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Saturday, 13 October 2012

Registration Desk Open: 7:00 am -- 12:00 pm
Exhibition Open, Posters Displayed:  8:00 am -- 12:00 pm
Revised Learning Objectives. Correct as of 14 September 2012
Faculty Disclosures 


NIDRR-Sponsored ARRT Young Investigators Panel
8:00 am – 10:00 am
In partnership with ACRM, NIDRR selects five ARRT Fellows to present research relevant to the ACRM mission and audience.

Course Directors:
Allen W. Heinemann, PhD
Director, Center for Rehabilitation Outcomes Research and
Associate Director of Research, Rehabilitation Institute of Chicago
Professor, Department of Physical Medicine and Rehabilitation
Feinberg School of Medicine, Northwestern University
Chicago, IL 

Ruth W. Brannon, MSPH, MA
Director, Research Sciences Division
National Institute on Disability and Rehabilitation Research
Washington, DC 


Differential Recruitment of Listening Strategies for Auditory Rhythms in Parkinson Disease (1147)
NIDRR ARRT Fellow: Nathaniel S. Miller, PhD, University of Michigan, Ann Arbor, MI

Neurodegenerative disorder with a focus on neuroscience

Impaired generation of an internal rhythm (or ‘beat’) is hypothesized to underlie the irregular timing of gait and speech in Parkinson disease (PD; Freeman, Cody & Schady, 1993). Here, we test this hypothesis by determining whether individuals with PD favor a non-beat, as opposed to beat-based, listening strategy for auditory rhythms compared to controls.

Individuals with PD recruit a non-beat based listening strategy more often than controls. Moreover, sequence discrimination thresholds do not explain this difference.

These data provide additional support for impairments in internal beat generation in PD. Additionally, this study lays the groundwork for the investigation of relationships between temporal processing strategies and the motor symptoms of PD that may inform rehabilitation.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives: 

  1. Discuss the temporal impairments of gait and speech in Parkinson disease.
  2. Describe the difference between a ‘beat’ and ‘non-beat-based’ listening strategy.
  3. Discuss how identifying individual differences in listening strategy may improve gait and speech rehabilitation.

Elucidating the Neurobiology of Self-Reported Fatigue in Multiple Sclerosis (MS): The Interplay of Networks (1005)

NIDRR ARRT Fellow: Abhijit Das, MBBS, MD, DM, Kessler Foundation Research Center, West Orange, NJ

Diagnosis: Neurodegenerative disorder with a focus on neuroscience

Objective: To examine the correlation between fractional anisotropy (FA), a measure of white matter integrity (WMI), and self-reported fatigue in patients with multiple sclerosis (MS).

Results: The MFIS-physical sub-score (21.2 ± 8.1) correlated positively with FA scores in bilateral cingulate; and correlated negatively with bilateral precuneus. The MFIS-cognitive sub-score (22.1 ± 7.4) correlated positively with FA scores in WM tracts of bilateral basal ganglia; and correlated negatively with right insula. The MFIS-psychosocial sub-score (4.3 ± 1.9) correlated positively with FA scores in WM tracts of right caudate; and correlated negatively with right insula.

Conclusions: These findings suggest that 1) cognitive and psychosocial fatigue seem to rely on the same network, and 2) this is different from the network underlying physical fatigue. This fractionation represents a significant breakthrough in understanding the neurobiology of self-reported fatigue.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Multiple Sclerosis
  2. Fatigue
  3. Diffusion Tensor Imaging
  4. Fractional anisotropy

Development and Evaluation of a Terrain Dependent Electrical Powered Wheelchair Driver Assistance System (1068)
NIDRR ARRT Fellow: Hongwu Wang, PhD, University of Pittsburgh, Pittsburgh, PA

Diagnosis: This presentation is diagnosis-independent with a focus on technology

Objective: Develop an electrical powered wheelchair (EPW) driver assistance system to improve the performance of EPWs, to decrease the chances of falls and tip over, and to increase the community participation and quality of life of users.

Results: An add-on package to commercial EPWs has been designed and developed where the sensing components can detect different terrains as well as EPW driving parameters, and a tablet computer can record performance variables. Experimental tests with different driving rules on different terrains showed that EPWs require different driving rules on individual terrains to improve their handling performance. A user study with ten able-body subjects confirmed the experimental test results and showed that performance variables agreed with user perceived ratings. Another user study with ten EPW users is planned in May where the system with terrains sensing and automated switching of driving rules will be evaluated.

Conclusions: An add-on terrain dependent EPW driver assistance system with developed driving rules will improve the EPW performance and provide better user experience on different terrains. With this system, the challenges related to hazardous terrains for EPW users could be minimized, thus their community participation will be increased. Furthermore, the add-on system could allow clinicians to better understand and evaluate driving performance of EPW users with quantitative data, enhancing the evidence-based practice for EPW prescription and clinical practice.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Evidence-based approaches to treatment
  2. Applications of technology in rehabilitation research and practice
  3. Methods for translation of evidence into clinical practice and policy

Effectiveness of Off-Axis Training on Improving Knee Function in Individuals with Patellofemoral Pain (1072)
NIDRR ARRT Fellow: Liang-Ching Tsai, PhD, PT, Northwestern University/Rehabilitation Institute of Chicago, Chicago, IL

Diagnosis: Patellofemoral Pain with a focus on technology

Objective: Patellofemoral pain (PFP) is thought to be associated with altered patellofemoral mechanics due to impaired neuromuscular control of the lower extremity, particularly on the frontal and transverse planes (i.e., off-axis motions). The purpose of this study was to examine the effectiveness of an off-axis training program on improving knee pain and function in individuals with PFP.

Results: On average, subjects reported a higher KOOS and IKDC score following the 6-week off-axis training program. Decreased variability of the FRA and FSD were also observed post-training.

Conclusions: An off-axis training program using a robotic elliptical trainer was effective in enhancing lower extremity neuromuscular control on the frontal and transverse planes. The enhanced off-axis neuromuscular control post-training was accompanied by a reduction in knee pain and improvement in knee function in persons with PFP.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Potential mechanism(s) of patellofemoral pain
  2. Limitation of current rehabilitation/intervention programs for patellofemoral pain
  3. Benefit of lower extremity off-axis training using a robotic elliptical trainer for individuals with patellofemoral pain

Leg Preference Associated with Protective Stepping Responses to Waist-Pull Perturbations of Standing Balance in Older Adults (1255)
NIDRR ARRT Fellow: Patricia M. Young, PhD, University of Maryland School of Medicine, Baltimore, MD

Diagnosis: This presentation is diagnosis-independent with a focus on neuroscience

Objective: To determine whether leg preference influenced the stepping response to a waist-pull perturbation of older adults at risk for falls.

Results: Mean number of recovery steps taken increased in response to increased perturbation magnitude for all subjects, regardless of whether the perturbation was to the preferred or non-preferred side. Low fall-risk subjects took lateral side steps when pulled to their preferred side and cross-over steps when pulled to their non-preferred side. In contrast, high fall-risk subjects frequently took more lateral steps when pulled to their non-preferred side. Variability of minimum margins of stability at first-step touchdown was greater for pulls to the non-preferred side for high fall-risk older adults.

Conclusions: Leg preference may influence the protective stepping response to standing balance perturbations in older adults at risk for falls. Such asymmetries in balance stability recovery may represent a previously unrecognized precipitating factor for falls among older individuals and should be considered for rehabilitation interventions aimed at improving balance stability and reducing the risk of falls.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Leg preference may influence stepping responses to standing balance perturbations.
  2. Type of recovery step in relation to leg preference used in response to standing balance perturbations may discriminate low- and high-risk fallers.
  3. Asymmetries in standing balance recovery may be an unrecognized precipitation factor for falls.

Putting TBI Common Data Elements into Practice (748)
8:30 am – 10:00 am

David S. Tulsky, PhD, University of Michigan, Ann Arbor, MI; Ramona Hicks, PhD, National Institute of Neurological Disorders and Stroke (NINDS), Bethesda, MD; David O. Okonkwo, MD, PhD, University of Pittsburgh, Pittsburgh, PA; Thomas J. DeGraba, MD, National Intrepid Center of Excellence (NICoE), Bethesda, MD

Diagnosis: Brain Injury with a focus on research methods

Traumatic brain injury (TBI) remains one of the greatest public health needs. Measurement limitations impede efforts to translate advances in basic science or hinder researchers’ ability to detect meaningful changes that are the result of a successful clinical trial or new treatment for TBI patients. The inconsistency in the selection and use of outcome and demographic measures make it even more difficult to interpret findings between studies. For this reason, an interagency initiative sought to identify and recommend common data elements (CDEs) for use in research and practice with individuals with TBI.

The recommended CDEs include standardized definitions and protocols for collecting data, as well as core tools for TBI research. If followed, the CDEs would facilitate data sharing. The recommendations were published in a series of articles in the Archives of Physical Medicine and Rehabilitation (2010, Vol 91(11)). While making recommendations, the committees recognized that the field is not stagnant and that several new measures show promise of being more sensitive and cost-effective, but did not have sufficient validation data at the time of the initial meeting.

This symposium will discuss the CDE recommendations and advances. The initial presentation will provide an overview of the CDE initiative and the recommendations. The second session will describe an ambitious multi-site collaborative project (TRACK TBI) to evaluate the ease of implementation of the recommendations in research. The third presentation discusses the emerging measures that hold promise to improve TBI research. The final presentation describes a complementary project to TRACK-TBI in the DoD which is testing CDE's in practice with individuals with mild TBI. A new federated database for TBI research will be described, which is a natural extension of the Common Data Elements Project.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the NIH Common Data Elements for TBI project
  2. Discuss the practical world implications of the NIH CDE project for the future of TBI research and clinical care
  3. Explain the new emerging outcomes measures that are under development and how these might be incorporated as new CDEs
  4. Discuss the real world implications for using CDE with military personnel and wounded warriors.
  5. Describe the Federated database being developed to track CDEs in TBI research

Strategy Use in Cognitive Rehabilitation (749)
8:30 am – 10:00 am

Yael Goverover, PhD, OT, New York University, New York, NY; Joan Toglia, PhD, OTR, Mercy College, Dobbs Ferry, NY; Deirdre R. Dawson, PhD, University of Toronto, Toronto, ON, CA; Denise Krch, PhD, Kessler Foundation Research Center, West Orange, NJ

Diagnosis: Brain Injury, Stroke, Neurodegenerative disorder with a focus on clinical practice

Cognitive rehabilitation enhances a person's capacity to process and interpret information, with the purpose of improving one's ability to function in all aspects of life. Despite the need for cognitive rehabilitation services as a standard of care, there is a scarcity of research studies designed to investigate treatment approaches and their effectiveness in persons with neurological disorders.

The aim of this symposium is to examine one aspect of cognitive rehabilitation, the use of strategies to improve cognitive and everyday functioning in persons with cognitive impairments. In this symposium we will present and discuss studies investigating the effectiveness of strategy use in persons with cognitive impairments, and ways to enhance generalization and transfer of strategies learned in treatment to everyday life.

The first presentation will provide an updated review of evidence-based research on cognitive rehabilitation and strategy use in individuals with acquired brain injury. The next two talks will focus on cognitive strategies that have been found to be beneficial in improving the learning and memory in persons with multiple sclerosis (MS) and traumatic brain injury (TBI).

Specifically, data on combining two learning and memory strategies (i.e. generation and spacing effect) will be described. Additionally, an established treatment protocol that utilizes context and visual imagery will be discussed. Consideration will be given to the impact of culture in the application of the strategies used in cognitive rehabilitation. Finally, strategy use in neurological populations and ways to increase their generalization in everyday life activities will be presented. Current status of and ideas for future work will be discussed.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Attendees will gain familiarity with new evidence to support the use of strategies in cognitive rehabilitation
  2. Attendees will identify methods to facilitate carryover of strategies across activities
  3. Attendees will be able to identify three cultural barriers that may hinder the use of strategies in rehabilitation
  4. Attendees will have basic knowledge of the key principles of the CO-OP approach to strategy training and the evidence supporting its use in adults with ABI

Comparing of Function across Post-Acute Rehabilitation Settings after Co-Calibration of Self-Care and Mobility Items (793)
8:30 am – 10:00 am

Trudy R. Mallinson, PhD, OTR/L, NZROT, University of Southern California, Los Angeles, CA; Anne Deutsch, RN, PhD, CRRN, Allen W. Heinemann, PhD, Rehabilitation Institute of Chicago, Chicago, IL

Diagnosis: Stroke, Hip Fracture, Lower Extremity Joint Replacement with a focus on research methods

Rehabilitation is provided in a range of post-acute care (PAC) settings, each varying in the intensity of care and services provided, and the payment systems that regulate reimbursement. Medicare mandates that PAC settings use different measures of functional status as part of the Medicare prospective payment systems: the Patient Assessment Instrument (IRF PAI) for inpatient rehabilitation facilities (IRFs), the Minimum Data Set (MDS) for skilled nursing facilities (SNFs), and the Outcome and Assessment Information Set (OASIS) for home health agencies (HHAs). Patients’ scores on these measures are also used to document the functional outcomes of patients.

This symposium will describe PAC payment policy and the application of two methods of item response theory (IRT) to co-calibrate functional status items of the IRF PAI, MDS, and OASIS. Primary data were collected on 571 patients with stroke, hip fracture, or hip replacement, in each of the three PAC settings, each rated on all tools. These primary data serve as the critical link to connect to a year of administrative and assessment data for Medicare patients receiving rehabilitation in IRF, SNF, & HHA for stroke, hip fracture or joint replacement.

We present the results of the co-calibration, which resulted in comparable measures of function for all patients, which we used to compare functional status across PAC settings at admission and discharge for each diagnosis. We present the results from models that predict functional gain and cost as a function of patient characteristics and PAC setting using Medicare administrative data for PAC rehabilitation discharges in 2005.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Participants will be able to describe differences in Medicare requirements for home health, skilled nursing, and inpatient rehabilitation settings including facility requirements, payment models, and assessment tools.
  2. Participants will discuss the results of the co-calibration of functional status items and the strengths and limitations of 1- and 2- parameter models.
  3. Participants will be able to describe the differences in functional status across post-acute care settings at both admission and discharge, and the implications for comparing recovery of function across settings.

Motor Control in SCI: The Utility of Electromyography in the Clinic and the Lab (822)
8:30 am – 10:00 am

Keith Tansey, MD, PhD, Deborah Backus, PT, PhD, Joy Bruce, DPT, PhD, Shepherd Center, Atlanta, GA; Mr. McKay.

Diagnosis: Spinal Cord Injury with a focus on research methods

Clinicians and researchers are often plagued by a lack of adequate outcome measures to assess motor control and recovery after neural injury. Clinicians are challenged to defend their choice of interventions based on measures that simply do not capture the full extent of motor improvements. Similarly, researchers are often stymied by the inadequacy of outcome measures to provide insight into the underlying mechanisms of functional change.

To achieve motor skill, one must have not only the ability to activate a muscle, but also the ability to turn it off, at the correct time during a task, at the sufficient amount, across multiple muscles and joints, in a controlled and coordinated fashion. While one may demonstrate the ability to perform a given task, the task itself may not be performed in a way that is smooth and accurate. To simply assess the task (e.g. reaching for a cup), with a functional tool (e.g. using the Arm Research Action test), will not provide any information about how an individual is performing the task, or the parameters (timing and control of muscle activation) that may be impacting the performance of the task.

Advances in electromyography (EMG) make this a valuable tool for providing insights into the way that the CNS is controlling movement. Both clinicians and researchers may benefit from using EMG to assess changes in muscle activation patterns during specific tasks, and may gain insights into underlying mechanisms of dysfunction and recovery of function in people with SCI.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives: 

  1. Discuss the role and value of EMG in assessment of motor control in people with SCI
  2. Describe example two research applications of EMG in the SCI patient population
  3. Define benefits and barriers to translating the application of EMG in the clinical setting
  4. Describe considerations for use and interpretation of EMG data in both the research and clinical settings.

Improving Cognition after Brain Injury: Advances in the Neuroscience of Cognitive Training
8:30 am – 10:00 am

Anthony J. W. Chen, MD, Tatjana Novakovic-Agopian, PhD, University of California, San Francisco, San Francisco, CA; Asha Vas, University of Texas, Dallas, TX; Scott Rome, MD, California Pacific Regional Rehabilitation Center, San Francisco, CA

Diagnosis: Brain Injury, Stroke, and diagnosis-independent conditions with a focus on neuroscience

Deficits in cognitive functioning are amongst the most prevalent and functionally disabling consequences of brain injuries, even in chronic stages of recovery. Improved interventions are needed. Faculty in this symposium will discuss examples of the development, testing and neuroscientific investigation of training higher order cognitive functions important for ‘goal-direction.’ Faculty will describe the rationale, design and testing of neuroscience-driven cognitive training interventions targeting integrated neural systems underlying attention regulation, executive control and strategic reasoning—all of which are processes important for the efficient and effective achievement of goals.

One common theme will be the importance of goal-directed selective processing of information as a crucial gateway for regulating neural resources during processes of goal attainment (such as learning, memory, decision-making, and problem-solving). Application and evaluation of the interventions will be discussed for individuals with chronic cognitive deficits from acquired brain injury, including military veterans with combat-related TBI and dysregulation in emotional as well as cognitive regulation.

Faculty will discuss new knowledge gained by taking an interventional cognitive neuroscience approach, combining neuroscience-driven interventions with hypothesis-testing measurements at multiple levels of human functioning, highlighting changes in specific neurocognitive domains and performance in ‘real life,’ as well as evidence pointing towards specific neural mechanisms that support cognitive improvement. Challenges and directions for advancing intervention development efforts, as well as implications for preparing individuals for occupational, scholastic and community re-integration goals will be important topics for discussion.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe gaps in available rehabilitation interventions designed to improve higher order cognitive functions important for goal-directed functioning after acquired brain injuries and describe neural-cognitive targets important for interventions.
  2. Describe at least 2 novel neuroscience-driven cognitive training interventions targeting attention regulation, executive control and strategic reasoning.
  3. Describe current evidence for understanding the effects and mechanisms of training to improve attention regulation, executive control and strategic reasoning.

BREAK: 10:00 am – 10:30 am

John Stanley Coulter Lecture
10:30 am – 11:30 am

ACRM is pleased to award the prestigious John Stanley Coulter Lectureship to Susan Harkema, PhD in recognition of her professional achievement and contributions to the advancement of the field of rehabilitation.

Dr. Harkema is a professor in the Neurological Surgery Department at the University of Louisville, and the Owsley B. Frazier Chair in Neurological Rehabilitation. She serves as research director for the Kentucky Spinal Cord Injury Research Center and as director of the Christopher and Dana Reeve NeuroRecovery Network at the Frazier Rehab Institute in Louisville, KY.

Neuromodulation of Spinal Circuitry for Recovery after Neurologic Injury

Studies in animals and humans have shown that the functionally isolated human spinal cord maintains specific properties recognized to generate locomotion in other species. These concepts now have been translated into the clinic by the Christopher and Dana Reeve NeuroRecovery Network of seven rehabilitation centers that provide standardized Locomotor Training to individuals with chronic incomplete spinal cord injury. Two hundred and six individuals ranging from 0.9 to 26 years post injury were assessed during intensive Locomotor Training, including step training using body weight support and manual facilitation on a treadmill followed by overground assessment and community integration. Significant improvement from enrollment to final evaluation was observed in balance and walking measures for AIS C and AIS D patients. These results indicate that rehabilitation that provides intensive activity-based therapy can result in functional improvements in individuals with chronic incomplete SCI even years after injury.

In another study we hypothesized the human spinal locomotor circuitry has sufficient automaticity potential to generate postural control and rhythmic, coordinated weight bearing stepping and that we can recruit this locomotor and postural circuitry with a tonic epidural stimulation of selected lumbosacral segments. We implanted in three individuals with motor complete SCI. We implanted a 5-6-5 electrode array epidurally spanning L2-S1 spinal cord segments and a neurostimulator (Medtronic) capable of stimulating any combination of the 16 electrodes in the array at intensities up to 10.5V and with frequencies ranging from 2-50 Hz. While sitting, without epidural stimulation, we observed minimal EMG activity in all leg muscles. While standing in a supportive system without stimulation and with assistance provided at both knee joints by a trainer, little or no observable EMG activity occurred in the leg muscles. With epidural stimulation the transition from sitting to standing was accompanied by an increase in the EMG amplitude by orders of magnitude beyond that observed in the sitting position. In addition, after several months of training he was able to voluntarily move his legs in the presence of epidural stimulation. These results demonstrate the interaction between sensory and epidural regulation of locomotor circuitry. The results also show that a physiological state can be achieved with epidural stimulation so that the sensory input can effectively control the locomotor circuitry to stand.

Supported by National Institute of Health, Christopher and Dana Reeve Foundation, Helmsley Foundation, Kessler Foundation, Frazier Rehab Institute, University of Louisville Foundation, Kentucky Spinal Cord and Head Injury Research Trust and Kentucky Spinal Cord Injury Research Center.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Discuss the clinical impact of activity-based therapy on recovery of balance and walking after spinal cord injury.
  2. Identify the levels of evidence and critical outcome measures needed to implement evidence based medicine for rehabilitation and document recovery in the clinic.
  3. Describe the novel findings of restoration of voluntary movement in individuals with motor complete SCI with epidural stimulation.


Health Promotion and Disease Prevention across the Lifespan in Spinal Cord Injury: from Pediatrics to Geriatrics (780)
11:30 am – 1:00 pm

Pouran D. Faghri, MD, MS, FACSM, University of Connecticut , Storrs, CT; Sue Ann Sisto, PhD, PT, FACRM, Stony Brook University, Stony Brook, NY; Therese Johnston, PT, PhD, MBA, University of the Sciences, Philadelphia, PA; Gail F. Forrest, PhD, University of Medicine and Dentistry of New Jersey, Newark, NJ

Diagnosis: Spinal Cord Injury with a focus on academic training, research mentoring, and research funding

Improvements in medical technology, understanding of pathology of disease and disability, and improvements in emergency response, have increased the prevalence of individuals living with spinal cord injury (SCI). Chronic diseases are the leading cause of death in SCI, and all are related to unhealthy lifestyle behaviors (sedentary lifestyle, unhealthy eating, obesity and smoking). However, little emphasis is placed on promoting healthy lifestyle and preventing secondary health conditions following SCI across the lifespan. Health care providers can play a major role, in the integration of health promotion, through interdisciplinary collaborations, as well as community and workplace integrations to promote the health and quality of life of people with SCI.

The purpose of this symposium is to address the lack of governmental efforts in promoting the health of people with SCI. We will discuss the need to change our present health care model of “treating the sick” to “promoting healthy lifestyle” through empowerment and education. Practices that increase access to technology that may promote a healthy lifestyle across the lifespan will be discussed along with the need for the development of community health promotion models by integration of fitness centers into health promoting activities of people with SCI while reducing physical, social, and attitudinal barriers and eliminate stigmatizations.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Discuss the issues related to chronic secondary health conditions post SCI and the need to refocus the rehabilitation health care model to include promotion of a healthy lifestyle.
  2. Compare and contrast unique health care prevention and promotion needs of individuals with SCI across the lifespan
  3. Discuss the current technologies available that may be appropriate for use in health promotion for individuals with SCI
  4. Identify the weaknesses in community fitness centers for individuals with SCI and discuss possible ways to overcome some of these weaknesses

Treating Frailty Using a Rehabilitation Approach: Providing an Effective Program (788)
11:30 am – 1:00 pm

Ian D. Cameron, University of Sydney, AU; Susan Kurrle; Nicola Fairhall

Diagnosis: Frailty with a focus on clinical practice

We have completed a clinical trial of treatment of frailty and have shown that a multifaceted interdisciplinary intervention reduces frailty and improves mobility. The treatment program was targeted at frailty defined phenotypically using the Cardiovascular Health Study criteria (1), and also utilized the principles of geriatric evaluation and management. Details of the treatment program have been published (2).

In the symposium we will review the conceptual basis of a rehabilitation approach to frailty. The implementation, monitoring and evaluation of the frailty rehabilitation program will be illustrated with reference to case studies. Issues related to adherence to the program and avoidance of adverse effects will be emphasized. Strategies for evaluation of effectiveness for individuals and for program evaluation will be presented. Symposium participants will be encouraged to develop a frailty intervention program for a patient using evidence- based components tailored to the circumstances of their own clinical practice.

1. Fried Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001;56:M146-56.

2. Fairhall N, Langron C, Sherrington C, Lord SR, Kurrle SE, Lockwood K, Aggar C, Monaghan N, Gill L, Cameron ID. Treating frailty – a practical guide. BMC Medicine 2011;9:83.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand the conceptual basis of a rehabilitation approach to frailty defined phenotypically
  2. Have the ability to implement a multifactorial interdisciplinary intervention to treat frailty
  3. Demonstrate the ability to evaluate a program for treatment of frailty
  4. Have the ability to adapt a frailty treatment program to the circumstances of the clinical practice of the attendee 

Goal Attainment Scaling as Assessment and Treatment: Concepts and Applications for Brain Injury Rehabilitation (805)
11:30 am – 1:00 pm

Tessa Hart, PhD, Moss Rehabilitation Research Institute (MRRI), Elkins Park, PA; Dr. Angelle Sander, credentials, TIRR Memorial Hermann and Baylor College of Medicine, Houston, Texas; Kathryn M. McPherson, RN, RM, Dip HV, BA (Hons), PhD, FAFRM (Hons), AUT University, Auckland, NZ; James F. Malec, PhD, ABPP-Cn, Rp, Rehabilitation Hospital of Indiana, Indianapolis, IN

Diagnosis: Brain Injury with a focus on research methods

Goal Attainment Scaling (GAS) is a quantitative method for measuring progress on individualized patient goals. It has been used as a sensitive supplement to standardized outcome measurement, and as a tool to engage patients in goal-setting. GAS has undeniable promise for rehabilitation, but questions remain about how best to implement it, especially with cognitively impaired participants.

In this symposium, three clinical researchers will discuss their use of GAS in studies of traumatic brain injury (TBI). Dr. Tessa Hart will provide an overview of GAS and describe its use as an outcome measure in a study of Goal Intention Reminding, an intervention for persons with emotional/ social dysfunction after traumatic brain injury (TBI). Dr. Angelle Sander will describe the use of GAS to set individualized goals and assess outcomes in a two-site clinical trial of home-based, contextualized memory strategy training for persons with TBI. Dr. Kathryn McPherson will discuss a study designed to promote goal engagement and self-regulatory strategy use by people with TBI, in which GAS was used not as an outcome measure but as an intervention.

Teaching clients how to use GAS was not only feasible but many ‘enjoyed’ using it, and it facilitated a constructive self-review of performance. All three talks will use case examples and preliminary data from the respective trials to illustrate the use of GAS and general principles/ techniques to facilitate its implementation. Discussant Dr. James Malec, a pioneer in the use of GAS in medical rehabilitation, will offer brief remarks and facilitate Q–and-A among the panel and audience.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe at least 2 advantages and 1 drawback of GAS as contrasted with standardized outcome measurement
  2. Describe at least 3 methods for standardizing the use of GAS to allow consistency in goal-setting and outcomes assessment across participants and across sites in a multi-center trial
  3. Discuss the use of GAS as a self-review strategy for clients in addition to its more traditional use as a tool for clinicians to evaluate goal attainment


11:30 am -- 3:30 pm

Differential Diagnosis in Dizziness

Susan E. Bennett, PT, DPT, EdD, Lacey Bromley, PT, University at Buffalo, Buffalo, NY

Dizziness is the third most common symptom for which patients seek medical care. This course will focus on differential diagnosis of dizziness disorders spanning peripheral disorders, central nervous system-based disorders and impact of the upper cervical spine in dizziness. Disorders that will be discussed include brainstem stroke, mild traumatic brain injury/concussion, unusual presentations of BPPV, and upper cervical dysfunction. Evidence supporting the examination, differential diagnosis and treatment of dizziness will be discussed with audience participation in three case discussions.


Brain Injury Coping Skills (BICS) Workshop: An Intervention for Survivors of Brain Injury and Caregivers

Samantha L. Backhaus, PhD, Summer Ibarra, Rehabilitation Hospital of Indiana, Indianapolis, IN

The Brain Injury Coping Skills Group (BICS) is a 20-week, Cognitive-Behavioral Treatment (CBT) intervention for individuals with brain injury (BI) and their caregivers. This is a small group intervention (although can be applied via various modalities) in which individuals are provided psycho-education, group support, and stress management skills to deal with their injury.

Modules include information about the: (1) Healthy Brain; (2) Effects of Brain Injury; (3) Caregiver Coping Strategies; (4) Expectations for Recovery; Effects of Alcohol and BI; Returning to Work and Driving; (5) Dealing with Challenges after BI; (6) Signs and Symptoms of Depression specific to BI; and (7)Stress Management Skills utilizing Beck and Ellis’s models of cognitive restructuring. This intervention is typically provided in an outpatient setting by rehabilitation professionals trained in brain injury as well as cognitive-behavioral techniques. It can be provided by psychologists, rehabilitation therapists, or other rehabilitation professionals that understand BI, making it multidisciplinary in nature.

Randomized-controlled studies have shown that participants of this treatment make significant improvements in self-efficacy, maintain the emotional benefits at follow-up, and show improvements in anger control and emotional disinhibition when compared to controls, and even compared to those who receive standard support groups. Participants in this workshop can expect to learn about the components of this intervention, as well as receive a clinical framework for utilizing common neurobehavioral and cognitive-behavioral interventions cited in literature. Workshop participants are expected to already have knowledge of brain injury and its effects.

TBI Practice-Based Evidence Preliminary Study Findings: Opening the Black Box of TBI Rehabilitation

Susan D. Horn, PhD, Institute for Clinical Outcomes Research, Salt Lake City, UT ; James Young, MD, Rehab Associates of Chicago, Rush University Medical Center, Chicago, IL ; Nora Cullen, MD, Toronto Rehab, Toronto, ON, CA; Cynthia Beaulieu, PhD, ABPP-Cn, Brooks Rehabilitation Hospital, Jacksonville, FL; Murray Brandstater, MD, Loma Linda University, Loma Linda, CA

This course will describe the TBI-PBE study design and variables included in the database, present preliminary findings from the TBI-PBE study about treatments and interventions that are associated with better outcomes at discharge and one-year follow-up, and stimulate discussion about how the findings can be challenged, improved in future analyses, and used in practice treating moderate to severe TBI patients.

The Science behind Hope and Keeping it Positive in Rehabilitation: Implications for Rehabilitation Engagement and Outcomes (755)
1:30 pm – 3:00 pm 

Kathleen B. Kortte, Johns Hopkins School of Medicine, Baltimore, MD

Diagnosis: Brain Injury, Spinal Cord Injury, Stroke with a focus on clinical practice

Rehabilitation is a process aimed at facilitating recovery and reducing the impact of impairments on daily life task completion and social role functioning. In order to maximize outcomes, patients must fully engage in this process. Traditionally, rehabilitation interventions have focused on reducing the influence of barriers, such as pain, depression, and cognitive impairment on the rehabilitation process. There is solid support that interventions aimed at barrier reduction are effective in enhancing functional abilities and emotional adjustment. However, this approach relies upon a more reactionary approach to care in which patients receive attention once a potential barrier is identified.

There has recently been increased attention to identifying positive variables believed to foster the rehabilitation process and, hopefully, result in better recovery and long-term outcomes. Building on an individual’s strengths and facilitating positive coping mechanisms at the beginning of rehabilitation may result in better engagement in the rehabilitation process and long-term outcomes than reacting to problems after they arise.

In a series of studies, we have examined the positive psychological variables of hope and positive affect in rehabilitation populations participating in rehabilitation. The findings support that hope and positive affect play significant roles in rehabilitation engagement, functional outcomes, and life satisfaction in a variety of rehabilitation populations. The current symposium will review the results of these studies within the context of the literature more broadly to highlight the need to focus clinical interventions to proactively assist individuals in cultivating positive thinking and attitudes that facilitate full engagement in the rehabilitation process.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify the role that positive psychology variables play in rehabilitation outcomes through discussion of the relevant literature
  2. Identify the role that both traditional psychological barriers and positive psychological variables play in engagement in the rehabilitation process
  3. Discuss potential implications of these findings for developing interventions to bolster psychological resources of rehabilitation participants

Women Living with TBI: What do We Know and What do We *Need* to Know (819)
1:30 pm – 3:00 pm

Angela Colantonio, Toronto Rehabilitation Institute, Toronto, ON, CA; Yelena Goldin-Lauretta, PhD, Center for Head Injuries at JFK-Johnson Rehabilitation Institute, Edison, NJ; Gregory O’Shanick, Center for Neurorehabilitation Services, Richmond, VA; Elisabeth Sherwin, University of Arkansas, Little Rock, AR; Jane Warren, James Young, Rush University Medical Centre, Chicago, IL

Diagnosis: Brain Injury with a focus on epidemiology/outcomes research

This symposium is part of the growing efforts to promote awareness and recruit efforts to address the unique issues facing women living with TBI. In 2010, at the International Brain Injury Association in Washington DC, an extracurricular session resulted in close to 50 women and men, from clinicians to consumers, convening on a Saturday at 7:00 am to start the organized effort.

In October of 2010, the first international workshop on women with acquired brain injury was held in Canada funded by the Canadian Institutes for Health Research and supported by the ACRM. An ACRM brain injury interest group task force on women and traumatic brain injury was subsequently formed and has been meeting regularly. In March 2012 a group of international professionals presented a pre-conference workshop on this topic at the International Brain Injury Conference in Edinburgh Scotland. This symposium extends and widens those efforts.

This symposium will present a multifaceted interdisciplinary perspective of women living with the effects of acquired brain injury across the continuum of care and beyond with implications for research and practice. We present data from both the US and Canada as well as synthesize international initiatives. Both quantitative and qualitative data sources are examined. Moreover, the goal is to provide researchers/clinicians information about what they should know and need to know about women with TBI. Finally, the symposium will conclude with an invitation for participation extended across disciplines and backgrounds, and details of exciting new networks and developments in this area.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. To disseminate current international efforts to promote awareness of the unique issues facing women with TBI
  2. To examine gender differences in prognosis and recovery using data from large administrative and/or research data-bases
  3. To present a consumer/stakeholder perspective of priorities for research and practice relevant to women and TBI.
  4. To discuss implications for evidence-based treatment approaches relevant to women with TBI
  5. To provide an opportunity for knowledge exchange and discussion regarding priorities for future research efforts and further collaboration

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