2nd TBI-Challenge.eu 2013...2nd TBI Challenge.eu 2013 2nd TBI Challenge.eu 2013 Traumatic Brain Injury is the second frequent neurological disease, directly after the ischaemic stroke

2nd TBI-Challenge.eu 2013

September 19th to 20th, 2013 in Vienna

Biennial Interdisciplinary Conference of the

Brain Injury and Families / European Federati on (BIF)

PROGRAM & ABSTRACT BOOK

www.tbi-challenge.eu

©WienTourismus/MAXUM© WienTourismus/Christi an Stemper

2nd TBI Challenge.eu 2013

INTENSIVENEUROREHABILITATIONfor TBI Patients

“Improving quality of life by restoring abilities.”

SCIENTIFIC

PROPRIOCEPTIVE

HYPERBARIC

CONCEPTS

30 HOURS

Effective Approach

Treatment

Oxygen Therapy

from Space Medicine

of Therapy per Week

Univ. Prof. Dr. Dr. h.c. mult.

“The ADELI Medical Center

at Piestany is equipped with

all the facilities of modern

neurorehabilitation.”

Franz Gerstenbrand

www.adeli-center.com

Contact:

ADELI Medical CenterHLBOKÁ 47, PIEŠŤANY

SLOVAKIA

Tel.: +421 33 79 15 900

E-mail:

[email protected]


Content

INTENSIVENEUROREHABILITATIONfor TBI Patients

“Improving quality of life by restoring abilities.”

SCIENTIFIC

PROPRIOCEPTIVE

HYPERBARIC

CONCEPTS

30 HOURS

Effective Approach

Treatment

Oxygen Therapy

from Space Medicine

of Therapy per Week

Univ. Prof. Dr. Dr. h.c. mult.

“The ADELI Medical Center

at Piestany is equipped with

all the facilities of modern

neurorehabilitation.”

Franz Gerstenbrand

www.adeli-center.com

Contact:

ADELI Medical CenterHLBOKÁ 47, PIEŠŤANY

SLOVAKIA

Tel.: +421 33 79 15 900

E-mail:

[email protected]

Welcome Address .........................................................................................................................................................2

Program Thursday, September 19 ............................................................................................................................ 4-5

Program Friday, September 20 ................................................................................................................................. 6-7

Poster Presentati on ..................................................................................................................................................... 7

TBI-Art Gallery ............................................................................................................................................................. 7

Organisati on ................................................................................................................................................................ 8

General Informati on .................................................................................................................................................... 9

Informati on for Presenters ........................................................................................................................................ 10

Abstracts ............................................................................................................................................................... 11-19

Author index / Keyword index ................................................................................................................................... 20

Announcement .......................................................................................................................................................... 20

Exhibitors & Sponsors ................................................................................................................................................ 21

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Traumatic Brain Injury is the second frequent neurological disease, directly after the ischaemic stroke. It represents a silent burden in Europe that is constantly growing. The TBI is difficult to grasp, because of the many faces of this illness that always results in an individually different situation after the trauma. It does not only concern the traumatised but also the family, the social environment and it also concerns the health and social security profes-sionals and the European governments.

The TBI is a challenge for many different research fields, such as traumatology, neurosurgery, intensive care and internal medicine, neurology, neurorehablitation, physical medicine, psychiatry or psychology. Scientifics have to research and collaborate in these different fields to find solutions for individual applicable response to the burden. The approach to TBI is varying in every European country as every health system is dealing with individual cultural and historically grown situations and needs.

After the acute phase of TBI the long rehabilitation and reintegration process needs intensive interdisciplinary team-work to combine acute and long term treatment and reeducation in a strong and trustful collaboration with the family parts. In the modern world also technical and ethical solutions have to and can be found to improve individual rehabi-litation after brain injury.

TBI itself can be prevented as well as secondary brain damage after the trauma. Medicine and paramedical professio-nals have to meet industries and governmental health responsible persons to be able to respond and prevent TBI and its consequences.

Through the intensive program of the TBI-Challenge.eu 2013 researchers, industries and TBI affected are brought to-gether with the goal to improve the contact between the involved groups, to highlight the recent scientific research on TBI and to raise collaboration in the European TBI society and awareness and visibility of TBI in Europe.

BIF-Europe in cooperation with the Austrian Association of TBI is organising the congress with endorsements through the European Brain Injury Society, the Austrian Society of Neurological Rehabilitation, the Austrian Society of Neurolo-gy, the Austrian and Viennese Family Association of TBI and the Austrian Ministry of Health.

We are looking forward to meeting you in Vienna!

With the very best regards

Nikolaus SteinhoffPresident of the TBI-Challenge.eu 2013

Welcome Address

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09.00 – 10.00 Opening Ceremony Dr. Nikolaus Steinhoff, General Secretary of BIF Mr. Hans Grugger, Austrian Ski Champion Prof. Dr. F. Gerstenbrand Prof. Dr. W. Oder, AUVA Prof. Dr. Evelyn Vincent, President of BIF

10.00 – 10.15 Coffee Break and Technical & Poster Exhibition

10.15 – 12.15 Panel Session 1 – Acute Management after TBI Chair: W. Mauritz

10.15 – 11.00 O.01 - Quality of early care influences long-term outcomes of patients with TBI W. Mauritz

11.00 – 11.25 O.02 - Disorders of consciousness after acquired brain injury - a review of possibilities with deep brain stimulation method K. Grabljevec

11.25 – 11.50 O.03 - Rehabilitation of disorders of consciousness after traumatic brain injury U. Leon-Dominguez

11.50 – 12.15 O.04 - Looking at TBI as a comprehensive trauma, a phenomenological perspective on TBI and its impact on family system P. Galiana y Abal

12.15 – 13.15 Break for Lunch, Technical & Poster Exhibition

13.15 – 15.20 Panel Session 2 – Minor TBI Chair: J. Opara

13.15 – 13.40 O.05 - Outcome measure after TBI - clinical scores and scales evaluating functioning following Rehabilitation J. Opara

13.40 – 14.05 O.06 - Protocol for early rehabilitation in patients with neurotrauma S. Wasti

14.05 – 14.30 O.07 - The use of Brief Core Sets for TBI in occupational therapy to measure outcome of rehabilitation - presentation case A. Rotar 14.30 – 14.55 O.08 - How to offer something more to persons with acquired brain injury in terms of long-term rehabilitation - example of good practice: introducing therapeutic approaches with animals M. Čeh 14.55 – 15.20 O.09 - Reorientation Syndrome, Loneliness and Emptiness after TBI - Mechanism, access and solutions to this underestimated and to all problems after TBI underlying phenomenon N. Steinhoff


Program - Thursday, September 19, 2013

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15.45 – 17.25 Panel session 3 - Neurological Long Term Rehabilitation in TBI Chair: P. Schnider

15.45 – 16.10 O.10 - Botulinum Toxine in neurological Rehabilitation P. Schnider

16.10 – 16.35 O.11 - A Randomized Controlled Trial on Impact of Two Training Packages on the Knowledge and Care Practices of The Family Care Givers of Operated Neurosurgery Patients M. Kalyanasundaram

16.35 – 17.00 O.12 - Ethical issues in the management of Brain Injury S. Wasti

17.00 – 17.25 O.13 - Acute subdural hematoma: prognostic factors in patients admitted to surgical drainage in the emergency department J. Lavrador

20.00 Mayor’s Invitation - Heurigen Evening at the “10er Marie” Vienna’s oldest Vine Tavern (Michael Perfler performing “Wienerlieder”)

Program – Thursday, September 19, 2013 (cont.)

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Program – Friday, September 20, 2013

09.00 – 10.45 Panel session 4 - Prevention and TBI Chair: J. L. Truelle

09.00 – 09.25 O.14 - Apply principles of neurorehabilitation to traumatic brain injury J. L. Truelle

09.25 – 09.50 O.15 - Teleneurorehabilitation - A Way to Improve Prevention at Home and Training in Neurological Long Term Rehabilitation N. Steinhoff

09.50 – 10.15 O.16 - Epidemiology of ABI: Characteristics of the hospital discharges of men and women under 50 years of age living in Castelló: Valencian Community MBDS 1995-2005 V. A. Arrufat Gallen

10.15 – 10.40 O.17 - Effects of long-term support for families with a child with acquired brain injury E. Hermans 10.40 – 11.05 O.18 - Serum biomarkers for predicting outcome after TBI J. Opara


11.30 – 13.00 Panel session 5 - Art and Neurorehabilitation Chair: G. Tucek

11.30 – 11.55 O.19 - Music and Rehabilitation G. Tucek

11.55 – 12.20 O.20 - Painting and Rehabilitation M. Murg-Argeny

12.20 – 12.45 O.21 - Challenged Conquistadors, Inc. S.W. Best

12.45 – 13.10 O.22 - Workshop French sheltered housing programmes J. Ruch

13.10 – 14.00 Break for Lunch, Technical & Poster Exhibition

14.00 – 15.45 Panel session 6 - Physical Brain Trauma and Psychological Trauma Chair: T. Wenzel

14.00 – 14.25 O.23 - Psychological Trauma after TBI T. Wenzel

14.25 – 14.50 O.24 - Is there an effect on the Self in individuals with PTSD and TBI: A feasibility Study K. G. McWilliams

14.50 – 15.15 O.25 - Risk factors for suicidal ideation after mild traumatic brain injury L. da Costa

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Program – Friday, September 20, 2013 (cont.)

15.15 – 15.40 O.26 - Self-Perceived Quality of Life in TBI Patients and ist plausible correlation with cognitive impairment and psychological disorder P. Galiana y Abal

15.40 – 16.05 O.27 - Environmental factors and their impact on the long term rehabilitation of a person with traumatic brain injury S. Dečman

16.05 – 16.30 Coffee break and Technical & Poster Exhibition

16.30 – 18.10 Panel session 7 – Neurological Rehabilitation in TBI and Ethics Chair: F. Gerstenbrand

16.30 – 16.55 O.28 - Ethics in Neurorehabilitation F. Gerstenbrand

16.55 – 17.20 O.29 - Games and Arts Fun Ways to Develop Capabilities E.B. Afonso

17.20 – 17.45 O.30 - Experienced Disablement in the Narration of People with Traumatic Brain Injury – Anthropological Perspective A. S. Marttila

17.45 – 18.10 O.31 - Ethics in neurorehabilitation A. Bernardini

18.10 Free Evening

Poster PresentationsP.01 New Innovative NCE for the Treatment of Traumatic Brain Injury A. Harel

P.02 Rehabilitation of people with brain injury in Slovenia V. Trdan

P.03 A survey on the use of medications in Italian rehabilitation center inpatients following acquired brain injury G. Cosano

P.04 Dance - movement therapy (DMT) T. Lipovšek

P.05 Dual-tasks as an approach to estimation of the brain functional recovery in patients with traumatic brain injury T. Shevtsova

TBI-Art GalleryPaintings by the following artists after Traumatic Brain Injury- Michal Balak - Liane Heim- Johannes Gruber - Asger Svendsen

will be presented at the conference7



Organisation

Congress President:Dr. Nikolaus Steinhoff Österreichische Gesellschaft für Schädel-Hirn-Trauma Lascygasse 20/18 A-1170 ViennaE: [email protected]

BIF Executive Committee Evelyn Vincent, President Niels-A. Svendsen, Vice-presidentNikolaus Steinhoff, Secretary GeneralChristian Memrez, TreasurerMarie-Jeanette Bergvall, Director Vera Bonvalot, Director Amalie Dieguez, Director Gerard Gueneau, Director Marcela Janeckova, Director Cristian Leorin, Director Kieran Loughran, DirectorPhilippe Palate, Director Marjatta Pihlajamaa, DirectorVeronika Trdan (Sl), Director

Scientific Board and ContributionKatherine AllenPaolo BoldriniNiel BrooksAmbrogio CozziChristine CroisiauxFrancois DanzéFranz Gerstenbrand Arièle LambertJosef OparaClaudio PerinoPeter Schnider Jean Luc TruelleKlaus von WildAndreas Zieger

Conference Management:Vienna Medical AcademyCatherine AltermannAlser Strasse 41090 Vienna, AustriaT: +43 1 405 13 83 18F: +43 1 407 82 74E: [email protected]: www.medacad.org

Exhibition Management:Medizinische Ausstellungs- und Werbegesellschaft (MAW)Antonia-Sophie DopplerFreyung 6/31010 Vienna, AustriaT: +43 1 536 63 75F: +43 1 535 60 16E: [email protected]: www.maw.co.at

Accommodation: COLUMBUS Ihr Reisebüro GmbH & Co.KG.COLUMBUS WELCOME MANAGEMENTUniversitätsring 8A-1010 Vienna T: +43 1 534 11 147 F: +43 1 534 11 202 E: [email protected] W: www.columbus-vienna.com

VIEN

NA

ACA

DEMY OF POSTGRADUATE MED

ICAL

EDUCATION AND RESEARCH

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General Informati on

Meeti ng Venue:University of ViennaFaculty of Law “Juridicum”Basement – Lecture Room 11Schott enbastei 10-161010 Viennawww.juridicum.at

Conference Fees (in EUR): Dayti ckets

BIF or Nati onal TBI Assoc Member Professional 350,- 175,-Non-Member Professional 400,- 200,-BIF or Nati onal TBI Assoc Member Family /TB Injured 180,- 90,-Non-Member Family /TB Injured 200,- 100,-Student 200,- 100,-Professional in Training 270,- 135,-

Registrati on hours:Thursday, September 19, 2013: 07:45 – 18:00 Friday, September 20, 2013: 08:00 – 18:00

DFP – Diplomfortbildungsprogramm:(Austrian Medical Associati on for Conti nuous Educati on)The Austrian Medical Associati on has granted the following points to the congress: subject-specifi c DFP credits: 18Die Anzahl der gemäß Approbati on durch das Fortbildungsreferat der Österreichischen Ärztekammer anerkannten Fortbildungsstunden lautet wie folgt: 18 DFP.Für den Erhalt der DFP-Punkte ist die Angabe der OÄK-Nummer verpfl ichtend.

Social Programm:Thursday, September 19, 2013 20:00 - 24:00 hrsMayor’s Invitati on - Heurigen Evening at the “10er Marie” Vienna’s oldest Vine Tavern

Dress code: Casual

Address: Ott akringer Strasse 222-224, 1160 Vienna, Austria

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Information for Presenters

Oral Presentation:

Speaking TimeThe chairpersons of your session will be strict in allowing no more than the time allotted to your paper. Remember to allow some time for the changeover of speakers and chairperson‘s introduction, and for questions and discussion. * For 25 minutes slots a maximum of 20 minutes speaking time + 5 minutes discussion timePlease rehearse your talk to make sure it will fit comfortably into the available time.

Please note that, as a rule, presenters can show a (final) slide with all acknowledgements, however, in view of the short time available, names cannot be read to the audience.

Make yourself known to the chairpersons in your session room before the beginning of the session.

Projection and Technical Setting • It is essential that you load and view your presentation with the technician in the room preferably in the break before your talk, but not later than 30 minutes in advance.• Please prepare your presentation on a USB-stick or a CD-ROM. You may want to carry a second USB-Stick/CD as a back-up in case there is any insoluble technical problem

Poster Presentation:

Schedule for display, mounting and removal• Posters will be on display from Thursday, September 19, 2013 (10.00 hrs) to Friday, September 20, 2013 (16.00 hrs).• Poster mounting will be possible on: Thursday, September 19, 2013 from 09:00 -10:00 hrs.• Removal will be possible on: Friday, September 20, 2013 from 16.00 hrs - 17.00 hrs.

Please note that posters not removed until then, will be taken down by the staff of the conference center and will not be stored or sent to the authors after the meeting.

• In order to enable discussion and interaction with other participants, we would kindly ask you or one of your group to be at your poster board during the Coffee and Lunch breaks.• Your poster board number has been sent to you in the information email for poster presenters. You will also find this number in the TBI-Challenge.eu 2013 – Program & Book of Abstracts.

Format• The usable surface on the poster board will be 90 cm width x 130 cm height (approx. 35 x 51 inches).• Adhesive material will be made available.

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Abstracts

ORAL PRESENTATIONS(Missing presentation numbers represent talks with no abstracts received as per date of production.)

01 - Acute Management after TBI

O.01Quality of early care influences long-term outcomes of patients with TBI

W. Mauritz, A. Brazinova, M. Majdan; International Neurotrauma Research Organization, Vienna, Austria.

Background: Earlier studies showed that early care is most important during management of traumatic brain injury (TBI) patients. The ob-jectives of this study were to analyze the current state of early TBI care in Austria, define areas for improving outcomes, implement the proposed changes, and analyze their effects.Methods: 16 Austrian centers treating TBI patients participated in the study. Between 2009 and 2012 all patients with Glasgow Coma Scale scores below 12 and/or AIS score for the region „head“ over 2 were enrolled. Data was collected in 2 phases. In the first phase data on 448 patients was collected and analyzed. Based on the analysis, a set of recommendations associated with improved outcomes was developed and implemented in participating centers. Main recommendations included direct transport to appropriate center, prehospital monitoring of pulse oximetry, blood pressure and capnography (in ventilated patients), maintaining normoventilation, avoidance of Ringer’s lactate solution in prehospital fluid resuscitation, start of first CT scan within 60 minutes, and start of neurosurgery (when indicated) within 120 minutes after hospital arrival. After the implementation of the recom-mendations data on 330 patients was collected and analyzed in the second data collection phase. Final analysis was performed to confirm the impact of the recommendations on patient outcomes.Results: Patients in both data collection phases were of comparable demographic and injury severity characteristics. Recommended treatment changes were implemented successfully and lead to sig-nificant improvement of patient outcomes. Second phase patients had 22% lower hospital mortality, 24% lower unfavorable long term outcomes, significantly more unexpected survivors, and significantly more patients with unexpected favorable outcomes.Conclusions: The results of this study demonstrate that the outcomes of TBI patients can be improved by optimal early care.

O.02Disorders of consciousness after acquired brain injury - a review of possibilities with deep brain stimulation method

K. Grabljevec; University Rehabilitation Institute Ljubljana, Ljubljana, Slovenia.

Improvements of emergency medicine enable to survive a major part of comatosed patients after severe brain injury. After evolving from coma, some of them show no evidence of awareness of self and environment and have no meaningfull response for the external stimuli, the condition which is called an ,,Unresponsive wakefulness syndrom“. The reason lies in focal or widespread uni- or bilateral injury of the central thalamic in parathalamic nuclei and rostro-caudal regions. In some patients we can observe inconsistend but cognitivelly mediated behaviour on external stimuli, which is reproducible or sustained long enough to be differentiated from reflexive behaviour and such condition is called ,,Minimally conscious state“. With the ,,Deep Brain Stimulation - DBS“ method, usually the region of centromedian - parafascicular complex in dominant hemisphere is timulated with implantable electrodes. Method

showed to be effective in rare cases of patients in vegetative state to improve awareness and responsiveness to external stimuli and ability to communicate, but no improvement of motorical control was observed. There was more ramarkable improvement in the group of patients in ,,Minimally conscious state“, who were able of independent ambulation and reached some degree of independence in daily activities.

O.03Rehabilitation of disorders of consciousness after traumatic brain injury

U. Leon-Dominguez1, J. Leon-Carrion2, M. Dominguez-Morales2; 1University Autonoma de Madrid, Madrid, Spain, 2University of Seville. Center for Brain Injury Rehabilitation (CRECER), Seville Spain, Seville, Spain.

Introduction: survivors of traumatic brain injury (TBI) may suffer disorders of consciousness as a result of a breakdown in cortical connectivity. However, little is known about the neural discharges and cortical areas working in synchrony to generate consciousness in these patients.Methods. In this study, we analyzed cortical connectivity in patients with severe neurocognitive disorder (SND) and in the minimally conscious state (MCS). We use quantitative electroencephalography (QEEG) to examine the status of the “default mode network”, which measures the brain’s intrinsic activity in two carefully matched patient groups. One group was comprised of patients diagnosed as minimal conscious state (MCS) and the second group had sustained severe neurocognitive disorder (SND). results QEEG functional connectivity was used to detect brain regions whose electrical signal fluctuations correlated across time in task-free resting state.Result. We found two synchronized networks subserving conscious-ness; one retrolandic (cognitive network) and the other frontal (executive control network). The synchrony between these networks is severely disrupted in patients in the MCS as compared to those with better levels of consciousness and a preserved state of alertness (SND). The executive control network could facilitate the synchronization and coherence of large populations of distant cortical neurons using high frequency oscillations on a precise temporal scale.Conclusions: Consciousness is altered or disappears after losing synchrony and coherence. We suggest that the synchrony between anterior and retrolandic regions is essential to awareness, and that a functioning frontal lobe is a surrogate marker for preserved consciousness.

O.04Looking at TBI as a comprehensive trauma - a phenomenological perspective on TBI and its impact on family system

P. Galiana y Abal; University Texas A & M Corpus Christi, Corpus Christi, TX, United States.

Introduction: If the TBI patient is often named in scientific literature as the “injured” or the “victim”, TBI affects the whole family system, changing daily dynamics, roles, relationships, and constraining future expectations.Objective: Aim of this paper is to explore family members’ experience of living with highly impaired TBI patients, identifying major changes in the family roles while observing adaptive methods commented on and described by the participants and discussing their efficiency.Patients, Materials and Methods: Clinical data has been compiled through 35 interviews (clinical assessments required for forensic reports and therapeutic clinical interviews) with family members (parents, spouses, siblings) of TBI patients.

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AbstractsResults: Families report important changes in the daily management of households mainly due to cognitive impairment in the

TBI patients. A high involvement with care, the need for instrumental and emotional support appeared as main worries of TBI patients’ family (35/35 cases). However, behavioral and psychological disorders due to TBI sequelae were reported as having the greatest impact on family well-being, consequently changing the family atmosphere (27/35 cases). Post-traumatic sexual dysfunction was reported as having an important impact in the affective dynamics of the couple relation-ships (21/35 cases). This aspect affected mostly young couples (≤30) causing high levels of distress and transforming the relationship into a care-receiver/care-giver relationship. Patients injured during youth or adolescence (12/35, ≤25 years) reported an increase of well-being and a better adjustment into the family system once having received care by an external care-giver. Inability to preserve parental authority with children has been reported by fathers of young children (6/35).Conclusion: The challenges posed by TBI for family members affect the entire family system, modifying family roles are mainly caused by cognitive and behavioral disorders. A need for reviewing family projects appears as a source of resilient behavior among family members.

02 - Minor TBI

O.05Outcome measure after TBI - clinical scores and scales evaluating functioning following Rehabilitation

J. Opara1, E. Małecka2; 1Paraplegia, Academy of Physical Education, Katowice, Poland, 2Academy of Physical Education, Katowice, Poland.

These are many clinical scores and scales on measures of physical functioning after traumatic brain injury (TBI). Those could be as well generic (universal) as specific measures. As for generic scales very good known are ADL scales: Barthel Index, Functional Independence Measure, Katz ADL Index. As for upper extremity: Fugl-Meyer Motor Assessment, Action Research Arm Test (ARAT) and Wolf Test. For balance: Balance Berg scale, Tinetti scale, Brunel scale. For walking: Up and Go test and Functional Ambulation Classification. Specific for TBI scales are: Disability Rating Scale (DRS) by Rappaport et al., Disabilities of the Arm, Shoulder and Hand outcome measure (DASH) by Hudak et al. and short version QuickDash-9 (Beaton et al. 2009). In 1997 H. Gill-Thwaites from Royal Hospital for Neuro-disability, West Hill, Putney in London described SMART - Sensory Modality Assessment Rehabilitation Technique.The sensory assessment has 8 modalities including the 5 sensory modalities (visual, auditory, tactile, olfactory, and gustatory) and also motor function, functional communication and wakefulness/arousal. Consisting of 29 standardized techniques, SMART provides opportunity for patients to exhibit their full behavioral repertoire, in each of the different sensory modalities. For example, to assess the patients’ responses within the auditory modality, a range of standardized auditory stimuli are presented, including loud sound, voice and a variety of specifically selected verbal instructions. The verbal instructions are carefully selected from the patient’s behavioral repertoire exhibited as being potentially meaningful in the SMART behavioral observation, such as “raise your eyebrows”, “move your thumb”, to provide the patient with the best opportunity to follow any one or more instructions.

O.07The use of Brief Core Sets for TBI in occupational therapy to measure outcome of rehabilitation - presentation case

A. Rotar; Institute for Rehabilitation Republic of Slovenia, Ljubljana, Slovenia.

Introduction: Traumatic brain injury (TBI) is referred to as the hidden disability because its long term problems are often in the areas of thinking and behaviour and are not as easy to see and recognise as many physical disabilities. A number of tools exist in order to assess the functional state of a pacient. One of them is ICF which provides a standard language and serves as the basis for the classification of functioning. Because it is too comprehensive, ICF Core Sets were developed.Goal: For this study we used the Brief Core Set for TBI. Functional status of the patient was recorded at admition and three years later. We were interested if these sets are sensitive enough to detect changes in a single patient and whether all the areas where these patients have problems are covered.Method: FIM scores, results of AMPS and results of AAA of a 21 years old male patient, who was admitted three times to comprehensive rehab programme at Department for TBI rehabilitation from January 2010 to July 2013, were reviewed. All data were entered in Brief Core Set for TBI form separately at first admission and after last therapeutic session.Results: The majority of problems were found at the level of Body Functions particularly in the area of mental functions. We got similar results when we used AMPS but when we used AAA questioner where patient described his performance we saw that he was not aware of his limitations.Conclusions: Positive side of ICF Core Sets is that they are significantly shorter because they are developed for specific health conditions, but they do not take into account the patient`s awareness of his limitation particularly in the areas of thinking and behaviour. This also have a certain influence on the outcome of rehabilitation.

O.08How to offer something more to persons with acquired brain injury (ABI) in terms of long-term rehabilitation service - an example of good practice: introducing therapeutic approaches with animals

M. Čeh, J. Vešligaj Damiš; Center Naprej, Maribor, Slovenia.

In this abstract we present an example of good practice, and the efforts made to establish it, in a non-governmental non-profit organization from Slovenia that offers long-term rehabilitation for people with ABI. The organization aims to improve the quality of its services by providing above-standard programmes. Center Naprej was established with the goals of providing comprehensive long-term rehabilitation for people with ABI, support for family members, and preventive action in the broader social context. The center focuses on providing high-quality pre-planned professional assistance in terms of guidance, care, health care, and employment under special conditions, depending on individual needs. The service is conducted in the form of daily treatment. In addition, users can participate in programmes that are not included in the basic service and for which additional funds must be obtained. Finances needed for the implementation of these programmes are acquired from various sources, mainly from European Union funding programmes. The above-standard programmes focus on transferring the process of rehabilitation in real life environments, practicing skills, and successfully integrating users into the broader social environment. Users learn strategies in real environments, which can help them to cope with their problems more efficiently. These methods have proven to be very successful and present an important complement to long-term rehabilitation. The main focus of this article is to present

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the project Magic touch, which was developed in collaboration with Switzerland. The goals of the project are to: - Establish new animal-assisted therapeutic approaches as part of long-term rehabilitation for people with ABI - Raise awareness of the importance of planned therapeutic approaches in the (wider) professional community - Positively impact on the quality of lives of people with ABI that are involved in long-term rehabilitation pro-grammes.

O.09Reorientation Syndrome, Loneliness and Emptiness after TBIMechanism, access and solutions to this underestimated and to all problems after TBI underlying phenomenon

N. Steinhoff1, 2;1Federal Hospital Lower Austria LK Hochegg, 2Austrian Association for Brain Injury

The brain in TBI in one second suffers damage mostly at all areas and the pattern of lesions reflect the forces on the scull at the moment of the trauma which results in different symptoms after every single trauma. The common problem for the TB Injured is to overcome the sudden change of emotions and to accept the new situation with memories in the body corresponding to the time before the accident. Method: TB Injured members of the Austrian Association of TBI were interrogated about the situation after TBI. Results: The change in life affects personnel capacities, the position in the families and at work, the financial/social situation and it results in a change of key persons in life. The burden of change is more important, if the person pre-viously was strong, body oriented and had to define himself through a hierarchic system, as e.g. military organisations represent. The TB Injured is in an inside/outside empty space and has to reorient himself with reduced brain capacity. Conclusions: Most persons, injured and families feel left alone after TBI. Care givers and case managers are not skilled enough to deal with emptiness, reorientation, mourning process and the issue of responsibilities resulting through medical, therapeutic and social consequences after TBI. The Reorientation Syndrome is a considerable condition after each TBI, that has to be respected to be able to help TB Injures and the families to be reintegrated after TBI.

03 - Neurological Long Term Rehabilitation in TBI

O.11A Randomized Controlled Trial on Impact of Two Training Packages on the Knowledge and Care Practices of The Family Care Givers of Operated Neurosurgery Patients Admitted in a Tertiary Care Hospital in North India

M. Kalyanasundaram1, S. Kaur2, M. K. Tewari3, A. Singh3; 1Pondicherry Institute of Medical Sciences, Pondicherry, India, 2Na-tional Institute of Nursing Education, Chandigarh, India, 3PGIMER, Chandigarh, India.

Introduction: Family caregivers of operated neurosurgery patients function as informal extensions of the health care system. But they are untrained and unprepared for their new role. It has been felt that their problems related to care provision can be resolved by appropri-ate training.Objectives: To compare the impact of two training packages on knowledge and practices of family caregivers of operated neurosurgery patientsMaterials and Methods: A Randomized Controlled Trial was done among the operated neurosurgery patients and their caregiver dyads (n=90). They were randomly allocated to receive training package 1 (TP1= self instruction manual & one to one training) or training package 2 (TP2= self instruction manual only). Block randomization (block size=4)

method was used. Sequentially numbered sealed envelope was used for allocation concealment. Primary outcome measure was knowledge gain of the caregivers. Variety of secondary outcome measures was also assessed in three monthly follow ups.Results: The Attrition rate was 15.5%. Intention to treat analysis was followed. Caregivers in the TP1 group had significant knowledge gain (95% CI of mean difference=9.4,14.5, Bonferroni corrected p value < 0.05).The number of caregivers who followed correct care giving practices were significantly more in TP1 group. The number of patients with bedsore was significantly low in the TP1 group. Life satisfaction of the caregivers in TP1 group improved significantly. We could not find any significant difference in the improvement in the degree of patients’ disability and in the caregivers’ strain between the groups.Conclusions: Training of caregivers by providing information along with one to one training is an effective strategy for improving the knowledge and skills of caregivers regarding care provision of the operated neurosurgery patients.

O.13Acute subdural hematoma: prognostic factors in patients admitted to surgical drainage in the emergency department

J. Lavrador, J. Teixeira, M. Manuel Santos; Hospital Santa Maria, Lisboa, Portugal.

Object: Acute Subdural Hematoma (aSDH) is a major cause of admission to our department. The goal of this study was to find important prognostic factors regarding the outcome of patients admitted to surgical drainage in the emergency department.Methods: We reviewed the 89 records of patients who were submitted to acute subdural hematoma (aSDH) in our institution between January 2008 and May 2012. Demographic characteristics, neurological status on admission, pre-operative treatment with anti-thrombotic therapy and outcome on discharge were collected.Results: 54% of the patients were male; 74% were older than 65 years; 44% were under anticoagulant or antiaggregant therapy preopera-tively; at admission, 58% presented in coma; in 22% of the patients was performed a craniectomy instead of a craniotomy; the ICP was recorded postoperatively in 13%; GCS at admission was the strongest determinant of prognosis: 40% of the patients admitted with severe TBI died, 67% of the patients admitted with mild TBI were independent on discharge. Gender male, spontaneous aSDH as mechanism of injury and a craniectomy were associated with poor outcomes on discharge.Conclusions: aSDH is common in elderly who are under anticoagulant/antiaggregant therapy. The concern regarding the surgical indication in these patients remains. However, in our series, GCS at admission was the strongest determinant of prognosis and anti-thrombotic therapy and age older than 65 years were not predictive factors of outcome in patients who underwent acute subdural hematoma drainage.

04 - Prevention and TBI

O.14Apply principles of neurorehabilitation to traumatic brain injury

J. L. Truelle1, M. S. Montreuil2, A. Schnitzler1; 1Department of neurorehabilitation University hospital, Garches, France, 2Laboratory of neuropsychology and psychopathology, Univer-sity Paris 8 Saint-Denis, France.

Introduction, material and methods: How four principles could be applied to traumatic brain injury rehabilitation and social re-entry, by submitting a few examples for each model.

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Results and discussion: 1. The bio-psycho-social model: the more distant in time the patient is from the accident, the biological predic-tors of re-entry decrease whereas the psychological and the social aspects increase in the genesis of the handicap. 2. Despite the difficulty to consider the psycho/social components of the handicap as a scientific object, publications (ALTMAN, 2010, GEURSTEN, 2010), demonstrate the significant priority of holistic programs and day programs, behavior programs and in-community programs as compared to in-facility programs. The evidence-based medicine is conventionally made up of scientific data, the therapist, and the patient. We show the difference of scientific and quantita-tive data versus qualitative ones and the such complex and subjective aspects of the individual care. Between these two poles, the multidis-ciplinary team have to keep moving the cursor. 3. The goal attainment concept is based on a clearly defined objective, together with a deadline, the human and material means to reach it and a final re-assessment. 4. The case management is based on the coherence of the multidisci-plinary team and on a holistic view of the program. The case manager has to be the coordinator, with an open mind, training on medical, psychological, social, legal and cultural task components. Explain, through examples, how to apply principles to clinical practice, is a pattern of the professional’s recurrent training.

O.15Teleneurorehabilitation - A way to improve prevention at home and training in neurological long term rehabilitation

N. Steinhoff1,2; 1Federal Hospital Lower Austria LK Hochegg, Grimmenstein, Austria, 2Austrian Association for Brain Injury, Vienna, Austria.

Neurological patients after release from the hospital for long term neu-rorehabilitation and care at home need intensive medical and social support and training. Several, well known problems emerge for the patients and the caregivers in the organization of this new situation at home to ensure high quality care. Several studies with patients suffering Traumatic Brain Injury and Hypoxic Enzephalopathia, being released at home after long term neurorehabilitation in the hospital were performed. We investigated the feasibility and valence of telemedicine and the technical requirements to overcome the distance between the patient at home and our neurorehabilitational service, regarding the impact on the quality of neurorehabilitation, the situation at home and the acceptance of the patient and caregiver. For this purpose, a video conferencing facility at the patients home and at the hospital were connected via usual telephone connetcion. Following a protocol (settings for the course of conversation, taking contact, time of conversation, possibility of investigation over a distance, patients data, suggestions for optimising neurorehabilitation and medical therapy and follow up, caregivers support, emerging technical needs in addition to the used particular connection), over a time frame of 12 to 140 weeks telemedical contact was performed with the patient and his caregiver, first daily and consequently at short regular intervals and on demand. The patient had neurological investigation at the beginning and at the end of the study to document possible changes of the physical status. Validated rating scales were used to investigate the acceptance and the influence of Teleneurorehabilitation on the situation at home. The results of this study show that under certain conditions Teleneurorehabilitation can be a potential alternative to the existing systems of long term care, prevention and rehabilitation of neurological patients at home.

O.16Epidemiology of ABI: Characteristics of the hospital discharges of men and women under 50 years of age living in Castelló: Valencian Community MBDS 1995-2005

V. A. Arrufat Gallen; ATEN3U Brain Injury Castelló-Health Public Center, Consejeria Sanitat Generalitat Valenciana.Castelló, Spain.

Today theres is a growing tendence to conduct research studies of hospital diagnoses based on group`s of pathologies of Diagnosis- Related-Groups. DRG. The aim of such studies is to decribe the magnitude of the diseases that have been treated.This article presents, for the first time, the incidence of the different pathologies affecting the brain, grouped together under the term Acquired Brain Injury (ABI), related with the hospital admissions due to ABI in the population of men and women under the age of 50 years living in the province of Castelló.As far as victims’ and relatives’ associations are concerned, ABI tends to include some of the pathologies from the International Classification of Diseases, ninth revision, ICD-9 (Spanish version: CIE-IX).The European Union uses the term Brain Injury (1) to group families „responsible for the care of persons who have suffered an accident resulting in serious injuries to the brain in order to attain these pepople‘s rigth to health.)The source of information used for this purpose was the hospital discharge registry of the hospitals in the Valencia Community Minimum Basic Data Set (MBDS) over the period 1995 to 2005.The ABI Incidence Rate in persons under the age of 50 years is 221 in men and 106.3 in women per 1,000,000 male or female inhabitants. Caring for persons with ABI is the paradigm of dependent care and an indicator of the quality of life and services that exist in the community.Footnotes: 1.- Brain Injury Federation: http://www.bif-ec.eu, Brain Injury refers to traumatic brain injuries. There are also other terms that do not exactly match the Spanish daños cerebrales, such as mild brain damage. Other terms employed in scientific studies include mild brain injury and mild brain traumatic injury, and the data cannot be extrapo-lated. J de Pedro Cuesta ISCIII 2003

O.17Effects of long-term support for families with a child with acquired brain injury

E. Hermans1,2; 1Vilans, Dutch centre of expertise for long term care, Utrecht, Nether-lands, 2Brain Project, Sittard, Netherlands.

Introduction: Acquired brain injury (ABI) in children places a great burden on families which may lead to adverse outcome in parents and siblings. In order to meet the needs of families we developed and implemented a pediatric ABI-specific family support offer (PAFS) in The Netherlands.Goal: We conducted a study to determine if: 1) PAFS is appreciated by families with a child with acquired brain injury, and 2) PAFS contributes to a reduction of burden in families with a child with ABI?Patients, material and method: PAFS was applied to 42 families with a child with ABI. Children were 11.9 years old (average); 21 had a traumatic brain injury (TBI) and 21 had a non-traumatic brain injury (NTBI). Evaluation of PAFS took place after average 60 weeks. Appreciation of PAFS was measured using a home made 10-point scale. Family burden was measured using he Family Burden of Injury Interview (FBII; Burgess et al 1999). FBII contains questions on 28 potential problems following ABI. On each item parents are asked how stressful the concern is on a 5-point scale (0-4). FBII was assessed at the start of the intervention (T1) and at evaluation (T2).Results: Appreciation of PAFS was high. No statistical significant difference in family burden was found on total FBII scores on T1 and T2. There were six FBII items on which the mean score on T1 was

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=>2, indicating significant stress and need for intervention. We found significant decreases in stress on four of these six items. On two of these items however there still remained a significant level of stress on T2. On both measures no differences were found between families with a child with TBI and NTBI.Conclusion: It is concluded that PAFS is highly appreciated by parents and may contribute to reduction of family stress.

O.18Serum biomarkers for predicting outcome after TBI

J. Opara1, A. Małecki2, E. Małecka2; 1Paraplegia, Jerzy Kukuczka Academy of Physical Education in Kato-wice, Katowice, Poland, 2Jerzy Kukuczka Academy of Physical Educa-tion in Katowice, Katowice, Poland.

The detailed presentation of the neuropathological consequences of traumatic brain injury is used to set the stage for better appreciating the neurological recovery occurring after traumatic injury. Potential linkages of recovery patterns to the known neuropathological sequelae of injury and various reparative mechanisms are considered and it is proposed that potential biological markers will better define these linkages.In recent decades, researchers and clinicians have focused on specific markers of cellular brain injury to improve the diagnosis and the evaluation of outcome. Many proteins synthesized in the astroglia cells or in the neurons, such as neuron-specific enolase, S100 calcium binding protein B, myelin basic protein (MBP), creatine kinase brain isoenzyme, glial fibrillary acidic protein (GPAP), plasma desoxyribonu-cleic acid, brain-derived neurotrophic factor, ubiquitin carboxy-terminal hydrolase-L1, ectoenzyme CD 38 (cluster of differentiation 38) and neuron specific endolase (NSE), have been proposed as potential markers for cell damage in central nervous system.In review report the various factors that must be taken into account in the search for a reliable non-invasive biomarkers in TBI and their role in predicting outcome evaluation will be described.

05 - Art and Neurorehabilitation

O.21Challenged Conquistadors, Inc.

S. W. Best; Challenged Conquistadors, Inc., Smackover, AR, United States.

Many unsophisticated people have thoughtlessly labeled chal-lenged individuals as incompetent, unworthy of respect, i.e., terms in the disability environment, ie., disabled, retarded, handicapped, etc. The fact is evident, i.e., Shakespeare in Hamlet “Words, words, words.”, acknowledges all that needs to be said. Words, in fact, are the reasons we have competencies & destruction. Language is very critical in the development of all individuals, i.e., infants, etc. This could lead one to believe we enjoy in destructive & demoralizing the human condition. Some capitalizing effects of life without imposed limitations: employers openly & reassuringly employ more individuals with challenges/learning differences/disabilities; a reduction of social programs; increased minds determined of productivity vs. negativism (terms in the disability environment); decreasing the homeless rate; reduce social injustices with economic partnerships & finally activate, demonstrate, educate, motivate, stimulate & validate utilization of your dollar, which will enhance our society! Beside the legal fear factor in the disability environment, another factor to consider is, many of those challenged are confronted with a difficult time in dealing with the existing/new circumstance, because it had not been antici-pated, however if individuals know the challenges they will confront have been successfully conquered, then positive results can be more

easily expected & accomplished. This will also promote prevention of activities that result in cognitive challenges/traumatic brain injuries (TBI), when individuals personally witness authoritative proof of recovery. This will, in turn, improve economics for everyone.

O.22French sheltered housing programmes

J. Ruch; UNAFTC, Paris, France.

What about the future for Traumatic Brain Injured people ? After several months in different care units, brain-injured people have to find solutions almost overnight. Their families try to accept, often painfully, the consequences of the accident and the brain injuries sustained. It‘s difficult for the brain-injured to turn the page on their former life and they long to be like they were before the accident without understanding that this may never be possible for them. When the consequences of the accident are very severe, life after can only be in institutions where the quality of life depends heavily on the existing teams and the way they perceive the injured person. But do only cognitive and behavioral problems justify placements in often inappropriate institutions? How many years do caregivers have to wait for a place in these institutions? How many places does society still accept to provide for these poorly-known situations in these times of economic constraints which are particularly unfavorable to social and medical needs? In order to answer such questions, families of people with TBI have set up sheltered housing programmes which are accompanied 24h/24h, 365 days a year. These Family Homes have been created through private funding or the pooling of funds from families in united and responsible securities investment. How does this work? Jean Ruch, President of the AFTC Alsace (NGO) proposes to explain the French solutions which allow for the most serene quality of life possible for the brain-injured and their families, far exceeding simple institutional solutions so that the brain-injured can live amongst us, all the while giving their families the necessary space for overall care.

06. Physical Brain Trauma and Psychological Trauma

O.24Is there an effect on the Self in individuals with PTSD and TBI: A feasibility study

K. G. McWilliams, L. Stopa; University of Southampton, Southampton, United Kingdom.

Background: Posttraumatic Stress Disorder (PTSD) and traumatic brain injuries (TBI) make up a serious comorbid condition of increasing concern for both civilian and military doctors. One to two million American civilians sustain a TBI annually and it is estimated that as many as 320,000 returning veterans suffer from a TBI. Research also shows that 17% of mild traumatic brain injury (mTBI) sufferers developed PTSD diagnoses within 6 months, and up to 43.9% of soldiers with loss of consciousness developed PTSD. Objective: To (1) conduct a feasibility study to determine whether there is a significant effect on self-esteem, self-concept, and affect referred to as ‘sense of self’, in those suffering from PTSD, TBIs and with comorbidity, and (2) to determine if a larger study on issues related to the self and PTSD and TBIs is justified. Method: Participants (n=81) completed an online survey concerning the self, symptomology, cognitions, and qualitative assessments of their condition(s). Results: A one-way ANOVA showed that the TBI-only group had self profiles similar to control groups while TBI/PTSD individuals had significantly worse profiles. TBI-only individuals that did not develop PTSD maintained higher self ratings. The comorbid and PTSD-only groups showed significant decreases in self-related measures. A Multiple Regression showed a significant

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correlation between ‘sense of self’ measures and the development of PTSD. Conclusion: There was significant data to support a follow-up study to continue evaluating links between a strong or weak ‘sense of self’ and the development of PTSD in individuals with TBIs. A l ongitudinal study following mild and moderate TBI cases has been proposed and should be underway by the date of this conference.

O.25Risk factors for suicidal ideation after mild traumatic brain injury

L. da Costa, A. Bethune, E. Waknine, W. Xiong, M. Scott, A. Feinstein; Sunnybrook Hospital - University of Toronto, Toronto, ON, Canada.

Introduction: Traumatic brain injury (TBI) has known association with depression and increased risk of suicidal ideation (SI). The prevalence and risk factors for SI following TBI were examined prospectively in mild and moderate TBI presenting to a large trauma hospital.Methods: Prospective data was collected over 14 years. Radiological and clinical features were collected at admission; psychiatric and social assessment took place at 3 and 6 months. Over 50 demographic, outcome,and psychometric measures were evaluated. Chi-square analyses were used to determine correlates of SI. Logistic regression analysis was performed to model the predictors.Results: Between1998 and 2012, 2296 TBI patients presented to ER (64% male, mean age = 34.7 years), 82% of cases were mild (mTBI). The overall frequency of SI at 3 months was 24% and increased to 53% by 6 months, regardless of severity.From presentation in ER, altered level of consciousness (p=.008), female sex (p=.01), and mechanism of injury (car driver, passenger or pedestrian, p=0.025) were correlated with higher SI. Radiological and clinical variables (GCS, amnesia length) were not. Follow-up psychi-atric assessment revealed sociodemographic predictors of SI: english as a second language (p=.0001), marital status (p=.002), professional (p=.003), previously diagnosed schizoprenia or depression (p=.0001). Unique predictors of SI at 6 months included unemployment (p=.024) and no past history TBI (p=0.0008).Conclusion: Suicidal intent following mTBI is frequent and risk does not decrease with time from injury. Current methods for ER assessment of patients with mTBI fail to identify patients at highest risk. The identification of demographic predictors of SI can guide improvements for identifying patients at risk. Our observation of a delayed increase in SI indicates a time window for therapeutic intervention.

O.26Self-perceived quality of life in TBIpatients and its plausible correla-tion with cognitive impairment and psychological disorders

P. Galiana y Abal1, M. Afonso2; 1University Texas A & M Corpus Christi, Corpus Christi, TX, United States, 2Forensic Civil Law Office, Paris, France.

Introduction: Designed to explore self-perception of quality of life, and inspired by WHO definition of QoL (1994), this clinical study has adopted a phenomenological perspective based on subjective perception (patients’ experience and expectations) and objective measurement (neuropsychological/psychological assessment).Objective: Aim of this study is to search for a plausible correlation of patient’s self-perceived quality of life with severity of cognitive impairment and psychological disorders.Patients: The sample is composed of 29 TBI patients (age 23 to 56), all having gone through the process of filing civil law suits.Materials and Methods: Data was compiled through two 4h00 length semi-directive interviews with patients and family (NRS, Levin, 1991) with open questions inspired from the WHO definition of quality of life (physical health, appearance, level of autonomy, self-esteem, family/social relations, personal/spiritual beliefs, environment, future

expectations) and neuropsychological and psychological assessment (Weschler Wais III, Grober et Buschke RL-RI-16, Rey-Osterrieth Complex Figure Test (ROCF), Trail Making Test, Cardebat Semantic and phonemic verbal fluencies, Beck Depression Inventory, Hirschfield Mood Disorder Questionnaire, Coopersmith Self-Esteem Inventory, Rorschach).Results: No correlation has been found between self-perceived quality of life with level of impairment or presence of psychologi-cal disorders but between awareness of cognitive impairment and self-perceived quality of life. Euphoric frontal syndrome and anosogno- diaphoria result as improving self-perception of quality of life and giving normative self-esteem even if patients show slight signs of depression, while awareness of cognitive impairment is paired with a negative per-ception of QoL, low self-esteem and more severe depression.Conclusion: A further longitudinal study with a larger sample of patients must be pursued to better understand the potential impact of awareness of neurological and psychological disorders after TBI in self-perception of quality of life in order to improve therapeutic care and information to families.

O.27Environmental factors and their impact on the long term rehabilita-tion of a person with traumatic brain injury

S. Dečman; University Rehabilitation Institute, Ljubljana, Slovenia.

Introduction: Traumatic brain injury (TBI) affects millions of people worldwide and causes significant physical, emotional, and cognitive disabilities among those affected. Advances in life-saving measures have increased survival from TBI, leading to more individuals living with the consequences of these injuries. Many factors influence the rehabilitation outcome, using International Classification of Functioning (ICF) occupational therapists recognize those factors and plan treatment program. The ICF Core Sets are tools that assess various health conditions and the functioning of an individual.Objective: In the study a Brief Core Set for TBI has been used, with emphasis on the environmental factors, to determine which environmental factors have the greatest impact on a person with TBI in the long term rehabilitation.Methods: Review of the case history of a 42 year old male patient after TBI was performed; data from the beginning of the rehabilitation program and also data from discharge into his home environment were entered into the Brief Core Set for TBI. Alongside a review of domestic and foreign literature was conducted.Results: The Brief Core Set for TBI showed that occupational thera-pists can influence some aspects of the environmental factors (family, products and technology), and that healthcare system takes care of the costs of rehabilitation. However, there is still a gap in the social aspects of the environmental factors (stigmatization, social isolation, high costs of home adaptation).Conclusions: Using the Brief Core Set for TBI, occupational therapists can determine what kind of facilitators or barriers patient after TBI will experience when returning to his home environment. Using our knowledge as occupational therapists we can educate family members or caregivers, we can advise how to adapt home environment in a way that person will be able to live a full life despite his limitations.07. Neurological Rehabilitation in TBI and Ethics

O.28Ethics in neurorehabilitation

F. Gerstenbrand, C. Kurzmann; Karl Landsteiner Institute for Neurorehabilitation and Space Neurol-ogy, Vienna, Austria.

The moral and social principles of the modern Western community were initiated with the onset of the Judeo-Christian Ideology, based

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on the 10 commandments of Moses, establishing the guidance of ethical and moral rules. In the antique phase of the Western world the philosophy of the Greco-Roman culture and its founders, Socrates, Plato and Aristoteles, was the basis of ethical rules. They were refined by the philosophical work of Saint Augustinus, critically analyzed by Thomas Aquinas.Imanuel Kant’s Categorical Imperative summarized the European ethical demands: “Every human being has to act that his action could be an eternal law”.Biomedical ethics are bound on Hippocratic principles and fundamentally based on the Western ethical rules with their historical roots. In modern medicine the Declaration of Human Rights (1948) in its practical use as well as in research the Helsinki Declaration (1965) and as a next step the Unesco Declaration of Paris (2005) are the actual directives. They are including social, legal and environmental dimensions in requiring patient’s autonomy and patient’s responsibility. Article 12 of the Paris Declaration requires respect for cultural diversity and pluralism. The development of modern medicine, especially in the field of neuroscience with all the new technical possibilities and the social considerations needs a harmonization to include the different cultural and religious requirements to be accepted.The ethical based demand is that neurorehabilitation in all acute neurological diseases has to be continued as long as improvement can be expected - even for years. A temporary neurorehabilitation program has to be accepted in chronic conditions. For ending a neurorehabilitation program all prognostic possibilities have to be proven.

O.29Games and arts fun ways to develop capabilities

E. B. Afonso; Novamente, Cascais, Portugal.

Before the accident I was a common teacher of arts. Now, I am still doing that but it doesn’t make sense for me anymore, because I’ve learned a lot after the TBI and now I want to work on confronting its sequels. In my experience as a TBI person, I learned one can be stimulated to improve their own rehabilitation.The brain is a mystery, and it can surprise us by doing improbable things.Through plastic arts one can stimulate their own brain to work the movement of the hand, to look for their own inner-self and happiness, to improve communication, to stand for a longer time.I created art classes for TBI persons. Students will come to these classes paying extra money (for material) after a course of neurorehabilitation in a very famous center in my country, Portugal. Plus, the result is a piece of art you can exhibit, offer and talk about with others. The result is not only the art, but also the social experience.In my speech at the TBI Challenge I would like to serve as an example to other TBI survivors as a living proof that we should always look for and find our best solutions for rehabilitation and for life. I want to stand before the scientific society and present myself as a person who could have been killed in a car accident, who lost all her friends , fiancé and hopes in life, and yet here I am fighting, talking, walking and surprising the medical society with my improvements. I would like to remember TBI families and care givers to give TBI persons a chance to prove they can do more than just rehabilitation treatments. I would like to present a multimedia exhibition throughout my intervention

O.30Experienced Disablement in the Narration of People with Traumatic Brain Injury - Anthropological Perspective

A. S. Marttila; University of Oulu, Oulu, Finland.

TBI affects often significantly person’s abilities as well as her personality, behaviour and emotionality. Her self/subjectivity fractures, which causes often feelings of confusion. Own reactions and action can be surprising. The self no longer works as it used to work.Objective: to search from cultural viewpoint the strategy of TBI-people to cope with their injury as well as to adapt the contradiction in self caused by the injury.Material: informal interviews of 24 Finnish TBI-people (16 male, 8 female) and written narratives of 23 Finnish TBI-people (12 female, 11 male). Nine of the writers (6 male, 3 female) are also interviewees. The interviews has been executed 3-4 times per person within about one year period (altogether 74 interviews). Interviewees are 22-62 years old and have been injured at the age of 14-53.Results: TBI causes disappearance of cultural knowledge and automation of function (when physical and cognitive functions (etc. memory) become injured), which leads to feelings of confusion and produces a fracture of experienced self as well as a need to reconstruct subjectivity according to a cultural norm/expectations. In addition, TBI-person‘s experience of her subjectivity is becoming layered, which can be described as the dynamics between 1) pre-injured, 2) post- injured, 3) rehabilitating and 4) norm selves. These layers appear partly overlapping and contradictory in the experience of an injured person and complicate the construction of coherent subjectivity.In rehabilitation there is a need to use the knowledge from studies searching the experiences of the injured people. How an injured person is experiencing herself affects crucially to her motivation in rehabilitation. The lost self is connected to information loss in cultural environment of a person, who does not have anymore sufficient control of her life because of inability to function successfully. Research is a PhD. study in cultural anthropology.

O.31Ethics in neurorehabilitation

A. Bernardini; Corpus et Mens Private Institute, Sinalunga (Siena), Italy.

In this study ethics means to be again able to take decisions to solve problems in a conscious way; that is: the objective/therapist does not overcome the subjective/patient.On the basis of : 1) the discovery of the passage from objective to the subjective and vice versa, 2) the new theory of the Cognitive Process, 3) the unicity of the Cognitive Process and consistent-ly the unicity of its recovery, this study aims to demonstrate the recovery of the synchronism of information coming from internal/ subjective and external/objective space leads to decisions awareness .Two subjects (Autistic and DSA) have been undergone, for six months to my rehabilitative method. The Autistic subject highlighted deficits caused by a perception based mainly on visual and auditive information due to genetic causes. The DSA subject had a very high IQ, but, besides, he was unable to solve problems. As a consequence of our investigation, this was due to an exposure in early age and for long time to prevalent visual and auditive information by video-game, TV and play-station. In both cases, the information of the internal space wasunconscious. The results reached by autistic subject were very in-teresting regarding the goals of the tailored rehabilitative program. The results showed by DSA subject were swinging: the parents were unable to deny their son to play with the games above named. If the information coming from the external space does not synchronize with the one of the internal space on the reference system

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body through motor experiences, the logical thinking/awareness, hence, an ethical approach in neurorehabilitation will be impossible. Also other parameters must be integrated or changed to evaluate the IQ.

POSTER PRESENTATIONS

P.01New Innovative NCE for the Treatment of Traumatic Brain Injury

A. Harel; Medicortex USA Ltd., Ness-Ziona, Israel.

Introduction: Traumatic brain injury (TBI) is one of the principal causes of mortality and morbidity among children, military personnel, athletes and elderly people. Causes include: falls, vehicle accidents, blasts and violence. The primary tissue injury induces a release of free metal ions in the brain, secretion of free radicals, as well as a series of protein degradation cascades and oxidation, leading to widespread molecular damage and neuronal cell death. At present, there is no pharma- ceutical treatment available to inhibit the continuous damage to the brain tissue upon TBI. Thus, an intervention that simultaneously targets multiple factors contributing to the progress of neuro- degradation could be more effective in halting secondary TBI.Objectives: To develop a new multi-functional drug that will inhibit and prevent the development of secondary degeneration.Methods: Medicortex USA Ltd. develops chemically verified molecules, NCEs with high solubility and stability in the plasma that are able to cross the Blood-Brain Barrier. Each of the molecules includes chemical elements capable of binding free metal ions as well as possessing anti-oxidation, anti-inflammation, or anti-bacterial effects, there by inhibit several cascades of events leading to brain degeneration upon TBI.The neuro-protective function of the molecules will be examined in vitro utilizing an innovative LiveCell® test, designed for the study of individual, living neurons and their interaction with non-neuronal cells upon an insult or damage. In vivo animal models of open and closed head trauma will be used in order to test the effect of the molecules on TBI.Conclusions: Medecortex’s NCEs which are composed with at least two biochemical functions, once proved to be safe and efficacies could be further developed to become an effective new drug for TBI.

P.02Rehabilitation of people with brain injury in Slovenia

V. Trdan; Association Vita, Ljubljana, Slovenia.

ACCIDENT - INJURY - EMERGENCY - NEUROSURGERY - INSTITUTE FOR REHABILITATION - RETURN HOMELONG TERM REHABILITATION - GOVERMENTAL CENTERS: »MAVRICA«day center (guidance, care, employment inside special conditions) - follow on intensive rehabilitation - lifelong learning opportiunities - psychological rehabilitation - case managment»STARA GORA«working therapy – physiotherapy – hydrotheraphy - psychological treatments – recreation - housing group» DORNAVA«integrating housing - general education - rehabilitaton of persons with TBI - riding and hypotherapy - health care - medical treatment - speach treatment - social work - working with parentsPRIVATE CENTERS WITH CONCESSION»KORAK«neurophysiotheraphy - working therapy - psychosocial rehabilitation - various pedagogical programs including study circles - employment

center for persons with reduced working capacity»NAPREJ«longterm rehabilitation – care - working therapyEMPLOYMENT CENTERS - ZARJAfor persons with TBI with reduced (30-70%) working capacityKORAK - DETELsocial integration with reduced (to 30%) working capacity - employ-ment centerSOCIAL COMPANY - ŠENTpermanantly employs the most vulnerable groupsASSOCIATION VITA - DAY CENTER - LJUBLJANAThe Association VITA was established in 1992 in Ljubljana by parents of children with a severe traumatic brain injury TBI. This non-govermental voluntary , disability organisation has reached600 members: injured people, their family members, professional workers. Association Vita has units in Ljubljana, Kočevje, Murska Sobota, Jesenice, Celje, Koper, Novo mesto and Črnomelj .ACTIVITIES OF ASSOCIATION VITApromotion of quality of life of people suffered a head injury and their families.day-care center: occupational therapy, physiotherapy, social programs, long life learning, workshop: painting, computer learning, forign languages, relaxation , theatrepersonal assistance - at home ( from 4 hours per week to 8 hours a day) - living house close supervision and different amount of daily living helpeducation on: health,, health system and insurance - summer camps, sports and recreation, socializiation - support to the families: informa-tion, advising, consulation, help and accompanying, day care at home and outside - prevention at schools, literature publishing,

P.03A survey on the use of medications in Italian rehabilitation center inpatients following acquired brain injury

G. Cosano1, T. Giorgini2, E. Biasutti2, F. Barbone1,3, F. E. Pisa3; 1Department of Medical and Biological Sciences, University of Udine, Udine, Italy, 2Institute of Physical Medicine and Rehabilitation, ASS4, Udine, Italy, 3Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy.

Introduction: Patients following acquired brain injury (ABI) suffer neurologic, psychiatric, neurocognitive and functional problems. Concurrent use of drugs is often required thus raising concern on safety, interactions and effectiveness in this vulnerable population.Objectives: To assess the use of medications in Italian rehabilitation centers (RCs) inpatients with ABI.Methods: The setting is: tertiary care RCs for ABI in Italy, between September 1 and November 30, 2012. 40 RCs were asked to participate in the study and mailed a structured questionnaire. The questionnaire encompassed 1. a section inquiring on facility characteristics and 2. a section inquiring on the characteristics of inpatients with ABI (age, sex, time since ABI, Level of Cognitive Functioning Scale score LCF) and the medications used (active substance, indication) at the survey. The prevalence of medication use was calculated.Results: Out of 35 (87.5%) participating RCs, 31 (88.6%) provided patient-level information. A total of 484 patients (63% men; 54.3% aged ≥ 50 years; 28.9% LCF 2 generalized response, 19.0% LCF 3 localized, 18.6% LCF 5 confused non-agitated) were included in the survey. Overall 84.7% used psychotropic drugs, mostly (62.2%) 2 or more. Prevalence of use was: anti-epileptics 73.1% (82.1% in LCF 2); antidepressants 36.2% (61.5% in LCF 7 - 8 automatic - purposeful ap-propriate), most of which SSRIs (59.4%); anti-Parkinson 20.4% (31.5% in LCF-3 localized), most of which dopaminergic agents (91.9%); an-tipsychotics 17.1% (40.4% in LCF 4 confused-agitated); anxiolytics 14.7%; psychostimulants 3.9%. More patients used atypical (69.9% of

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users, n=58) than typical antipsychotics and the most frequent agent was quetiapine (48.2%). Muscle relaxants were used by 21.3% of the patients.Conclusions: Use of psychotropic drugs and of atypical antipsycotics were frequent in ABI inpatients. Prevalence of selected psychotropic drugs varied with LCF score. Monitoring of drug use and its conse-quences is recommended in ABI patients.

P.04Dance - movement therapy (DMT)

T. Lipovšek; University Rehabilitation Institute Slovenia, Ljubljana, Slovenia.

Introduction: For the normal functioning of an individual the coordina-tion and connection between brain hemispheres is important. Patients after traumatic brain injury (TBI) often have problems with coordina-tion and the processing of information between the hemispheres.Dance - movement therapy (DMT) use body movement, as the core component of dance, interventions to facilitate body functions, activi-ties and participations, which is based on international Classification of Functioning Disability and Health (ICF). DMT contains elements from three different approaches: sensory-motor integration, motor learning and neurotherapeutic approach. Instrumental music is incorporated to facilitate movement, enhance memory, improve communication, stimulating social interaction.Objective: The purpose of this study is to investigate the efficiency of using DMT for patients after TBI in terms of participation in human occupation through activities of everyday life, work and leisure.Methods: The group consists of six patients (4 male, 2 female; mean age 35 years). Treatment takes place 3 times a week, since May 2013. Each treatment lasts for 45 min. For patients after TBI, we currently use instrumental music, adapting to meet the needs of rhythm, tempo and dynamics of the integrated movement patterns. To begin our therapeutic treatment we select patients with TBI (up to 6 months after injury, moderate TBI) who met the inclusion criteria, which were determined on the basis of assessment tests.Preliminary Results: Improvements are noticed in higher independence in ADL, in greater participation of patients in activities that occur outside of the routine of their environment, and in the overall improvement of communication skills within the group and outside the group.Conclusions: As evidenced by the preliminary results of a study currently being conducted at University Rehabilitation Institute, DMT is a useful method for treatment of patients after TBI.

P.05Dual-tasks as an approach to estimation of the brain functional re-covery in patients with traumatic brain injury

T. Shevtsova1, L. Zhavoronkova2, A. Zharikova2, O. Maksakova3, S. Kuptsova3; 1MSU, Faculty of Fundamental Medicine, Moscow, Russian Federation, 2Institute of Higher Nervous Activity and Neurophysiology, RAS, Mos-cow, Russian Federation, 3Burdenko Neurosurgery Institute, RAMS, Moscow, Russian Federation.

Introduction: Long-term brain dysfunctions from severe traumatic brain injury (TBI) that could not overlooked by routine clinical methods may be detected by special research approaches. Dual-tasks require flexible attention allocation to some streams of information (model everyday life). The aim of study was to determine brain resources involved in task coordination during dual-task performance in TBI patients. Methods: Seventeen patients after TBI and forty healthy subjects (with a mean age of 26,8±2,8 and 29,8 ± 2,47 years, accordingly) participated in the study. FIM, MPAI, MMSE and BERG scales were used for examination

of functional abilities of patients. All persons performed cognitive and postural tasks both separately and concurrently - dual-tasks. Analysis was focused on measures of psychological, stabilographic, EEG data and clinical scales. Results: Healthy subjects with large cognitive resources better performed dual-tasks comparing to isolated tasks. EEG analysis revealed specific markers for successful performance of cognitive and motor components of dual-tasks. TBI patients showed a lower quality of performance for both components in dual-tasks and the most prominent impairment has been shown for cognitive component. EEG changes demonstrated an increase of coherence for different spectral bands (“hyperactivation”) in patients including thus who demonstrated good recovery estimated by clinical scales. Over 6 till 12 months after TBI a trend to normal EEG was observed in patients with absence of clinical impairment estimated by scales while “hyperactivation” EEG-signs were remained in dual- tasks performance. Conclusions: Dual tasks could be used as a diagnostic tool for estimation of adaptive possibilities to everyday life in TBI patients. Quality of dual tasks performance can be used as a measure of the brain dysfunction and (or) recovery during their rehabilitation and possibilities for everyday adaptation. EEG-markers observed during dual-tasks performance can be as reflection of compensator brain mechanisms in TBI patients.

Abstracts

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AUTHOR INDEXAAfonso, E. B.: O.29Afonso, M.-E.: O.26Arrufat Gallen, V. A.: O.16

BBarbone, F.: P.03Bernardini, A.: O.31Best, S. W.: O.21Bethune, A.: O.25Biasutti, E.: P.03Brazinova, A.: O.01

CČeh, M.: O.08Cosano, G.: P.03

Dda Costa, L.: O.25Dečman, S.: O.27Dominguez-Morales, M.: O.03

FFeinstein, A.: O.25

GGaliana y Abal, P.: O.04, O.26Gerstenbrand, F.: O.28Giorgini, T.: P.03Grabljevec, K.: O.02

HHarel, A.: P.01Hermans, E.: O.17

KKalyanasundaram, M.: O.11Kaur, S.: O.11Kuptsova, S.: P.05Kurzmann, C.: O.28

LLavrador, J.: O.13Leon-Carrion, J.: O.03Leon-Dominguez, U.: O.03Lipovšek, T.: P.04

MMajdan, M.: O.01Maksakova, O.: P.05Małecka, E.: O.05, O.18Małecki, A.: O.18Manuel Santos, M.: O.13Marttila, A. S.: O.30Mauritz, W.: O.01McWilliams, K. G.: O.24Montreuil, M. S.: O.14

OOpara, J.: O.05, O.18

PPisa, F. E.: P.03

RRotar, A.: O.07Ruch, J.: O.22

SSchnitzler, A.: O.14Scott, M.: O.25Shevtsova, T.: P.05Singh, A.: O.11Steinhoff, N.: O.09, O.15Stopa, L.: O.24

TTeixeira, J.: O.13Tewari, M. K.: O.11Trdan, V.: P.02Truelle, J. L.: O.14

VVešligaj Damiš, J.: O.08

WWaknine, E.: O.25

XXiong, W.: O.25

ZZharikova, A.: P.05Zhavoronkova, L.: P.05

KEYWORD INDEXAabove-standard programmes: O.08acquired brain injury: P.03acute subdural hematoma: O.13age: O.13animal-assisted therapeutic ap-proaches: O.08anti-thrombotic therapy: O.13arts: O.29auditive and visual information: O.31awareness of limitation: O.07

Bbehavioral disorders: O.04

Ccaregivers: O.09, O.11case management: O.09, O.14children: O.17community studies ABI: O.16comprehensive trauma: O.04concussion: O.25consciousness: O.03cortical connectivity: O.03cultural knowledge: O.30

Ddance movement therapy: P.04deep brain stimulation: O.02dual-tasks: O.09

EEEG analysis: O.09environment: O.27epidemiology ABI: O.16ethics: O.28evaluation: O.05experienced disablement: O.30

Ffamilies: O.09, O.22family dynamics and roles: O.04family support: O.17frontal syndrome: O.26future: O.22

Ggender and brain injury: O.16

Hhousing: O.22

IICF Core Sets: O.07

Kknowledge: O.11

Llong term rehabilitation: O.15long term: O.17long-term rehabilitation for

people with ABI: O.08

Mmental functions: O.07mild head injury: O.25minimally conscious state: O.02multi-functional drug: P.01

Nneuropathological conse-quences: O.18neurorehabilitation: O.14, O.28neurosurgery: O.11new drug: P.01

Ooccupational therapy: O.27, P.04optimistic: O.21outcome measure: O.05

Ppositivism: O.21posttraumatic Stress: O.24proprioceptive information: O.31psychotropic medication: P.03

Qquality of life: O.26quantitative electroencephalo-graphy: O.03

Rrehabilitation: O.05, O.29resilience: O.24

Ssecondary degeneration: P.01self-perception: O.26sense of self: O.24serum biomarkers: O.18subjectivity: O.30suicidal intent: O.25survey: P.03synchronism of information: O.31

TTBI: P.05, O.09, O.14, O.27, P.04TBI, early hospital care: O.01TBI, outcomes: O.01TBI, prehospital care: O.01teleneurorehabilitation: O.15

Uunresponsive wakefulness syn-drome: O.02

Vvisual: O.29

Wworthy: O.21

Author Index

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Announcement

Information on Aquired Brain Injury and NeurorehabilitationDay: Saturday, 21. September 2013Venue: Reed Messe Wien GmbH, Congress CenterHall G - Messeplatz 1, 1020 Wien

15:00 Welcome & Opening of the 1st Patient´s day of the World Congress of Neurology Vladimir Hachinski,Canada/GB (englische Präsentation – English presentation) President World Federation of Neurology 15:05 Presentation – European Federation of Neurological Societies Richard Hughes, London (englische Präsentation – English presentation) President EFNS

Vorträge in deutscher Sprache – Presentations in German15:10 Brain tumors Wolfgang Grisold, Vienna Congress Secretary World Congress of Neurology Vorstand Neurologische Abteilung, Kaiser-Franz-Josef Spital Wien

15:25 Fragen und Antworten

15:35 Schlaganfall / Stroke Wilfried Lang, Vienna Vorstand Neurologische Abteilung, Barmherzige Brüder Wien


16:00 Morbus Parkinson / Parkinson‘s disease Eduard Auff, Vienna Congress President World Congress of Neurology Vorstand Universitätsklinik für Neurologie Wien


16:25 Multiple Sklerose / Multiple sclerosis Fritz Leutmetzer, Vienna Leiter MS-Ambulanz, Universitätsklinik für Neurologie Wien


16:50 Voraussichtliches Ende

21


Exhibitors & Sponsors

The organizers acknowledge the support of the following companies:

Documents

2nd TBI-Challenge.eu 2013...2nd TBI Challenge.eu 2013 2nd TBI Challenge.eu 2013 Traumatic Brain Injury is the second frequent neurological disease, directly after the ischaemic stroke