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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).
$348 Wednesday, November 9, 2005 Poster Abstracts
Timed 10m walk (i]referred pace), neurological assessment (EDSS), mobility (Rivermead Mobility Index (RMI), MS Walking Scale (MSWS)) and disease impact scales ( U K Neurological Disability Scale (UNDS), SF-36) were also assessed. Results: 53 subjects with MS (35F, mean age 38.4y, EDSS 2.0-6.5) were recruited. The mean daily right stepcount/24hrs over 7 days (range) was 2941 (285-5989). Test re-test reliability (intraclass correlation) was excellent r - 0.93 (p -- 0.001). There was good correlation with the EDSS (Spearman's the - 0.77 p < 0.01) and timed walk (is) (r - 0.78 p < 0.01). There is a lesser relationslfip with the mobility scales (RMI rho -- 0.62 (p < 0.01), MSWS rho - 0.55 (p < 0.01)) and physical function of SF-36 (the -- 0.68, p < 0.01). There was poor correlation with the kINDS (the - -0 .22 , p -- 0.12). Conclusion: Ambulatory monitor ing allowing the counting every step over many days in the patient 's own environment is feasible, acceptable and reliable. It appears to provide additional in fommtion about what the patient does do compared to measures that tell us potential (can do). If one aim of therapies in MS is reduced decline or improvement of walking then demonstrat ing change in own- environment walking activity should be a relevant goal.
0975 Efficacy of an intensive Cognitive neurorehabilitntion program in timetiOnal outcome of patient with cerebral vascular accident (CVA): ease report
Pefia, G l, Mosquera, I, Puccio, F a'~. Zlnstituto de Neurologla y Neuroeieneias Aplieadas. Caracas, Venezuela; 2Instituto de Biomedi- cina/UCV. Caracas, Venezuela
Background: CVA has implication for physical as well as neurocog- nitive function of patients affected. In the treatment of CVA the cognitive neurorehabilitarion has not been employed as a primary treatment option. The neurocognitive deficit as a consequence of a CVA will be as disabilitable or even more than motor deficit. This study was under taken to evaluate the efficacy of an intensive cogtfitive neurorehabilitation program in functional outcome of a patient with cerebral vascular accident (CVA). Methods: We study a 50 year old male patient who assisted to the Neurological and Neurosciences Institute, Caracas, Venezuela. Patient was evaluated before an after cogtfitive neurorehabilitation program with a magnetic resonance imaging (MRI), neurological exanfination and a standardized neuropsycological battery tests. Results: The M R I do not shows anatomical changes in brain damage area after the treatment. However, after the treatment the results indicate an important reduction of deficit manifested in all neuropsy- cological tests. The tests evaluated cogtfifive areas as an attention, concentration, reaction times, memory, execute function, arithinetic reasorfing and calculus, visuospatial and visoconstructive abilities, language and communicat ion capacity, prmxis and gnosis. Patient is able to talk fluently and he is independent in the daily living activities. Conclusion: These results indicated that an intensive cognitive neurorehabilitation program applied in patients with CVA that using together with others treatment as a motor therapy will be a successful management to improve functional outcome and independence wlfich confer quality of live of the patients with a brain damage.
0976 Tile Relntionship of Brain Lesion Location to Functional Outcome in Isehemic Stroke
Saadab, M, Nazzal, M, Trebinjack, S, Saadah, L. t~ashid Hospital, Neurology Department, Dubai, UAE; Jordanian University for Science and Technology, Irbid, Jordan; Rashid Hospital, Physical Medicine Department, Dubai, UAE; Yordanic~ University for Science and Technology, Irbid, Jordan
Objective: Establish the relationship o f the brain lesion location to functional outcome in ischemJc stroke.
Methods: One hundred and eleven (111) ischemic stroke patients, admitted to the rehabilitation department at H a m a d Medical Corporation in Qatar during the period from 1999 to 2002, were evaluated. Stroke was diagnosed by neurological symptoms and signs and neuroradiological findings derived from brain CT scans. The location of brain lesions was defined and correlated to patient performance and functional outcome on admission and discharge. The patient performance on admission and discharge before and after a comprehensive rehabilitation program, was evaluated using the Modified Barthel Index. Results: Motor recovery and functional outcome after stroke were statistically analyzed. Our results demonstrated a correlation between functional outcome and brain lesion location. Confusion: CT scans could be used to predict functional outcome in ischemic stroke patients and should provide the clinicians with an opportunity to offer realistic expectations to stroke patients. Never- theless, in order to obtain the desired outcome, each patient should be given the opportunity to undergo the rehabilitation program regardless of the brain lesion location.
0977 Patients With Left Heudspatial Neglect Have Also Cognitive Dysfunction Of Right Hemispace
Sakai, Y, Katoh, N, Tanaka, S, Katsuyama, S. Gunma University School of Heahh Sciences, Maebashi, Japan
Background: Spatial properties of left hemispatial neglect (USN) were studied using event-related potentials (P300). Method: We recorded wave P300 from 22 patients (15 males, 7 females) with cerebro-vascalar diseases to their right hemispheres. 13 of them suffered from USN. All of them were right-handed. 16 patients had right dominant eyes, and 6 patients had left dominant eyes. Subjects were seated upright 45 cm away from CRT display (117 inches) in a dark room. Visual P300s were recorded in a s tandard oddball paradigm. The common non-target event was a blue circle (diameter: 3cm) in the center of the display in the black background. The target event was a gray square, 3 cm each side, 1 lean away from the circle in the same background. L(R) paradigm had this square situated in the left (right) side of the circle. They were instructed to tap a but ton for a target with an occurrence of 20 '5 , with a inter-stimuhis of 2 sec, and were measured as their reaction time. Five electrodes were placed at Fz, Cz, Pz, C3 and C4 according to the international 10-20 systems, referenced to linked ear electrodes. Results: In both L and R paradigms, P300 latencJes of USN group were longer than those of non -USN group (Mann-Wtfitney, p < 0.05). In U S N group, reaction time of L paradigm were longer than that of R paradigm (Wilcoxon, p < 0.01), and P300 latencies o f L paradigm tended longer than that of R paradigm. Conclusion: Patients with Left hemispafial neglect have also cognitive dysfunction of right hemispace, in addition to left hemispace.
0978 Measureinent of inusde tiber conduction velocity using inulti-point slhnulation technique in rats
Tsubahara, A ~, Metani, H 2, Tanaka, y a Hiraoka, T ~. ZKawasaki Medical School, Okayama, Japan," 2Tamatszdcuri Koseinenkin Hospital, Shimane, Japan
Background: Several techlfiques for measur ing muscle fiber conduction velocity (MFCV) have been reported. We also found that M F C V in a single motor unit could be measured by recording F-waves evoked by weak stimulation. There are, however, no earlier reports of the use of multi-point stimulation (MPS) technique to measure MFCV. In this study, we examined the expectation of measur ing M F C V using MPS in normal rats. Methods: Ten male Wistar rats (10-weeks-old) were anesflletized by intraperitoneal pentobarbital injection, and the right sciatic nerves and