciences, Neurology, New Delhi, India

³All India Institute of Medical Sciences, Department of Psychiatry, New Delhi, India

⁴All India Institute of Medical Sciences, Biomedical Engineering, New Delhi, India

Background: Customization of Virtual Reality (VR) technology in the area of post-stroke rehabilitation is an emerging research area. A library of non-immersive VR-tasks was developed for targeted distal upper-limb rehabilitation.

Objective: The objective of this pilot study was to evaluate the clinical potential of these VR-tasks in a small cohort of patients specifically with chronic stroke. We also aim to explore the possible neuronal reorganizations in corticospinal pathways in response to the VR-therapy.

Methodology: Seven patients (M/F=3/4, mean age=40.5±11.5 years) with chronic stroke (mean chronicity=64±54 months) were enrolled in this study and were given 20 therapy sessions of 45min each. Clinical Scales, cortical-excitability measures (using Transcranial Magnetic Stimulation): Resting Motor Threshold (RMT), and Motor Evoked Potential (MEP) amplitude, task performance metrics i.e., Time taken to complete the task (TCT), trajectory smoothness, relative error were evaluated at pre- and post-therapy to evaluate the therapy-induced improvements.

Results: Pre-to post-therapy improvements were observed with increase in the Fugl-Meyer Assessment total (from 45.2±8.3 to 52.1±7.4) and wrist/hand component (from 14±4 to 17.5±4.7), Modified Barthel Index (from 90±5 to 95±4), wrist active range of motion (from 36.4º±15.9º to 47º±14º). Pre-to post-intervention ipsilesional RMT (in%) was observed to be reduced by 8% (from 67±15 to 59.4±16.3) and an increase in MEP-amplitude (in µV) by 31µV (from 75±17.5 to 106.5±39.4), indicating increased cortical excitability at post-therapy. TCT (in%) (from 100 to 73±11), trajectory smoothness (from 2912±829 to 1120±643), and error (in%) (from 42±15 to 11.3±4.6) showed a relative reduction in measurement by day 20 as compared to values at day 1.

Conclusion: VR-training exhibited improved motor outcomes in chronic phase of stroke. Improved cortical-excitability might be a consequence of plastic reorganization induced by VR-therapy.

P-640

Virtual reality in cognitive rehabilitation: neural mechanisms from fMRI research

L. Lorentz¹, A. Schüppen^1,2, B. Suchan³, F. Binkofski^1,4

¹University Hospital Aachen, Division of Clinical Cognitive Sciences, Aachen, Germany

²University Hospital Aachen, Brain Imaging Facility, Aachen, Germany

³Ruhr-University Bochum, Institute of Cognitive Neuroscience, Bochum, Germany

⁴Research Center Jülich, Institute for Neuroscience and Medicine (INM-4), Juelich, Germany

Introduction: Virtual Reality technology is increasingly used in the cognitive rehabilitation of attention deficits. However, the neural mechanisms by which Virtual Reality can stimulate attentional functions in a potentially more ecologically valid way than conventional training methods are still mostly unstudied.

Objective: Examining the effects of different forms of binocular presentation (Virtual Reality-characteristic stereoscopic "3D" vs. monoscopic "2D") on neural processing during a visual attention task.

Materials & methods: Thirty-two healthy participants performed a visual attention task in an immersive virtual environment that was displayed via MR-compatible video goggles in an MRI scanner. The paradigm altered between trials that required active engagement with the task and mere observation trials. Furthermore, the form of binocular presentation switched between monoscopic and stereoscopic presentation.

Results: Analyses yielded evidence for increased activation in stereoscopic compared to monoscopic trials in the tertiary visual cortex area V3A as well as elevated activation in the dorsal attention network when engaging in the attention task. An additional ROI analysis of area V3A revealed significantly lower attentional engagement costs in stereoscopic conditions compared to monoscopic conditions.

Conclusion: The results support previous findings indicating that V3A is involved in binocular depth perception. Furthermore, heightened activation in V3A following stereoscopic presentation seemed to facilitate attentional engagement with the task. Considering V3A"s critical position as the origin of the dorso-dorsal, ventro-dorsal, and ventral visual processing pathways, the current findings suggest that it serves as a gating area distributing visual inputs to different visuomotor systems partially contingent on binocular presentation which might represent a measure of higher ecological validity.

P-641

Virtual reality navigation serious game for spatial orientation training of people living with Alzheimer’s

R. Chatterjee¹, Z. Moussavi¹

¹University of Manitoba, Biomedical Engineering, Winnipeg, Canada

Introduction: A key symptom of Alzheimer’s disease from its earliest stage is spatial impairment. Despite many existing cognitive exercises used for memory improvement, games with spatial cognition focus are lacking.

We have developed a new virtual reality navigation game with a focus on strengthening spatial orientation while being enjoyable; the game uses gadgets that are easily accessible, and easy to use even for people with Alzheimer’s. These are crucial for the game to be used for rehabilitation in Alzheimer’s population.

Objectives: To investigate the efficacy of the developed serious game, "Barn Ruins Navigation (BRN)", as a rehabilitation tool by studying performance on the game over time and assessing pre and post-training performance on an independent spatial assessment.

Patients & methods: Four people with mild to moderate Alzheimer’s (one female, 74.75±7.85 years) participated in the study so far. They played the BRN game, 30 minutes each day, three times a week for 4 weeks. The game is played on a laptop screen and a gaming controller is used for movement.

Performance pre and post-training on a spatial assessment developed and validated by our research group, VRN-House, and the BRN game score are used as the main outcome measures.

Results: All participants showed an improvement in the BRN scores. Participants with moderate Alzheimer’s started with lower scores on the game but showed a higher rate of improvement than participants with mild Alzheimer’s, who perhaps had ceiling effect. The VRN-House assessment showed increased or stable spatial performance at post-training for all participants.

Conclusion: Participants verbally commented at various points that they enjoyed playing the game. Everyone’s spatial performance in the BRN game improved while maintaining or improving spatial performance in an independent spatial assessment. Thus, the BRN game could potentially be a good spatial orientation training tool for people living with Alzheimer’s.

P-642

Investigating the effects of a novel virtual reality intervention using music-based mirror therapy on upper limb motor function in chronic stroke – a protocol paper

T. Beltrame^1,2, M. Hollis^1,2, K. Pope^1,2, B. Lange^3,2, S. Hillier⁴, D. Hobbs^1,2

¹Flinders University, College of Science & Engineering, Adelaide, Australia

²Flinders University, Medical Device Research Institute, Adelaide, Australia

³Flinders University, Nursing and Health, Adelaide, Australia

⁴University of South Australia, Allied Health & Human Performance, Adelaide, Australia

Introduction: The cost of stroke is significant; unilateral motor impairments are experienced by 50% of chronic stroke survivors, and delivering long-term rehabilitation remains an ongoing challenge. Thus, there is a need to provide accessible therapy, that can be undertaken independently. The project aims to address this need by developing a novel Virtual Reality (VR) intervention for Upper Limb (UL) rehabilitation. The VR program combines virtual musical instruments with Virtual Reality Mirror Therapy (VRMT).

Objectives: The project objectives are two-fold, centred around improving stroke-specific quality of life: (1) create a therapy modality that is engaging, affordable, and enjoyable, and (2) facilitate musical creation in a population that is typically unable to access conventional musical instruments due to UL impairments.

Materials & methods: A 12-week in-home Single Case Experimental Design pilot trial with 30 participants is scheduled for June 2024. Prior to the pilot trial, the VR application will undergo two rounds of co-design with two populations: stroke survivors and professionals (clinical). The feedback is expected to increase participant engagement and UL outcomes. The pilot trial will be delivered via the Meta Quest 3 VR headset and use an Axivity AX6 activity monitor to quantify changes in affected arm use during the intervention.The test battery includes the Fugl-Meyer Assessment of Motor Recovery for Upper Extremity, Stroke Impact Scale, and Profile of Mood States.

Results: An initial prototype has been developed which focuses on musical exploration and sound production based on therapeutic movements. Preliminary co-design feedback indicates that a single, exploratory VRMT session improved movement and positively increased sensation on the affected side (self-reported).

Conclusion: VR shows significant rehabilitative promise, and the upcoming pilot trial will evaluate the feasibility and preliminary effectiveness of this novel music-based VRMT.

P-643

Flow experience during immersive virtual reality training in patients with stroke with neglect or apraxia

M. Pastore-Wapp¹, C. Cox¹, B. Ottiger¹, T. Nyffeler¹, T. Vanbellingen¹

¹University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Switzerland

Introduction: In addition to conventional training, newer technologies such as immersive virtual reality (VR) are used in stroke rehabilitation. Immersive VR has shown some results on various outcomes such as gait and upper limb outcomes. Sometimes patients lose track of time during VR training, get strongly involved and motivated by the immersive VR training environment. Losing track of time is a key element of flow experience and may be impaired in stroke patients with neglect or apraxia, having an impact on outcome.

Objectives: The aim of the present study was to investigate how stroke patients with neglect or apraxia experience flow during VR training in an inpatient neurorehabilitation environment.

Patients & methods: 54 stroke patients (36 right hemisphere stroke patients, 18 left hemisphere stroke patients) participated in a short (1 to 2 weeks) VR training (+- 150 min average duration, in addition to ongoing conventional training). Flow was measured using the Flow State Scale for Rehabilitation Tasks (FSSRT). Spatial neglect with the Catherine-Bergego scale (CBS) and apraxia with the TULIA apraxia screen (AST).

Results: Overall high flow values were observed for the entire patient group during VR training. There were no differences in the degree of flow experience between right and left hemisphere stroke patients. The extent of flow was significantly correlated with neglect (r = -0.44, p = 0.018), but not between flow and apraxia, r = 0.22, p = 0.57).

Conclusions: Immersive VR training is a highly motivating and challenging training alongside traditional stroke rehabilitation techniques. Even stroke patients suffering from neglect or apraxia achieve high levels of flow during VR training, although the severity of the neglect appears to influence the flow experience. Therapists who use immersive VR in stroke rehabilitation should be careful to adjust the level of VR training so that stroke patients with neglect also achieve optimal flow levels

P-644

A case report of a stroke patient with moderate hemiplegia who underwent upper extremity functional training using an immersive virtual reality device

Y. Uchiyama¹, K. Domen¹

¹Hyogo Medical University, Rehabilitation, Nishinomiya, Japan

Introduction: In recent years, the effectiveness of rehabilitation using virtual reality (VR) technology has been reported. In Japan, rehabilitation using VR for upper Extremity (UE) dysfunction is recommended in the Stroke Treatment Guidelines, but there is still little experience of its treatment and effectiveness for stroke.

Objectives: We report a case of a stroke patient who underwent UE functional training using an immersive VR device and achieved relatively good short-term therapeutic effects.

Patients & methods: The patient was a man in his 50s. After suffering a stroke, he suffered from right hemiplegia. Six days after the onset of stroke, he came to our hospital for further rehabilitation treatment. The Stroke Impairment Assessment Set-Motor at the time of the patient’s visit was as follows: knee-mouth test 3, finger-function test 2, hip-flexion test 3, knee-extension test 3, foot-pat test 2. Each treatment consisted of UE functional training (20 minutes) and task-oriented training (20 minutes) using KAGURA (medi VR), an immersive VR device, 2-3 times a week for a total of 10 sessions. Before and after the treatment, the Fugl-Meyer Assessment (FMA)-UE, Functional Reach Test (FRT), Mini-Balance Evaluation Systems Test (Mini-BESTest), Motor Activity Log-Amout of Use (MAL-AOU), and MAL-Quality of Movement (MAL-QOM).

Results: The FMA-UE improved from 28 to 33 points, FRT from 25.5 cm to 32.5 cm, and Mini-BESTest from 15 to 17 points before and after treatment, while MAL-AOU decreased from 1.79 to 1.07 and MAL-QOM from 1.64 to 1.07.

Conclusion: Rehabilitation treatment using VR devices for stroke patients with moderate paralysis may improve UE function, trunk function, and balance function in a relatively short period of time. However, behavioral therapy is needed to improve the frequency of UE use in daily life.

P-645

A novel virtual reality glove system with integrated vibro-tactile feedback for Parkinson’s disease: a usability study

T. Vanbellingen¹, M. van Wegen², J. Herder², R. Adelsberger³

¹University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Switzerland

²Technical University Delft, Delft, Netherlands

³Sensoryx AG, Zurich, Switzerland

Introduction: Parkinson’s Disease is one of the most common neuro-degenerative diseases worldwide, affecting patients’ability to perform Activities of Daily Living, such as cooking and dressing, and consequently decreasing Quality of Life. Besides the traditional physical interventions, Virtual Reality (VR) technology has proven a viable tool to facilitate rehabilitation by providing flexibility in design and simultaneously creating pleasant and immersive environments. It is suggested that implementing haptic feedback into a Virtual Environment (VE) could further boost motor learning during training and improve patients’ compliance. Till date, haptic feedback during VR training, has not been evaluated in PD.

Objectives: The purpose of the present study was twofold. First, a novel VR haptic glove system, consisting of existing VRFree gloves integrated with a Haptic Device to provide Vibrotactile Feedback (VTF) was developed. Second, this newly developed system was then technically tested with regard to its latency, intensities and compatibility.

Patients & methods: the system was evaluated on its performance and usability in both healthy subjects and PD patients.

Results: Technical tests yielded positive results; a latency of 13 +- 12 ms was found, the HD was able to convey different intensities and the HD produced no visually noticed interference with the VRFree gloves. The user tests revealed positive results on increased grasp performance with the VTF in terms of grasp time and smoothness among healthy subjects and a good Haptic Experience (HX) evaluation among all subjects. An average System Usability Scale (SUS) score of 75 suggested good usability of the overall system.

Conclusion: This usability study demonstrated for the first time that VTF on the fingertips during VR rehabilitation is feasible to possibly train dexterity related ADL in PD. Further studies will be needed to evaluate its value as a rehabilitation tool to improve ADL, QoL in PD.

PL-001

Development and content validation of the Pediatric Dizziness Index (PDI)

D. Tiwari¹, M. Allen², R. Schulz², B. Gotts², C. Stewart², M. Kaur¹

¹MGH Institute of Health Professions, Department of Physical Therapy, Boston, United States

²Simmons University, Department of Physical Therapy, Boston, United States

Introduction: Approximately, 3 million children are impacted by dizziness nationally, and as a result are at a greater risk of intellectual and learning disability. Given the wide variations between children and adults in brain morphology, maturity, and perceptions of injury impact, valid, age-specific patient reported outcome measures are crucial to capture the breadth of disability from dizziness post-concussion.

Objectives: To develop and examine content validity of the PDI to evaluate activity limitation and participation restriction due to dizziness.

Materials & methods: Eight pediatric clinical and research content experts participated in the Modified Delphi Process. PDI was developed in four steps: 1) item development, 2) item evaluation, 3) content validity ratio and index calculation, and 4) cognitive interviews to ensure face validity, and comprehension of the items. A comprehensive literature search and review of the International Classification of Functioning, Disability and Health- Children and Youth model was conducted to identify potential items. Content validation process followed the Consensus based Standards for the selection of health status Measurement Instruments (COSMIN) guidelines. Content validity ratio (CVR) was calculated using Lawshe"s formula CVR = (ne –N/2)/N/2 (ne=number of experts identified an item as essential; N=total number of experts).

Finally, content validity index (CVI) was calculated (CVI >0.8 indicated good content validity).

Results: After two rounds of modified Delphi process, the initial item bank of 33 items was condensed to 10 items in final version of PDI. Three items on the PDI were revised post cognitive testing. The final version of PDI demonstrated good content validity (CVI=0.87).

Conclusion: PDI is the first comprehensive patient reported measure specific to dizziness and provides evidence of strong content validity. Further research to establish factor structure and construct validity is recommended.

PL-004

Recognising syndrome of the trephined in neurorehabilitation: a case series

S. K. J. Lui ¹

¹Singapore General Hospital, Rehabilitation, Singapore, Singapore

Introduction: Syndrome of the trephined (SoT) is a complication following a decompressive craniectomy (DC) which can impact on neurologic recovery.

Objectives: Highlight the clinical features of SoT and identify the risk factors for SoT.

Patients: Case one was a 52-year-old female with a history of left basal ganglia stroke was admitted for a massive right frontal contusion and right subdural haematoma. She underwent right-sided decompressive craniectomy (DC). She was transferred to the inpatient rehabilitation unit 1 month later. Twelve days later, she was noted to have a decline in her sitting balance and worsening of her right arm strength. CT brain showed a sunken appearance at the site of prior craniectomy with a paradoxical midline shift to the left.

Case two was a 32-year-old male who was admitted for traumatic brain injury. He required right-sided DC. Three months after TBI, he developed weakness in his left hand. CT brain showed midline shift to the right.

Results: Case one underwent cranioplasty a week later and she improved functionally, whereby she required mostly supervision in her ADLs and could ambulate with a quad-stick.

Case two underwent cranioplasty 2 months later and had good recovery within 2 days post- surgery. He regained full strength in his left hand was able to resume work.

Conclusion: SoT is caused by reduced cerebral blood flow, reduced cerebrospinal fluid flow, and impaired glucose metabolism associated with cranial defects.¹ The most common findings of SoT were motor weakness, followed by cognitive decline and other neurological deficits.² Risk factors such as very large DC, extensive brain damage and cerebrospinal fluid circulation abnormalities have been reported.³ Rehabilitation physicians should promptly recognize the clinical features of SoT and raise the discussion of earlier cranioplasty to improve the functional outcome of these patients.

References

1. Arai N et al. Progress in rehabilitation medicine. 2022;7:20220008.

2. Ashayeri K etal. Neurosurgery. 2016;79(4):525-34.

3. Di Rienzo A et al. Neurosurgical Review. 2020;43(1):323-35.

PL-005

Meeting the Unmet Need: A vision for equitable access to sexual and reproductive health for persons with Spinal Cord Injury/Disorder (SCI/D)

K. McBride^1,2,3, S. Elliott^1,2

¹GF Strong Rehabilitation Centre, Vancouver, Canada

²Blusson Spinal Cord Centre, Vancouver, Canada

³University of British Columbia, Vancouver, Canada

Introduction: Sexual wellbeing is a top priority for persons with SCI, yet it continues to be an area of unmet need, with little attention to the topic in rehabilitation or available health care professionals with the knowledge and comfort to address the area. Since the inception of the Sexual Health Rehabilitation Service (SHRS) in 1975, trained sexual health clinicians have focused on the sexual and reproductive needs of those with SCI (and other neurological conditions) and trained interdisciplinary team members.

Objectives: Funded by the Rick Hansen Foundation, project objectives were to identify the gap in service delivery in sexual rehabilitation in BC; outline the current model of service delivery for the Sexual Health Rehab Service, and present strategies, goals and actions that could serve to close the gap in care.

Materials & methods: From July 2021 to November 2022, over 30 interviews were conducted with clinicians, researchers, administrators, and persons with lived experience. Their responses, together with extensive literature review, informed the development of an informative report that met the objectives.

Results: The report was finalized in February 2023. Analysis uncovered approximately 60% of those with traumatic SCI, and only 10% with non-traumatic SCI in BC received sexual health rehab (SHR), despite data supporting sexual and fertility rehabilitation as more important than most secondary complications.

A high-level provincial action plan, utilizing a hub and spoke model, was developed by the steering committee and included these five goals: increased awareness of SHR; equitable access to specialized services at appropriate times; operational continuity and service enhancement; health provider education and training program; multi-year funding for innovation, research, and translation.

Conclusion: The initiative lays the foundation towards promoting access to equitable, quality health care that includes sexual and fertility rehabilitation for those with SCI/D.

PL-006

Enhancing Cognitive Inhibition in Older Adults Through Exergame

Q. Yang¹, L. Siyuan¹, C. Leung², Z. Shen^1,3

¹Nanyang Technological University, LILY Research Centre, Singapore, Singapore

²University of British Columbia, Department of Electrical and Computer Engineering, Vancouver, Canada

³Nanyang Technological University, School of Computer Science and Engineering, Singapore, Singapore

Introduction: With aging comes a decline in both physical and cognitive functions, negatively affecting life quality. Cognitive inhibition, crucial for cognitive health, is particularly vulnerable to these declines. Enhancing cognitive inhibition in older adults is vital for mitigating age-related cognitive deficits and improving life quality.

Objectives: This study investigates the efficacy of a ping pong-themed exergame, designed to train cognitive inhibition in older adults by combining cognitive tasks with physical exercises, aiming to mitigate age-related declines in cognitive inhibition.

Patients & methods: A study with 33 participants aged 58-90 assessed the impact of the exergame over five weeks. The System Usability Scale (SUS) evaluated usability, while cognitive performance was measured using Flanker, Simon, and Stroop tasks before and after the intervention. The exergame incorporated physical activity and cognitive tasks through Kinect technology, focusing on improving cognitive inhibition via a Go/No-go task embedded within a ping pong context.

Results: The exergame received a high usability score (mean SUS score of 72.12). Significant improvements in cognitive task performance were noted post-intervention. Participants exhibited a decrease in response times by 1151.2 ms for congruent Flanker tasks and an increase in accuracy for Simon tasks by 6.5%. These results indicate the exergame’s potential in enhancing cognitive inhibition.

Conclusion: The ping pong-themed exergame effectively improves cognitive inhibition among older adults, combining physical and cognitive exercises in an engaging format. This study highlights the potential of exergames as practical tools for cognitive enhancement, suggesting a promising approach to healthier cognitive aging and counteracting cognitive decline.

PL-007

ADL+: A novel ai-driven approach to prevent cognitive decline in older adults

Q. Yang¹, Z. Zeng¹, T. H. B. Tan¹, J. J. Chin², C. Miao¹

¹Nanyang Technological University, LILY Research Centre, Singapore, Singapore

²Tan Tock Seng Hospital, Institute of Geriatrics and Active Ageing, Singapore, Singapore

Introduction: Current research highlights the importance of addressing multiple risk factors concurrently to tackle the complex etiology of dementia. However, limited evidence exists on the efficacy of technology-driven, multidomain community-based interventions for preventing cognitive decline.

Objectives: To develop and evaluate the efficacy of ADL+, an artificial intelligence (AI)-enabled digital toolkit integrating cognitive assessments and multidomain interventions, on outcomes of cognitive function in older adults at risk of cognitive decline.

Patients & methods: We conducted a quasi-experimental study including community-dwelling older adults aged 60 years and above without dementia, but with subjective memory complaints (AD8 score≥2). Participants received a 6-month intervention (app-based cognitive training, personalized nutritional, physical, and social activities recommendations) or a control group treatment (cognitive health educational package). The primary outcome was change in neuropsychological test battery (NTB) Z-scores (NTB composite and its individual domains–attention, processing speed, memory, and executive function). Outcomes were assessed at the end of the intervention and three months post-intervention using linear mixed effects models.

Results: 152 individuals were assigned to the intervention group (N=75) or control group (N=77). At six months, the intervention group showed a significant NTB composite score improvement (mean change: 0.086 (95% CI 0.020-0.15)), resulting in a between-group difference of 0.17 (95% CI 0.071-0.27). Significant differences in attention, processing speed, and memory domains were observed, with benefits sustained in processing speed domain at nine months.

Conclusions: The ADL+ toolkit shows potential beneficial effects on cognitive function, activity levels, and quality-of-life for older adults at risk of cognitive decline. Findings will guide future randomized controlled trials and implementation efforts.

PL-008

Automated clock drawing test for early dementia risk assessment

Q. Yang¹, H. Jiang¹, Z. Zeng², Y. Chi³, C. Miao^1,2

¹Nanyang Technological University, LILY Research Centre, Singapore, Singapore

²Nanyang Technological University, Alibaba-NTU Singapore Joint Research Institute, Singapore, Singapore

³Alibaba Group, n/a, China

Introduction: Dementia poses a significant challenge for the elderly, leading to dependency and diminished life quality. Early detection is crucial to manage symptoms and reduce care costs. The Clock Drawing Test (CDT), an effective dementia screening tool, requires hand-drawn clocks to be assessed by clinicians, limiting its frequent use due to the need for expert scoring.

Objectives: This study developed an automated, mobile-based CDT for easy, self-administered testing at minimal cost, facilitating more frequent dementia screening. The aim was to create a system that evaluates hand-drawn clocks using advanced AI techniques to produce scores closely aligned with human expert evaluations.

Materials & methods: The automated CDT integrates spatial-temporal and image-based deep learning analyses against established clinical criteria. It employs DBSCAN for spatial segmentation and a CNN trained on an augmented MNIST dataset for digit recognition. Mask R-CNN with a ResNet50 backbone and Feature Pyramid Network was utilized for image-based recognition. A rule-based scoring system assessed drawings on clinical criteria, including digit placement and clock hand positions, with corrections for detection errors implemented via Levenshtein distance. The system’s efficacy was tested with 100 clock drawings from individuals aged 21-55, comparing system scores with those from expert human raters.

Results: The automated CDT achieved a Pearson correlation coefficient of 0.763 with expert raters’ scores, demonstrating high reliability and the system’s ability to closely replicate human scoring accuracy.

Conclusion: The automated, mobile-based CDT advances early dementia detection, promising to transform care by facilitating regular cognitive assessments. The results invite further validation and research to assess effectiveness across different populations, potentially revolutionizing dementia screening and monitoring.

PL-009

Pediatric traumatic brain injury: the effects of anxiety and depressive disorders

M. Witort ¹

¹Case Western Reserve University, Communication Science and Disorders, Cognitive Science, Department of Psychological Sciences, Cleveland, OH, United States

In the United States, an estimated 475,000,000 children sustain a traumatic brain injury each year. Traumatic brain injury (TBI) or concussion is a form of brain injury from either direct or indirect force to the head. TBI affects several aspects of neurological functioning. It is important to measure psychosocial disturbances (anxiety/depression) and executive functioning after the injury as they impact quality of life.

This project investigates if there is a relationship between higher rates of psychological disorders and executive functioning disorders among traumatic brain injury patients who have access to formal return-to-school programs compared to children who do not have access to formal return-to-school services. It is hypothesized that more pediatric TBI patients without formal return-to-school services will be significantly correlated to an increased likelihood of reporting psychological disorder and executive functioning disorder post-injury compared to children who do receive formal return-to-school services. A secondary analysis of data collected as part of the School Transition after Traumatic Brain Injury (STATBI) study was conducted. STATBI is a longitudinal study that uses primarily parent-proxy reports for a variety of outcome measures. Children recovering from TBI (5-18 years at age of injury) with access to BrainSTEPS (Strategies Teaching Educators, Parents, and Students) educational support program in the state of Pennsylvania, and children recovering from TBI in the state of Ohio without access to BrainSTEPS services were recruited. Assessments included pre-injury function, time of study entry (baseline), three months post-injury, six months post-injury, and twelve months post-injury. These assessments include the Child Behavior Checklist (CBCL) which measures emotional and behavior disturbances in adolescents as well as the Behavior Rating Inventory of Executive Functioning (BRIEF) which measures deficits in executive functioning. The analysis used in this project did not find differences for CBCL scores; however, more detailed analysis are needed to consider interaction of site, time point, and injury severity.

These results underscore the importance of mixed-methods research as quantitative measures could potentially miss changes that youth with TBI report in qualitative interviews. Future research should consider additional factors that might influence post-TBI outcomes, such as individualized interventions, social support systems, or differing recovery trajectories across diverse populations.

Project Mentor: Professor Angela Ciccia, Department of Psychological Sciences, Case Western Reserve University

PL-010

Development of a prehabilitation approach for surgeries in pediatric patients with cerebral palsy

S. Horne^1,2, C. Lowe-Pearce^1,2, A. A. Publicover^2,3, L. Gauthier^1,2, J. Sheriko^1,2

¹Dalhousie University, Medicine, Halifax, Canada

²IWK Health Centre, Halifax, Canada

³Queen’s University, Faculty of Health Sciences, Kingston, Canada

Introduction: Single-event multilevel surgery (SEMLS) and selective dorsal rhizotomy (SDR) surgeries are performed in pediatric patients with cerebral palsy (CP) to improve gait and function. Recovery involves inpatient rehab and integration of rehab into daily life. Unfortunately, many patients face barriers to participation, such as weakness and instability, lack of support, and cost and traveling. "Prehabilitation" refers to interventions done prior to surgery that address these barriers to optimize recovery and functional outcomes. Unfortunately, prehab has not been well documented in pediatrics. The IWK Kids" Rehab Service has therefore developed a prehab program using the WHO"s ICF framework with a focus on postoperative outcomes in pediatric CP patients undergoing SEMLS and SDR surgeries.

Objective: Explore the impacts of our prehab program on postoperative outcomes in this population. Patients & methods: The IWK prehab program emphasizes patients" functional goals and considers barriers and facilitators at play (e.g., through education, counselling, and physical therapy). Prehab is done over several interdisciplinary appointments with the rehab and surgical team. Identified functional goals and evaluations in each ICF domain are then used to create patient-specific care plans. Interviews and focus groups will be conducted to explore patient, family, and the care team"s experiences with prehab. Reflexive thematic analysis will be used to identify common themes and patterns relating to the impacts of the intervention.

Results: We are in the process of beginning data collection and hope to have preliminary findings by May 2024.

Conclusion: This study is one of the first to explore the impacts of prehab in pediatrics. This study may therefore help inform future interventions and shape how clinicians evaluate and support patient and family readiness for surgery, and ultimately lead to more success with rehabilitation and optimized surgical outcomes.

PL-011

The importance of nutritional supply in the acute phase of stroke: the cohort study

J. H. Choi¹, J. S. Baik², K. Lee¹, Y. I. Shin^1,2,3

¹Pusan National University Yangsan Hospital, Department of Rehabilitation Medicine, Yangsan, South Korea

²Pusan National University Yangsan Hospital, Biomedical Research Institute, Yangsan, South Korea

³Pusan National University School of Medicine, Department of Rehabilitation Medicine, Yangsan, South Korea

Introduction: Many stroke patients tended to have poor nutritional status during the acute phase of stroke due to catabolic conditions caused by stroke mechanism. Assessing nutritional status during the acute periods after stroke was important because this related to functional recovery of patients. Many studies had researched functional recovery after stroke based on nutritional status, but there was a lack of comparative analysis of pre-stroke nutritional status and post-stroke nutritional status.

Objective: To assess importance of nutritional supply in acute stroke period by comparing pre-stroke nutritional status and post-stroke nutritional status.

Methods: This study analysed 401 stroke patients" data of the Korean Stroke Cohort for Functioning and Rehabilitation study. Participants" nutritional state was assessed using the Prognostic Nutritional Index(PNI). Patients were divided into three groups by PNI score at the day of admission and on the 28th day after admission. Patients with high PNI on admission and low PNI on the 28th day after admission were group 1; low PNI on admission, low PIN on the 28th day after admission were group 2; high PNI on admission, high PIN on the 28th day after admission were group 3. Low PNI on admission and high PIN on the 28th day after admission were excluded because of lack of participants" number. FAC, FIM, FMA, and mRS were used to evaluate functional recovery. Mortality of all participants was assessed up to 3 years after stroke onset. ANOVA was performed to analyze factors of functional recovery. The 3-year mortality was estimated using the Kaplan-Meier methods.

Results: Sufficient nutritional supply in the acute stage of stroke was associated with significant improvements in function scores and decreased mortality.

PL-012

Effect of memantine in chronic post-stroke aphasia: a case report

A. Joshi¹, S. Gawande²

¹Cleveland Clinic Foundation, Department of PM&R, Cleveland, OH, United States

²AIIMS Nagpur, Department of PM&R, Nagpur, India

Introduction: Post-stroke aphasia (PSA) is an important symptom in post-stroke rehabilitation, noted in 30% of ischemic stroke population leading to variable degree of communication impairment. Speech-language therapy (SLT) is the mainstay of treatment but there is no clear consensus on use of SLT approach. Studies have shown enhancement of effect of SLT with pharmacotherapy but fail to provide specific recommendations.

Objectives: To study efficacy of Memantine in chronic PSA in combination with SLT.

Patients & methods: A 38-year-old right-hand dominant male with 16-month-old left MCA stroke presented to rehabilitation facility with global aphasia, right spastic hemiparesis, and circumduction gait. After shared decision making, pharmacotherapy with Memantine was initiated at 5mg/day and increased every week to upto 15mg/day. It was tapered after 6 weeks and stopped due to headache. Concurrent SLT in the form of constraint induced aphasia therapy (CIAT) 5 days/week was provided by same speech therapist twice/day in divided sessions of 30-45 minutes. The western aphasia battery aphasia quotient (WAB-AQ) score was used to monitor treatment response.

Results: Pre-treatment WAB-AQ of 12 improved to 35 at 6 weeks with Memantine and CIAT showing transition from Global to Broca"s aphasia. It improved to 37.8 measured at 3 weeks after discontinuation of Memantine. Improvement in comprehension of simple commands, two staged complex commands and occasionally multi-dimensional commands was noted. He could respond with yes/no, repeat 3-4 words at a time and could spontaneously ask for things like food, comb.

Conclusion: The results of this case study suggest the possibility of improvement in PSA even after a period of 16 months with combination of Memantine and SLT. Memantine can be a safe and effective option for treatment of chronic PSA. Studies with Memantine focusing on long term follow up, standard dosing, treatment duration and use of various SLT approaches should be helpful.

PL-013

Repetitive peripheral magnetic stimulation in a traumatic spinal cord injury patient with cervical radiculopathy – a case report

H. Y. Hsu¹, Y. T. Yeh¹

¹Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Department of Physical Medicine and Rehabilitation Medicine, Hualien, Taiwan

Introduction: Spinal cord injury (SCI) often results in significant impairment of motor function, leading to substantial challenges in daily living and mobility. Various therapeutic approaches have been explored to enhance motor recovery in individuals with SCI. Emerging evidence suggests that the presence of radiculopathy in conjunction with SCI may lead to poorer prognostic outcomes and hindered functional recovery. Repetitive peripheral magnetic stimulation (rPMS) has emerged as a promising non-invasive neuromodulation therapy to potentially improve motor function by painlessly stimulating deep anatomical structures. However, to the best of our knowledge, there is currently no literature reporting on the safety and therapeutic efficacy of rPMS in patients with spinal cord injuries with radiculopathy.

Objectives: To investigate the effects of rPMS on motor function in a patients with SCI combined radiculopathy

Methods: We present a clinical case of a 66 year-old male with C4 incomplete spinal cord injury and subsequent monoplegia combined right C5 radiculopathy.

Results: He undergoes rPMS therapy three times a week, with each session lasting ten minutes, targeting stimulation for flexion movements of the hand. His grip strength improved from 3.6 kg to 5.6 kg after a total of 10 sessions. His ISNCSCI ASIA motor subscores of right limbs have improved from 15 points to 33 points. There has also been progress in daily activities. The Functional Independence Measure (FIM) increased from 76 out of 126 (60.3%) to 113 out of 126 (89.6%).

Conclusion: We present that rPMS therapy seems to be helpful for promoting motor recovery in patients with SCI combined radiculopathy through neurofacilitation.

PL-014

Effects of 8 weeks of FES-Cycling on post-stroke patients: preliminary results

M. Descollonges¹, L. Popović-Maneski^2,3, A. Metani², P. H. Pouillart⁴, S. Mitrovic⁵, A. Radić⁵, J. V. Brugniaux⁶, J. Di Marco^2,4, G. Deley¹

¹Université de Bourgogne, Inserm CAPS U1093, Dijon, France

²Kurage, Lyon, France

³Institute of Technical Sciences of SASA, Belgrade, Serbia

⁴SSR Val Rosay, Saint-Didier-au-Mont-d’Or, France

⁵Rehabilitation clinic Dr Miroslav Zotovic, Belgrade, Serbia

⁶Université Grenoble Alpes, Inserm HP2 U1300, Grenoble, France

Introduction: Hemiparesis (HP), a partial loss of motor function on one side of the body (mainly caused by strokes), is present in nearly 90% of post-stroke patients and ranks as the leading cause of severe and long-term disability. Restoration of functional capacities is therefore paramount during post-stroke rehabilitation. Clinical evidence suggests that functional electrical stimulation cycling (FES-Cycling) can help to reduce motor impairments for HP patients. Several studies already demonstrated the feasibility and effectiveness of FES-cycling rehabilitation in stroke patients, but little is known regarding the size of these effects as compared with those obtained after conventional rehabilitation programs.

Objectives: The main aim of this study was to compare the effects of FES-cycling and a conventional cycling program in stroke patients.

Materials & methods: 25 patients with HP following ischemic or hemorrhagic strokes were recruited and divided randomly into two cycling groups, with FES (n=11) and without (n=14; CON). Each session lasted 30 minutes at 60% of maximal aerobic power. FES was applied to the quadriceps, hamstrings, and gluteal muscles of the paretic side at maximum tolerated intensity. The effects of rehabilitation programs were assessed through quadriceps muscles" thickness, maximal aerobic capacity and walking capacities.

Results: The results revealed significant benefits in both groups in terms of VO2max (FES: +23%; CON; +11%), maximum aerobic power (FES: +51%; CON; +47%), walking perimeter (FES: +44%; CON; +24%) and muscle thickness in the rectus femoris (FES: +17%; CON; +9%) and vastus intermedius muscles (FES: +20%; CON; +8%).

Conclusion: The study showed that 24 sessions of FES-cycling had beneficial effects on all parameters. In addition, this exercise modality was well-tolerated and accepted by the patients making FES as a very interesting rehabilitation alternative, particularly for stroke patients.

PL-015

Brain wellness, beyond all boundaries: from idea to implementation

S. A. Stelling¹, A. Hashimoto¹, S. Appel-Cresswell¹, A. Camalleri¹

¹UBC Centre for Brain Health, BC Brain Wellness Program, Vancouver, Canada

As our population ages, there is an increased need for prevention and accessible care. Symptoms of many disorders of ageing can be prevented or mitigated with modification of lifestyle factors. Lifestyle-based research and programs have been emerging as effective adjunct therapies for a variety of neurological conditions. Research indicates positive effects of exercise and movement-based interventions on dementia, PD, MS, stroke, and healthy agers. Recently, creative expression activities such as mindfulness, art therapy, music, improvisation and gardening have been examined showing positive impacts on brain health and mental well-being. While many lifestyle-based programs involve singular interventions, some more recent therapies have shown the promising results of combining treatments, and have shown the positive impact of multimodal lifestyle interventions on specific populations.

We believed that a program which could cater to several neurological conditions, healthy agers and care partners alike could mitigate effect of participants comparing their current state of condition to those who have progressed further along, and could enhance feelings of community, through engagement with others of varying conditions and health qualities. We also believed that successful engagement is contingent on accessibility and removing or reducing barriers including financial and geographic. Overall, a lifestyle intervention with a multimodal nature, diverse participant pool, and online accessibility would be ideal for older adults, enhancing the current health care system and addressing the inequities in the aging experience as well as the needs of the underserved.

The British Columbia Brain Wellness Program (BCBWP), demonstrates the feasibility and effectiveness of a province wide online and in-person multimodal lifestyle intervention-based program. Our program is tailored to individuals with a wide variety of neurological conditions, their care partners, and healthy agers. Through an interconnected three-pillar structure of program delivery, research, and education, we provide programs and classes based on current scientific literature, conduct various research projects on these programs and cycle the research back to improving program delivery as well as dispersing the knowledge in a comprehensible manner to the public and to our participants.

Since opening in October 2019, the BCBWP has had remarkable growth and success. We have conducted in excess of 1200 individual assessments, supported over 800 active participants per semester and have a participant base that now exceeds 2000 individuals. The development history, mission, structure and content of the program as well as highlights from feedback surveys and participant focus groups will be shared, demonstrating the positive impact of our program on participants and encouraging the opportunity for this model of intervention to be replicated and expanded in other communities.

PL-016

Artificial intelligence powered functional electrical stimulation walking for gait rehabilitation after stroke

A. Metani^1,2, E. Jafari^1,2, B. Moreau¹, R. Nollot¹, N. Feppon¹, L. Vergnes-Blanquer¹, J. Di Marco³, L. Popović-Maneski^1,4

¹Kurage, Lyon, France

²Université de Lyon, ENS de Lyon, CNRS, Lyon, France

³Centre de Soins de Suite et de Réadaptation du Val Rosay, Lyon, France

⁴Institute of Technical Sciences of SASA, Belgrade, Serbia

Introduction: Stroke is a major cause of neurological impairment globally, highlighting the need for effective walking rehabilitation. Functional Electrical Stimulation (FES) shows promise in post-stroke rehabilitation, yet challenges remain in hardware complexity and electrode placement.

Objectives: Integrating Artificial Intelligence (AI) addresses these challenges. The NeuroSkin© system utilizes AI to automate stimulation calibration and offers user-friendly features like reusable garments with dry electrodes, simplifying operation and improving accessibility.

This retrospective study aims to assess gait improvement in post-stroke patients using the NeuroSkin© system during regular rehabilitation.

Methods: Participants: 18 adults in the sub-acute phase of stroke, receiving supervised FES-walking therapy sessions using NeuroSkin©.

Intervention: 30-minute sessions, at least weekly for 4 to 6 weeks.

Assessment Metrics: 10mWT, 6mWT, TUG, and NFAC score.

Device: NeuroSkin© is an AI-powered real-time gait monitoring and correction system for walking rehabilitation. It integrates the following components:

Garment embedded with dry electrodes targeting six muscle groups: Gluteus Maximus, Quadriceps, Hamstrings, Tibialis Anterior, Fibularis, and Gastrocnemius. 7 Inertial Measurement Units; 10 Ground Reaction Force sensors Cloud-based AI-driven real-time Clinical Gait Analysis incorporated into a microcomputer positioned on the back of a vest worn by the patient.

Results: Significant improvements in walking speed, endurance, and autonomy were observed.

Conclusion: The study underscores the potential of FES-walking therapy, but larger samples are needed to establish therapy efficacy conclusively.

PL-017

Using Radionuclide Ventriculoperitoneal shunt scintigraphy for patient with suspicious shunt malfunction

C. S. Tseng¹, T. L. Chiu^2,3, H. Y. Hsu⁴, S. H. Liu¹

¹Hualien Tzu Chi Hospital, Department of Nuclear Medicine, Hualien, Taiwan

²Neuro-Medical Scientific Center, Hualien Tzu Chi Hospital, Department of Neurosurgery, Hualien, Taiwan

³Tzu Chi University, Medicine, Hualien, Tajikistan

⁴Hualien Tzu Chi Hospital, Department of Physical Medicine and Rehabilitation Medicine, Hualien, Taiwan

Introduction: Ventriculoperitoneal (VP) shunt placements are one of the most commonly performed procedures to treat most forms of hydrocephalus. However, shunt malfunction could happen occasionally due to multiple causes. With obstruction as the most common cause of shunt malfunction, assessing shunt patency is crucial for clinical planning. Shunt scan by Tc-99m DTPA could provide helpful information for decision-making.

Materials & methods: This is a case of a 68-year-old woman with a VP shunt implanted due to hydrocephalus. She was admitted because of a sudden onset of conscious disturbance.

Results: The radionuclide VP shunt scintigraphy was performed after giving 2.0 mCi of Tc-99m DTPA via the reservoir into the VP drainage tube. The initial head-to-neck SPECT/CT (Figure 1) showed a visualization of radioactivity into the ventricles but only a faint trace of radioactivity drainage downward from the injection site; the tract terminated at the mastoid region. The following static images from head to pelvis region showed no definite radioactivity in the chest and abdominal regions (Figure 2). The study indicated VP shunt obstruction. Therefore, shunt revision was later performed. The patient"s consciousness gradually improved after the precedure.

Conclusion: Radionuclide VP shunt scintigraphy is a useful tool when VP shunt malfunction is suspected, giving necessary information for clinical planning.

PL-019

Connective tissue and skeletal muscle function. Implication for neurorehabilitation

S. Bonomi^1,2, A. Fusco^1,2, M. Filisetti^1,2, L. Padua^1,2

¹Policlinico Gemelli, Neurorehabilitation department, Rome, Italy

²Cattolica del Sacro Cuore University, Rome, Italy

Introduction: Recent studies shed light into the role of connective tissue (CT) structures with implication in skeletal muscle (SKM) function in physiological and pathological conditions. Neurological conditions that cause immobilization produce early modification of CT properties that alter SKM functions with implication in recovery process.

Objectives: We aim to review knowledges about CT structure and function in pathological conditions and explore possible therapeuthic applications.

Materials & methods: Review scientific literature concerning connective tissue structure, mechanical properties, biological acivity and modification after neurological injury

Results: CT is an anisotropic tissue with mechanical properties and regulative function in mechanical force transmission that affect muscular actions. CT change very early after neurological injury and immobilization: increase intramuscular CT, disruption of three-dimensional orientation of collagen fibers, increase fibroblasts activity (fibrosis), ECM remodelling, increase HA viscosity, changes in interstitial fluid content decrease of capillaries, altered muscle splindle sensitivity. CT modifications alter biomechanical properties of the immobilized SKM with increased stiffness and altered functions. These modifications contribute to the development of rectraction and spastic mouvement desorders.

Conclusions: These knowledges are a framework to develop therapeutic approach that consider CT to support SKM recovery in early rehabilitative process. Recent studies suggest that manual miofascial release techniques included in the rehabilitative program could effect CT and improuve SKM function.

References

1. Dietz V et al. Spastic movement disorder: impaired reflex function and altered muscle mechanics. Lancet Neurol 2007

2. Gracies J.M. Pathophysiology of spastic paresis: paresis and soft tissue changes. Muscle nerve, 2005

3. Stecco A et al. Peripheral mechanisms of spasticity and treatment implications. Current Physical Medicine and Rehabilitation Reports 2014

4. Peter P. Purslow The Structure and Role of Intramuscular Connective Tissue in Muscle Function. Front. Physiol., 2020