Article 15 Executive Dysfunction Immediately Post Mild-Stroke
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Stroke Diagnosis Article 14 Closing the Gap: Early Intervention for Cognitive Disability After Stroke. Elizabeth R. Skidmore (University of Pittsburgh, Pitts- burgh, PA), Deirdre R. Dawson, Ellen M. Whyte, Margo B. Holm, James T. Becker. Disclosure: None disclosed. Objective: We examined meta-cognitive strategy training for indi- viduals with cognitive impairments after acute stroke. Design: Pilot randomized controlled trial. Setting: Inpatient rehabilitation at an academic health center. Participants: We recruited participants who demonstrated cognitive impairments (Executive Interview3) after acute stroke. We excluded individuals with severe aphasia (Boston Diagnostic Aphasia Examination 2), pre-morbid diagnoses of de- mentia, current major depressive or bipolar disorder, recent alcohol/ drug abuse, or psychosis. Interventions: We administered either a meta-cognitive strategy training (ST, n15) or an attention control session (discussion group, AC, n15) every weekday of the length of stay, in addition to usual inpatient rehabilitation. Main Outcome Measures: To describe the sample, we administered measures of cognitive function (Repeatable Battery of Neuropsychological Status, Delis Kaplan Executive Functioning System), motor function (Che- doke McMaster Assessment Impairment Inventory), and mood (Ham- ilton Depression Rating Scale, Apathy Evaluation Scale). To measure outcomes, we administered the Functional Independence Measure (FIM) at study admission, rehabilitation discharge, three and six months later. Results: There were no differences between groups with respect to participant characteristics (age, gender, race, stroke type, hemisphere or chronicity), baseline cognitive status or FIM scores, or length of stay. The ST group demonstrated significantly greater stroke severity (t 28 2.77, p.01). Mixed model analyses examining the group by time interaction suggest that meta-cognitive strategy training was superior to attention control (F 3,87 7.65, p.001), yielding a strong effect size (Cohen’s f.78). Conclusions: Meta-cognitive strat- egy training administered to individuals with cognitive impairments after stroke during inpatient rehabilitation promotes faster improvements in FIM scores compared to an attention control intervention. Key Words: Stroke; Cognition; Rehabilitation; Disability. Article 15 Executive Dysfunction Immediately Post Mild-Stroke. Timothy Wolf (Washington University School of Medicine, St. Louis, MO), Amy Barbee, Desiree White. Disclosure: None disclosed. Objective: To identify executive function deficits immediately post mild stroke that are known to impair transition back into everyday life. Design: This was a cross-sectional study of individuals one week post mild stroke. Setting: Program in Occupational Therapy at Washington University School of Medicine. Participants: All participants in this study (N 53) were admitted to the Barnes-Jewish Hospital (BJH) stroke service in St. Louis, Missouri. Inclusion criteria: (1) diagnosis of mild stroke; NIHSS 6; (2) first stroke; and (3) all individuals aged 18 –90. Exclusion criteria: (1) history of previous stroke or other neurological disorder; (2) unwillingness to provide informed consent; (3) non-English speaking; (4) dementia; and (5) scoring 3 or more standard deviations below the mean on full-scale IQ assessment. Main Outcome Measures: (1) Delis-Kaplan Executive Function System (DKEFS): D-KEFS Sorting Test, D-KEFS Color-Word Interference Test, and D-KEFS Trail Making Test; and (2) the Executive Function Performance Test (EFPT). Results: Using very rigorous criteria to identify specific deficits in executive function, results showed that 66% of the population (N 35) scored in the deficit range on at least one of the four measures of executive function; 27% of the population (N 14) scored in deficit range on two or more measures. Conclu- sions: Executive dysfunction is often undetected and can have a debilitating effect on the ability of individuals with mild stroke to return to home, work and community roles. Early detection is critical to provide these individuals with the appropriate rehabilitation recom- mendations before they are discharged. Key Words: Stroke; Cogni- tion and perception; Clinical practice; Rehabilitation. Article 16 Effectiveness of Home/Community-Based Rehabilitation for 738 Patients With Stroke: Evidence of a Dose-Response Relationship. Irwin M. Altman (Rehab Without Walls, Phoenix, AZ), Shannon Swick, James F. Malec. Disclosure: Irwin M. Altman is the Area Executive Director for Rehab Without Walls. Shannon Swick is the Area Vice President of Rehab Without Walls. James F. Malec is an Inventive Software Solutions grant subcontractor. Objectives: (1) To assess the effectiveness of home-and commu- nity based brain rehabilitation (HCBR) in a large cohort of individuals with disabilities secondary to cerebrovascular accident (CVA), and (2) to evaluate the responsiveness to treatment of the Mayo-Portland Adaptability Inventory (MPAI-4) to changes resulting from HCBR in this patient group. Design: Retrospective analysis of program evalu- ation data for treatment completers and non-completers. Setting: HCBR conducted in 7 geographically distinct U.S. cities. Partici- pants: 738 individuals with CVA who completed the prescribed course of rehabilitation (CCT) compared to 150 who were precipi- tously discharged prior to program completion (PD). Intervention: HCBR delivered by certified professional staff on an individualized basis. Main Outcome Measures: Mayo-Portland Adaptability Inven- tory (MPAI-4) completed by professional consensus on admission and at discharge. Results: Using analysis of covariance, MPAI-4 total scores at discharge for CCT participants were compared to PD partic- ipants, with admission MPAI-4, age, length of stay, and time since event as covariates. CCT participants showed greater improvement than PD participants (F99.48, p.001) with a moderate effect size (partial 2 .10). Group differences and effect sizes were similar for the 3 index scores: Ability (F75.96, p.001; partial 2 .08), Ad- justment (F99.67, p.001; partial 2 .10), and Participation (F69.15, p.001; partial 2 .07). Conclusions: The CCT group who received the entire planned course of HCBR showed greater improvement on all MPAI-4 indices than the PD group who were discharged prior to completing the prescribed program. This dose- response relationship provides evidence of a causal relationship be- tween treatment and outcome. Key Words: Stroke; Community inte- gration and participation; Clinical practice; Rehabilitation. Article 17 Post-Stroke Exercise: Effects on Cardiovascular Risk, Fitness and Function. Ada Tang (University of British Columbia, Vancouver, BC, Canada), Janice J. Eng, Andrei V. Krassioukov, Penelope Brasher, Kenneth M. Madden, Michael Tsang, Tereesa SM Tsang. Disclosure: None disclosed. Objectives: To examine the effects of exercise on cardiovascular risk factors, cardiorespiratory fitness and cardiac function among in- dividuals living in the community with stroke. Design: Single-blinded randomized controlled trial. Setting: Community. Participants: Fifty participants were randomized into either a 6-month Aerobic exercise (AE) or Balance/Flexibility (BF) program. Interventions: Six-month exercise interventions of three 60-minute sessions per week, where intensity in the AE program progressed gradually up to 70-80% heart rate reserve (HRR), while intensity in the BF program was maintained below 40% HRR. Main Outcome Measures: Pulse pressure, fasting lipid and glucose levels were measured for cardiovascular risk, VO2peak for cardiorespiratory fitness, and echocardiographic mea- sures for hemodynamics and cardiac function. Results: Twenty-three (92%) of 25 in the AE group completed the program (withdrawals unrelated to the intervention) and all participants completed the BF program. Both groups demonstrated post-program improvement in triglyceride levels (1.520.62 to 1.350.49 mmol/L, P0.008). The AE group, however, demonstrated greater improvement in right atrial E11 2012 ACRM–ASNR Annual Conference Abstracts Arch Phys Med Rehabil Vol 93, October 2012
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E112012 ACRM–ASNR Annual Conference Abstracts
Stroke Diagnosis
Article 14Closing the Gap: Early Intervention for Cognitive Disability AfterStroke. Elizabeth R. Skidmore (University of Pittsburgh, Pitts-burgh, PA), Deirdre R. Dawson, Ellen M. Whyte, Margo B. Holm,James T. Becker.
Disclosure: None disclosed.Objective: We examined meta-cognitive strategy training for indi-
viduals with cognitive impairments after acute stroke. Design: Pilotrandomized controlled trial. Setting: Inpatient rehabilitation at anacademic health center. Participants: We recruited participants whodemonstrated cognitive impairments (Executive Interview�3) afteracute stroke. We excluded individuals with severe aphasia (BostonDiagnostic Aphasia Examination � 2), pre-morbid diagnoses of de-mentia, current major depressive or bipolar disorder, recent alcohol/drug abuse, or psychosis. Interventions: We administered either ameta-cognitive strategy training (ST, n�15) or an attention controlsession (discussion group, AC, n�15) every weekday of the length ofstay, in addition to usual inpatient rehabilitation. Main OutcomeMeasures: To describe the sample, we administered measures ofcognitive function (Repeatable Battery of Neuropsychological Status,Delis Kaplan Executive Functioning System), motor function (Che-doke McMaster Assessment Impairment Inventory), and mood (Ham-ilton Depression Rating Scale, Apathy Evaluation Scale). To measureoutcomes, we administered the Functional Independence Measure(FIM) at study admission, rehabilitation discharge, three and sixmonths later. Results: There were no differences between groups withrespect to participant characteristics (age, gender, race, stroke type,hemisphere or chronicity), baseline cognitive status or FIM scores, orlength of stay. The ST group demonstrated significantly greater strokeseverity (t28�2.77, p�.01). Mixed model analyses examining theroup by time interaction suggest that meta-cognitive strategy trainingas superior to attention control (F3,87�7.65, p�.001), yielding a
trong effect size (Cohen’s f�.78). Conclusions: Meta-cognitive strat-gy training administered to individuals with cognitive impairmentsfter stroke during inpatient rehabilitation promotes faster improvementsn FIM scores compared to an attention control intervention. Key
ords: Stroke; Cognition; Rehabilitation; Disability.
rticle 15xecutive Dysfunction Immediately Post Mild-Stroke. Timothyolf (Washington University School of Medicine, St. Louis, MO),
my Barbee, Desiree White.
isclosure: None disclosed.Objective: To identify executive function deficits immediately post
ild stroke that are known to impair transition back into everyday life.esign: This was a cross-sectional study of individuals one week postild stroke. Setting: Program in Occupational Therapy at Washingtonniversity School of Medicine. Participants: All participants in this
tudy (N � 53) were admitted to the Barnes-Jewish Hospital (BJH)troke service in St. Louis, Missouri. Inclusion criteria: (1) diagnosisf mild stroke; NIHSS �6; (2) first stroke; and (3) all individuals aged8–90. Exclusion criteria: (1) history of previous stroke or othereurological disorder; (2) unwillingness to provide informed consent;3) non-English speaking; (4) dementia; and (5) scoring 3 or moretandard deviations below the mean on full-scale IQ assessment. Mainutcome Measures: (1) Delis-Kaplan Executive Function System
DKEFS): D-KEFS Sorting Test, D-KEFS Color-Word Interferenceest, and D-KEFS Trail Making Test; and (2) the Executive Functionerformance Test (EFPT). Results: Using very rigorous criteria to
dentify specific deficits in executive function, results showed that 66%f the population (N � 35) scored in the deficit range on at least onef the four measures of executive function; 27% of the populationN � 14) scored in deficit range on two or more measures. Conclu-
ions: Executive dysfunction is often undetected and can have aebilitating effect on the ability of individuals with mild stroke toeturn to home, work and community roles. Early detection is criticalo provide these individuals with the appropriate rehabilitation recom-endations before they are discharged. Key Words: Stroke; Cogni-
ion and perception; Clinical practice; Rehabilitation.
rticle 16ffectiveness of Home/Community-Based Rehabilitation for 738atients With Stroke: Evidence of a Dose-Response Relationship.rwin M. Altman (Rehab Without Walls, Phoenix, AZ), Shannonwick, James F. Malec.
isclosure: Irwin M. Altman is the Area Executive Director for Rehabithout Walls. Shannon Swick is the Area Vice President of Rehabithout Walls. James F. Malec is an Inventive Software Solutions
rant subcontractor.Objectives: (1) To assess the effectiveness of home-and commu-
ity based brain rehabilitation (HCBR) in a large cohort of individualsith disabilities secondary to cerebrovascular accident (CVA), and (2)
o evaluate the responsiveness to treatment of the Mayo-Portlanddaptability Inventory (MPAI-4) to changes resulting from HCBR in
his patient group. Design: Retrospective analysis of program evalu-tion data for treatment completers and non-completers. Setting:CBR conducted in 7 geographically distinct U.S. cities. Partici-ants: 738 individuals with CVA who completed the prescribedourse of rehabilitation (CCT) compared to 150 who were precipi-ously discharged prior to program completion (PD). Intervention:CBR delivered by certified professional staff on an individualizedasis. Main Outcome Measures: Mayo-Portland Adaptability Inven-ory (MPAI-4) completed by professional consensus on admission andt discharge. Results: Using analysis of covariance, MPAI-4 totalcores at discharge for CCT participants were compared to PD partic-pants, with admission MPAI-4, age, length of stay, and time sincevent as covariates. CCT participants showed greater improvementhan PD participants (F�99.48, p�.001) with a moderate effect sizepartial �2�.10). Group differences and effect sizes were similar for
the 3 index scores: Ability (F�75.96, p�.001; partial �2�.08), Ad-ustment (F�99.67, p�.001; partial �2�.10), and ParticipationF�69.15, p�.001; partial �2�.07). Conclusions: The CCT group
who received the entire planned course of HCBR showed greaterimprovement on all MPAI-4 indices than the PD group who weredischarged prior to completing the prescribed program. This dose-response relationship provides evidence of a causal relationship be-tween treatment and outcome. Key Words: Stroke; Community inte-gration and participation; Clinical practice; Rehabilitation.
Article 17Post-Stroke Exercise: Effects on Cardiovascular Risk, Fitness andFunction. Ada Tang (University of British Columbia, Vancouver,BC, Canada), Janice J. Eng, Andrei V. Krassioukov, PenelopeBrasher, Kenneth M. Madden, Michael Tsang, Tereesa SM Tsang.Disclosure: None disclosed.
Objectives: To examine the effects of exercise on cardiovascularrisk factors, cardiorespiratory fitness and cardiac function among in-dividuals living in the community with stroke. Design: Single-blindedrandomized controlled trial. Setting: Community. Participants: Fiftyparticipants were randomized into either a 6-month Aerobic exercise(AE) or Balance/Flexibility (BF) program. Interventions: Six-monthexercise interventions of three 60-minute sessions per week, whereintensity in the AE program progressed gradually up to 70-80% heartrate reserve (HRR), while intensity in the BF program was maintainedbelow 40% HRR. Main Outcome Measures: Pulse pressure, fastinglipid and glucose levels were measured for cardiovascular risk,VO2peak for cardiorespiratory fitness, and echocardiographic mea-sures for hemodynamics and cardiac function. Results: Twenty-three(92%) of 25 in the AE group completed the program (withdrawalsunrelated to the intervention) and all participants completed the BFprogram. Both groups demonstrated post-program improvement in
triglyceride levels (1.52�0.62 to 1.35�0.49 mmol/L, P�0.008). TheAE group, however, demonstrated greater improvement in right atrialArch Phys Med Rehabil Vol 93, October 2012
