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ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Poster 268 Gait Assessment in a Clinical Setting During the Initial Fitting of an Ankle-Foot Orthosis in Persons With Acute Stroke. Noel Rao, MA, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL); Alex Aruin, PhD; Daniel Hasso, CPO; Gouri Chaudhuri, MD; Keith DSouza, MD. Disclosure: N. Rao, None; A. Aruin, None; D. Hasso, None; G. Chaudhuri, None; K. DSouza, None. Objective: To evaluate if the measurement of gait parameters performed in the course of an ankle-foot orthosis (AFO) tting has a benecial effect on the gait pattern of people affected by an acute stroke. Design: Before-after trial. Setting: Stroke orthotic clinic of a freestanding rehabilitation hospital. Participants: 8 people with hemiparesis secondary to acute stroke who were able to ambulate safely without an orthosis. Interventions: The subjects were required to walk without and then with a newly designed AFO over a 4.57m-long and 0.9m-wide GaitRite mat. The system recorded the temporospatial characteristics of gait on a portable computer. In both conditions, each subject performed three 10-m walks, with rest periods between trials. Main Outcome Measures: Velocity, cadence, and step length. Results: The mean velocity without and with an AFO was 34.84 11.11 and 46.86 12.83cm/s, respectively (F1,7 10.95, P .01); the mean cadence without and with an AFO was 53.78 8.85 and 63.01 9.24 steps/min, respectively (F1,7 24.65, P .01); the mean step length on the affected side without and with an AFO was 38.83 4.72 and 43.11 4.76cm, respectively, and the main step length on the nonaffected side was 29.31 5.98 and 36.05 6.62cm (F1,7 6.04, P .05). Conclusions: Results indicate that AFO utilization signicantly improves velocity, cadence, and step length in people with acute stroke. The current study demonstrated that gait assessment can be incorporated into a clinical routine to evaluate gait improvements during an initial tting of an AFO. This will be useful for patient education and training, justication to payers of medical necessity, monitoring progress, and decision making in weaning patients off an orthosis. Key Words: Cerebrovascular accident; Gait disorders, neurologic; Orthotic devices; Rehabilitation. Poster 269 Performance of Manual Wheelchair-Handling Skills by Caregivers: Randomized Controlled Comparison Between Conventional Rear Anti-Tip Devices and a New Design. R. Lee Kirby, MD (Dalhousie University, Halifax, NS, Canada); Paula Rushton, MSc (OT); Cher Smith, BSc (OT); Donald A. MacLeod, MSc (Kinesiology). Disclosure: R.L. Kirby, Canadian Institutes of Health Research; P. Rushton, None; C. Smith, None; D.A. MacLeod, None. Plans are underway to commercialize the new device. Objectives: To test the hypothesis that, in comparison with caregivers handling manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), caregivers using a new design (Arc-RADs, so-named because the RAD arm deploys through an arc) perform RAD-relevant wheelchair skills better and as safely. Design: Randomized controlled study. Participants: 16 actual caregivers and the wheelchair users for whom they cared. Setting: Tertiary-level rehabilitation center. Interventions: Participants were provided with 1 to 2 sessions of training in wheelchair-handling skills, totaling an average of 54.3 minutes each. Main Outcome Measures: Caregiver-relevant subtotal percentage scores from the Wheelchair Skills Test (WST version 3.2), administered a minimum of 3 days after training. Results: For the control and Arc-RAD groups, the mean ( 1 SD) WST scores were 76.1% 3.1% and 99.5% 1.4%, respectively (2-sample t test, P .001). Skills that required the wheelchair to be tipped back into the wheelie position (eg, ascending a 15-cm curb) accounted for most of the differences between the groups. There were no serious adverse
Arch Phys Med Rehabil Vol 88, September 2007

effects in either group. Conclusions: The Arc-RAD design allows signicantly better caregiver wheelchair-handling skills than the CRAD design, without compromising safety. The new design has the potential to improve the participation of manual wheelchair users who are assisted by caregivers. Key Words: Rehabilitation; Wheelchairs. Poster 270 Transtibial Residual Limb Protector Utilized to Reduce Knee Flexion Contracture: A Case Report. James D. Switzer, PT; Joe Shamp, CPO; Kenneth B. Calder, MD (University of South Florida College of Medicine, Tampa, FL); Julie N. Martin, PT; Gail Latlief, DO. Disclosure: J.D. Switzer, None; J. Shamp, None; K.B. Calder, None; J.N. Martin, None; G. Latlief, None. Setting: Tertiary Veterans Administration hospital. Patient: A 68year-old transtibial amputee. Case Description: We present a transtibial amputee ambulating independently and utilizing a prosthesis for 14 years; his original amputation was secondary to sarcoma. Most recently, he underwent re-excision and radiation therapy for recurrent sarcoma. He was instructed not to wear his prosthesis, to promote wound healing, and developed a 25 of knee exion contracture. Also during this time, he had a fall incident, landing directly on his residual limb, which further complicated healing. Assessment/Results: After referral to the prosthetics clinic, a transtibial residual limb protector (TRLP) was devised to both protect the residual limb in case of another fall and to promote knee extension. The TRLP was constructed of co-polymer plastic in a bivalve clam shell design, with full .64cm (.25in) polyethylene foam padding and a 2.5cm (1in) distal pad, fabric hook-and-loop fasteners as closures, and progressive step hinges to lock the knee joint in various positions of exion and extension while allowing ease of donning and dofng. The TRLP allowed for maximal 90 of exion while locking at varying degrees of knee extension. He used the TRLP throughout the day, removing the device for skin evaluation and home exercises. After 30 days, a signicant 20 gain in knee extension was noted. Discussion: Traditionally, wound healing and contractures are complications encountered frequently in amputee care, which can ultimately limit function. The purpose of this case presentation is to demonstrate the benets of a TRLP for protection of wound healing and prevention and/or treatment of contractures. Conclusions: There is an integral role of TRLP devices in the postoperative care of amputees. At the same time, emphasis is placed on the importance of a comfortable prosthetic t and ease of donning and dofng to ensure compliance. Key Words: Amputation; Orthotic devices; Rehabilitation; Wound healing. Poster 271: Canceled. Poster 272 The Use of 3-Dimensional Quantitative Gait Analysis to Assess a Bilateral Transtibial Amputee Following Initial Prosthetic Fitting. Derek P. Watson, MD (East Carolina University, Greenville, NC); Arash Bidgoli, DO; Peter Gemelli, MD; Blaise Williams, PhD, PT; Thurman Whitted, MD. Disclosure: D.P. Watson, None; A. Bidgoli, None; P. Gemelli, None; B. Williams, None; T. Whitted, None. Setting: An academic biomechanics lab afliated with an inpatient rehabilitation facility (IRF). Patient: A 39-year-old man status post 4-limb amputation (bilateral transtibial and bilateral transradial). Case Description: He underwent bilateral transtibial and transradial amputations following critical limb ischemia secondary to sepsis requiring high doses of multiple vasopressors. At admission to the IRF he was nonambulatory. He underwent a comprehensive rehabilitation program