Spinal Cord Injury e81

Poster 248

Post-Traumatic Syringomyelia Refractory to Surgical Intervention: ASeries of Cases on Recurrent Syringomyelia

Hannah P. Leahy (TJUH), Akinpelu A. Beckley, Guy W. Fried,Christopher Formal

Objective: To analyze a series of traumatic spinal cord injury (SCI) pa-

tients with diagnosis of syrinx who had recurrence of symptomatic syrinx

following surgical intervention.

Design: Case series.

Setting: Acute inpatient rehabilitation facility.

Participants: Patients (NZ 6) with post-traumatic syringomyelia who had

recurrent syrinx despite surgical repair.

Interventions: Not applicable.Main Outcome Measure(s): Time period between injury and clinical

manifestations of syrinx, time to recurrence, and presenting symptoms.

Results: Amongst the 6 patients, there is great variability between timeof the

initial SCI and development of syrinx. In terms of temporal relationship

between diagnosis of syrinx and recurrence of syrinx, there is also some

variability (ranged 6 to 936 weeks). The median length of time to recurrence

was 104 weeks. In all cases, the presenting symptom was ultimately weak-

ness, and in most cases associated with rising sensory deficits. Notably, all

patientsweremale, aged 31-55, had suffered diffuse traumatic SCI, and 4of 6

patients lost the ability to ambulate due to syrinx formation.

Conclusions: This series suggests that there may be risk factors for

developing post-traumatic syringomyelia; particularly in young men with

diffuse type versus penetrating injuries. Further study is warranted to

determine whether there are factors that put some patients at increased risk

of syrinx recurrence following surgical intervention. Furthermore, by the

time the syrinx has caused obvious symptoms, it may be more difficult to

treat. Earlier detection and prevention may be important in optimizing

outcomes in recurrent post-traumatic syringomyelia.

Key Words: Syringomyelia, Spinal Cord Injury, Spinal Cord Compression

Disclosure(s): None Disclosed.

Poster 249

Patient-centered Care: Perceptions of Individuals With a Spinal CordInjury

Allen Heinemann (Rehabilitation Institute of Chicago), Holly DeMarkNeumann, David Chen

Objective: 1-examine patient-centered care (PCC) perceptions in persons

with spinal cord injuries (SCI). 2-evaluate differences in PCC between

Veterans and non-Veterans (civilians) with SCI.

Design: Mailed survey.

Setting: Veterans Affairs (VA) and one SCI Model Systems facility.

Participants: Veterans and civilians with SCI (nZ422).

Interventions: N/A.Main Outcome Measure(s): Validated measures of PCC concepts: patient

activation, shared decision-making (SDM). We extracted demographic/

injury characteristics and select conditions from administrative databases.

Results: Veterans with SCI were older than civilians (61% vs. 51%,

p<.0001). A greater proportion of Veterans were male (94% vs. 78%,

p<.0001), black (31% vs. 20%, pZ.05), had incomplete injuries (75% vs.

44%, p<.0001), were older at injury (45 vs. 31 years, p<.0001), had 1 or

more mental health disorder (32% vs. 6%, p<.0001), diabetes (29% vs.

8%, p<.0001), and pressure ulcers (29% vs. 16%, pZ0.0014). The groups

did not differ in level or duration of injury, global PCC experience, holistic

care, or SDM. Veterans reported lower patient activation (57 vs. 62,

pZ0.04), but better chronic illness care (CIC) (3.4 vs. 3.0, pZ0.0002).

Conclusions: VA and one Model System facility have distinct strengths in

providing PCC. Civilians report higher patient activation. Greater proportions

of Veterans experience select conditions (e.g., diabetes, pressure ulcers), but

their CIC is well aligned with the chronic care model (CCM). Civilians may

benefit from better alignment between care and the CCM. Veterans with SCI

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could benefit from greater attention to patient activation and select conditions.

Clinicians can use findings to optimize PCC delivery and outcomes.

Key Words: patient-centered care, spinal cord injury, shared deci-

sion-making

Disclosure(s): None disclosed.

Acknowledgements: This work was funded by the US Department of

Veterans Affairs, Office of Health Services Research and Development,

Quality Enhancement Research Initiative (LIP 42-149) and the Office of

Patient-Centered Care and Cultural Transformation (PCE 13-002).

Poster 250

Impact of Abdominal Binder on Six-Minute Arm Test Performance ina Person With Tetraplegia

Jane L. Wetzel (Youngstown State University), Amanda Furey,Frank Bosso

Objective: To describe physiologic differences observed during the Six-

Minute Arm Test (6-MAT) with and without a binder and lower extremity

stockings in an individual with tetraplegia.

Design: Intervention study: Repeated measures single subject case report.

Setting: Institutional post rehabilitation practice.

Participants: 22 year old male with C8 (ASIA B) tetraplegia, 3 months

post injury.

Interventions: Two trials of arm ergometry, 50 RPM, eliciting rating of

perceived exertion(RPE) of 11-15 (Borg 6-20) for 6 minutes. Cycling was

performed with Monark 881e mounted on adjustable platform table. One

trial without and second trial with abdominal binder(10” wide elastic) and

thigh high stockings (20-30 mm Hg). The subject was breathing through a

mouthpiece and one way valve directed to a metabolic cart (Turbo Fit

VacuMed) to sample expired gas every 30 seconds. Gas analysis deter-

mined oxygen uptake and ventilation. Heart rate (HR) measurement was

taken with a Polar monitor. Oxygen pulse was calculated for each minute.

Main Outcome Measure(s): Oxygen consumption (VO2 ml/kg/min),

ventilatory equivalent for oxygen (VE/VO2), HR, O2 pulse.

Results: An RPE of 11 was reached at minute 3 at a workload of 25 watts for

both conditions. TheRPE increased in both conditions but at a lower arm cycle

load (10 watts) during the final two minutes. There was a lower VE/VO2 and

higher HR without the binder. O2 pulse improved in the binder condition.

Conclusions: The binder may allow improved HR and O2 pulse during the

6-MAT. The use of a binder and stockings may assist sub-maximal exercise

performance in those with tetraplegia.

Key Words: Abdominal Binder, Six-Minute Arm Test, Submaximal Ex-

ercise, Tetraplegia

Disclosure(s): None disclosed.

Poster 251

WITHDRAWN

Poster 252

Correlations Between Functional Independence Measure and PressureUlcer Risk During Inpatient Spinal Cord Injury Rehabilitation

Heather Margaret Flett, Jude J. Delparte, Carol Scovil (Toronto Rehabe UHN), Kristina Guy, Anthony Scott Burns

Objective: To investigate the relationship between the Functional Inde-

pendence Measure (FIM) and pressure ulcer (PU) risk and occurrence

following spinal cord injury (SCI).

Design: Retrospective chart review.

Setting: Tertiary Rehabilitation Centre (UHN - Toronto Rehabilitation

Institute, Toronto, ON).

Participants: Patients with traumatic and non-traumatic SCI (nZ382)

undergoing inpatient rehabilitation.

Interventions: NA.Main Outcome Measure(s): Spearman correlations between FIM and PU

risk scores (Braden and SCI Pressure Ulcer Scale (SCIPUS)). Difference in

FIM across risk stratification and PU occurrence.

e82 Spinal Cord Injury

Results: PU risk correlated to the admission FIM, with the Braden

demonstrating a stronger correlation (rZ0.77) vs. the SCIPUS (rZaV‘0.47).

Admission FIM scores decreased as PU risk increased for both the Braden

and SCIPUS. Mean FIM admission scores for the Braden low and high risk

categories were 97 and 53 respectively. Similarly, mean FIM score for the

SCIPUS low risk category was 94 compared to 66 for the high risk category.

Patients having PUs had lower FIM scores at admission (62 vs. 79) and

discharge (90 vs. 110) compared to those without PUs (p<0.0001). Results

were similar when the FIM motor subscale was substituted for total FIM.

Conclusions: Study results confirm a relationship between admission

impairment severity (FIM) and PU risk during inpatient SCI rehabilitation

as measured by both the Braden and SCIPUS. Lower admission functional

ability is linked to PUs. This study demonstrates the convergent validity of

the SCIPUS, a SCI-specific but under-utilized PU risk assessment as

overall patient function is expected to be related to PU risk.

Key Words: Spinal Cord Injuries, Pressure Ulcer, Outcome Assessment,

Risk Assessment

Disclosure(s): Jude J. Delparte, None Disclosed; Anthony S. Burns, None

Disclosed; Heather Flett, None Disclosed; Kristina Guy, None Disclosed;

Carol Scovil, None Disclosed.

Poster 253

Implementation of Physical Activity Guidelines for Spinal CordInjury: Effects on Vascular Structure and Function

Julia Totosy de Zepetnek (McMaster University), Chelsea Pelletier,Audrey Hicks, Maureen Jane MacDonald

Objective: To determine the effects of implementing 4-months of the

physical activity guidelines (PAG) on vascular-health outcomes in adults

with spinal cord injury (SCI).

Design: Randomized controlled trial.

Setting: McMaster University.

Participants: Twenty-three persons with SCI (NLI C3-T11, AIS A-C, YPI

12.0�9.9 years, age 41.4�11.6 years).

Interventions: Participants were randomized into PAG (nZ12) or active

control (CON, nZ11) for 4-months. PAG training involved 2x/wk of

�20min of moderate-vigorous aerobic exercise (RPE 3-6) and 3x10reps of

strength exercises for upper-body muscles. The CON group maintained

existing physical activity levels with no guidance on training intensity.

Main Outcome Measure(s): Vascular health indicators of arterial structure

via local compliance and regional stiffness, and arterial function via local

endothelial functionweremeasured at baseline and after 4-months of training.

Results: No baseline differences between groups or changes over time

within groups were found in arterial structure (carotid compliance,

regional stiffness) or function (arm and leg endothelial function). However,

a trend was found for measures of carotid artery compliance (group x time

interaction pZ0.07), in which improvements in local carotid artery

compliance were seen in the PAG group concurrent with declines in local

carotid artery compliance in the CON group.

Conclusions: Four months of implementation of the PAG in adults with

SCI is insufficient to improve peripheral vascular structure and function.

However, there was an indication of trends towards positive local carotid

artery compliance changes with 4-months of the PAG. The PAG should

continue to be promoted as a means to increase physical activity, but may

need to be modified for vascular health improvements. Increases in the

duration and/or intensity of the aerobic exercise component of the existing

PAG may be needed to improve vascular health outcomes in adults

with SCI.

Key Words: spinal cord injury, cardiovascular health, physical activity

guidelines

Disclosure(s): None Disclosed.

Poster 254

Health Care Access and Utilization After Spinal Cord Injury

Lee Saunders (Medical University of South Carolina), David Murday,James S. Krause

Objective: To assess health care access and utilization in a population

based cohort of persons with traumatic spinal cord injury (SCI).

Design: Cross-sectional study of a population-based cohort of adults with

SCI of 1+ years duration injured between 1998-2011.

Setting: A medical university.

Participants: Persons discharged from the hospital in South Carolina were

included in the SCI Surveillance System Registry and invited to participate.

Interventions: Not applicable.Main Outcome Measure(s): Participants answered questions regarding

access to health care as well as health care utilization in the past year.

Results: Of participants (nZ775), 72.5% were male, 59.9% were white, and

the average age was 49.1 (13.0). Thirty-seven percent reported one or more

hospitalizations and 10.0% two or more hospitalizations in the past year, with

11.2 (13.3) average days hospitalized. At least one emergency department visit

was reported by 46.8%, and 28.5% reported one or more surgeries in the past

year. For health care access, 55.2% reported being worried at least sometimes

that theywould not be able to afford the health care services they needed, 50.2%

worried they can’t afford prescriptionmedications, 48.1%worried theywill lose

their insurance, and 51.8% worried they won’t be able to afford supplies.

Conclusions: Access to care is critical to individuals with SCI to maintain

their health and avoid secondary conditions. Unfortunately, many people

with SCI do not have access to the appropriate follow-up care, and this

could have negative consequences for their health.

Key Words: access to health care, spinal cord injuries, health

Disclosure(s): None disclosed.

Poster 255

WITHDRAWN

Poster 256

Rehabilitation of Walking: Are Key Kinetics Disrupted by BodyWeight Support?

Lise Worthen-Chaudhari (The Ohio State University),James Schmiedeler, D. Michele Basso

Objective: To evaluate the extent to which key kinetics of walking at

community ambulation speeds above 0.8m/s are preserved or disrupted

when body weight support is applied.

Design: Participants acted as their own controls in a within-session design.

Setting: Gait Laboratory within a rehabilitation hospital.

Participants: 8 neurologically intact persons.

Interventions: Body weight support (50%, 30%, 0%) was applied during

walking on a treadmill at self-selected speed (1.10-1.53m/s) and 50% of

self-selected (0.55-0.77m/s).

Main Outcome Measure(s): Timing andmagnitude of joint power about the:

sagittal hip (HS), frontal hip (HF), sagittal knee (KS), sagittal ankle (AS).

During weight acceptance, power absorption was examined (WA-). During

propulsion, power generation was examined (PR+). Baseline condition, or the

“rehabilitation target”, was defined as self-selected speeds at 0% BWS. Out-

comes from studied conditions were compared to those of the target.

Results: The results of our analysis (ANoVA) show that kinetics of step-to-

step transitions during community ambulation speed walking are largely

preserved when BWS is applied (up to 50%) but are lost when speed

is slowed.

Conclusions: Key kinetics, specifically joint powers in weight acceptance

and propulsion, are preserved when BWS is applied, but lost at speeds 50%

below the rehabilitation target, it is recommended to train at the speeds you

intend the patient to walk at, post-rehabilitation, applying BWS to facili-

tate training as needed.

Key Words: Rehabilitation, Gait disorders, Neurologic, Biomechanical

Phenomena, Spinal Cord Injuries

Disclosure(s): None Disclosed.

Poster 257

WITHDRAWN

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