$346 Wednesday, November 9, 2005 Poster Abstracts

Conclusion: The earlier beginning and longer period o f rehabilitaive therapy was benefit for the patients ofmidding-sever cerebral vascular diseases. Key Words: Stroke, rehabilitation, Prognosis.

0967 User Involvement in the Development of Remote Assistive Technology will for Rehabilitation of Spinal Cord Injury

Mawson, S ~, Eiiderby, P~, Bradley, D ~, Acosta-Marquez, CA 4, Hawley, M 5, Browllsell, SJ s, Buff, H 7. 2Sheffield Hallam University, United Kingdom; 2University of Shefj)'eld, United Kingdom; 3University of Abertay, Dundee, United Kingdom; 4University of Abertay, Dundee, United Kingdorn; SBarnsley District General Hospital, Barnsley, United Kingdom; *Brnsley District general Hospital Barnsley, United Kingdom; ZUniversity of Sheffield, United Kingdom

Backgrouml: The incidence of SCI in the U K is 10-15 cases per millioli of the populat ion (Grundy et al., 1986). Tiffs means that there are approximately 600-900 per annum. During the rehabilitation process the physiotherapist is required to move the lower limb through complex movement cycles. This has led to an increasing interest in the provision o f automated and robotic aids to support the manipulative process. One of these developments is the NeXOS project (Bradley et al; 2004), wlffch sets out to design, and pilot a robotic system with computerized patient therapist interface. User involvement is a key element in the development process for any technology and is particularly important in relation to systems for Health Care (Kujala, 2003). Tiffs paper describes the methods, process and results of ilivolvilig users in an early stage of the development of sophisticated rehabilitation equipment. Method: A qualitative approach was used in which eight focus groups were conducted, four with physiotherapist (in -- 32) and four with users (n -- 12). Data were collected using semi-structures interview schedule and analysed thematically with checks for validity. Results: User requirements emerging fi'om the physiotherapists: usefulness, compliance, control, location of treatment, face-to-face contact with users and features of the robot. User requirements emerging from the patients: progress monitor ing and feedback, contact with the physiotherapist. Conclusions: Tiffs information was used by the project team to establish the techuical requirements for the prototype robotic devise and computerized interface, which is currently undergoing further evaluation by users.

0968 Clitdeal outcome predictors in strokes above 55 Years: A eommunily hospital experience

Menon, E. St.Andrew's Community Hospital, Singapore

Introduction: stroke has remained the third leading cause of death in Singapore, accounting for about 12% of all deaths annually. In acute stroke care after their journey from stroke units to step down colimmliity rehabilitation hospitals for continued rehabilitation the cliuical factors that affect their mobility and their cooperatioli ill this program is what made us want to study the demograplffc profile of our inparients in a communi ty hospital rehabilitation program, their cognitive status as measured by the abbreviated memory test (amt) and the mini mental state exaliffliatioli (nm~se) and their fulictiolial status on adliffssioli and discharge using the modified barthel index (mbi), to make realistic and relevant informed decisions as a team and to the family, to coordinate and continue stroke care into the community. Method: 82 inpatients for stroke rehabilitation were stuydied from September 2001 to April 2002. Left hemiplegics were 46.3%, right hemiplegics were 50%. Ischemic strokes were noted in 72 patients, the remainder was classified as haemoragic in nature. The mean age of the cohort group was 75 years and their mean length of stay in our colimmliity hospital was 28 days. Details of age, gender, side o f stroke,

previous strokes, hemianopias, dysphasias, dysphagias, continence together with the above mentioned scores on admission and discharge were correlated with our IIlobility points o f dischage plaliiiilig in core adl activities and whether they remained bedboulid, home or a comlilunity ambulater achieving certain conmmuity adl skills of food preparation, finance and medication management in addition to moving around in the community. Results: patients admitted with a mbi score of 0, amt below 1 and mmse below 1, remained totally dependant and bedbound upon discharge (14 patients). Homeboulid patients with poor sitting balance with, inability to stand and severe coguitioli impaitallelit (142 patients) had on admission a mbi score o f less than 33, amt score less than 3 and a mmse score less than 12. All our remaining 26 patients with an amt score above 4, mmse score above 12 and a mbi score on admission above 33 went onto a walking program, corfmluliity ambulant with all aid and requiring IIloderate to IIlinimal assistance in their colimlUlffty adl skills. None of our cohort patients achieved total independence in walking or adi skills.

0969 Muscle liber conduction veloeily in rats with steroid ulyopathy

Metani, H ~, Tsubahara , A 2, Tanaka, y2, Hiraoka, T 2, Tadatoslff, M 1 . ZTamatsukuri Koseinenkin Hospital, Shimane, Japan 2Kawasaki Medical School, Okayama, Japan

Background: Muscle fiber conduction velocity (MFCV) was reported to decrease in patients with some kinds of myopathy as well as disuse atrophy. There are, however, no reports about chaliges of M F C V in steroid myopa thy (SM). In tiffs study, M F C V in rats with SM was compared to that in normal rats. Methods: Ten male Wistar rats (8-weeks-old) were treated with intramuscular injection of triamcinolone for 2 weeks (group SM). Other 10 normal male rats (10-weeks-old) were bred as the control group. After the right sciatic IIerve and soleus muscle were exposed, all original 4-chaliiiel surface electrodes array was placed over the IImscle belly parallel to the fibers. The sciatic nerve was stimulated electrically at various sites based on the motor point stimulation (MPS) technique. Stimulus intensity was set at rninimum to record a single motor unit potential. MFCW was calculated fi'om the distance of each electrode and each time lag between IIeighborilig potentials. Twenty M F C V values per each material were recorded. Results: There were significant differences ill the IIleali M F C V values between the group SM and the control group. The fast values of MFCV decreased markedly in rats with SM, while the lowest values were the same as the control group. Conclusion: M F C V in rats was found to decrease after the treatment of steroid injection. Decrease in the fast values of M F C V is in agreement with type-2 fibers atrophy in SM. Additionally, it cannot be denied that the present technique could not detect the slow components of MFCV.

0970 Monitoring of early post-apoplectic rehabilitation (EPR)

Nicpon, K. Dept. of Neurology and Early Post-Apoplectic Rehabilitation

Background: EPR is a new item in the catalogue of medical procedures contracted by the National Health Fund in Poland. It aims at an improvement of motor function, daily livilig activity, and reduction of the degree of invalidity. Aim of the present study was to argue for the efficacy and necessity of EPR from the point of view of medical services of a profiled ward on the basis o f achieved results confirmed by chnimetric assessment. Methods: We exaliffned 158 patients with ischemic stroke (IS), hospitalized for EPR (141 to 90 years old -iileali 69): 83 women and 75 men. Monitoring included all identification o f the degree of

Poster Abstracts Wednesday, November 9, 2005 $347

invalidity (Rankin scale), the activity of daily living (Barthel index), and motor function (Bydgoszcz Scale of the General Body Motility). Results: In the total group of patients after IS, the degree of invalidity at the beginning of EPR was higher than after its completion (13,2 (1,9) vs. 2,6 (11,7); p < 0,05), and the activity of daily living at the beginning of EPR was lower than after its completion (8,8 (10,3) vs. 10,3 (6,2); p < 0,05); similarly, the motor function (14,9 (6,3) vs.16,7 (7,1); p < 0,05). Conclusion: In result of EPR a significant improvement was achieved in reduction of the degree of invalidity, improvement of daily living activity and motor function. This may confirm the necessity of conducting that form of therapy in the system of complex medical care of patients after IS in Poland.

0971 Tile etti~et of applying aCetyl solyefl acid (ASA) on tile degree of neurological deticit and the result of rehabilitation in stroke patients with atrial tibrillalion

Nik$evifi Lj ~, Saris M a, Jovanovi6 M ~, Plavsie, A ~. 1The Hospital "Saint Sara" for prevention and treatment of eerebrovaseular diseases, Belgrade, Play,fir A.-Military Medical Academy; 2Military Medical Academy, Belgrade, Serbia & MOntenegro

Background: To examine the effects of ASA on the result of rehabilitation at patients with atrial fibrillation. Method: 144 patient was examined (followed) Group A-with atrial fibrillation, Group B in sinus rhytham. The groups have been divided into subgroups 1. regular ASA application, 2. periodically, 3. never. The graveness of neurological deficit on arrival (reception of the patients) and after 90 days treatment was determined by FIM test. The results were processed by the standardized statistical methods.

The results-The mean values A1 -- 40,72, A2 -- 38,55, A3 - 31,35 difference between 1 and 3 p < 0,01 on the reception. A1 -- 79,41, A2 -- 70,75, A3 - 55,70 dift'erence still exist even after 90 days of rehabilitation p < 0,01. Between the patients of group A FIM-the mean values 37,13 and the group B 41,35 there is a significant difference on the reception p < 0.01. After 90 days of rehabilitation there is no difference, the group A - 69,43, group B -- 73,92, p > 0.05. In the scope of group B there is no significant difference among subgroups on the reception, but appears after 90 days rehabilitation p < 0.01. Conclusion: Regular application of ASA at patients with atrial fibrillation influence on minor neurological deficit and faster rehabilitation after stroke. The ASA application does not give statistical significant result at patients with sinus rhytham at the reception, but significantly improves the results of rehabilitation.

0972 Comparative study of neurodevelopment lreatment with or without BTX- A injection in the management of spagticity of hemiplegie patients

Olyaei, G, Aboulfazli, R, Talebian, S, Ansari, N, Sheikh, M. Tehran University of Medical Sciences; Department Neurology, Amiralam Hospital

The aim of this study was to compare the effect of neurodevelopment treatment (NDT) with BTX-A injection and NDT alone in reduction of spasfidty and improvement the quality of movement patterns of lower limb in hemiplegic patients.

Twenty hemiplegic patients (19 female, 11 male) with age ranging from 41 to 78 years participated in tiffs study. They were in spastic phase and could have been walked with or without assistive device. Severity of spasticity according to original ashworth scale (OAS) was between 1 to 3. In group one patients were treated by NDT method and in group two patients were treated by NDT and BTX-A injection. Baseline assessments consisted of: spasticity severity in plantar flexor's muscles according to OAS, active and passive range of motion of ankle joint and quality of movement patterns of lower limb in standing

position according to NDT. Injection of BTX-A was performed in gastrocnemius muscle (1200 u in 4 sites of medial and lateral heads), soleus muscle (75 u in 2 sites) and tibialis postenor muscle (50 u in 2 sites). NDT in two groups was performed by 10 sessions.

In two groups, decreasing of OAS, increasing of active and passive range of motion and quality of movements patterns were seen. All of this changes were more significant in group 2. In each group, severity had been significant correlation with recovery according and quality of movement patterns.

NDT with inlfibition of abnormal patterns, fascilitation of normal responses and increasing the ability of patient to perform discrete movements in spite of presence of synergic movement patterns can reduce spastidty, increase range of motion and quality of movement patterns. Direct effect of BTX-A on muscle tone and reduction of spasticity can increase the effectiveness of neurodevelopment treat- ments.

0973 Does fatigue influence real-life mobility?

Pearson, OR ~, van Deursen, R 2, Robertson, NP a, Wiles, CM ~. 1Departments of Neurology & 2Physiotherapy Education, Cardiff University, Cardiff, UK

Background: Fatigue and mobility difficulties are extremely prevalent in people with multiple sclerosis (MS). Ambulatory activity monitoring allows continuous monitoring of every right step taken within an nidividual's own environment permitting assessment of real-life mo- bility. We aim to investigate the relationship between real-life mobility and fatigue. Methods: Subjects with MS (across a range of disability) underwent 1 week of activity monitoring and the Kurtzke Expanded Disability Severity Scale (EDSS). Fatigue was assessed using the Fatigue Severity Scale (FSS) and fatigue component of the United Kingdom Neurological Disability Scale (F-UNDS). Results: 39 MS subjects (24F, mean age 40.4, EDSS 1.5 6.5) completed monitoring. The mean daily tight stepcount over 7 days was 2652 (range 451-6017, SD 1434): there was a significant correlation with the EDSS (Spearman's rho - -0.81 p -- 0.001). With respect to fatigue step count was negatively correlated with the FSS (rho -- -0.56 p - 0.001) but there was no sigtfificant correlation with the F-UNDS (rho - 0.27 p -- 0.1). The fatigue scales were related with each other (rho - 0.68 p - 0.001). There was a confounding correlation between EDSS and the FSS (rho - 0.52 p -- 0.001). When this is corrected for, the partial correlation with the mean stepcount is -0.37 p -- 0.02. Analysis of variance reveals that EDSS accounts for 65% of the variability in mean stepcount and fatigue an additional 5%. Contusion: It is possible to measure actual perforated mobility in neurological disease, rather than that which is derived or perceived. Fatigue does influence real-life mobility, but this relationship is com- plicated by the over-riding impact of disability. When this is adjusted for, the role of fatigue per se in actual performed mobility is small.

0974 Can actual real-lite mobility be measured?

Pearson, OR ~, Busse, ME e, Robertson, NP ~, van Deursen, R ~, Wiles, CM a . 1Departments of Neurology & 2Physiotherapy Education, Cardiff University, Cardiff, UK

Background: In Multiple Sclerosis (MS) impaired walking is a key marker of disability and has a fundamental impact on participation. Walking mobility in MS is assessed using subject- or observer- rated tools but it is uncertain how these relate to real life mobility. Ambulatory activity monitoring allows unobtrusive counting of every right step, which may allow a closer estimate of what patients actually do. Methods: Ambulant MS subjects underwent two activity-monitoring periods of one week in their own envirotmtent (mean stepcount/24hr).