PM&R Vol. 6, Iss. 8S2, 2014 S111

and validity are properties of instruments that affect credibility of therehabilitation process. The objectives of this study are identify strokerehabilitation arm function domain of scales that have been validated toBrazilian cultural context and classify them using the International Classi-fication of Functioning Disability and Health (ICF). Methods: Literaturereview was performed including sources from 1980 to 2013 from Medline(scale [MESH] or assessment or evaluation or measurement or Brazil orPortuguese) LILACS (stroke and evaluation and (instance:“regional”)) andSCIELO (stroke and evaluation) databases. Only stroke patients and vali-dation studies in Brazilian cultural context of stroke assessment scales thatcontain a function arm domain were selected. Data extraction: afterreviewing the 7778 abstracts resulting from searching, 13 papers have beenselected. Five independent researchers have analyzed the articles. One studyhas been excluded because it does not contain an arm function evaluationand the other because the study doesn’t involve the Brazilian culturalcontext. Findings: 11 different scales (Jebsen-Taylor test, stroke impactscale, Rankin scale, functional independence measure, Barthel index, NIHSSmotor activity log, Wolf motor function test, Fugl-Meyer assessment,Scandinavian stroke scale, Nottingham sensory assessment for strokepatients). Interpretation: Only 11 commonly used scales that evaluatedthe arm function are validated in Brazilian cultural context. Future studiesshould also include instrumental evaluation according to the participationICF domain.

No. 77 Frenchay Aphasia Screening Test Validity in PostStroke Colombian Patients.Camilo Chaves; Ma. De Los Angeles Tamayo, SLP;Fernando Ortiz.

Disclosure: None. Objective: To establish the validity of the Frenchayaphasia screening test (FAST) in Colombian population to establish thecriterion validity of the FAST by comparing it with a diagnostic and eval-uation aphasia battery. Setting: Inpatient post stroke adult population inBogota, Colombia. Participants: 65 patients (men and women) older than18 years who were hospitalized because of first-time stroke within a 30 daycourse. Interventions: We applied the FAST in the stroke patients intwo different times and by two different observers. To a 10 patient sub-group we applied the Boston diagnostic aphasia examination. Then wecompared the results between the two FAST observers and between theFAST and the Boston diagnostic aphasia examination to establish thevalidity criterion and the interobserver validity of the FAST. Main Out-come Measures: Interrater validity of the FAST, FAST and Bostondiagnostic aphasia examination, correlation time of the FAST application.Results: The kappa index between the FAST interobserver applicationwas 0.8 or greater. When comparing the FAST and the Boston diagnosticaphasia examination the Spearman correlation was of at least 0.6. The FASTapplication time was between 5-10 minutes. Conclusions: The FASTshowed an excellent interrater validity. The FAST showed a good correlationwith the Boston diagnostic aphasia examination. The FAST was an easy andbrief tool for screening aphasia.

No. 79 Association of CASP Gene Polymorphisms andIschemic Stroke.Jinmann Chon; Minho Park; Seung Yeol Lee.

There are several evidences of the correlation between apoptosis andischemic stroke (IS). Apoptosis can influence neuronal cell death and neu-roprotection of brain tissue thereby may have effect on the development andclinical severity of IS. The purpose of this study is to investigate whether thepolymorphisms of CASP 3 gene (rs4647602; intron A/C and rs1049216;UTR C/T) and CASP9 (RS1052576; Gln/Arg G/A and rs1052571; Ser/ValT/C) were associated with the development, clinical severity and daily activ-ities in IS. Genomic DNA from 110 IS patients and 201 healthy controlsubjects were extracted and polymerase chain reaction products weresequenced. In order to investigate the association of polymorphisms and

the development modified Barthel index (K-MBI) score and National Insti-tutes of Health Stroke Scale (k-NIHSS), multiple logistic regression modelswere analyzed. These results revealed that a single nucleotide polymorphism(SNP) of CASP3 (RS1049216; UTR C/T) and a missensce SNP of CASP9(rs1052571; Ser/Val T/C) was associated with the development of IS. Poly-morphism of untranslational region of CASP3 (RE1049216) has associationwith the development of IS (in codominant1 model OR¼ 0.51 95%CI¼0.29-0.88 p¼0.017 in dominant model OR¼0.57 95% CI¼0.34-0.97p¼0.034 in overdominant model OR¼0.50 95% CI¼0.29-0.87p¼0.011). A missense SNP of CASP9 gene (rs1052571 Ser/Val) was associ-ated with the development of IS (OR¼1.93 95% CI¼1.05-3.55 p¼0.034 inrecessive model). These results indicate the possibility that CASP3 andCASP9 gene CASP3 (RS1049216 and RS1052571) is a marker for the devel-opment of IS.

No. 80 Programa de Terapia Cognitiva Integral enPacientes Con Afectación Cognitiva Secundariaa Enfermedad Vascular Cerebral Isquémica.David Adrian Delgado Ruiz; Dra. Ofelia Martinez Villa.

Divulgación:Ninguna.Objetivo:Mejorar el déficit cognitivo de los pacientescon enfermedad vascular cerebral isquémica. Diseño: Estudio observacionalprospectivo longitudinal de cohorte. Configuración: programa de terapiacognitiva con una evaluaciones inicial y final. Nivel de evidencia: IIB - III.Participantes: Treinta y cinco hombres y doce mujeres (47 pacientes) condiagnóstico de enfermedad vascular cerebral y déficit cognitivo de ambossexos edad de 40 a 70 años. Se valoró el estado cognitivo inicial y final con el testde minimental el test pfeiffer y la prueba del reloj. Se aplicó el programa deterapia cognitiva por 20 sesiones consistió en actividades cognoscitivas memoriagnosias y praxias cálculo y funciones ejecutivas atención razonamiento y len-guaje. Principales medidas: Los resultados se analizaron con el paqueteestadístico spssv.10 mediante la prueba de Wilcoxon (significancia p<0.05).Resultados: En la evaluación inicial del nivel cognitivo con los test MSSEPfeiffer y prueba de reloj se encontró predominio del déficit leve en un 74.46%.Las áreas que mostraron más afectación de acuerdo a test de MSSE fueron laorientación memoria inmediata atención y calculo recuerdo diferido lenguaje yconstrucción. Al finalizar el programa de terapia cognitiva integral el déficit levemejoró en un 61.7%. En relación con la mejoría de las funciones valoradas elporcentaje que se encontró mediante el test de prueba de reloj fue de un 60.1%para las funciones visoperceptivas visomotoras visoconstructivas planificación yejecución motoras expresadas en cada una de las pruebas valoradas con unasignificancia estadística de p < de 0.05. Conclusión: El programa de terapiaintegral cognitiva mejora el deterioro cognitivo en pacientes con enfermedadvascular cerebral isquémica.

No. 81 Realidad Virtual Como Terapia Complementaria enel Tratamiento De Pacientes Con Parálisis Cerebral InfantilEn Edad Escolar.David Adrian Delgado Ruiz; Dra. Amparo Asenath Lugo Calles;Irene Rodríguez Ramírez.

Divulgación: Ninguna.Objetivo: Valorar el beneficio en independenciafuncional utilizando la escala weeFIM con el uso de realidad virtualcomo terapia complementaria en pacientes con parálisis cerebral infantil.Diseño: Estudio cuasiexperimental descriptivo no ciego longitudinal yprospectivo. Nivel de evidencia: II Y III. Participantes: Incluimos6 pacientes con las siguientes características: derechohabientes en edadescolar diagnóstico PCI clasificación funcional motora gruesa grados i al iiiclasificación topográfica de hemiparesia con puntaje 0 a 2 escala tardieu.Resultados: Realizamos una valoración inicial y final se aplicaron 10sesiones de terapia con el uso de la consola wii y el software wii Sports enjuegos de baseball y box durante 20 minutos por sesión. Se realizó unaevaluación final y análisis estadístico de los resultados con el paquete SPSSbajo un nivel de confianza de 95% con las pruebas de chi cuadrado y deFriedman con el coeficiente de concordancia de Kendall obtuvimos

S112 PRESENTATIONS

una p igual a 0.000 en las subescalas de autocuidado locomoción y cogni-ción social estadísticamente significativo en la independencia funcional.Conclusión: La realidad virtual como terapia complementaria mostróresultados significativos en la independencia funcional.

No. 82 Comprehensive Therapy Program in Patients WithCognitive Affection Due to Ischemic CerebrovascularDisease.David Adrian Delgado Ruiz; Ofelia Martinez Villa.

Disclosure: None. Objective: To improve the cognitive deficit inpatients with ischemic stroke. Design: Observational prospective longi-tudinal cohort study. Level of Evidence: II-III. Configuration: Cognitivetherapy program with initial and final evaluations. Participants: Thirtyfive male and twelve female (forty seven patients) with ischemic cere-bralvascular disease and cognitive deficit from 40 to 70 years. The initial andfinal cognitive status was measured with mini-mental, Pfeiffer and clocktests. A 20 session cognitive therapy program was provided. It includedcognitive practical and executive therapy, memory, calculus, attention,reasoning, and language exercises. Main Measures: The results wereanalyzed using the Wilcoxon SPSSv. 10 statistical package (significancep <0.05). Results: In the initial assessment of cognitive level with MSSE,Pfeiffer and clock tests, prevalence of 74.46% mild deficit was found. Areasthat showed impairment according to MSSE were orientation, immediatememory, attention, calculus, delayed recall, language and construction. Atthe end of the comprehensive cognitive therapy mild deficit improved61.7%. We found a 60.1% improvement in motor planning and executionand visual-perceptive motor and constructive functions evaluated with theclock test showing statistical significance correlation of p <0.05. Con-clusion: The comprehensive cognitive therapy improves cognitiveimpairment in patients with ischemic stroke.

No. 84 Patient Registry of Outcomes in Spasticity (PROS)Care World.Alberto Esquenazi; Nathaniel Mayer; Stella Lee.

Objectives: To provide insight into the real-world assessment, treatment,and outcomes in patients after stroke and traumatic brain injury (TBI)treated for spasticity with chemodenervating and neurolytic agents.Design: Prospective multicenter observational study. Setting: Multi-center with 29 participating sites globally. Participants: 122 TBI and 539post-stroke patients. Interventions: Clinically indicated botulinumtoxinAor phenol injection. Main Outcome Measures: Ashworth score painglobal assessment and satisfaction. Level of Evidence: Level 1.Results: The most commonly treated pattern of dysfunction in the upperlimb (UL) was the flexed wrist (27.2%) with flexor carpi radialis (FCR)(31.0%) being the most frequently treated muscle. The total onabotuli-numtoxinA dose used per patient in the UL was 312.2 � 175.8U and for5.0% phenol 6.4 � 3.2cc. The most commonly treated pattern ofdysfunction in the lower limb (LL) was the equinovarus/equinus foot(64.2%) with the medial/ lateral gastrocnemius (25.1%) being the mostfrequently treated muscles. The total onabotulinumtoxinA dose used perpatient in the lower limb was 260.1 � 134.6U and for 7.0% phenol 5.6 cc� 2.4. There was a significant improvement in the Ashworth score(p<0.0001). The foot showed the largest reduction in pain score -3.9 � 3.3.Nearly half of the patients reported they were satisfied (45.9%) withtheir overall treatment 71.8% of patients’ reported “made some progresstowards primary goal” and 68.1% reported “made some progress towardssecondary goal”. No significant related adverse effects were reported.Conclusion: Our findings suggest different dosing patterns forcommonly treated limb deformities resulting from UMN dysfunction andimprovement in Ashworth and pain scores. This robust database indicatesa preference for onabotulinumtoxinA and can guide clinicians in the muscleselection and management of spasticity.

No. 85 Spatiotemporal Changes in Gait Performance Due toOnabotulinumtoxinA Injection to Lower Limb Muscles inPatients With Upper Motor Neuron Syndrome.Alberto Esquenazi; Patrizio Sale, MD; Daniel Moon;Amanda Wikoff, BS.

Objective: To evaluate the effects of onabotulinumtoxinA (ONABOTA)on spatiotemporal walking parameters of patients with equinovarus-relatedgait dysfunction caused by upper motor neuron syndrome (UMNS).Design: Retrospective before and after intervention analysis. Setting: Gaitanalysis laboratory. Participants: A total of 42 patients with UMNS(19 male 23 female) with ages ranging from 18-78. Stroke and traumaticbrain injury were the predominant diagnoses. Interventions: Patientrecords were retrospectively reviewed for spatiotemporal data before andafter ONABOTA injection to the ankle muscles. For data collection patientswalked down a 12 meter walkway multiple times at their self-selectedvelocity. Using electrical stimulation guidance, up to 6 selected lowerextremity muscles were injected with ONABOTA. The most commonmuscles injected were medial and lateral gastrocnemius followed by soleusand tibialis posterior. The average ONABOTA injection dose used was320�107U. Within 10 weeks of injection patients had their spatiotemporaldata recorded again. Main Outcome Measures: Spatiotemporalparameters of walking assessed before the injection (T0) and within 10weeks post injection (T1). Results: Statistically significant improvementwas seen on average walking velocity between pre and post injectionat T0¼0.40�0.26 m/s and T1¼0.48�0.29 m/s (p¼0.00001) and cadenceat T0¼63.48�23.93 steps/min and T1¼70.88�23.65 steps/min(p¼0.00001). There was a decrease in stance time on the unaffected legT0¼74.93�9.13% and T1¼73.05�7.72% (p¼0.039) suggesting the pa-tient felt more stable on the affected limb. Increased velocity appears to berelated to increase in step length and cadence. Conclusions: This studydemonstrated that ONABOTA injection to the ankle muscles is an effectiveway to significantly improve gait velocity in adult patients with UMNS.Other studies have not demonstrated a significant increase in walkingvelocity in a large group of patients after ONABOTA injection to the anklemuscles. Level of Evidence: Level II. Financial Disclosure: None.

No. 86 Pre-Clinical Validation of a Robot AidedPhysiotherapy System for Practicing ADL Tasks in PatientsPost-Stroke.Gabor Fazekas; Zoltan Denes; Ibolya Tavaszi; Andras Toth.

Disclosure: None. Objective: There was a pre-clinical study to verifyergonomic compliance of the REHAROB robotic therapeutic system thatsupports upper limb physiotherapy of patients with spastic paresis. Theresearch question is whether normal exercise trajectories pre-defined formeans of small (S), medium (M), and large (L) size ranges derived fromanthropometric design theory are comfortable for randomly selectedsubjects. Design: Non-blinded pilot study. Setting: Biomedical labora-tory of a rehabilitation institute. Participants: 9 healthy volunteers clas-sified into 3 anatomically defined sizes of the Hungarian adult population: Ssize (n¼2) if smaller than M size, M size (n¼3) if height is between 164.07 cmand 175.36 cm, L size (n¼4) if higher than M size. Interventions: TheREHAROB robotic therapeutic system was connected to the elbow, to thehand, and to the fingers of the subject. Five reach and grasp type activities ofdaily living (ADL) tasks were practiced via the selected S/M/L normaltrajectories with the assistance of the robot: 1. Cup 2. Phone 3. Zipper 4.Doorhandle 5. Towel. Main Outcome Measures: Force and torqueacting between the robotic system and the subject were measured at theelbow, at the hand, and at the fingers. Subjects were asked if the force/torque attained was comfortable. Level of Evidence: Level 2. Results: 5of the subjects declared discomfort after the exercises. 6 of the subjectsfalling between size range borders �25 cm produced on average 47% higherpeak force and torque than those of the rest. Conclusions: Trisectionof the normal height range for subjects into S/M/L sizes led to insufficient