P075 IS INTER-RECTI DISTANCE (IRD) A RELIABLE PROXY FOR EVALUATION OF FUNCTIONAL IMPAIRMENTS ASSOCIATED WITH DIASTASIS RECTI ABDOMINIS (DRA)?

Aim Diastasis recti abdominis (DRA) following pregnancy is associated with functional impairment such as back pain, abdominal core instability, urinary incontinence, and abdominal bulging. Several studies have reported functional improvements after surgical repair of the DRA. The aim of this study was to investigate the association between the inter-recti distance (IRD) and self-reported functional disabilities measured with the Disability Rating Index questionnaire (DRI), with the hypothesis that inter-recti distance could serve as a proxy for core instability symptoms. Material and Methods A retrospective study based on a consecutive cohort of patients with core instability symptoms combined with DRA. The IRD was measured with ultrasonography among women with symptomatic post-partum DRA and functional impairments were registered with the self-report DRI questionnaire that covers twelve unspecific daily activities. IRD results were analysed against the DRI score with uni- and multivariable regression analyses. Results A total of 222 women were included in this study. Univariable regression analyses showed a significant positive correlation between the heavier activities running, heavy work, lifting heavy objects and exercise/sports and IRD, which failed to reach significance in the multivariable regression analysis with adjustments for length, weight, and BMI. Conclusions This study could not show any significant correlation between self-reported functional impairments and DRA isolated in the multivariable analysis, even though there is a tendency towards an association between DRA and heavy activities. The post-partum core instability situation is complex and probably origins from more components than solely the inter-recti distance.

Efficacy of Botulinum toxin A in treatment of primary hemifacial spasm

Objective: Evaluating the effects of toxin botulinum A in treatment of primary hemifacial spasm. Methods: A total of 48 patients with primary hemifacial spasm were treated by injections of botulinum toxin A (Dysport) in Tam Anh Hospital from 6/2020 to 5/ 2021. Methods: Prospective, descriptive study. Results: Forty-eight patients (8 male, 40 female) were included in the study, the ages were from 36 to 79 years with an average age of 57 ± 10,43 years, having mean Jankovic disability rating scale score of 3.25±0.55SD. MRI revealed vascular compression in all patients. The dose Dysport was 80-145UI; 91,7% reported improvement after 2 weeks - 1 month from the injected. Benefits begin in 2-7 days after the treatment and last for an average of 5,50 ± 0,97 months (3-8 months). Side effects such as ectropion (45,83%), ptosis (4,2%), and hematoma (12,5%) are transient and reversible after 1-3 weeks. No severe complication was noted. Conclusions: This finding show that local botulinum toxin treatment provides effective and safe relief of hemifacial spasm.

Reversals in initially denied Department of Veterans Affairs’ PTSD disability claims after 17 years: a cohort study of gender differences

Background In 2011, the Department of Veterans Affairs (VA) strengthened its disability claims processes for military sexual trauma, hoping to reduce gender differences in initial posttraumatic stress disorder (PTSD) disability awards. These process improvements should also have helped women reverse previously denied claims and, potentially, diminished gender discrepancies in appealed claims’ outcomes. Our objectives were to examine gender differences in reversals of denied PTSD claims’ outcomes after 2011, determine whether disability awards (also known as “service connection”) for other disorders offset any PTSD gender discrepancy, and identify mediating confounders that could explain any persisting discrepancy. Methods From a nationally representative cohort created in 1998, we examined service connection outcomes in 253 men and 663 women whose initial PTSD claims were denied. The primary outcome was PTSD service connection as of August 24, 2016. Secondary outcomes were service connection for any disorder and total disability rating. The total disability rating determines the generosity of Veterans’ benefits. Results 51.4% of men and 31.3% of women were service connected for PTSD by study’s end (p < 0.001). At inception, 54.2% of men and 63.2% of women had any service connection—i.e., service connection for disorders other than PTSD (p = 0.01) and similar total disability ratings (p = 0.50). However, by study’s end, more men than women had any service connection (88.5% versus 83.5%, p = 0.05), and men’s mean total disability rating was substantially greater than women’s (77.1 ± 26.2 versus 66.8 ± 30.7, p < 0.001). History of military sexual assault had the largest effect modification on men’s versus women’s odds of PTSD service connection. Conclusion Even after 2011, cohort men were more likely than the women to reverse initially denied PTSD claims, and military sexual assault history accounted for much of this difference. Service connection for other disorders initially offset women’s lower rate of PTSD service connection, but, ultimately, men’s total disability ratings exceeded women’s. Gender discrepancies in service connection should be monitored beyond the initial claims period.

Association of Malnutrition with Functional and Cognitive Trajectories in People Living with Dementia: A Five-Year Follow-Up Study

Background: In dementia, functional status depends on multiple factors in addition to cognition. Nutritional status is a potentially modifiable factor related to homeostasis and proper functioning of body systems and may contribute to cognitive and functional decline. Objective: This paper aims to analyze the association of malnutrition with the course of cognitive and functional decline in people living with dementia. Methods: This is an analysis of a longitudinal cohort study, the Dementia Study of Western Norway. Data of 202 patients diagnosed with mild dementia were analyzed; Alzheimer’s disease (AD) (n = 103), Lewy body dementia (LBD) (n = 74), and other dementias (OD) (n = 25). Cognition was assessed with the Mini-Mental State Examination and functional decline through the activities of daily living included in the Rapid Disability Rating Scale. The Global Leadership Initiative on Malnutrition Index was used to determine nutritional status. Associations of nutritional status with cognitive and functional decline were evaluated through adjusted linear mixed models. Results: At baseline, the prevalence of general malnutrition was 28.7%; 17.3% were classified as moderate malnutrition and 11.38% as severe malnutrition (there were no significant differences between AD and LBD). Malnutrition at diagnosis and over follow-up was a significant predictor of functional-decline, but not of cognitive decline. Conclusion: According to our results malnutrition was associated with faster functional loss but, not cognitive decline in older adults with dementia. A more comprehensive dementia approach including nutritional assessments could improve prognosis.

Disability Rating Scale in the First Few Weeks After a Severe Traumatic Brain Injury as a Predictor of 6-Month Functional Outcome

BACKGROUND An early acute marker of long-term neurological outcome would be useful to help guide clinical decision making and therapeutic effectiveness after severe traumatic brain injury (TBI). We investigated the utility of the Disability Rating Scale (DRS) as early as 1 wk after TBI as a predictor of favorable 6-mo Glasgow Outcome Scale extended (GOS-E). OBJECTIVE To determine the predictability of a favorable 6-mo GOS-E using the DRS measured during weeks 1 to 4 of injury. METHODS The study is a sub analysis of patients enrolled in the Epo Severe TBI Trial (n = 200) to train and validate L1-regularized logistic regression models. DRS was collected at weeks 1 to 4 and GOS-E at 6 mo. RESULTS The average area under the receiver operating characteristic curve was 0.82 for the model with baseline demographic and injury severity variables and week 1 DRS and increased to 0.88 when including weekly DRS until week 4. CONCLUSION This study suggests that week 1 to 4 DRS may be predictors of favorable 6-mo outcome in severe TBI patients and thus useful both for clinical prognostication as well as surrogate endpoints for adaptive clinical trials.

Te.M.P.O., an app for using temporal musical mismatch in post-stroke neurorehabilitation: A preliminary randomized controlled study

BACKGROUND: Recently, the potential rehabilitation value of music has been examined and music-based interventions and techniques such as the Negative Mismatch (MMN) have been increasingly investigated in the neurological rehabilitation context. OBJECTIVE: The aim of this study was to investigate the effectiveness of a negative mismatch-based therapy on the disability and quality of life in patients with stroke in sub-acute phase. METHODS: Thirty patients with a stroke diagnosis in sub-acute phase were randomly assigned to one of two groups: Mismatch (Mg) or Control (CTRLg) group. Both groups used an innovative Android application: Temporal Musical Patterns Organisation (Te.M.P.O). The Disability Rating Scale (DRS), the Modified Barthel Index (MBI) and the Stroke Specific Quality of Life scale (SSQoL) were used at the baseline (T0) and after four weeks of training (T1), in order to assess changes over time. RESULTS: Statistical analysis was performed using the data of 24 (Mg = 12, CTRLg = 12) subjects. The results show a major improvement of the Mg with respect to the CTRLg in all clinical scales score. CONCLUSION: The temporal negative mismatch-based therapy performed with the Te.M.P.O. application could be useful in improving the disability and the quality of life in stroke survivors in a sub-acute phase.