S146 S290
Poster 14:
Randomized Supplemental Therapeutic Conventional
or Robotic Upper Limb Exercise in Acute Stroke
Rehabilitation
Alberto Esquenazi, MD, FAAPMR (MossRehab, Elkins Park, PA, United
States), Stella Lee, MPA, Thomas K. Watanabe, MD, FAAPMR,
Alexey Nastaskin, MS OTR/L, Katherine Scheponik, MS, OTR/L,
James O’Neill, OTR/L
Disclosures:
Alberto Esquenazi: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
To maximize improvements on function and activity level
in the recovery of the upper limb, we implemented a pilot study to
determine the feasibility and impact of supplemental upper limb ex-
ercises in an acute stroke population.
Design:
Blinded, randomized pilot study.
Setting:
Tertiary rehabilitation hospital, inpatient stroke unit.
Participants:
Stroke patients with unilateral hemiparesis with mini-
mum Fugl-Meyer Assessment (FMA) score of 8/66 or Modified Ashworth
Score of
<
3 receiving usual minimum of 3 hours of daily therapy.
Interventions:
Patients were randomized to conventional or robotic
additional upper extremity exercise groups.
Main Outcome Measures:
This study collects the number of
completed sessions; withdrawals; serious/adverse events and func-
tional parameters data: FMA, Functional Independence Measure (FIM)
and FIM efficiency.
Results:
Data on 15 acute post stroke patients of
<
2 months. Mean
age was 66 years. More than half of the participants were male
(64%) and most participants presented left-sided paresis (79%).
Embolic and ischemic strokes were similarly represented (36%) and
29% of hemorrhagic stroke. One patient withdrew for personal
reasons prior to his first session. All 14 participants (8 robotic, 6
conventional) continued their training sessions until discharge. Of a
total of 80 training sessions, 15 were incomplete. Adverse events
ranged from upper limb pain; fatigue; gastrointestinal symptoms
interfering with training and falls that occurred unrelated to their
study participation.
Conclusions:
This ongoing study depicts an acute stroke population
that received additional upper extremity exercises. Based on the
available data thus far, it is feasible to provide a supplemental func-
tional exercise program to acute post stroke patients in an Inpatient
Rehabilitation Facility (IRF) without serious adverse effects. We
expect to complete and present data analysis on all 40 subjects
including functional outcomes.
Level of Evidence:
Level II
Poster 16:
Technology-Assisted Toilets: Enhancing Toileting
Independence and Hygiene in Geriatric
Rehabilitation
David Yachnin (University of Ottawa, Ottawa, ON, Canada),
Ami AC. Chin, MD, Jeffrey W. Jutai, PhD, Hillel M. Finestone, BS MD
Disclosures:
David Yachnin: Research Grants - TOTO USA
Objective:
To investigate whether Technology-Assisted Toilets (TATs)
could be used to improve toileting hygiene and independence for
geriatric rehabilitation patients. TATs are commercially available
toilet seats that use a stream of warm water to clean the user, have a
fan for drying, and are operated by a wall-mounted remote control.
Design:
Pilot clinical trial.
Setting:
Geriatric Rehabilitation In-patient Unit.
Participants:
25 geriatric rehabilitation patients.
Interventions:
Participants had two trial bowel movements. One trial
involved cleaning themselves with toilet paper; the other involved
cleaning themselves with the TAT functions. After each trial, partici-
pants received a visual inspection for cleanliness and answered a
questionnaire to assess their sense of competence, adaptability, and
self-esteem in the bathroom.
Main Outcome Measures:
Psychosocial Impact of Assistive Devices
Scale (PIADS), a validated tool, was used to assess participants’
competence, adaptability and self-esteem on each trial. A toileting
cleanliness scale, designed for this study, was completed by a nurse
after each trial. Participants received a score from 1 (completely
clean) to 4 (completely soiled) based on a visual inspection after
cleaning.
Results:
TAT and standard toileting cleanliness scores were similar.
PIADS scores showed a trend towards higher scores when using the
TAT, but results were not statistically significant.
Conclusions:
TATs cleaned as well as standard hygiene practice in
geriatric rehabilitating inpatients. Patients rated the TAT as effective
as usual toileting on the PIADS scale. Physiatrists and rehabilitation
professionals should consider prescribing TATs in their practice.
Level of Evidence:
Level III
Poster 18:
Recognizing the Potential of Utilizing Zebrafish
(Danio rerio) for Physical Medicine and Rehabilitation
(PM&R) Research Studies
Manoj K. Poudel, MBBS (Nepalese Academy of Physical Medicine and
Rehabilitation, Nepal; ZENEREI Institute, Slidell, Louisiana, USA,
Clovis, California, United States), Allan V. Kalueff, PhD
Disclosures:
Manoj Poudel: I Have No Relevant Financial Relationships
To Disclose
Objective:
To explore the prospective of zebrafish for translational
research studies related to PM&R specialty and its sub-specialties.
Design:
Literature review.
Setting:
Pubmed database.
Participants:
N/A.
Interventions:
N/A.
Main Outcome Measures:
Importance of zebrafish in PM&R research.
Results:
Zebrafish (Danio rerio) models of human pathologies are
significantly cheaper to maintain, and easier and faster to perform.
Recently, utility of this model organism (including its developing em-
bryo and larvae) as a vertebral model organism is rapidly growing in
biomedical preclinical studies. Numerous human genetic disorders were
found to be modeled in zebrafish because of high genetic homology with
humans, and the availability of its complete genome sequence. The
exceptional regenerative potential of muscle, skeletal, nervous and
cardiac cells of this fresh-water fish was also distinctly discussed in the
literature. In the literature review, the focus of zebrafish models within
rehabilitation medicine research studies was mostly found to be on
various topics of cancers, neuropsychology, imaging studies, regener-
ative medicine, stem cell biology, spinal cord injury, genetic disorders,
immunology and inflammation, wound healing, myopathies, neurode-
generative disorders, neurodevelopmental disorders, musculoskeletal
disorders, neuropathies, traumatic brain injury, electromyogram
studies, pain medicine, etc. A number of publications were on drug
discovery and pharmacology, including the study on botulinum. Despite
the immense potential, there was the lack of significant number of
extensive studies related to rehabilitation medicine which would utilize
zebrafish models to establish strong foundation for preclinical
mammalian studies, and clinical trials in this field.
Conclusions:
Since research is critical to PM&R specialty for improving
practice and rehabilitation outcomes, we emphasize the need of
extensive utilization of zebrafish as an important vertebrate model
organism for translational research in this field. Specifically, PM&R
scientists can strongly explore more roles of zebrafish to revolutionize
regenerative medicine and stem cell biology fields, to understand the
complex pathologies of nervous, musculoskeletal and cardiovascular
systems, and for drug discovery and therapeutics.
Level of Evidence:
Level V
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Abstracts / PM R 9 (2017) S131-S290