1 Volume 6, Issue 8S2 August 2014 Supplement to: The journal of injury, function and rehabilitation Abstracts and Posters 8th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM) June 1-5, 2014, Cancun, Mexico The Offi cial Journal of the American Academy of Physical Medicine and Rehabilitation ISSN
2 8th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM) June 1-5, 2014, Cancun, Mexico Oral Presentations S83 S83 S84 S86 S87 S90 S93 S93 S93 S94 Cancer Rehabilitation Cardio-pulmonary Rehabilitation Education and Administration Neurological Rehabilitation Other Pain and Spine Medicine Pediatric Rehabilitation Prosthetics Orthotics and Assistive Devices Rehabilitation of Patients with Spinal Cord Injury Sports and Musculoskeletal Rehabilitation Poster Abstracts S97 S99 S102 S103 S107 S125 S135 S146 Cancer Rehabilitation Cardio-pulmonary Rehabilitation Education and Administration Electrodiagnosis Neurological Rehabilitation Other Pain and Spine Medicine Pediatric Rehabilitation (cont.) A1
3 S151 S153 S153 S159 S168 Prosthetics Orthotics and Assistive Devices Rehabilitation in Hemophilia Rehabilitation of Patients With Spinal Cord Injury Sports and Musculoskeletal Rehabilitation Vocational Rehabilitation A2
4 Abstracts from the 8th World Congress of the International Society of Physical and Rehabilitation Medicine XXII CONGRESO MEXICANO DE MEDICINA FISICA Y REHABILITACION Provided here are the abstracts of scientific papers and posters that were presented at the 8th World Congress of the International Society of Physical & Rehabilitation Medicine (ISPRM), June 1-5, 2014, Cancun Center, Mexico. These abstracts have not undergone peer review by PM&R. ORAL PRESENTATIONS CANCER REHABILITATION No. 1 Clinical Study to Assess the Efficacy of Pre-Operative Training on Histomorphometry and Muscle of Pelvic Floor Muscle in Patients Undergoing Radical Prostatectomy. Robinson Ramírez-Vélez; Ángela Ocampo-Trujilo; Carlos Andrés Muñoz-Zuluaga. Disclosure: None. Objective: To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry and muscle function of patients undergoing radical prostatectomy (RP). Design: A prospective intervention clinical study. Setting: Tertiary care oncology centre. Participants: 16 male. Interventions: The intervention group (n¼8) received a training session with PFMT supervised three times a day three session for week 30 days before the RP. The control group (n¼8) received oral and written instructions to be performed at home (lifestyle modifications). Main Outcome Measures: Before and after the intervention we evaluated muscle function of the external urethral sphincter and contraction pressure of the levator ani. At the end of the intervention and day of the surgery muscular tissue samples residual external sphincter muscle of urethra for histomorphometric analysis. Results: After the intervention participants who performed PFMT showed increased crosssectional area of the muscle fibers of the external urethral sphincter ( mm 2 vs mm 2 p¼0.03) and higher pressure contraction of the levator ani (f¼9.188 p¼0.010). Conclusions: Early PFMT induces changes in the histology and function of the pelvic floor muscles. These results provide new evidence of the benefit of PFMT in preventing complications associated with RP. No. 2 The Effect of Aerobic Exercise on Quality of Life Among Breast Cancer Survivors: A Randomized Controlled Trial. Ardiana Murtezani; Zana Ibraimi; Aurora Bakalli; Shaip Krasniqi. Disclosure: None. Objective: To determine the effect of moderateintensity aerobic exercise on quality of life (QoL) and physical functioning in breast cancer survivors. Design: Randomized controlled study. Participants: We randomly assigned 62 breast cancer survivors to an exercise (n¼30) or control group (n¼32). The exercise group trained at a moderate intensity progressing from 25 to 40 minutes over a 10 week period. The control group did not train. Main Outcome Measures: Outcomes were assessed at baseline and post intervention. The primary outcomes were overall QoL - as assessed by the functional assessment of cancer therapybreast (FACT-B) scale. Secondary outcomes were changes in various subscales of overall QoL and changes in body composition outcomes; body weight body mass index and changes in performance in a 12 minute walk test (12MWT). Results: Sixty-two of 73 women randomized (84.9%) completed the study. There were no significant differences amongst the two groups at baseline for any variable. In the exercise group significant improvements was demonstrated for the FACT-B (13.4 points p<0.003) functional assessment of cancer therapy-general (FACT-G) (9.16 points p<0.008) the functional well-being subscale (p<0.010) and the emotional well- being subscale (p<0.035) compared to the control group. No significant changes in body weight or BMI were observed. Exercise group showed a significant increase in 12MWT (p<0.009). Conclusion: We conclude that 10 weeks of moderate-intensity aerobic exercise program significantly improves QoL and physical functioning in breast cancer survivors. Future studies are needed to evaluate the effectiveness of similar exercise programs over longer periods of time and involving a greater number of breast cancer survivors. CARDIO-PULMONARY REHABILITATION No. 3 Application of the CAT to Patients With Interstitial Lung Disease. Fujiko Someya, MD; T. Nakagawa, MD; Y. Motozaki, MD; N. Mugii, OTR. Disclosure: None. Objective: We applied a recently developed health status assessment test designed for chronic obstructive pulmonary disease (CAT) to patients with interstitial lung disease and examined the relationship between the CAT score and pulmonary function and oxygen saturation similar to preexisting questionnaires that revealed a correlation with pulmonary impairments. Design: Retrospective study. Setting: Division of rehabilitation university hospital. Participants: 27 consecutive patients with interstitial lung disease underwent a closer physical examination in Intervention: The CAT (with a score ranging between 0 and 40 and a higher score representing a worse health status) which consisted of eight simple items regarding the health status of patients was completed on the first day of the visit. Main Outcome Measures: The CAT score pulmonary function test oxygen saturation at rest and after submaximal exercise blood gas analysis and the administration of oxygen therapy. Results: A correlation (r value) was observed between the CAT and percentage of predicted forced vital capacity (-0.59), forced expiratory volume in 1 second (-0.50), and total lung capacity (-0.52) but not with the diffusion capacity of carbon monoxide. The CAT score was higher in patients with oxygen desaturation ( 4%) during submaximal exercise up to 6 minutes than in those without oxygen desaturation (p ¼ ). The partial pressure of oxygen in arterial blood in room air oxygen saturation at rest with oxygen supplementation depending on the treatment and home oxygen therapy did not affect the CAT score. The reliability of items of the CAT was 0.86 by Cronbach salphacoefficient which indicated adequate internal consistencies. Conclusions: The results obtained in the present study indicated that the CAT may represent a candidate for evaluating the health status of patients with interstitial lung disease similar to preexisting questionnaires. Reprinted with permission. No. 4 Cardiac Rehabilitation Adherence as a Determinant of Cardiovascular Disease Burden After ACS. José Miguel Santoalha; Hugo Amorim; Rui Cadilha; José Afonso Rocha. Objective: Adherence to cardiac rehabilitation (CR) in acute coronary syndrome (ACS) patients has been shown to exert positive effects. We sought to compare baseline characteristic of adherents (a)/non-adherents (Na) and establish the prognostic impact of CR non-compliance over cardiovascular morbidity and mortality. Design: Retrospective study. Setting: CR unit. Participants: 505 consecutive patients referred to CR after an ACS. PM&R /14/$36.00 Printed in U.S.A. ª 2014 by the American Academy of Physical Medicine and Rehabilitation Vol. 6, S83-S168, August 2014 S83
5 S84 PRESENTATIONS Interventions: No. Main Outcome Measures: Sociodemographic and clinical data. Psychosocial status and quality of life assessed using HADS and SF-36 respectively. Data on mortality and morbidity outcomes collected using hospital records and a nation-wide health data platform. Nonadherence to CR was defined as completing less than 30% of programmed exercise sessions. We used a composite outcome (all cause mortality new hospital admission for ACS stroke and CHF and/or revascularization procedures). Level 1 of evidence. Results: In the study population 460 (86.9%) were male with mean age We found 56 (11.1%) Na participating in exercise sessions. Na was more common in women (Na:21.4% vs a:12.0% p¼0.04) those living alone (Na:32.1% vs a:12.7% p<0.01) and those unemployed (Na:27.3% vs a:16.3% p<0.01). Except for previous ACS history (Na:34.5% vs a:14.5% p<0.01) there were no between-group differences regarding classic cardiovascular risk factors. Mean follow-up time was months and a total of 46 events were identified (3 deaths 2 strokes 2 CHF admissions 26 revascularization procedures (RP) and 13 ACS not submitted to RP) more frequently in nonadherents [Na:11(19.6%) vs a:35(7.8%)] at a mean time of months. CR adherence status was a predictor of composite adverse outcome on univariate analysis (hr %ci ). After logistic regression multivariate analysis adjusted for other relevant covariates (age sex history of previous ACS) non-adherence to CR was associated with a 1.9-fold higher risk of developing the composite adverse outcome (CI ). Conclusions: CR non-adherence associates with higher risk of cardiovascular morbidity and mortality after an ACS. No. 5 Pulmonary Rehabilitation Outcome in Patients After Single or Double Lung Transplantation. Evren Atabas; Tessa Schneeberger; Klaus Kenn. Introduction: Pulmonary rehabilitation (PR) following lung transplantation (LT) can be seen as an established therapeutic modality. However differences concerning the efficiency of rehabilitation procedures in patients with single (SLT) or double (DLT) lung transplantation have barely been studied yet. Methods: The data of 550 patients suffering from chronic obstructive pulmonary disease (COPD) or interstitial lung diseases who underwent PR after SLT (n¼212; age 586) and DLT (n¼338 age 538) during the years 1997 to 2013 were retrospectivly analysed. All patients underwent a standardized inpatient PR program of about 4118 days in average. Data of 6-minute walking distance (6MWD), health related quality of life (HRQoL) (physical [PCS] and mental [MCS] component summary of the SF-36 questionnaire) and adverse events during PR have been registered and analyzed. Results: In SLT patients 6MWD increased from to (p<0001), PCS from 329 to 3910 (p>0001) and MCS from 4017 to 4815 (p<0001). In DLT patients 6MWD increased from to (p<0001), PCS from 2711 to 3510 (p<0001) and MCS from 4116 to 5014 (p<0001). The improvement of 6MWD in the DLT -group was significantly (p<005) higher than in the SLT -group. Benefits in HRQoL were comparable in patients with SLT and DLT (p>005). The frequency of complications was similar in both groups with bacterial infections occurring with 16.5% in the SLT -group and 20.4% in the DLT -group and virus infection (cytomegaly) with 13.2% SLT and 9.2% DLT. Conclusion: Our results show that patients significantly benefit from a comprehensive PR program performed immediately after LT. While HRQoL improved in similar degree in both groups the DLT -group showed superior improvement in exercise capacity (6MWD) in comparison to SLT. PR programs are therefore a medically sensible procedure after LT. EDUCATION AND ADMINISTRATION No. 7 Deterioration of Walking Ability One Year After Discharge from Rehabilitation Hospital. Lena Lutsky, MD, MHA; Iuly Treger, MD, PhD, MHA. Disclosure: None. Objective: To find out if patients ambulating at discharge from rehabilitation hospital are still walking at home one year later and what is the role of community based rehabilitation (CBR) in the preserving of walking ability. Design: Retrospective comparative study. Setting: Outpatient rehabilitation setting. Participants: 61 patients ambulating at discharge from rehabilitation hospital. They were divided into 2 groups according to their attendance in the CBR setting. Intervention: The level of patient s ambulation was evaluated at discharge from the rehabilitation hospital and at home one year later according to community records. Main Outcome Measures: The level of patient s ambulation (1-independent, 2-with crutches or cane, 3-with walker, 4-nonfunctional gate). The ambulation level change was analyzed in correlation with age and CBR. Results: Upon discharge from the rehabilitation hospital the median mobility function was at level 2 and it was found to deteriorate after one year to level 3. Only 5 (0.08%) patients achieved better ambulation within the community. The walking quality of 34 patients (55.7%) deteriorated at home. Only one patient from the CBR subgroup (36) improved the level of mobility. The ambulation quality of 20 patients within this subgroup (55.5%) deteriorated at home. The median mobility change in both groups was found to be negative (from level 2 to level 3). Using chi-squared test we determined with p¼0.02 that the level of ambulation upon discharge was related to age: younger age predicts more independent mobility. 71% of young patients (<65) achieved level 1 or 2 while only 41% of older patients achieved the same level. Conclusions: The level of patient s independent ambulation is deteriorating at home one year after discharge from rehabilitation hospital and it is not related to CBR. More appropriate maintenance approaches must be developed to achieve the goal of walking preservation at home. No. 14 Assessing for Unilateral Spatial Neglect Using Eye Tracking Glasses. Dr. Brenton Kortman; Ms. Kate Nicholls. Disclosure: None. Objective: To pilot a standardised assessment for unilateral spatial neglect (USN) using Tobii eye tracking glasses and compare results to current paper-based assessments (bells line bisection). This study used new technology that has not previously been reported in neurological rehabilitation. Design: Evaluation research. Setting: Standardised kitchen within a rehabilitation hospital. Participants: 6 participants who were attending inpatient rehabilitation after a stroke. 3 clients had no reported USN 1 had mild USN and 2 had severe USN. Interventions: Participants prepared a hot drink while wearing eye tracking glasses. Assessment occurred in a standardised kitchen environment with a standardised task. Main Outcome Measures: Generated videos were analysed using Tobii software. This enabled comparison between subjects of visual representations including heat maps and gaze plots and aspects such as duration and frequency of scanning left vs. right. The visual data were also compared with the paperbased assessments. Level of Evidence: 2. Results: Participants with no USN passed the paper assessments and rapidly and efficiently located items with only a few visual fixations. The participant with mild USN passed the paper assessments but displayed lengthy and inefficient search and fixation patterns. Participants with severe USN failed the paper assessments had longer fixations on the right side and significant tracking difficulty or could not complete the task because they could not scan effectively to the right. Direct video comparison between subjects completing the task will be presented. Conclusions: Eye tracking can effectively differentiate between clients with no, mild, and severe neglect and provided a real-life picture of the effect of USN whilst doing a daily task rather than the indirect and potentially limiting method of current paper based assessments. Using eye tracking to assess for USN holds promise in understanding the impact of neglect following stroke and measuring functional recovery.
6 PM&R Vol. 6, Iss. 8S2, 2014 S85 No. 16 Prevalence of Burnout Syndrome and Related Factors in Workers in a Children s Rehabilitation Center in Mexico. Morales Martínez Daniela; López Valencia Ana Karina; Castillejos López Manuel De Jesús. Objective: Determine the prevalence of burnout syndrome and related factors among the workers in a rehabilitation center. Design: Prevalence survey. Setting: A children s rehabilitation center in Mexico. Participants: Workers in a rehabilitation center. From 106 eligible subjects 10 did not attend the invitation to complete the survey, 4 were out of the workplace, and 3 were temporary workers. Of the remaining 89, three were excluded for not signing the informed consent and 1 for being part of the research. 85 participants (physician, therapists, psychologists, nursery, social workers, home service special projects and volunteering) completed the selfadministered survey which consisted of one questionnaire of demographic data the Maslach Burnout Inventory the Beck Depression Inventory for assessing depression and the audit scale for alcoholism. Interventions: Not applicable. Main Outcome Measures: Maslach Burnout Inventory (depersonalization, emotional exhaustion and personal accomplishment computed separately) Beck Depression Inventory and audit scale for alcohol. Level of Evidence: Level 1. Results: The median of age was 30 years. 11.9% were men and 88.1% were women. Of all participants 12.9% showed moderate emotional exhaustion and 12.9% showed a high degree. 10.6% were moderate depersonalized and 5.9% highly depersonalized. Only the half of the participants showed high personal accomplishment (56.5%) and it was low in 18.8% of the workers. The prevalence of burnout syndrome was 49.4% while 20% have some degree of depression and 6 subjects were alcohol drinkers at risk. None of the main outcomes related to demographic variables. Conclusions: The burnout syndrome is high among people who work in the area of rehabilitation. Because of this it is necessary to adopt measures to avoid the development of this pathology and assess the evolution. These results correspond with other studies conducted in Mexico in medical staff. No. 17 Efficacy and Safety of AbobotulinumtoxinA (Dysport Ò ) in the Treatment of Adults With Upper Limb Spasticity: Randomized Double-Blind Placebo-Controlled Phase III Study. Jean Michel Gracies; Allison Brashear; Robert Jech; Philippe Picaut. Disclosures: AbobotulinumtoxinA is not approved by the FDA for the treatment of upper limb spasticity. JMG: consultant/research support (Allergan, Ipsen, Merz). AB: consultant (Allergan, Ipsen, Merz, XenoPort, Concert); research support (Allergan, Merz, Ipsen, NINDS). RJ: consultant/research support (Ipsen, AbbVie, Medtronic). PP: Ipsen employee. Objective: To assess the efficacy and safety of abobotulinumtoxina (Dysport Ò ) in hemiparetic adults with upper limb spasticity (ULS) post stroke/traumatic brain injury. Design: Randomized placebo-controlled double-blind study. Setting: 34 sites in 9 countries. Participants: 243 adults â&u6 months post stroke/traumatic brain injury. Interventions: Randomization (1:1:1) to abobotulinumtoxina (500 or 1000U) or placebo (single treatment cycle). Main Outcome Measures: Muscle tone (Modified Ashworth Scale [MAS]) passive function (Disability Assessment Scale [DAS]) active function (active range of motion [AROM] ease of applying splint Modified Frenchay Scale [MFS]) overall clinical benefit (Physician Global Assessment [PGA]). Level of Evidence: I. Results: Four weeks post injection 73.8% (500U) and 78.5% (1000U) of patients were responders determined by MAS 1 grade improvement versus 22.8% (placebo); p< % (500U) and 62% (1000U) of patients responded as determined by DAS 1 grade decrease for their principal target of treatment versus 39.2% (placebo). Patients increased their mean (SEM) AROM at both doses (500U/1000U) versus placebo: against finger flexors (þ23.9 (3.6)/17.6 (4.4) versus -6.2 (5.3)) elbow flexors (þ12.6 (4.4)/15.8 (5.1) versus 2.7 (3.1)) and wrist flexors (þ15.7 (6.0)/26.4 (7.7) versus 3.5 (7.5)). Use of splint was assessed as easier in both active groups and MFS scores trended positive but not statistically significant. Overall clinical benefit (PGA þ1) was observed in 75% and 87.3% of the patients versus 40.5% (placebo). The safety profile was as expected. Conclusions: AbobotulinumtoxinA (500/1000U) injected into upper limb muscles improved muscle tone passive and active function in hemiparetic adults with ULS at week 4. Safety profile was consistent with the known profile of abobotulinumtoxina in this disorder. No. 18 Visual Dependence After Stroke: A Multi-Dimensional Concept. Alain Yelnik; Sophie Tasseel-Ponche; Isabelle Bonan; Pierre-Paul Vidal. Objective: Visual dependence (VD) often observed after stroke has to be taken into account for rehabilitation as it could have a negative impact on balance. Various tests are designed to evaluate VD. The aim of this study was to compare two of these tests with the hypothesis that the results could be not correlated as they examine different physiological functions. Design: Monocentric prospective study. Settings: A PRM department. Participants: 84 patients were enrolled days after a unilateral hemispheric stroke: years, 65% ischemic, 51% of right lesion, 65% men, functional impairment measurement 79 26/ % of patients had a sensory impairment, 11% a visual field defect, 35% a visuospatial neglect, 44% were able to walk without human assistance. Intervention and Measures: The first test was the adjustment of a luminous rod to the vertical position despite a tilted framework using the rod and frame test (RFT). Parameters recorded were the tilt and the uncertainty. The second test was a sitting posture on a dynamic force platform under optokinetic stimulation. Parameters recorded were the tilt of the body and the stabilization reaction. The correlation analysis between tilt data and between variability data was made using Spearman rank correlation coefficient. Level of Evidence: 2. Results: There were no correlations between the two tests for all patients neither in subgroup analysis according to the main clinical features. Conclusion: These two tests are very different and not correlated in a post-stroke population. The RFT is a cognitive task assessing the VD for perception of verticality; the second test is a postural task evaluating the effect of dynamic visual disturbance. Visual dependence is not an absolute concept but is depending on the task. The exact impact of each kind of VD on balance has to be investigated. No. 19 Upper Limbs Post-Stroke Robotic Rehabilitation. Daniel G. Goroso; Thais Terranova; Denise R. Tsukimoto; Linamara R. Battistella. Background: The number of experimental approaches that attempt to understand how to improve the neuroplasticity through rehabilitation techniques is increasing. Robotic devices intend to assist patients who have total or partial sensory-motor loss. However studies are needed to identify an ideal treatment. Objective: To understand the role of two robotic systems for upper limbs in the rehabilitation process of post-stroke patients. Design: Randomized controlled study. Materials: One robot is suitable for wrist rehabilitation (InMotion3) and the other for shoulder-elbow rehabilitation (InMotion2). Participants: Twenty post-stroke patients with at least 6 months of the injury occurrence participated in this research. Seven patients were randomly allocated to form group A (GA) training with the InMotion2 robot focusing on the shoulder-elbow and training InMotion3 focusing on the wrist training on alternate days during 36 sessions. The thirteen remainingpatientsformedgroupb(gb)whotrainedwiththeinmotion2
7 S86 PRESENTATIONS and InMotion3 robots at the same number session that GA. Protocol: The rehabilitation task consisted of a series of point-to-point movements with each robot. Both groups received the same amount of conventional therapy sessions. Main Outcome Measures: The performance between the groups before and after the robotic therapy was evaluated by scores of: Fugl-Meyer (FM), motor active log (MAL), Wolf Motor Function Test (WMFT), Functional Independence Measure (FIM), stroke impact scale (SIS), arm motor ability test (AMAT), and kinematic variables. Result: I)bothgroupshaveamoresignificant gain (p< 0.05). II) the gain is greater in GB than in GA (p< 0.05). III) the most sensitive scales to assess rehabilitation intervention robotics are: FM, WMFT, AMAT. IV) the scale WMFT and AMAT has correlation with the temporal parameters measured by own robot. Conclusions: It is expected that the results of this study will enable us to define a tailored therapy according to patient s particular needs. NEUROLOGICAL REHABILITATION No. 20 Development and Evaluation of a Multidisciplinary 8-Week Health Promotion Program for Chronic Stroke Survivors. Seung Hee Ho; Jung-Kook Kim; Jiye Baek; Seo Jin Yang. Objective: This study was conducted to develop and evaluate a multidisciplinary 8-week health promotion program for chronic stroke survivors in Korea. Design: One-group pre-post test. Setting: Communitydwelling chronic stroke survivors. Participants: Thirty-five (27 men 8 women; aged years old; years since the onset; 21 right hemiparesis 14 left hemiparesis; 22 ischemic stroke 13 hemorrhagic stroke) community-dwelling chronic stroke survivors participated in the program. Interventions: The multidisciplinary 8-week health promotion program was developed to improve rehabilitation for chronic stroke survivors. All subjects participated in the once-a-week eight-week program combining education and exercise components for 90 min. The education component consisted of providing stroke related information and helping them better manage nutrition stress and life habits. The exercise component incorporated fitness, strength, mobility and balance trainings. In addition the short message service (SMS) was provided individually to encourage and motivate the participants regarding lifestyle modifications. Main Outcome Measures: Stroke-specific functions were assessed using the Stroke Impact Scale (SIS) and the National Institutes of Health Stroke Scale (NIHSS). Functional performance was measured by the Berg Balance Scale (BBS), the six minute walk test (6MWT) and the Timed up and go (TUG) test. Quality of life was estimated using the EuroQol 5- Dimension questionnaire (EQ-5D). Results: There were significant reductions in NIHSS (p¼0.002) and TUG (p<0.001) and an increase in BBS (p<0.001) and EQ-5D (p¼0.027). The mean SIS scores of all domains and 6MWT were improved but the differences were not significant (p>0.05). Conclusion: We concluded that the multidisciplinary 8-week health promotion program which incorporated physical activities and education could help chronic stroke survivors improve both physical functioning and health-related quality of life and that this program could potentially save much of healthcare expenditure for chronic stroke survivors. No. 21 Valoración de la Espasticidad Independencia y Calidad de Vida en la Lesión Cerebral Crónica tras Infiltración con Toxina Botulínica. Idoya Barca; Adriel Cuevas; Concepcion Cuenca; Rocio Vacas. Objetivo: Revisar la evolución de pacientes en tratamiento rehabilitador que presentan espasticidad severa secundaria a daño cerebral durante dos años de tratamiento con toxina botulínica asociada a fisioterapia y evaluar de manera subjetiva y objetiva cómo afecta la mejoría de la misma en la calidad de vida e independencia para sus actividades diarias así como en el manejo por el cuidador principal. Diseño: Estudiamos la variación de la espasticidad tras infiltración de toxina semestralmente y su impacto en calidad de vida funcionalidad articular y muscular y dolor mediante escalas. Variables: Sexo edad causa intensidad y localización de espasticidad tiempo de evolución dosis y lugar de infiltración. Ubicación: Consultas externas de hospital de primer nivel. Participantes: Pacientes que acuden a consulta con espasticidad de más de un año de evolución. Causas: Parálisis cerebral infantil (2) infarto cerebral (3) y traumatismo craneal (3). Edades entre 21 y 65 años. Cuatro varones. Seguimiento de dos años. Intervenciones: Infiltración de toxina botulínica en los músculos espásticos. Principales medidas de resultados: Exploración física y escalas calidad de vida SF-12 actividades diarias Barthel independencia funcional FIM valoración motora Fugl Meyer dolor eva y impacto en cuidador principal. Nivel de Evidencia: 2. Resultados: Encontramos mejora en puntuaciones de escalas obtenidas tras tratamiento tanto de funcion de miembros superiores (3 pacientes) marcha (dos pacientes) percepción estética (dos pacientes) actividades diarias (3 pacientes) dolor (4 pacientes) y calidad de vida (6 pacientes). En todos los casos el cuidador principal se mostro contento con los resultados. Conclusiones: Existe asociación entre mejoría de espasticidad funcionalidad y calidad de vida de los pacientes. Es fundamental una correcta exploración y valoración previa y posterior alainfiltración así como dar pautas de ejercicios y consejos. No. 22 Impact of Early Occupational Therapy on the Cognitive and Functional Recovery in Adult Patients with Traumatic Brain Injury in Chile. Sandra Olivares, OT; Javiera González, SLP; Claudio Soto; Daniel Muñoz, MD, MSc. Disclosure: None. Objective: To evaluate the impact of early occupational therapy (OT) in a cohort of patients with traumatic brain injury (TBI). Design: Retrospective cohort study. Setting: Trauma and rehabilitation referral center in Santiago Chile. Level of Evidence: Level II. Participants: 106 patients with TBI who started OT interventions in intensive care unit (ICU), intermediate care unit (INCU), or medicine care unit (MCU). Interventions: An early OT rehabilitation program was applied (environmental management, cognitive stimulation, activities of daily living training, postural management and early mobilization) as part of a multidisciplinary program of TBI patient care. Main Outcome Measures: Onset of rehabilitation variation (final versus initial) of functional motor level (FML) and Rancho de Los Amigos (RLA) scale, disability rating scale (DRS), functional independence measure (FIM), Montreal cognitive assessment (MOCA), frontal assessment battery (FAB) and Loewenstein occupational therapy cognitive assessment (LOTCA). Results: At the end of the OT program all patients improved results in RLA, MOCA, DRS and FIM (p¼0.006 each). Analyzing each services patients in INCU obtained higher recovery especially in MOCA scale (p¼0.016). Patients who received the early onset intervention had a better cognitive and functional performance according to ERLA (p<0.001), FIM (p<0.001), DRS (p¼0.006) and FAB (p¼0038). A 72.7% of ICU patients who started with supine level in FML presented a statistically significant improvement in this variable. At the end of the program an increase in FML was observed being patients who started at INCU the largest number of subjects who achieved gait level in relation to the initial level (71.43% versus 19.05% p<0.001). Conclusions: Early occupational therapy may have an impact on the cognitive and functional recovery in adult patients with TBI mainly if the intervention started at INCU.