S136 S290
Design:
Control study.
Setting:
Plasticity of spinal cord injury.
Participants:
Fifteen patients with incomplete SCI and 22 normal
subjects were enrolled.
Interventions:
Not applicable.
Main Outcome Measures:
The whole brain gray matter density
(GMD) was measured to indicate the structural changes. The brain
networks, including region-based whole brain network, and voxel-
based local network, were used to evaluate functional brain
characteristics.
Results:
It was found that the brain structural alteration following SCI
was accompanied by changes of local network connectivity. Dorsal
lateral prefrontal cortex (DLPFC) was found an important area of both
decreased GMD and changed intra-region network. DLPFC features of
intra-region network significantly related to sensory disability posi-
tively or negatively. DLPFC features of intra-region network signifi-
cantly related to sensory disability positively or negatively.
Conclusions:
It is suggested that structural and functional charac-
teristics of DLPFC could serve as potential MRI biomarkers to predict
functional recovery. Furthermore, DLPFC may be a key region for
potential therapeutic target for rehabilitation of incomplete SCI
patients.
Level of Evidence:
Level II
Poster 89:
Delineation of Brain Circuit Changes after Mild TBI
(mTBI) in Veterans with and without Post-Traumatic
Stress Disorder (PTSD)
Juewon Khwarg, MD (VA-GLAHS/UCLA PM&R, Los Angeles, CA, United
States), Vincent Y. Ma, MD, Daniel Estrada, MD, Joseph Collins, DO,
Ryan C. Brewster, PhD, Neil G. Harris, PhD, Sharon Gohari, MD
Disclosures:
Juewon Khwarg, MD: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
1. To use functional MRI to identify characteristic post-
mTBI differences in brain circuit organization between Veterans with
and without concomitant PTSD. 2. To correlate measures of brain
circuit organization to performance on clinical balance assessments
and neuropsychological testing.
Design:
This cross-sectional study will recruit Veterans diagnosed with
mTBI with and without PTSD. Subjects will undergo a clinical balance
assessment on the SMART Balance Master system and a brief battery of
neuropsychological assessments, including Beck Depression Inventory,
PTSD-M Check List, Rey-15 Item Test, Wechsler Adult Intelligence Scale
IV Digit Span subtest, Wechsler Test of Adult Reading, and Trail Making
Test. Subjects will then undergo neuroimaging with various MRI mo-
dalities to assess: 1) white matter disruption using diffuse tensor im-
aging (DTI), 2) blood flow using arterial spin-labeling (ASL) MRI, and 3)
synchrony of brain regions using resting state functional MRI. Abnor-
malities will be correlated with clinical measures including presence of
PTSD and performance on balance and neuropsychological
assessments.
Setting:
Outpatient Specialty TBI Clinic.
Participants:
OEF/OIF/OND veterans diagnosed with mTBI with and
without PTSD; Demographically-matched controls. Estimated study
population of 60 total.
Interventions:
Not applicable.
Main Outcome Measures:
1. DTI/fMRI changes will be compared be-
tween the TBI+PTSD, TBI only, and control groups. 2. DTI/fMRI changes
will be correlated with clinical balance and neuropsychological
assessments.
Results:
Results pending. Will be complete at time of annual
assembly.
Conclusions:
Mild TBI continues to pose diagnostic challenges,
particularly in the veteran population. Resting state-fMRI offers a
promising imaging modality that can detect previously unnoticed
changes in neural networks. This study aims to elucidate the poten-
tially confounding effect of PTSD on fMRI imaging findings in mTBI. This
could lead to insights on how PTSD and mTBI interact, as well help
differentiate clinical findings caused by mTBI vs PTSD.
Level of Evidence:
Level IV
Friday, October 13, 2017
10:00 AM
e
11:00 AM
Exhibit Hall D, Exhibit Hall Level
RESEARCH SPOTLIGHT: NEUROLOGICAL REHABILITATION
ePOSTER SESSION
Poster 84:
Estimated Life Time Savings from Specialist
Rehabilitation Following Traumatic Brain Injury: A
Large Multi-Centre Cohort Analysis from the UK
Rehabilitation Outcomes Collaborative (UKROC)
Database
Alan R. Bill, ACA (UK Rehabilitation Outcomes Collaborative),
Lynne F. Turner Stokes, DM FRCP, Alan R. Bill, ACA, Heather Williams,
MSc, Keith Sephton, N/A
Disclosures:
Lynne Turner Stokes: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
To estimate potential life-time savings in the cost of
ongoing care following rehabilitation for complex traumatic brain
injury, comparing three groups of dependency.
Design:
Analysis of prospectively collected clinical data from the
UKROC national clinical database.
Setting:
Specialist (Levels 1 and 2) rehabilitation centres in England
(n
¼
66).
Participants:
All TBI episodes with complete data between 2012-2016
(n
¼
2639).
Interventions:
Inpatient specialist rehabilitation.
Main Outcome Measures:
Recorded on admission and discharge, the
Northwick Park Dependency and Care Needs Assessment (NPDS/
NPCNA) calculates the savings in ongoing care-costs in the com-
munity. Life expectancy was computed in four groups defined by
Functional Independence Measure (FIM) scores at discharge: ‘Walks
well alone’, ‘Some walking ability’ and ‘Unable to walk: self-feeds
or fed by others’.Percentage reduction in predicted life expectancy
following TBI calculated using US mortality figures (Shavelle 2007,
Brooks 2015) applied to national UK projected life expectancy
figures (Office of National Statistics). Life-time savings (‘savings in
ongoing care costs/year x remaining years of life’) were analysed in
three groups of dependency, based on NPDS scores on admission:
High (NPDS
>
25; n
¼
1407); Medium (NPDS
¼
10-25; n
¼
678): Low
(NPDS
<
10; n
¼
499).
Results:
Mean age 48 (sd18.9) years; mean length of stay 81 (sd72)
days. Mean annual savings in care costs were
£
29,057 (95%CI:
£
27299,
£
30,686) and the mean remaining life expectancy was 26.3 (95%CI:
25.7, 27) years. Estimated life-time savings in ongoing care costs were
£
1,047,779 (95%CI:
£
982,946,
£
1,109,651) per patient, totaling
£
2.7
billion for the analysed population (n
¼
2639).
Life expectancy was shortest in the High-dependency group at 21.5
years (Medium 29.7 and Low 32.7). However, the cost savings were
larger, so the mean life-time savings were greatest in the High- and
Medium dependency groups (
£
1,031,399 and
£
1,145,511 respectively,
compared with
£
263,124 in the Low-dependency group).
Conclusions:
Despite their shorter life expectancy, the more depen-
dent patients had the greatest potential for making life-time savings in
the cost of ongoing care.
Level of Evidence:
Level II
S136
Abstracts / PM R 9 (2017) S131-S290