Brain Injury e65

how their recovery trajectories may extend beyond self-reported symp-

tom resolution.

Design: This prospective multiple cohort study examined data obtained

from youth athletes between 10-18 years of age. The Post Concussion

Scale Inventory (PSCI), computerized cognitive testing, and sport-related

physical tasks were administered to each participant at pre-injury and at

multiple time-points following concussion.

Setting: Hospital-based research Lab: Concussion Research Centre,

Holland Bloorview Kids Rehabilitation Hospital, within Toronto, Ontario

Participants: A convenience sample of youth athletes between 10 to 18

years of age from various sport backgrounds.

Interventions: Not Applicable.Main Outcome Measure(s): The Post-Concussion Symptom Inventory

(PCSI); theABI Concussion Assessment, the Immediate Post-Concussion

Assessment and Cognitive Testing (ImPACT), and the Biosway portable

balance system are used to assess post-concussion symptoms, sport-related

physical performance, cognitive performance and balance respectively.

Results: Post-injury data illustrate deviations from baseline scores post

concussion across a variety of physical and cognitive assessments. Com-

ponents of the ImPACT test, Biosway Balance Assessment and ABI

Concussion Assessment exhibit a protracted rate of recovery compared to

self-reported post-concussive symptoms.

Conclusions: Assessing readiness to return-to-play requires an integrated

approach including assessment of physical and cognitive performance.

This study provides preliminary findings from measures that warrant

attention in the clinical management of sport-related concussion in youth.

Key Words: Youth, Concussion, Athletes, Recovery, Assessment

Disclosure(s): None Disclosed.

Poster 192

Activity and Participation Outcomes of Self-Awareness Interventionsfor Adults With Brain Injury: A Systematic Review

Lisa Engel (Rotman Research Institute (Baycrest)/University ofToronto), Adora Chui, Deirdre Dawson

Objective: 1) To systematically review published studies of self-aware-

ness interventions that report activity and participation outcomes in adults

with acquired brain injury and impaired self-awareness; 2) to identify

elements of the interventions that result in activity and participation

improvements.

Data Sources: Using the Preferred Reporting Items for Systematic Re-

views and Meta-Analyses (PRISMA) standards and a systematic review

protocol, two reviewers electronically searched five databases and hand-

searched reference lists.

Study Selection: Inclusion criteria were that the study 1) reported quan-

titative outcomes of a self-awareness intervention; 2) included participants

with acquired brain injury and impaired self-awareness; and 3) published

activities and participation outcomes. Non-English or studies that did not

report outcomes in adult populations were excluded. Seventeen articles

met inclusion and were included in the final review.

Data Extraction: Two reviewers completed the data extraction using an

independent review-agreement process. A third reviewer was available in

cases of disagreement.

Data Synthesis: Studies were graded using the Oxford Centre for Evi-

dence Based Medicine’s levels of evidence.Study design and methods were

described.Studies were further analyzed by population, intervention,

comparator groups, outcome measures and reported outcomes.

Conclusions: This review synthesizes the evidence in acquired brain injury

and self-awareness rehabilitation research.It describes the progress from

past reviews and remaining gaps in the literature.Review results indicate

that interventions with functional versus general awareness outcomes have

unique features.Cerebral injury differences between participants are often

not described and the outcome measures used between studies is hetero-

geneous.Both factors could be impacting reported outcomes.

Key Words: Awareness, Brain Injuries, Intervention Studies, Review

Disclosure(s): None Disclosed.

www.archives-pmr.org

Poster 193

Quantitative Assessment of Limb Motion by Inertial Sensors Beforeand After Botulinum Toxin for Spasticity

Lu Bai (University of Kent), Matthew Pepper, Yong Yan,Sarah Katherine Spurgeon, Mohammed Sakel, Malcolm Phillips

Objective: To develop an assessment tool utilising inertial sensors to

investigate an objective measure of the efficacy of upper limb rehabilita-

tion before and after Botulinum toxin (BTX) in clinical setting.

Design: The system utilises four inertial sensors to provide dynamic 3D

upper limb segment and joint motion data including acceleration, orien-

tation and position.

Setting: Rehabilitation Engineering Lab of a University & a Rehabilitation

Unit in a hospital, UK.

Participants: Patients with stroke (NZ5; 1 woman, 4 men).

Interventions: Intramuscular BTX.

Main Outcome Measure(s): Modified Ashworth Scale (MAS), Disability

Assessment Scale (DAS). Shoulder extension range of motion (ROM) and

Movement Unit Number (MUN) - a parameter for movement smoothness

were measured and recorded by the system.

Results: Five stroke patients were assessed immediately before and one

week after BTX therapy. Shoulder extension ROM increased significantly

from 12 degrees to 72 degrees, the value of MUN decreased from 159 to 40

and Modified Ashworth Scale (MAS) scores decreased from 5 to 3 for this

patient. The Spearman’s correlation with the MAS for ROM was -0.95 and

for MUN was 0.95.

Conclusions: This inertial sensing system provides dynamic upper limb

motion data which correlates well with the standard MAS assessment.

The detailed analysis of upper limb behaviour such as segment orien-

tation, velocity and smoothness of movement may detect impacts of

BTX before the gross changes of MAS & Disability Assessment Scale

(DAS). Hence, this tool may guide the clinicians in the assessment of

the response to treatment and therapists about post-injection

physiotherapy.

Key Words: inertial sensors, Spasticity, BTXDisclosure(s): None Disclosed.

Poster 194

Heart Rate Variability of Concussed Athletes through Recovery andPost-Return-to-Play

Arrani Senthinathan (University of Toronto), Lynda Mainwaring

Objective: To assess HRV in concussed athletes over the course of natural

recovery and through return to play (RTP).

Design: Repeated measures with case and matched control groups.

Setting: Interuniversity athletic teams at a single institution.

Participants: Varsity athletes diagnosed with concussion (nZ 11) and

their matched controls (nZ11) (ages 18-26).

Interventions: Heart rate variability in athletes with concussion was

assessed at three times: (1) 72-96 hours post-injury; (2) when asymp-

tomatic; and (3) one-week after medical clearance to RTP. Healthy

matched control teammates were assessed at the same times. A

Main Outcome Measure(s): The frequency domain of HRV was analyzed

for 1) sitting, 2) standing and 3) the absolute difference between sitting &

standing. RTP dates were documented.

Results: A 2 (Group) x 3 (Phase) repeated measures ANOVA revealed

significant interactions for sitting HF norm (pZ0.041), sitting LF norm

(pZ0.041), the difference between sitting & standing HF norm

(pZ0.021), and LF norm (pZ0.035). Acutely, concussed athletes dis-

played increased LF norm and decreased HF norm while sitting and a

smaller change in their HF and LF norm measures between sitting and

standing, indicating diminished autonomic response. Non-significant

correlations were found between acute phase HF norm (r Z - 0.518;

pZ 0.103,) and LF norm (r Z 0.519; pZ0.102) and number of days

to RTP.