Journal of the International Society of Physical and Rehabilitation Medicine
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VIRTUAL ISPRM 2021 CONGRESS

Virtuale, 12/06/2021 - 15/06/2021

Topic: 6. Health Policy and Systems

Sub Topic: 6.5 Rehabilitation A cross the Continuum of Care

Gendered experiences of providing informal care for older people: A systematic review and thematic synthesis

I. Zygouri1, F. C2, A. P3, M. G4, S. M5

1Faculty of Medicine, University of Ioannina, Ioannina, Greece, 2School of Nursing and Midwifery, Birmingham City University, Birmingham, United Kingdom, 3Faculty of Medicine, University of Ioannina, Ioannina, Greece, 4Department of Nursing, University of Ioannina, Ioannina, Greece, 5Department of Nursing, University of Ioannina, Ioannina, Greece

Background and Aims: The caregiving’s impact on informal carers’ quality of life and gender-based stereotypes make older individuals’ informal care a complex process for which our knowledge is still limited. The purpose of this review is to identify how gender relates to informal carers’ experiences of providing care for people aged 60 years and over with mental and physical health needs by synthesising the available empirical data published between 2000 to 2020. Methods: The systematic method for reviewing and synthesising qualitative data was performed using the Preferred reporting items for systematic review and meta-analysis. (PRISMA) guidelines. The Critical Appraisal Skills Programme (CASP) was used to examine the quality of the included papers. Thematic synthesis was used as the methodological framework. Results: While informal caregivers share motivators, a linkage between traditional gender stereotypes impacts women’s and men’s caregiving burden and coping strategies. Informal carers’ experiences entail a constant pursuit of self-agency after acquiring the caregiver role. Cultural values and their intersection with gender appear to influence caregivers’ healthy adjustment into their new caregiving identities. The flexibility to move beyond gender boundaries could mediate caregivers’ negotiations between self and society on developing their new caregiving identity.

Conclusions: Transgressing gender lines and expanding gender possibilities can ease the caregiving burden and strengthen caregivers coping potentials. Health professionals can empower informal careers to challenge gender binaries and expand gender possibilities by intentionally injecting the language of diversity in caring information and caring processes. The review findings outline a path for research on gender identity development in older people’s care.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Association between the severity of stress urinary incontinence and pelvic floor, trunk, hip and respiratory muscles strength in non-active women

S. Ghroubi1, Y. Zribi1, S. Abidi2, H. Ben Ayed3, M. Chlif4,5, M. H. Elleuch1

1Department of Physical Medicine and Rehabilitation, Habib Bourguiba University Hospital, Sfax, Tunisia, 2Research Unit Education, Motricité, Sport et Santé, High Institute of Sport and Physical Education of Sfax, Sfax, Tunisia, 3Department of Preventive Medicine and Hospital Hygiene, Hedi Chaker University Hospital, Sfax, Tunisia, 4EA 3300 APS and Motor Patterns: Adaptations-Rehabilitation, Picardie Jules Verne University, Amiens, France, 5Tunisian Research Laboratory Sport Performance Optimization, Tunis, Tunisia

Background and Aims: Interactions between pelvic floor muscles (PFM), trunk, hip and respiratory muscles have been established. The aim of this study was to assess the strength of pelvic floor, trunk, hip and respiratory muscles using objective methods and to study their association with the severity of stress urinary incontinence (SUI). Methods: Twenty five women with SUI were enrolled. The severity of SUI was assessed using one-hour Pad test. Pelvic floor muscles function was assessed using the modified Oxford Scale, and electromyography. Trunk and hip muscles strength was assessed using a Cybex Norm II ® dynamometer. The respiratory muscles were assessed using the maximal inspiratory and expiratory pressures. Results: The severity of SUI was associated to the Oxford scale measures (P=0.004, r =-0.55), PFM motor activity measured by electromyography (P=0.002, r= -0.58), trunk flexors pic torque at 60°/sec (P=0.022, r=-0.45),the ratio of the right hip flexors pic torque on extensors pic torque at 60°/sec (P=0.041, r=-0.41). Multivariate linear regression analysis revealed that the independent factors associated with the severity of SUI were PFM strength (P=0, β=-0.73), trunk flexors pic torque at 60°/s(P=0.013 β=-0.73), right hip flexors pic torque at 60°/sec (P=0.033, β=-0.22) and the ratio of trunk flexors pic torque 60°/sec on the women weight (P=0.004, β=0.95). Conclusions: We found that incontinent women with greater pelvic floor, abdominal and hip flexor muscles strength had a less severe SUI. Anatomical connections and co-activation between these muscles can explain our findings.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Application of neuroelectrophysiological techniques in the evaluation of spasticity after stroke

X. Zhu1, H. Wang2

1Zhongda Hospital Affiliated to Southeast University, Nanjing, China, 2Nanjing Sport Institute, Nanjing, China

Background and Aims: To explore the neuromuscular physiological characteristics of patients with spasticity after stroke, to analyze the correlation among spasticity, neuroelectrophysiological parameters and Brunsstrom functional stage. Methods: Study was performed in 41 patients with unilateral hemiplegia and finger flexor spasticity after stroke, including 12 cases of stage 1, 17 cases of stage 2 and 12 cases of stage 3 according to Brunsstrom stage. We evaluate the modified Ashworth scale (MAS),the compound muscle action potential(CMAP) amplitude of the median nerve, the latency of F wave, the amplitude and occurrence rate of F wave, F/M(the ratio of F wave amplitude to CMAP amplitude), F-patient / F-health (the ratio of F amplitude of affected side to F amplitude of healthy side).} Results: The amplitude of CMAP wave of the median nerve in the affected side was significantly lower than that in the healthy side (p<0.001), and the latency, amplitude, occurrence rate and F/M of F wave in the affected side were significantly higher than those in the healthy side (p= 0.035; p=0.006; p=0.005; p=0.001). The MAS grade of finger flexor muscle was positively correlated with amplitude of F wave, F/M and F-patient/F-health (r=0.507, p =0.001; r=0.518, p<0.001; r=0.617,p<0.001), From stage 1 to stage 3, Brunsstrom was positively correlated with MAS grade of finger flexor muscle, F-patient/F-health, and median nerve CMAP amplitude (r=0.380, p=0.014; r=0.421, p=0.006;r=0.369,p=0.018). Conclusions: Neuroelectrophysiological parameters can reflect the state of spasticity, degree of nerve injury and function.

Topic: 5. Engineering and Technology

Sub Topic: 5.1 Assistive Products

The effectiveness of a computerized cognitive training program for children with intellectual and developmental disabilities

J. Zhu1, J. Peng1,2, Z. Li1,2, J. Song1, 2, 3, Y. He1,2, J. Huang1, 2, 3, 4, J. Tao1, 2, 3, 4, L. Chen1, 2, 3, 4, J. Wu1, 2, 3, 4

1Fujian University of Traditional Chinese Medicine, Fuzhou, China, Fuzhou City, Fujian Province, China, 2Key Laboratory of Orthopedics and Traumatology of Traditional Chinese Medicine and Rehabilitation, Fuzhou City, Fujian Province, China, 3Fujian Collaborative Innovation Center for Rehabilitation Technology, Fuzhou, China, Fuzhou city in Fujian Province, China, 4TCM Rehabilitation Research Center of SATCM, Fuzhou, China, Fuzhou City, Fujian Province, China

Background and Aims: Children with intellectual and developmental disabilities (IDD)experience heightened attention, which have been linked to poorer cognitive, academic and social outcomes. Computerised cognitive training(CCT),an effective means for children’s cognitive function. However, limited studies have assessed whether CCT could be utilised for attention disorder in children with IDD. We performed a pilot double-blind randomized controlled trial to evaluate the efficacy of CCT for attention diffificulties in children with IDD.

Methods: 60 qualified participants were randomized to computerized cognitive training group (CCT) and traditional cognitive training group (TCT), receiving 5 weeks (20 min per day, 5 days every week), follow-up after 3 months. The scale used for attention evaluation was Conners’ Parent Rating Scale-Revised. The effectiveness of interventions between groups were evaluated using an intention-to-treat analysis. Results: The baseline was no statistical difference between the two groups. After intervention, there was a greater effect in CCT.

From baseline to post-training, CCT had an descending effect on total score, impulse-restlessness and abnormal restlessness index scores. From baseline to follow-up, CCT had a descending effect on total score, learning problems, impulse-restlessness and abnormal restlessness index scores.

From post-training to follow-up, had a descending effect on total score and abnormal restlessness index scores, while had an ascending effect on Conduct problems. Conclusions: Our data suggest that Computerised cognitive training could alleviate the attention problems, and the improvement of impulse-restlessness and abnormal restlessness index could last 3 months.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/Pulmonary Rehabilitation

Effects of pulmonary rehabilitation based eras program on postoperative pulmonary complications in patients undergoing lung cancer surgery: primary results from the phase III multicenter random

Y. Zheng1, M. Mao1, F. Li2, L. Wang1,3, X. Zhang1, X. Zhang1, H. Wang4, H. Zhou5, M. Ji6, Y. Wang7, L. Liu8, Q. Zhu2, X. Lu1

1Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, 2Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China, 3Department of Rehabilitation Medicine, Qingdao Municipal Hospital, Qingdao, China, 4Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, 5Department of Rehabilitation Therapy, Taizhou Enze Medical Center, Enze Hospital, Taizhou, China, 6Department of Rehabilitation Therapy, the Second Affiliated Hospital of Hainan Medical University, Haikou, China, 7Department of Rehabilitation Medicine, Shenzhen Dapeng New District Nanao People Hospital, Shenzhen, China, 8Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medica, Nanjing, China

Background and Aims: Lung cancer surgery is associated with a high incidence of postoperative pulmonary complications (PPCs). This trial was designed to investigate the effects of pulmonary rehabilitation based ERAS program (PREP) on PPCs and length of hospital stay (LOS) following lung cancer surgery. Methods: The PREP trial is a pragmatic multi-center, randomized controlled, parallel group, phase III clinical trial. Eligible patients with lung cancer were randomly assigned to 1) the PREP group, followed a pathway with pulmonary rehabilitation components implanted into generic thoracic ERAS pathway or 2) the control group, followed the routine thoracic ERAS pathway. Results: The primary outcome was incidence of PPCs within 14 postoperative days. A total of 428 patients were listed for lung cancer surgery, and 374 were randomized with 168 in the PREP group and 163 in the PREP group completed the trial. PPCs incidence was 18.7% (35/187) in the PREP group and 33.2% (62/187) in the control group (ITT hazard ratio 0.523, 95% confidence interval 0.348 to 0.786, p=0.002). Significant risk reduction was detected in secondary complication outcomes including pleural effusion, pneumonia and atelectasis. LOS were not significantly shortened with the application of pulmonary rehabilitation while higher adherence rate to the PREP pathway was significantly associated with lower PPCs and atelectasis incidence. Conclusions: In a representative population of patients listed for lung cancer surgery, the PREP pathway halved the incidence of PPCs. Implantation of pulmonary rehabilitation components into the generic thoracic ERAS pathway should be considered a primary step in PPC prophylaxis.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis - Osteoarthritis

Clinical effects of warm acupuncture combined with herbal fumigation in the treatment of rheumatoid arthritis of the knee joint

S. Zhao

Shaanxi University of Traditional Chinese Medicine, Xi’an, China

Background and Aims: To explore the clinical effect of warm needling moxibustion combined with traditional Chinese medicine fumigation in the treatment of rheumatoid arthritis of the knee. Methods: Seventy patients with rheumatic knee arthritis with cold-dampness obstruction type were randomly divided into control group and observation group, each with 35 cases. The control group was given conventional treatment combined with traditional Chinese medicine fumigation treatment; the observation group was given warm needle moxibustion on the basis of the treatment of the control group. Continuous treatment for 2 months, observe the changes in HSS scores, erythrocyte sedimentation rate (ESR), rheumatoid factor (RF), and C-reactive protein (CRP) levels before and after treatment in the two groups. Results: After treatment, the levels of ESR, RF and CRP decreased significantly (P<0.05), HSS score significantly decreased (P<0.05), and HSS score significantly decreased (P<0.05). Compared with the control group, the ESR, RF and CRP levels of the observation group decreased significantly after treatment (P<0.05), and the HSS score was significantly reduced (P<0.05). The total effective rate of the observation group was 92.1%, and the total effective rate of the control group was 75.3%. There was a statistically significant difference in the clinical efficacy between the two groups (P<0.05). Conclusions: Warm needle moxibustion combined with traditional Chinese medicine fumigation can significantly reduce the CRP and HSS scores of patients with rheumatoid knee arthritis of cold-dampness blockage type, improve their inflammatory response, and improve the treatment efficiency.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

A follow-up study on the functional level of patients one year since stroke

Y. Zhang1, J. Jia1,2

1Fujian University of Chinese Traditional Medicine, Fuzhou, China, 2Department of rehabilitation medicine, Huashan Hospital, Fudan University, Shanghai, China

Background and Aims: Follow up in stroke rehabilitation is of great value especially in patients without medical care. This study aims to perform a follow-up in patients one year since stroke. Methods: Through the hospital information management system, we obtained the phone numbers of stroke patients who met the research criteria. Then we asked the patients or their families on telephone to obtain the patient’s current medical status, dysfunction, exercise habits, walking ability and so on. Results: All patients with transient ischemic attack (TIA) reached an independent level of activity of daily living and the same situation in cerebral infarction and cerebral hemorrhage patients accounting for 55.4% and 36.4%. The type of dysfunction that most affects the quality of life is dyskinesia, accounting for 48.9%, followed by cardiopulmonary dysfunction, accounting for 8.85%. Among the patients who prefer exercise, 82.35% of them have a rating of 5 in the Holden Walking Ability Scale. While there are only 45.57% for the patients who do not like exercise. Conclusions: Among all types of stroke, TIA patients have the best prognosis. The biggest problem for patients at this stage is motor dysfunction, and it may also be accompanied by other problems such as cardiopulmonary function and mental psychology. Patients who do more exercise tend to have better walking ability.

Reference

Fan Q, Jia J. Translating research into clinical practice: importance of improving cardiorespiratory fitness in stroke population. Stroke 2020:51:361-7.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Effect of transcranial direct current stimulation combined with melodic intonation therapy on image naming in patients with aphasia

Z. Qian, X. Qian, C. Yunjia, X. Jiayi, W. Ping, L. Ningining, Q. Jun, S. Chunlei

Rehabilitation Medicine, Shanghai, China

Background and Aims: To investigate the effect of tDCS combined with MITon image naming in patients with aphasia. Methods: 5 patients with poststroke aphasia were selected for four weeks of training. Patients received classical MIT for the first 2 weeks (stage A) and transcranial tDCS for the second 2 weeks (stage B). The stimulation site of tDCS was the Broca region on the left, the stimulation intensity was 1.5mA. MIT is a speech therapist who instructs aphasia patients to sing the target words together, and at the same time lets them tap the table rhythmically to beat, inducing the patients’ language expression. 30 minutes each time, 5 times a week, 20 minutes of tDCS treatment at the same time of MIT training in phase B. At week 0, weekend 2, and weekend 4, the patients were evaluated using the named part of the western aphasia test suite and the black-and-white line graphs of randomly selected nouns and verbs, and the results were recorded. Results: The data showed that there was no significant improvement in the nomenclature of patients evaluated after phase A treatment. The evaluation after stage B treatment showed A significant improvement compared with stage A. The treatment showed significant improvement in image naming in patients with aphasia after stroke by transcranial direct current stimulation combined with MIT. Conclusions: tDCS junction and MIT can improve the accuracy and fluency of image naming in aphasia patients. The potential mechanism may be that the combination of tDCS and MIT can better activate the speech expressive-related cortex.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Electro-acupuncture suppresses pulmonary vascular remodeling in rats with chronic obstructive pulmonary disease via VEGF/ PI3K/ AKT pathway

L. Zhang1, Y. Tian1, 2, 3, P. Zhao1, 2, 3, F. Jin1,2, Y. Miao1,2, Y. Liu1,2, J. Li1,2

1Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Minis, Zhengzhou, Henan, China, 2Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Zhengzhou, Henan, China,3Academy of Chinese Medicine Science, Henan University of Chinese Medicine, Zhengzhou, Henan, China

Background and Aims: Purpose: This study aimed to explore the effect in regulating pulmonary vascular remodeling of electro-acupuncture (EA) on chronic obstructive pulmonary disease (COPD) and investigate its underlying mechanism. Methods: Methods: 48 sprague-dawley rats were randomly divided into normal, model, EA and sham acupuncture (SA) groups. The COPD model was established in all rats except the normal group. The EA group was bundled and given EA treatment for three times a week at Dazhui, Feishu and Shenshu for 8 weeks. Meanwhile, the SA group was given the same bundling. The pulmonary function, lung tissue histology, levels of IL-6 and IL-10 in lung tissue, levels of angiogenesis related factors, as well as the activation of VEGF/PI3K/Akt pathway were measured and evaluated. Results: Results: Compared with the model and SA groups, FVC and FEV 0.1 were significantly increased (P<0.01), EA could improve the pathological structure of small airway and pulmonary vessels in rats. WT%, WA% and BWT decreased significantly (P<0.01), and MAN increased significantly (P<0.05). Immunofluorescence showed that the expression of CD34 in EA group was significantly decreased (P < 0.01). VEGF, VEGFR2 and ET-1 mRNA levels in the EA group were decreased (P<0.01). The protein expression of VEGF, VEGFR2, p-vegfr2, p-Akt and p-mTOR in the EA group was lower than the model group (P<0.05, P<0.01). There was almost no difference between SA group and model group. Conclusions: Electro-acupuncture has curative effects in COPD rats, and the mechanism may involve down-regulating VEGF/PI3K/Akt pathway.

Keywords: Chronic Obstructive Pulmonary Disease, Electroacupuncture, pulmonary vascular remodeling, VEGF/PI3K/Akt pathway

Topic: 5. Engineering and Technology

Sub Topic: 5.3 Robotics

Effect of ankle intelligent stretching training on improving mechanical properties of ankle and balance performance

X. Zhai1, Y. Pan1,2, Q. Wu1,2, X. Li1,2, Q. Xu1,2, Y. Zhang1,2, S. Fan1,2, D. Cheng1,2

1Beijing Tsinghua Changgung Hospital, Beijing, China, 2School of Clinical Medicine Tsinghua University, Beijing, China

Background and Aims: Stroke patients show abnormal balance ability due to spasticity of the ankle. Passive stretching of the ankle could improve balance due to change the mechanical properties of the joint. This study aimed to observe the differences between the manual and intelligent training post-stroke on mechanical properties of ankle and balance function. Methods: Inpatients post-stroke (n=40) with ankle spasticity were randomly assigned to the control group (n=20) or the study group (n=20). The study group received the intelligent stretching used a robot and the control group received manual stretching (5sessions/week, 20 minutes/session, 2-week). Outcome measures included mechanical properties [muscle strength, passive ranges of motion, and stiffness of dorsiflexor and plantarflexor (DF, PF)]and clinical evaluations [Berg Balance Scale (BBS), Modified Barthel Index (MBI)]. Results: There were no significant between-group differences in baseline before training. After training, significant improvements were found in both groups in DF and PF muscle strength, DF PROM, PF PROM, BBS, MBI (P<.05). Besides, significant decreases were found in DF MAS, DF Stiffness in the study group (P=.001, .001), but not in the control group (P>.05). Between-groups differences were not found after training (P>.05). Conclusions: The manual and intelligent stretching training could both improve the mechanical properties of the ankle post-stroke, further improving the balance function and activities of daily living. Besides, the intelligent stretching of the ankle had additional positive effects on reducing the stiffness and spasticity of the ankle, which may be a feasible, efficient, and labor-saving training in the rehabilitation of the ankle function and balance post-stroke.

Topic: 7. Functioning and Disability

Sub Topic: 7.4 Impairment Rating, Disability Evaluation and Certification

The Portuguese version of the musculoskeletal pain intensity and interference questionnaire for musicians (MPIIQ-PT): Translation, cultural adaptation, and multicenter validation study

A. Zão1-5, E. Altenmüller5, L. Azevedo3, 4, 6

1Department of Physical and Rehabilitation Medicine, Pain Medicine Unit, Hospital Senhora da Oliveira Guimarães - Guimarães, Portugal, 2International Center of Arts Medicine, Instituto CUF Porto, Porto, Portugal, 3???, Faculty of Medicine University of Porto, Porto, Portugal, 4Center for Health Technology and Services Research, Cintesis, Porto, Portugal, 5???, Institute for Music Physiology and Music Medicine, Hannover, Germany, 6Department of Community Medicine, Information and Health Decision Sciences - Medcids, Porto, Portugal

Background and Aims: Playing-related pain and functional disability are a major health problem among musicians. Until now, there is no validated instrument to evaluate these outcomes among Portuguese musicians. Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians (MPIIQM) is a self-administered multidimensional questionnaire based on the biopsychosocial principle, with excellent psychometric properties. The aim of our study was to translate and culturally adapt the MPIIQM for European Portuguese population of professional orchestra musicians (MPIIQM-Pt) and to assess its applicability, reliability, internal consistency, and validity.

Methods: MPIIQM-Pt was created through a process of translation, back translation, expert panel evaluation and a pilot and validation studies. It was administered to 134 musicians from 3 Portuguese professional orchestras, at baseline and after 7 days. Internal consistency and test–retest reliability were assessed by Cronbach’s alpha (alpha) and intraclass correlation coefficient (ICC). Construct validity was assessed based on a set of previously developed theoretical hypotheses about interrelations between the MPIIQM-Pt and other measures. Results: The internal consistency and test–retest reliability coefficients for each respective subscale (pain intensity/pain interference) were alpha = 0.896/0,879 and ICC = 0,997/0,999. Exploratory factor analysis revealed a two-factor structure (pain intensity and pain interference) that explained 75,5% of the variance. Concerning construct validity, MPIIQM-Pt shown strong correlations with the other measures (more than 90% of the previously defined hypotheses regarding interrelations were confirmed).

Conclusions: The MPIIQM-P has excellent reliability, internal consistency, and validity. It may contribute to a better pain assessment among Portuguese musicians and is suitable for research and clinical use.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Playing-related pain and functional disability among professional orchestra musicians in Portugal: A multicentre study

A. ZÃO1-5, E. Altenmüller5, L. Azevedo3, 4, 6

1Department of Physical and Rehabilitation Medicine, Pain Medicine Unit, Hospital Senhora da Oliveira Guimarães, Guimarães, Portugal, 2International Center of Arts Medicine, Instituto CUF Porto, Porto, Portugal, 3Faculty of Medicine University of Porto, Porto, Portugal, 4Center for Health Technology and Services Research, Cintesis, Porto, Portugal, 5Institute for Music Physiology and Music Medicine, Hannover, Germany, 6Department of Community Medicine, Information and Health Decision Sciences - Medcids, Porto, Portugal

Background and Aims: The prevalence of playing-related pain (PRP) among musicians has shown to be high (about 70-86%). Few studies had evaluated pain among Portuguese musicians, and there is no published study that used validated instruments. We aim to evaluate PRP and functional disability among Portuguese professional orchestra musicians using a validated tool specifically designed for this population. Methods: Out of 183 musicians from 3 Portuguese professional orchestras, 134 (73,2% response rate) completed the self-report Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians, Portuguese version (MPIIQM-Pt) and the Portuguese version of Medical Outcomes Study Short Form 36-Item Health Survey (SF-36). Results: The average time of playing the instrument was 20,56 ± 8,7 years (mean ± SD). There was a slight male predominance (51,5%), with an average age of 30 years. Life-time prevalence of PRP was 86,6% and point prevalence was 47,0%. The main pain locations were neck and lower back. The average pain intensity score was 14,98±7,27 (out of 40) and the average pain interference score was 17,46±10,79 (out of 50), increasing significantly with the number of reported pain locations and the number of hours played per week (p<0,01). Higher pain intensity and interference scores were significantly correlated with lower quality of life (SF-36). Conclusions: Our results corroborate the high prevalence of PRP among professional orchestra musicians described in literature and its significant negative impact in musician’s performance and quality of life. This is the first study using a validated tool for Portuguese musicians, which highly contributes to more accurate and robust knowledge concerning PRP.

Topic: 4. Therapeutics

Sub Topic: 4.2 Injections (Joint. Spine, etc.,)

Ultrasonographic assessment of safe zone for carpal tunnel intervention: A case-control study

J. H. Lee1, J. S. Yoon2

1Department of Physical Medicine and Rehabilitation, Korea University Guro Hospital, Seoul, South Korea, 2Department of Medical Sciences, Korea University Medical College, Seoul, South Korea

Background and Aims: This study aimed to identify the transverse safe zone (TSZ) and longitudinal safe zone (LSZ) of the median nerve in the carpal tunnel using ultrasonography in healthy individuals and patients with carpal tunnel syndrome (CTS). Methods: This is a prospective observational case-control study. 40 wrists of 20 healthy individuals and 40 wrists of 24 patients with CTS were observed. Patients with CTS were classified into 3 groups based on electrodiagnostic findings - mild, moderate, and severe. With ultrasound, we measured cross-sectional area (CSA) and the distance between the median nerve and ulnar vessels to identify a TSZ. Also, we checked distance between the distal flexor retinaculum and superficial palmar artery arch to confirm a LSZ. We used independent t-test, analysis of variance (ANOVA) and Pearson’s correlation coefficient for analysis. Results: The TSZ was 6.44±1.18mm in the healthy group and 4.73±2.45mm in the CTS group. The LSZ was 8.24±2.74mm in the healthy group and 6.39±3.20mm in the CTS group. The TSZ and LSZ were significantly different between healthy subjects and patients with CTS (P=0.001 and P=0.007, respectively). The TSZ showed significant difference between the mild and severe CTS groups (P<0.05); the LSZ was not significant different among groups.

Conclusions: The TSZ and LSZ were narrower in patients group than in healthy individuals, especially TSZ showed difference depending on disease severity.

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2020R1A2C009024)

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

Gold standard? method of citric-acid-solution swallowing test as a screening test for patients with tracheostomy

J. A. Yoon, J. W. Hong

Pusan National University Hospital, Busan, South Korea

Background and Aims: The purpose of our study was to apply various range of citric acid concentration mouth and T-cannula to compare the validity against instrumental measures of aspiration in patients with tracheostomy.

Methods: 61 patients completed citric acid cough reflex test (CRT) and videofluoroscopic swallowing study (VFSS) at the same day. Delivery of citric acid was via facemask and T-cannula with three incremental concentrations (0.4 mol/L, 0.6mol/L, 0.8mol/L) of citric acid solution. For each test, amount of coughing reflex were counted and presence of two or more (C2) and five or more (C5) coughs were recorded. Results: The sensitivity and specificity were optimized at 0.8 mol/L C2 for mouth inhalation and 0.8 mol/L C5 for T-cannula inhalation. Only CRT via facemask at 0.4 mol/L C2, 0.6 mol/L C5, 0.8 mol/L C2 and C5 were significantly associated with presence of tracheal aspiration during VFSS. The coughing count during CRT showed statistically significant difference between patients with or without tracheal aspiration during VFSS in 0.4 mol/L and 0.8 mol facemask inhalation. There was no statistical significance during T-cannula inhalation. Conclusions: Citric acid CRT via mouth inhalation showed was significantly associated with tracheal aspiration and coughing reflex during VFSS. There was no superiority of T-cannula over mouthpiece inhalation as supplemented method to perform CRT for tracheostomy patients.

References

Perry L, Love CP. Screening for dysphagia and aspiration in acute stroke: A systematic review. Dysphagia 2001;16:7-18.

Monroe MD, Manco K, Bennett R, Huckabee ML. Citric acid cough reflex test: Establishing normative data. Speech Lang Hear 2014;17:216-24.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Ultrasound-guided suprascapular nerve block for hemiplegic shoulder pain: An audit of practice in a tertiary rehabilitation centre

E. Yilmaz KARA1, A. Saif2, A. Pick2

1Royal Berkshire Hospital, Reading, United Kingdom, 2Oxford Centre For Enablement, Oxford, United Kingdom

Background and Aims: Hemiplegic Shoulder pain (HSP) is a common condition following stroke and traumatic brain injury. Suprascapular Nerve Block (SSNB) is an invasive procedure used to manage HSP in Rehabilitation practice. SSNB requires a trained clinician to inject local anesthetics (LA)+/-steroids under a guidance The procedure includes not only the injection itself but also assessment of HSP, patient selection, taking consent, safety checks, and documentation in patients’ records. Methods: The local standard used in this audit had been previously created to enable optimizing SSNB practice and documentation at the Oxford Centre for Enablement. All SSNBs were compared to this standard; including the type of guidance, the content of the injections, safety checks, documentation on patients’ medical records. Only inpatient injections are included. Demographics are recorded and analyzed. Moreover, pre and post-injection assessments and any additional injections e.g botulinum toxin for HSP management were evaluated retrospectively from the medical records. Clinician and patient feedback were noted as other outcome measures when available. Results: 16 injections for 14 patients were performed out of 118 inpatients between February 2019 and July 2020. All injections were ultrasound-guided using an aseptic technique. Safety checks in line with WHO guidance were done in all injections. Difference in Shoulder ROM pre-injection and post-injection were noted as follows: change of abduction:+ 32.7 degrees (+10- +50), change of flexion: +18.6 degrees (0-+50). Conclusions: Results indicated high adherence to the local standards and positive outcomes. Pre and post-injection assessments and patient/clinician feedback could be standardized to improve outcome measurement.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Review the therapeutic parameters of mirror therapy in stroke

Z. Yan1, J. Jia2

1Xinxiang Medical University, Xinxiang, China, 2Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China, Shanghai, China

Background and Aims: Mirror therapy (MT), as a rehabilitation treatment for the central nervous system, has been widely studied and applied in clinic. However, there are still some problems about the specific treatment parameters. Our objective is to review the technology paradigm, frequency, and duration of MT in stroke rehabilitation, so as to give reasonable suggestions for clinical and family application. Methods: We searched the PubMed, Embase, Cochrane, Web of Science, and Scopus to find relevant studies was performed. Results: We totally included 24 studies that compared MT with other interventions, in terms of upper and lower limbs of motor function and sensory function, children with hemiplegia, complex regional pain syndrome (CRPS). Therapeutic parameter selection from once a day to twice a day, 3 to 7 days a week, 15 to 60 minutes per session, lasting for 2 to 12 weeks. The duration ranged from 300 minutes to 1800 minutes. The average treatment duration was 1026 minutes in 12 studies involving upper extremity motor function, 600 minutes in 2 studies involving lower extremity motor function, and 960 minutes in 3 studies involving sensation. 19 studies with positive results used central combined with peripheral interventions. There were no serious adverse events in all the included studies.

Conclusions: Mirror therapy is a safe treatment for stroke patients. The recommended program is central intervention combined with peripheral intervention, the improvement of upper limb function lasts longer than that of lower limbs, and the treatment of sensory recovery is recommended to last about 6 weeks.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Factors related to daily step counts of stroke patients during hospitalization in a convalescent rehabilitation ward

R. Yamada1,2, S. Shimizu 1, S. Yasuhara1, R. Shimose3, S. Tsunoda1, M. Ogura1, N. Takemura2, K. Taira2, M. Goya2, M. Shimabukuro2, T. Yamazato2, S. Shinzato2, Y. Nakamura2, T. Nakanishi2, A. Matsunaga1

1Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan, 2Department of Rehabilitation, Okinawa Rehabilitation Center Hospital, Okinawa, Japan, 3Department of Physical Therapy, Okayama Healthcare Professional University, Okayama, Japan

Background and Aims: Decreased physical activity is associated with an increased risk of cardiovascular events and death. However, factors related to physical activity of stroke patients during hospitalization in a convalescent rehabilitation ward are still unknown. This study aimed to clarify the factors related to daily step counts. Methods: Eighty-nine stroke patients (60.8±14.4 years; 55 males) with hemiparesis who were hospitalized in a convalescent rehabilitation ward were enrolled. The inclusion criteria were: walking independently within the ward; and a walking speed of 24 m/min or faster. Data on clinical characteristics (age, sex, body mass index, stroke type, affected side, time since stroke onset), motor function (Stroke Impairment Assessment Set [SIAS]), independence of ADL (Functional Independence Measure [FIM] motor items), and cognitive function (FIM cognitive items) were collected. Daily steps were counted using a Fitbit Flex2. The number of steps taken outside rehabilitative activities (non-rehabilitation steps) were counted. Results: The non-rehabilitation steps were 4,523±2,339 steps per day. The hierarchical multiple regression showed that there was a significant interaction effect of SIAS×FIM cognitive items on the non-rehabilitation steps. The simple slope analysis demonstrated that the slope of SIAS was greater at lower levels of FIM cognitive items than at higher levels of FIM cognitive items for the non-rehabilitation steps. Conclusions: In stroke patients with a high cognitive function, there was no association between the level of physical impairment and the non-rehabilitation steps, but in stroke patients with low cognitive function, the non-rehabilitation steps were less at greater levels of impairment.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

The effect of comprehensive rehabilitation treatment on wassel 4 polydactyly deformity after repair and reconstruction

Q. Xunhan1, S. Quanwei2, L. Hongyuan3, M. Ji4

1Shanghai Renji Hospital, Shanghai, China, 2Shanghai Yangpu Central Hospital, Shanghai, China, 3Shanghai Guanghua Hospital, Shanghai, China, 4Shanghai Shidong Hospital, Shanghai, China

Background and Aims: To study the effect of comprehensive rehabilitation treatment on Wassel 4 polydactyly deformity after repair and reconstruction. Methods: 16 patients with Wassel 4 polydactyly deformity after repair and reconstruction were randomly divided into observation group (8 cases) and control group (8 cases) by random number table method. The control group began to wear the ulnar fixed support orthopedic brace for 24 hours immediately after the operation for 6 weeks, until the Kirschner wire was removed. After removing the Kirschner wire, adjust the brace, and then continue to wear the brace for 3-6 months. During the day, remove the brace and move freely, and wear the brace at night before going to bed. In the observation group, on the basis of the control group, the patient’s thumb were treated with rehabilitation techniques such as passive joint movement techniques, joint mobilization techniques and circulatory resistance training techniques, as well as physical factor therapy such as ultrasound therapy equipment. recovery treatment. The MMT scores and ROM of patients were compared between the two groups. Results: The MMT score and ROM of the observation group after intervention were higher than those of the control group. The MMT score and ROM of the two groups after intervention were higher than those before the intervention, and the observation group was better than the control group. The difference was statistically significant (p <0.05). Conclusions: In patients with Wassel 4 polydactyly deformity after repair and reconstruction, the muscle strength and ROM have been significantly improved after comprehensive rehabilitation treatment.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Correlation analysis of lower limb function and surface myography in stroke patients at different recovery stages

W. Xu1, H. Wang2, M. Wang3

1Bengbu Medical University, Bengbu, China, 2Zhongda Hospital Affiliated to Southeast University, Nangjing, China, 3The First Affiliated Hospital of Bengbu Medical University, Bengbu, China

Background and Aims: To investigate the characteristics and regularity of the surface EMG of tibialis anterior muscle, gastrocnemius muscle and soleus muscle of lower limbs in stroke patients at different recovery stages.

Methods: Forty patients with stroke were selected and divided into three groups according to stages 3, 4 and 5. Under the maximum voluntary contraction, EMG was used to collect the EMG signals of lower limbs and calf muscles, and then the data were collated and analyzed. Results: The average myoelectric value (AEMG), root mean square value (RMS) and integral myoelectric value (IEMG) of the affected side of stroke patients under different stages; The difference of AEMG, RMS and IEMG between gastrocnemius muscle and tibialis anterior muscle on the affected side were all lower than those on the healthy side (P<0.01). There were significant differences in AEMG, RMS, IEMG, AEMG, RMS and IEMG of the affected side among the three groups (P<0.05), while there were no significant differences in AEMG, RMS and IEMG of the gastrocnemius tibialis anterior muscle in the healthy side under different stages (P>0.05). The lower limb function Fugl-Meyer score was correlated with the tibialis anterior muscle, gastrocnemius muscle and soleus muscle. Conclusions: Ankle joint stability in stroke patients is closely related to functional recovery of lower limbs, strengthening tibialis anterior muscle training and increasing coordination training with gastrocnemius muscle will help stroke patients to recover. Surface EMG has potential application value in clinical evaluation of lower limb function in stroke patients.

Topic: 4. Therapeutics

Sub Topic: 4.6 Neurostimulation (rTMS, tDCS, etc.)

Meta-analysis of the ameliorative effect of functional magnetic stimulation on neurogenic bladder after spinal cord injury

W. Xu1, H. Wang2, M. Wang3

1Bengbu Medical University, Bengbu, China, 2Zhongda Hospital Affiliated to Southeast University, Nangjing, China, 3The First Affiliated Hospital of Bengbu Medical University, Bengbu, China

Background and Aims: To systematically evaluate the therapeutic effect of functional magnetic stimulation on patients with neurogenic bladder after spinal cord injury, and to explore the therapeutic effect of clinical magnetic stimulation on patients with neurogenic bladder after spinal cord injury.

Methods: To search PubMed, CNKI, VIP and Wanfang databases to date on randomized controlled trials of functional magnetic stimulation in the treatment of neurogenetic bladder after spinal cord injury in both Chinese and English. The search strategy is determined by subject words, title, keywords, etc. Key words include’ magnetic/functional stimulation, magnetic innervation, extracorporeal magnetic stimulation, magnetic field therapy, Spinal cord injury, SCI, Neurogenic bladder, DNB, Neurogenic bladder, NB, Bladder dysfunction, Detrusor Hypermotility, etc’. Chinese search terms are’ magnetic stimulation, functional magnetic stimulation, pelvic floor magnetic stimulation, spinal cord injury, bladder, neurogenic bladder, bladder dysfunction, detractor hyperactivity, etc’. Results: A total of 7 literatures and 7 randomized controlled trials involving 410 patients (experimental group n=203, control group n=207) were included excluding reviews, systematic reviews, meta-analysis, conference papers, etc. Meta-analysis results showed that [MD=6.9, 95%CI (2.77, 11.02), P=0.0007]. Conclusions: Functional magnetic stimulation is effective in improving bladder function and quality of life in patients with neurogenic bladder after spinal cord injury compared to controls.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

The effect of radial extracorporeal shock wave therapy in the treatment of mild to moderate carpal tunnel syndrome

Y. Wu, Y. A. Jiang, S. S. Luo, Y. N. Zhang

Yangpu Hospital, Tongji University, Shanghai, China

Background and Aims: Carpal tunnel syndrome (Carpal tunnel syndrome, CTS) is one of the common peripheral nerve compression diseases, and its incidence is still rising. Because the muscle atrophy caused by CTS is irreversible, early diagnosis and early treatment are necessary. Among them, mild to moderate patients are given conservative treatment. At present, there are many conservative treatment methods used in clinic, but the curative effect is uneven. This study explored the effect of Radial Extracorporeal Shock Wave Therapy (RESWT) on the treatment of mild to moderate carpal tunnel syndrome (CTS). Methods: A total of 40 CTS patients were divided into two groups with 20 cases each according to the random number table method. Both groups of patients were given oral mecobaltamine and regular rehabilitation training. The observation group added REAWT once a week for 4 weeks. The VAS and the Boston Carpal Tunnel Questionnaire (BCTQ) were used to evaluate the clinical efficacy of the patients at the 4 and 8 weeks. Results: After treatment, the VAS scores and The BCTQ scores of the observation group was more significant than that of the control group (P <0.05); while the BCTQ scores of the control group was significantly different only after 8 weeks of treatment. Conclusions: RESWT can further improve the clinical efficacy of mild to moderate CTS, reduce pain, and improve wrist symptoms and function. In clinical practice, RESWT can be recommended as a conservative treatment for patients with moderate CTS.

Topic: 2. Social sciences

Sub Topic: 2.4 Psychology

Living with stigma and low self-esteem: Burns in china - A cross-sectional study

X. Wu1, Z. Wang1, Y. Li1, L. Chen1, Y. Hu2, A. Hu2

1Sun Yat-Sen University, Guangzhou, China, 2The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

Background and Aims: The burn was a significant public health burden globally, and the psychological problems left by burn are worth paying more attention. Research has shown that eliminating the stigma of burn patients and improving their self-esteem were the effective means to promote social reintegration. The study aims to explore the relationship between stigma and self-esteem among Chinese burn survivors. Methods: A cross-sectional study was conducted among 146 burn survivors in Guangzhou, using Social Impact Scale (SIS), Rosenberg Self-Esteem Scale (SES), and a Socio-Demographic questionnaire. The non-probability purposive sampling technique was used for this study. Results: The mean score of SIS was 57.03±6.762. Among those 2.7% had mild stigma, 66.7% had moderate stigma, 30.8% had severe stigma. Among the four components of SIS, the highest mean score was on social rejection, followed by internalized shame, and the lowest one was financial insecurity. The mean score of SES was 21.05±2.492, which was a marked difference from the norm. Moderate positive correlation(r=0.49) was found between stigma and self-esteem among burns. Furthermore, stepwise regression analysis identified occupation, itching, and score of SES as significant influencing factors, accounting for 34.5% of the total stigma variance. Conclusions: The burn patients have a certain degree of stigma and low self-esteem. Self-esteem is an independent factor that affects patients’ stigma. In order to promote the physical, psychological, and social recovery of patients, it is necessary to make efforts to eliminate stigma and improve self-esteem.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Clinical study of sacral nerve magnetic stimulation in the treatment of primary nocturnal enuresis in children

J. Wu

Xuzhou Rehabilitation Hospital Affiliated to Xuzhou Medical University, Xuzhou, Jiangsu, China

Background and Aims: To explore the clinical value of sacral nerve magnetic stimulation in the treatment of primary nocturnal enuresis in children. Methods: Methods A total of 40 children treated in Xuzhou Central Hospital, Rehabilitation Hospital and Children’s Hospital from October 2019 to September 2020 were diagnosed with primary nocturnal enuresis in children and randomly divided into control group and observation group according to the treatment plan There were 20 cases in each group. Both groups took bladder function training, awakening training, and life and psychological intervention. The observation group added sacral nerve magnetic stimulation based on the first three methods. Before and after treatment, the degree of enuresis, the frequency of enuresis, curative effect evaluation and bladder capacity were evaluated and compared. Results: The two groups of children were improved after 1 month of treatment, and the treatment effect and bladder capacity of the observation group were significantly improved compared with the control group, the difference was statistically significant (P<0.05). Conclusions: Sacral nerve magnetic stimulation can be used as a method to treat primary nocturnal enuresis in children, and it is worthy of clinical application.

References

But I, Faganeij M, Sostaric A. Functional magnetic stimulation for mixed urinary incontinence. J Urol 2005;173:1644-6.

Yamanishi T, Homma Y, Nishizawa O, Yasuda K, Yokoyama O; SMN-X Study Group. Multicenter, randomized, sham controlled study on the efficacy of magnetic stimulation for women with urgency urinary incontinence. Int J Urol 2014;21:395-400.

Suzuki T, Yasuda K, Yamanishi T, Kitahara S, Nakai H, Suda S, et al. Randomized, doubleblind, sham controlled evaluation of the effect of functional continuous magnetic stimulation in patients with urgency incontinence. Neurourol Urodyn 2007;26:767-72.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

The dose-response relationship of subacromial corticosteroid injection in hemiplegic shoulder pain

R. Wissner, R. Wilson, J. Chae

MetroHealth/Case Western Reserve University, Cleveland, USA

Background and Aims: The aim of this study is to determine the dose response of subacromial triamcinolone injection for the treatment of hemiplegic shoulder pain (HSP). Methods: Randomized, double-blind controlled trial of stroke survivors with HSP randomized to subacromial injections of anesthetic plus 20mg(n=9), 40mg(n=9), or 60mg(n=10) triamcinolone and followed for 12 weeks. The primary outcome measurement is the worst pain in the last week. Secondary outcome measures include the upper-extremity Fugl-Meyer score, pain-free shoulder abduction range of motion, and pain-free shoulder external rotation range of motion. Results: There was statistically significant pain reduction in the pooled analysis of all three groups (p = 0.002), however there was no statistically significant difference between groups. Mean (SD) change in Worst Pain from baseline to 12-week period: 1.7 (3.8); 2.2 (3.1); 4.4 (3.1). Eighty percent of participants experienced a >30% reduction in pain in the 60mg group, compared to 55% in the 20mg and 40mg groups. (p = 0.4). Mean (SD) change in upper extremity Fugl-Meyer score between groups was 5.1 (6.2), 5.9 (7.9), and 2.3 (5.1). Mean (SD) change in pain-free shoulder abduction was 33.3 (50.2), 15.4 (18.3), and 28.2 (27.0) degrees; Mean (SD) change in pain-free external rotation was 26.7 (39.0), 14.0 (13.1), and 9.4 (10.6) degrees. Conclusions: Subacromial corticosteroid injection is associated with improvement in pain, upper-extremity Fugl-Meyer Assessment, and pain-free shoulder abduction/external rotation. Although the responder rate with respect to pain reduction was 25% higher with the 60mg dose compared to 20mg or 40mg, this difference did not reach statistical significance, possibly due to limited sample size.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (i.e., Spasticity, Immobilization and Frailty)

Baclofen withdrawal symptoms due to spinal CSF leak in a patient with established intrathecal therapy

T. Win1, S. Balakrishnan1, A. Mahmood1, R. Chelvarajah2

1Birmingham Community Healthcare NHS Foundation Trust, Birmingham, United Kingdom, 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom

Background and Aims: Intrathecal Baclofen Therapy (ITB) is effective in the management of severe spasticity. ITB withdrawal is a potentially life-threatening complication. There are established algorithms to identify potential causes of withdrawal. We would like to share our experience in managing spinal CSF leakage in a patient with spinal cord injury and troublesome neuropathic pain and spasms who was managed initially on intrathecal morphine and subsequently using combination of intrathecal baclofen and morphine.

Methods: A case report based on medical records and investigations. Results: Patient had been managed by local pain team for 18 years and was stable on therapy for 2 years after the last pump revision. After a holiday abroad, patient experienced return of the spasms. Patient was reviewed by local team, ruled out hardware malfunctions and transferred to the implanting centre for further investigations. Catheter aspiration and dye test with CT scan were normal. The baclofen dose was increased and morphine was weaned off and the care was transferred to our service for spasticity follow-up. Patient presented with severe symptoms and abdominal collection and later on with symptoms of low CSF tension. MRI of the whole neuraxis did not show any features of low CSF pressure. However, the abdominal collection on 2 occasions proved positive for CSF. Paraspinal CSF leakage was diagnosed based on that. The whole system was revised and the catheter was re-sited at a different level. Conclusions: This case report highlights the possibility spinal CSF leakage in an established system. We suggest this should be part of the diagnosis algorithm.

Topic: 3. Clinical Sciences

Sub Topic: 3.7 Rehabilitation of Individuals with Post COVID-19 Impairments and Sequalae

Predicting participation and quality of life in covid-19 rehabilitation patients 3 months post-ICU

C. Wiertz1, S. Sep1,2, D. A. Lechner3, B. H. M. Michielsen1,4, J. A. Verbunt1, 2, 3

1Adelante Zorggroep, Hoensbroek, The Netherlands, 2Research School CAPHRI, Maastricht University, Maastricht, The Netherlands, 3Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands, 4Department of Rehabilitation Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands

Background and Aims: Objectives: Describe changes in and predictors of quality of life and participation up to three months after ICU-discharge due to COVID-19. Methods: Participants: Post-ICU COVID-19 patients, referred for inpatient rehabilitation, aged 18y or older. Methods: In this prospective cohort study, data of 67 patients (age 62 ± 11y, 78% male) were collected at 1 and 3 months post-ICU. Self-administered questionnaire outcomes were : quality of life (EQ5D-5L) and participation restrictions (USER-P). Potential predictors analysed by backward linear regression included demographics, retrospective ICU-specific data, and self-reported physical function (PROMIS), breathlessness (MRC), pain (NRS), fatigue (MFI), anxiety and depression (HADS), psychotrauma (GPS) and cognitive complaints (CLC-IC). Results: Subjective health status (p=0.02) and participation (p<0.01) improved between 1 and 3 months post-ICU, whereas changes in generic quality of life were not statistically significant (p=0.19). Higher age, better physical function, less fatigue and less breathlessness were associated with better quality of life, whereas the a longer ICU-stay, thromboembolic complications, pain, anxiety and depression and cognitive complaints were positively associated with participation restrictions at 3 months. Conclusions: A considerable part of post-ICU COVID-19 patients experience restrictions in participation after ICU-discharge indicative for rehabilitation treatment. Although our findings indicate subtle improvement of participation in the first 3 months, quality of life does not improve. Several variables are predictive of quality of life and participation, offering opportunities for personalized care. More research is necessary regarding long term participation and quality of life post-covid-19 to optimize rehabilitation treatment.

Topic: 3. Clinical Sciences

Sub Topic: 3.4 Complications/Sequelae (I, e., Spasticity, Immobilization and Frailty)

The spasticity-related quality of life 6-dimensions tool (sqol-6d) in upper limb spasticity: a first psychometric evaluation

J. Whalen1, L. Turner-Stokes2, K. Fheodoroff3, J. Jacinto4, J. Lambert5, C. de la Loge5, P. Maisonobe1, S. Ashford2

1Ipsen Biopharm, Slough, United Kingdom, 2Regional Hyper-Acute Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom, 3Gailtal-Klinik, Hermagor, Hungary, 4Centro de Medicina de Reabilitação de Alcoitão, Serviço de Reabilitação de adultos, Estoril, Portugal, 5Patient-Centered Outcomes, ICON plc, Lyon, France

Background and Aims: To describe the psychometric properties (validity, reliability, responsiveness) of SQoL-6D, a tool designed to assess disease burden and change after focal upper limb spasticity (ULS) therapy. Methods: Multicentre prospective study in adults (>=18 years) with ULS. Patients completed the SQoL-6D at enrolment (Visit [V]1), 8(±2) weeks (V2) and 1–4 days after V2 (re-test). SQoL-6D covers 6 dimensions (pain/discomfort, involuntary movements/spasms, restricted range of movement, caring for the affected limb, using the affected limb, mobility) each rated from 0–4 (4=worse outcome) and a total score (TS) calculated from 0–100 (100=better outcome). Standard ULS measures were also recorded. Results: The SQoL-6D was shown to be unidimensional and demonstrated adequate construct validity, allowing the calculation of a TS. The internal reliability of the SQoL-6D was supported by Cronbach’s alpha (>0.70), while the intraclass correlation coefficient supported the test-retest reliability (0.82). Correlation coefficients with established instruments supported convergent validity, while significant differences between known-groups (of differing clinical severity of weakness) in SQoL-6D TS confirmed its sensitivity. Significant differences in mean SQoL-6D TS change and effect sizes across patients rating ‘Some benefit’ and ‘Great benefit’ (0.51 and 0.88 respectively, Table) supported its sensitivity to clinical change.

Conclusions: SQoL-6D is a promising new measure of patient-reported disease burden and health status in ULS.

Funded by Ipsen.

Topic: 2. Social sciences

Sub Topic: 2.4 Psychology

Difference between short-term and long-term visual memory is greater in individuals with non-alcoholic fatty liver disease

L. de Avila1, A. Weinstein1,2, J. Price1, J. Hakeem2, M. Namman2, G. Ganganaboina2, P. Golabi1, C. Escheik1, L. Gerber1, 2, 3, Z. Younossi1,3

1Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, United States, 2Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, United States, 3Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, United States

Background and Aims: Visual memory (VM) is the ability to store and retrieve previously experienced visual sensations and perceptions. Although the neural underpinnings of VM are not well-established, it is likely to be a key to understanding impaired cognitive abilities. The relationship between NAFLD and VM has not been previously examined and therefore the aim of the current project was to determine if individuals with and without NAFLD demonstrate differences in short- and long-term VM. Methods: Individuals between the ages of 25-69 were enrolled in a prospective data collection study at a community hospital. Individuals with excess alcohol consumption or viral liver disease were excluded. NAFLD was diagnosed by sonographic assessment. VM was assessed by the Wechsler Memory Scale (4th Edition) Visual Reproduction test. Results: There were 98 individuals included, 63 individuals with NAFLD (62% male, age:53.5±11.0, BMI:33.6±5.8) and 35 individuals without NAFLD (51% male, age:51.2±13.8, BMI:25.7±4.1). When looking at performance on the immediate and delayed recall trials, there were no statistically significant differences between individuals. However, when comparing delayed to immediate recall performance within each group, individuals with NAFLD had a statistically significantly worse delayed to immediate recall performance (change in score: -7.6±7.3) compared to those without NAFLD (change in score: -4.6±4.80, p<0.05). Conclusions: Individuals with NAFLD were less likely to convert short-term into long-term VM. The ability to achieve VM consolidation may be impacted in individuals with NAFLD. This potential difference in performance needs further study, as impacts on the VM system may be a first indication of additional cognitive performance issues.

Topic: 4. Therapeutics

Sub Topic: 4.1 Exercise

Effects of robot-assisted training on cognitive and motor function after stroke: a randomized controlled study

Y. Wang, J. Rong, C. Geng

Shanghai First Rehabilitation Hospital, Shanghai, China

Background and Aims: Cognitive and motor dysfunction are common complications and often coexist after stroke. The effects of robot-assisted therapy on cognitive and motor function are inconclusive. The aims of the study are to examine the effects of robot-assisted training on cognitive and motor function after stroke. Methods: Sixteen stroke patients were randomized assigned into the experimental group (N = 8) or control group (N = 8). In addition to conventional therapy, the experimental group received robot-assisted training, for 20 min/day and 7 days/week for 3 weeks. Before and after intervention, the MoCA, Fugl-Meyer Assessment Upper Limb subscale, the modified Barthel Index were measured. Results: All measurements improved significantly in experimental group following intervention (p<0.05). In addition, the control group showed a certain improvement trend, but did not reach statistical significance (p>0.05). The MoCA score was improved significantly in the experimental group compared with the control group (p<0.05). No serious adverse events were reported. Conclusions: Robot-assisted training can significantly improve cognitive and motor function in stroke patients. The finding supports the application of robot-assisted training as provided in this trial in routine clinical practice.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

Observation on the effect of low-temperature impact analgesia on knee joint pain and swelling after total knee arthroplasty

Y. Wang

Shanghai Yangpu District Central Hospital, Shanghai, China

Background and Aims: TKA is an effective treatment for knee joint diseases that are ineffective in conservative treatment. However, after knee replacement, joint swelling and pain are often accompanied by problems. TST is an effective treatment measure to solve the above problems. The research is to explore the clinical effect of TST on knee joint pain and swelling after TKA. Methods: Selected from December 2019 to December 2020 in our hospital, 48 cases of knee replacement patients were divided into observation group and control group with 24 cases each according to the random number table method. Both groups were given general rehabilitation training. The observation group was treated with TST and used once/day, 1 Min/time after rehabilitation training; the control group was added with ice packs and used once/day after rehabilitation training. 10Min/time. Both groups were treated for 1 week. Before and after treatment, the visual analogue scale (VAS) was used to evaluate the knee joint pain; the knee circumference was compared before and after the knee joint circumference, and the circumference was measured at the midpoint of the suprapatella when the knee was flexed at 5°. Results: After treatment, compared with the control group at the same time after treatment, the observation group’s VAS score was significantly lower, the knee circumference decreased more significantly, and the difference was statistically significant. Conclusions: TST has a good clinical effect on knee joint pain and swelling after TKA.

Topic: 7. Functioning and Disability

Sub Topic: 7.2 Classification Systems (ICD, ICHI, ICSO-R)

A model for assessing knee joint health: contribution of principle component analysis and weighted rank-sum ratio method for pain and function in elderly patients with knee osteoarthritis

M. Wang1, H. Chen1, X. Zheng2, Y. Wang1, S. Shang1, K. Chen1, Y. Wang3

1Peking University School of Nursing, Beijing, China, 2The Open University of China, Beijing, China, 3Peking University School and Hospital, Beijing, China

Background and Aims: Knee osteoarthritis (KOA) is one of the top ten disabling diseases. Accurate evaluation is the basis for the treatment of KOA and is of great significance to clinical practice. However, there is a lack of more objective comprehensive evaluation criteria for symptoms and functions. Therefore, the purpose of this study is to explore the comprehensive evaluation and grading of symptoms and functions in patients with KOA. Methods: A total of 5 indicators from the baseline data of three studies conducted during 2014-2020 were selected, including pain, Five-Times-Sit-to-Stand Test (FTSST), Timed Up and Go test (TUG), Six-Minute Walk Test (6MWT) and Five-Stairs Climb Task (5SCT). Principal component analysis (PCA) was performed to calculate the weight of each indicator, and the weighted rank-sum ratio (WRSR) method was performed to determine the three-level grading thresholds. Results: The baseline data of 200 elderly patients with KOA were analyzed. PCA identified two components explaining 86.91% of the variance. According to the eigenvalue, explained variance and loading value, the weights of each parameter are 22.26%, 19.85%, 19.69%, 20.63% and 17.57%, respectively. The obtained weight was introduced into WRSR method to obtain the WRSR fitting value =-16.428+5.118*Probit (F=4345.925, P<0.001), and the three-level grading thresholds are 4.044 and 14.28. 200 patients were judged as grade 1 with 31 patients, grade 2 with 137 patients and grade 3 with 32 patients. Conclusions: PCA and WRSR method can be used to comprehensively evaluate and grade the symptom and function of KOA, which provides a low-cost and effective model for assessing knee joint health.

Topic: 3. Clinical Sciences

Sub Topic: 3.3 Diagnosis

Clinical study on correlation the functional status of upper limb motor neurons with motor function in patients with stroke

Z. Shao1,2, T. Zhou1, W. Chen1, B. Liu1, X. Zhu1, Y. Gong1, J. Huang1, Y. He1, J. Xiang2, H. Wang1

1Department of Rehabilitation Medicine, Zhongda Hospital, Southeast University, Nanjing, China, 2Department of Rehabilitation Medicine, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China

Background and Aims: To explore the correlation between the functional status of upper limb motor neurons and motor function in stroke patients, and to provide guidance for rehabilitation assessment and functional prognosis. Methods: Motor unit number estimation (MUNE) and F wave were examined in forty-two stroke patients to evaluate the functional status of motor neuron. Fugl-Meyer Assessment (FMA) and modified Ashworth score (MAS) were used to evaluate upper limb motor function, and the correlation between electrophysiological parameters and FMA score, MAS score were analyzed respectively. Results: The MUNE of the abductor pollicis brevis on the affected side was lower than the unaffected side (P<0.01); the percentage of F waves with different shapes on the affected side was lower than the unaffected side (P<0.001); the F/M ratio on the affected side was higher than the unaffected side (P<0.001); the F wave latency and amplitude on the affected side were not statistically significant compared with the unaffected side; The affected/unaffected side ratio of the percentage of F waves with different shapes was positively correlated with FMA score (P<0.05). The correlation analysis between the affected/unaffected side ratio of MUNE and FMA score was not statistically significant; in patients with flexor carpi MAS score >=1+, the affected/unaffected side ratio of the F/M ratio was positively correlated with MAS score (P< 0.05). Conclusions: Stroke may result into the number of functional motor neurons of the upper limbs of the hemiplegic side decreased and the excitability of motor neurons increased simultaneously, which were related to motor function and muscle tone.

Topic: 4. Therapeutics

Sub Topic: 4.5 Physical Modalities

The effects of transcutaneous electrical acupoint stimulation on upper-limb impairment after stroke

H. Wang1, J. Jia1, Y. Chen2, Y. Xiang2, C. Wang3

1Rehabilitation Department, Huashan Hospital, Shanghai, China, 2Rehabilitation Department, Shanghai Third Rehabilitation Hospital, Shanghai, China, 3Shanghai University of Sports, shanghai, China

Background and Aims: To investigate whether transcutaneous electrical acupoint stimulation (TEAS) can improve upper limb motor recovery in post-stroke rehabilitation. Methods: Two hundred and four stroke patients with unilateral upper limb motor impairment were recruited in this prospective, multicenter, double-blinded randomized trial. Patients were randomized 1:1 to receive TEAS or sham TEAS therapy. TEAS therapy was applied to two acupoints (LI10 and TE5) with a pulse duration of 300 µs at 2Hz on the affected forearm 30min/day, 5days/week, for 6 weeks. The sham group received identical treatment, while the electrical circuit was disconnected internally. The upper-extremity section of the Fugl-Meyer assessment (FMA-UE), Manual Muscle Testing, Modified Ashworth Scale, Lindmark hand function score, and Barthel Index were evaluated at baseline, every 2 weeks during the treatment period, and 4 and 12 weeks after completion of treatment. Results: Ninety-nine patients in the TEAS group and 97 patients in the sham group completed the 6 weeks of intervention. No statistical difference was observed at baseline assessment for all outcomes. At 18 weeks, the TEAS group showed greater improvements in wrist extension strength than the sham group (P<0.05). A favorable trend for better improvement of the distal part of FMA-UE in the TEAS group was also observed, albeit not significant. Beyond that, there were no significant differences in all other outcomes between the two groups.

Conclusions: This study suggests that TEAS therapy applied to hemiplegic forearm contributes to muscle strength improvement, and provides potential benefits for motor recovery of hand and wrist.

Topic: 5. Engineering and Technology

Sub Topic: 5.3 Robotics

Effects of transcranial direct current stimulation combined with rehabilitation robot on hand function in patients with subacute stroke

C. Wang1, J. Jie2

1Chinese Association of Rehabilitation Medicine, Beijing, China, 2Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China

Background and Aims: Hand motor dysfunction after stroke is one of the most serious disorders affecting the daily life of stroke patients, and there is still less effective rehabilitation methods to solve this problem. In recent years, transcranial direct current stimulation (tDCS)combined with rehabilitation robot has become a new combination therapy for hand function rehabilitation after stroke, but the effectiveness of this therapy still needs further clinical research to prove. Therefore, the purpose of this study is to study the rehabilitation effect of tDCS combined with hand functional rehabilitation robot on subacute stroke patients. Methods: 40 patients with subacute stroke were randomly divided into two groups. The experimental group received tDCS for 20 minutes and then received rehabilitation robot therapy for 30 minutes, while the control group received sham stimulation for 20 minutes and rehabilitation robot therapy. Hand function was evaluated Before and after 4 weeks treatment, including Fugl Meyer assessment upper extremity scale (FMA-UE),, box and block test (BBT), action research arm test (ARAT), and modified Barthel index, MBI), grip strength and pinch strength of affected hand. Results: After statistical analysis, the indicators of the two groups before and after the intervention were statistically significant progress. The scores of FMA-UE, MBI and grip strength in the experimental group were significantly different from those in the control group after intervention, and no statistical significance was found in the other indexes. Conclusions: tDCS combined with rehabilitation robot has rehabilitation effects on hand function of patients with subacute stroke.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Bladder management assistance predisposing factor analysis in spinal cord injury patients in the subacute rehabilitation period

P. Vorobjovs1, A. Nulle1

1National Rehabilitation Center Vaivari, Jurmala, Latvia, 2Riga Stradins University, Riga, Latvia

Background and Aims: Neurogenic bladder dysfunction is one of life-threatening conditions in spinal cord injury patients. The aim of the study collect and analyze data about bladder management methods and assistance predisposing factors for patients with spinal cord injury in the subacute rehabilitation period. Methods: Information was collected in 2020 from the medical records of 125 patients with a spinal cord injury admitted for primary rehabilitation course. The data regarding assistance necessity, bladder management method, spinal cord injury clinical manifestation, injury etiology, completeness of spinal cord injury was analyzed. Results: At the moment of the discharge from the rehabilitation center 87 (69,6%) patients were able to performe bladder management without assistance, 38 patients (30,4%) needed assistance. Assistance necessity showed statistically significant difference in spinal cord injury etiology subgroups (p = 0,021), completeness of spinal cord injury subgroups (p = 0,001), clincal manifestation subgroups (p = 0,001), bladder management subgroups (p <0,001). The most significant bladder management assistance prediction factors were shown the association of clinical manifestation factor – tetraplegia (p <0,001) and completeness of injury factor – complete injury (p = 0,001). Conclusions: Research findings suggest that bladder management assistance predominantly associated with traumatic spinal cord injury etiology, complete spinal cord injury (ASIA scale A), tetraplegia clinical manifestation. Among bladder management methods assistance predominantly was needed in patients group who perform clean intermittent catheterization, use an indwelling and suprapubic catheter and external collection devices. The most significant bladder management assistance prediction factors were tetraplegia and complete injury spinal cord injury.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Plasmablastic myeloma: Unusual cause of peripheral facial paralysis

J. P. Vieira Dias1, D. Costa2, V. Marques1, L. Dias1

1CHMAD - Serviço de Medicina Fisica e de Reabilitação., Vila Real, Portugal, 2CHP - Serviço de Medicina Fisica e de Reabilitação., Porto, Portugal

Background and Aims: Peripheral Facial Paralysis is the most common mononeuropathy. Most cases are idiopathic; however, some have rare etiologies such as neoplasms. The purpose of this study is to raise awareness of less common causes of Peripheral Facial Paralysis. Methods: The authors present the clinical case of a 60-year-old patient, evaluated in the Emergency Service as a left Bell’s Paralysis case with one day of evolution, grade VI of House-Brackmann. No significant alterations were observed in the complementary diagnostic exams. He started therapy with corticosteroids and acyclovir and was referenced to the Physiatrics consultation. During the course of physiatric treatment, and in a reevaluation consultation, he presented asthenia, anorexia and weight loss and improvements at the level of neurological deficits were not identified. On physical examination, he presented icteric skin and icteric mucous membranes, left retroauricular swelling was visible and palpation was painful, so he was referred to the ORL. On computerized tomography were seen space-occupying lesions with bone invasion, periaortic adenopathic conglomerate, globose liver and pancreas conditioning obstructive jaundice. Ears and neck magnetic resonances revealed infiltrative formation of the parotid gland, neck muscles and infiltration of the holes at the base of the skull. The mastoid apophysis was clearly invaded. Results: This patient was transferred to the Hematology Service, where bone marrow and supraclavicular mass biopsies revealed plasmablastic myeloma. Conclusions: Plasmablastic myeloma is a morphological subtype of multiple myeloma with poor prognosis. Early diagnosis is challenging as the symptoms develop later in the course of the disease.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Post stroke cognitive impairment after minor to moderate stroke

A. Vieira1, P. Martins1, J. Ramos1, F. Rodrigues1

1Hospital Central do Funchal, Funchal, Portugal, 2Hospital S. João, Porto, Portugal

Background and Aims: Stroke is an important cause of cognitive impairment and dementia. with prevalence of post stroke cognitive impairment (PSCI) ranging from 25 to 81% of patients. There is an association between PSCI and poor rehabilitation results after stroke. MoCA is a reliable cognitive instrument that can be used to screen for PSCI. Methods: We selected patients admitted to the stroke unit of São João Universitary Hospital Center, from November to December 2020, and applied the Montreal Cognitive Assessment Test. Results: The population was composed of 25 individuals. The average NIHSS score at unit admission was 4.12 and 4 had underwent thrombolysis. MoCA score had mean=21, 28, the most impacted domain was the short-term memory (mean=1.08) with spatial and temporal orientation being fairly preserved (mean= 5.72). After normalizing the score for their age and education there were 16% (n=4) that had score significantly inferior to what would be expected for them. Conclusions: This study has some important limitations, such as the small number of patients evaluated, lacking of a pre-stroke cognitive status evaluation, additionally the tests were done in a stroke unit that can have several distractions and weren’t assessed for depression. Yet, after normalizing for age and educational, there were some patients that screened with cognitive impairment and therefore were signaled for cognitive rehabilitation. As cognitive symptoms are not always necessarily detected before discharge, and can have an impact in the rehabilitation process, it is important to implement screening tests after stroke.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Chopart amputation revision: “Please Cut Here” - A case report

X. Verraest1, B. Lopes2, I. Ferro1, F. Ermida1, F. Carvalho1, J. Laíns1

1Centro de Medicina de Reabilitação da Região Centro - Rovisco Pais, Tocha, Portugal, 2Centro Hospitalar Tondela-Viseu, Viseu, Portugal

Background and Aims: The primary goal after limb amputation is to maximize function. In children, it is useful to preserve length and growth plates, perform disarticulation and stabilize limb’s proximal portion. Chopart amputation excises a greater portion of the midfoot and disarticulates the talonavicular and calcaneocuboid joints. Methods: A 38-years-old men, with a history of bilateral Chopart amputation after a severe burn at age one, is a recurrent outpatient in our Rehabilitation Center for prosthetic evaluation. Seven years ago, he developed a pressure ulcer in the stub distal extremity and after 2 years, also in the contralateral side. Considering the functional repercussion, incapacity of ambulation and prosthesis use, he required an amputation revision. A transtibial bilateral amputation was performed in 2016, followed by an individualized rehabilitation program for prosthesis use. The patient experienced an improvement in life quality, functional status and gait pattern, with no further skin lesions or stub pain. Results: Historically, the utility of traditional midfoot amputations is considered to be low, given the high rates of subsequent proximal revision amputations. This amputation level allows the patient to place their stub on the ground, making short distance ambulation possible with low metabolic walking cost, especially in small children. Nonetheless, it’s commonly associated with equinovarus contracture, with consequent subtalar joint instability, excessive anterior weightbearing and distal ulceration. Conclusions: There are multiple determinants involved in a successful prothesis. It’s crucial to understand the functionality potential that can be achieved with different levels of amputation, in order to limit prosthesis complications and improve patient’s life quality.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Ultrasound-guided barbotage for rotator cuff calcific tendinitis in physical medicine and rehabilitation Clinics

E. Vaquero Ramiro1, J. De Lamo Rovira2, C. Tafur Urueña1, J. Santana Canchanya1, R. Sancho Loras1

1Department of PMR, Hospital Virgen de La Luz, Cuenca, Spain, 2Department of Orthopaedic Surgery, Hospital Virgen De La Luz. Cuenca, Spain

Background and Aims: Calcific tendinopathy is a common disease associated with shoulder pain. This study describes the results of ultrasound-guided barbotage for rotator cuff calcific tendinitis in PMR clinics.

Methods: Patients were included who had painful calcific deposits >5mm in the supraspinatus tendon, confirmed on radiologic examination. Exclusion criteria were other shoulder diseases, use of anticoagulants, or previous extracorporeal wave shock therapy. After administration of local anesthesia (10ml 1% mepivacaine), US-guided needling and lavage of calcifications were performed using a single needle. All patients received a subacromial steroid after the barbotage. Size and Gartner classification were measured on radiographs, before the procedure and 8 weeks afterward. Reduction of the calcific deposit was graded as none, partial or complete. Results: 22 patients were included (mean age 55.2 ± 9.6 years SD), 72,7 % female. The dominant arm was affected by 66.0 %. Calcium deposits were Gartner I in 86.4% and Gartner II in 13.6%. The average area size of the calcification before treatment was 58.8 mm2 (range 119.3mm2-23.5 mm2). Calcic material was obtained in 81,8% of procedures. The mean size of the deposits decreased to 26.6 mm2 (p<0.05). Calcifications disappeared completely in 45.5% and partially in 27.7% of the patients. No adverse events were recorded. Two patients underwent an additional procedure during the follow-up period because of persistent symptoms and no resorption. Conclusions: Ultrasound-guided barbotage is a safe and effective procedure that can be performed by physical medicine and rehabilitation specialists in outpatient clinics.

Topic: 3. Clinical Sciences

Sub Topic: 3.2 Pain Osteoporosis -Osteoarthritis

Prevalence of neuropathic pain in osteoarthritis

I. Urbano, M.E. Zuluaga, C. Baena

1Universidad del Valle, Cali, Colombia

Background and Aims: Different factors contribute to severely decrease quality of life in patients with osteoarthritis. Historically, osteoarthritic pain has been the most important reported symptom, and usually has been classified as somatic pain. However, recent studies have shown that neuropathic pain may play an important role in the underlying pathological mechanisms of the disease. Despite that effective tools are currently available for the diagnosis of neuropathic pain in daily clinical practice, the prevalence of neuropathic pain in osteoarthritis is still unknown. Objective: To determine the prevalence of neuropathic pain in patients with osteoarthritis who received medical attention in an outpatient pain clinic in southwestern Colombia.

Methods: A cross-sectional study was carried out, using The Leeds questionnaire for the Evaluation of Symptoms and Signs of Neuropathic Pain on telephone versions and the perception of the general state of health. Results: The prevalence of neuropathic pain in our sampled population of patients with osteoarthritis was 28%, of which 84% were women. Symptoms associated with neuropathic pain, such as dysesthesias and paroxysmal pain were present in 92% of patients. 60% of the patients perceived their general state of health as ‘fair’. Conclusions: Neuropathic pain in osteoarthritis is a very frequent condition that is poorly recognized. More studies are needed and with a greater number of patients.

References

Schaible HG. Osteoarthritis pain. Recent advances and controversies. Curr Opin Support Palliat Care 2018;12:148-53.

Thakur M, Dickenson AH, Baron R. Osteoarthritis pain: Nociceptive or neuropathic? Nat Rev Rheumatol 2014;10:374-80.

Topic: 1. Biomedical sciences

Sub Topic: 1.1 Biomechanics

Direction-dependent differences in the movement characteristics of horizontal reaching in patients after stroke

S. Uehara1, A. Yuasa2, K. Ushizawa2, S. Kitamura1, Y. Obayashi3, K. Ito3, Y. Otaka2

1Faculty of Rehabilitation, Fujita Health University School of Health Sciences, Aichi, Japan, 2Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Aichi, Japan, 3Department of Rehabilitation, Fujita Health University Hospital, Aichi, Japan

Background and aims: Reaching function is often impaired in patients after stroke. It remains unclear, however, whether reaching characteristics differ depending on aiming directions and how they change along with functional improvement. The present study aimed to elucidate direction-dependent kinematic differences of reaching in post-stroke participants. Methods: Twelve and 10 patients with mild-to-moderate (score of Fugl-Meyer Assessment, 40 to 66) and severe (4 to 30) hemiparesis performed horizontal reaching with their affected and unaffected sides on a robot (KINARM). They performed rapid reaching toward targets displayed in one of eight positions arrayed radially at 10 cm from a central starting position. We analyzed data at admission (time after onset, mean of 36.4 and 44.8 days for each group) and at discharge (60.3 and 103.0 days). As proxies for kinematic parameters, we computed the movement time, path length, and the number of velocity peaks for the mild-to-moderate group while the total amount of displacement separately for mediolateral and anteroposterior directions for the severe group. Results: Mild-to-moderate cases showed decreases in movement parameters when reaching toward anteroposterior directions irrespective of the hands or functional improvement over time. As if significantly affected by this direction-dependent difference in the level of difficulty, severe cases tended to exhibit a greater amount of mediolateral movement at admission and then expand their movement toward the anteroposterior direction along with functional improvement. Conclusions: The performance of reaching tends to degrade in the anteroposterior direction irrespective of the hands, which may impact the pattern of movement appearance specifically for patients with severe hemiparesis.

Topic: 3. Clinical Sciences

Sub Topic: 3.9 Cardiac/ Pulmonary Rehabilitation

Efficacy and safety of the awake prone positioning in patients with COVID-19 related respiratory distress: A scoping review

T. Uddin1, N. Siddiquee2, A. Khandaker1, M. Bashar3, H. Rahim4, S. Islam1, B. Amatya5

1Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, 2United Hospital, Dhaka, Bangladesh, 3Shaheed Ziaur Rahman Medical College Hospital, Bogra, Bangladesh, 4Combined Military Hospital, Dhaka, Bangladesh, 5Royal Melbourne University Hospital and the University of Melbourne, Victoria, Australia

Background and Aims: COVID 19 pandemic overwhelmed the health care facilities globally. Patients with COVID-19 presents with mainly respiratory problems and the treatments are mostly supportive. Prone positioning (PP) is emerging as important treatment modality for the management of COVID-19 related respiratory distress syndrome. The aim of this review was to evaluate effectiveness and safety of awake PP in non-intubated patients with COVID-19 related acute respiratory distress at different care settings. Methods: The study was conducted during December 1, 2019 to August 30, 2020 using health science electronic databases and grey literature. PRISMA flow chart was used for preparing the manuscript. 338 studies were identified initially and after careful screening and eligibility check finally 06 studies with 187 patients were included for review.

Results: All the 06 studies were done in developed countries. Male patients were predominating with the mean age of approximately 55yrs. Oxygenation was improved in 79.14% patients. 157 (83.95%) patients with COVID-19-related hypoxemic respiratory distress tolerated the procedure. 25.41% of the patients required intubation or mechanical ventilation and 06(3.2%) patients expired. Number of patients in the reported studies could tolerate more than 03hrs of pp without a major side effect.

Conclusions: Awake proning improved oxygenation of the patients suffering from COVID-19 related respiratory hypoxia in different care settings. Early instituted prone positioning may be an effective alternative method of treating COVID-19 related respiratory distress particularly while waiting for positive pressure ventilation. Patient compliance, heterogeneity and small size cohort studies are the limitations of this review. Multicenter controlled studies are therefore recommended.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Recent trends on the role of physical modalities in the rehabilitation program for patients with rheumatoid arthritis

I.-.A. Tzanos1, P. Tsatsani2, E. Koutsantoni2, D. Moshou2, G. Fragoulis3, E. Grika4, A. Tsilioni4, G. Liantinioti3, M. Tziafalia4, S. Gazi2, A. Kotroni1

1Department of PRM, KAT General Hospital, Athens, Greece, 2Department of Rheumatology, KAT General Hospital, Athens, Greece, 3Department of Rheumatology, LAIKO General Hospital, Athens, Greece, 4Department of Rheumatology, EVAGGELISMOS General Hospital, Athens, Greece

Background and Aims: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that affects mainly women. Its’ main clinical course includes symmetrical and destructive polyarthritis. The small joints of the hand and feet are predominantly affected. Additionally to pharmacological treatment, various rehabilitation protocols have been proposed including functional assessment, therapeutic patient education, exercise therapy, physical agents, orthoses, assistive devices, dietary interventions and balneotherapy. The aim of this study is to document the recent data regarding the efficiency of physical modalities as a component of a rehabilitation program for patients with RA. Methods: We conducted bibliographic research of the last 8 years in the scientific search engines, PubMed and Cochrane Library. Keywords used were rheumatoid arthritis, rehabilitation, physical modalities and physical agents. Results: Nineteen original studies regarding physical modalities conservative treatment for rheumatoid arthritis patients were included in this review. It was reported that the appropriate and individualized use of thermotherapy, including paraffin baths, cryotherapy and ultrasound, has potential beneficial effects on pain, range of motion, function and activity. Electrical stimulation for muscle atrophy of the hand, and Transcutaneous Electrical Nerve Stimulation (TENS) – conventional or acupuncture-TENS – for pain alleviation have also been reported as effective rehabilitation options. Low-level Laser Therapy (LLLT) has been also highlighted as a possible measure to increase flexibility and to reduce pain and stiffness. Intermittent Whole-Body Vibration (WBV) has been also proposed for preventing bone mass loss and fatigue occurrence. Conclusions: Thermotherapy (deep and superficial), electrotherapy, LLLT and WBV are the main effective physical agents for patients with RA.

Topic: 3. Clinical Sciences

Sub Topic: 3.1 Health conditions (Neuro, MSK, CP, Trauma, Cardio-Pulmonary conditions, Vascular and Vestibular Impairments)

Plantar fasciitis: A current literature review of the conservative interventions

I.-.A. Tzanos, S. Sivetidou, E. Tzani, A. Anamorlidis, E. Damianakis, O. Nikolaidou, S. Migkou, A. Sabanis, A. Papaspyrou, E. Simopoulou, A. Kotroni

Department of PRM, KAT General Hospital, Athens, Greece

Background and aims: Plantar fasciitis is a common cause of musculoskeletal foot pain among adults and especially women. The aim of this study is to highlight the various effective conservative measures for this syndrome that have been identified by recent research. Methods: Bibliographic research of the last 5 years in the scientific search engines, PubMed, Google Scholar, Uptodate and Cochrane Library. Keywords used were plantar fasciitis conservative and plantar fasciitis treatment. Results: The database search featured 41 original studies that were relative with conservative treatment for plantar fasciitis. We excluded 17 studies for several reasons. Analyzing the rest studies, it was generally approved that rest, ice, NSAIDS, passive stretching, orthotics (mainly silicon cups) and night splints are the main globally used treatment options at the initial stage. For patients that do not respond to the these measures, the application of corticosteroid, platelet rich plasma or autologous blood injections and the extracorporeal shock wave therapy have been identified as the most effective options. Conclusions: Since there are various effective conservative therapeutic options for patients with plantar fasciitis, it is important to utilize at first all the applicable alternatives before considering surgery as a mandatory.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Timed up and go test and fall history in older adults during COVID-19 pandemic

Z. Turan, O. Ozyemisci Taskiran

Department of Physical Medicine and Rehabilitation, Koc University School of Medicine, Istanbul, Turkey

Background and Aims: In pandemic, physical activity of people was affected due to curfew. The aim of this study was to evaluate the gait and fall history in older patients who admitted to the PMR outpatient clinic during the pandemic. Methods: Among 120 patients, 98 patients (72 women, 26 men) aged >=65 years were enrolled to this retrospective study between July and December 2020. The patients with severe orthopedic or neurologic diseases or history of COVID-19 were excluded. Diagnosis, comorbidities, fall history, timed up and go test (TUG) and SARC-F questionnaire were recorded from hospital medical records. Results: Median age, TUG duration and SARC-F was 73 years, 8.4 seconds, and 2, respectively. The prevalence of fall was 26%. Patients with SARC-F >=4 had longer TUG duration, higher prevalence of lower extremity problems and fall history (p<0.001, p=0.013 and p=0.003, respectively). Although, TUG was positively correlated with age and SARC-F, prevalence of fall history did not differ between patients with TUG>=13.5 and <13.5 (p=0.577).

Conclusions: Prevalence of fall history during pandemic was similar to that of community dwelling people. It was interesting to note that median TUG duration of all patients was lower than the cut-off value for an increased fall risk (>=13.5). Prevalence of fall history was not higher in patients with longer TUG. Since the study was conducted in patients attending to outpatient clinic, these results cannot be generalized to the general population.

Topic: 3. Clinical Sciences

Sub Topic: 3.5 Specific Target Groups: Children, Elderly, Athletes, Musicians, Refugees, Ethnic Groups, Workers, and Others, Women

Comparison of peak oxygen consumption during exercise testing between sexes among children and adolescents in southern Taiwan

S. Tuan1, G. B. Chen2, I. H. Liou3, K. L. Lin3

1Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung City, Taiwan, 2Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung City, Taiwan, 3Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan

Background and Aims: Studies among Western children observed that boys’ peak oxygen consumption (peak VO2) values are higher than those of girls, and this difference increases as children progress through adolescence. However, the process of maturation and the social expectation toward boys and girls in Eastern are much different from Western countries. We aimed to provide baseline information on cardiopulmonary fitness of children and adolescents in relation to age and sex in Taiwan. Methods: We conducted a retrospective study among children and adolescents aged 4 to 18 years in Taiwan. The participants were classified to 4 groups based on age (group 1 from 4 to 6, group 2 from 7 to 9, group 3 from 10 to 13, and group 4 from 14 to 18 years old). All the participants completed symptom-limited exercise test by treadmill and anthropometric measurements by bioelectrical impedance method. Results: 897 (448 males, 449 females) were analyzed at final. Boys had higher peak VO2(all p < 0.0