London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 783 827 Rehabilitation and reorganisation after stroke Rehabilitation After Discharge: Using Specialist Instructors to Support the Hospital Thera-pists T. Balchin1, C. Van-As2 THE ARNI INSTITUTE, Lingfield, UNITED KINGDOM1, Bedfordshire & Hertfordshire Heart & Stroke Network, Bedford, Bedford, UNITED KINGDOM2 Background and aims: The UK Stroke Strategy highlights the importance of effective community stroke exercise programmes to be accessible after discharge. The National Institute for Health Re-search indicates the need for rehabilitation which is one step removed from therapy. ARNI is a UK charity which has refined an approach to stroke recovery utilising intensive task-related practice and resistance training allied to the personalising of physical coping techniques. ARNI trains and match-es specialist exercise instructors with stroke survivors who require further functional training after formal therapy stops. Following many anecdotally-reported successes, the Luton Chaul End Project was a pilot study to explore the efficacy of the ARNI rehabilitation intervention. Methods: In Chaul End Centre, Luton, 4 blocks of 3 months of training took place from July 2011 to July 2012 using 4 ARNI instructors in one-hour, weekly sessions. Participants (n=24) were eval-uated on mobility, range of movement, fatigue, mood, confidence, care package content, ambulance call outs, A&E attendance, continency material use and mood medication. Results: Participants reported improved mobility, range of movement, fatigue, and confidence. Ser-vice audit data reported 24 ambulance call-outs for fallers during the year preceding intervention. In the year of the intervention there were 0 call outs, with an ambulance service saving of £7,200. Fur-ther savings of £5482 were due to reduction in care packages, nursing input, catheter care, respite care, appliance support and medications. Conclusions: ARNI sessions can be a cost-effective way to provide stroke specific exercise in the community with excellent physical and psychological outcomes. A further project with larger num-bers and wider outcome measures will be complete by mid-2013. This will feed into multi-centre clinical evaluation work currently being prepared by teams from Brunel University, London and the National Institute of Health Research’s Collaboration for Leadership in Applied Health Research and Care for the South West. 828 Rehabilitation and reorganisation after stroke Neural substrates underlying motor skill learning enhancement driven by dual-tDCS in stroke patients, a fMRI study. Y. Vandermeeren1, L . Dricot2, W. Gradkowski3, P. Laloux4, P. Desfontaines5, F. Evrard6, A. Peeters7, J. Jamart8, S. Lefebvre9 CHU Mont-Godinne UCL (Université catholique de Louvain) Neurology Department / Insti-tute of NeuroScience (IoNS), UCL, Yvoir, BELGIUM1, Institute of NeuroScience (IoNS), Uni-versité catholique de Louvain (UCL), Brussels, BELGIUM2, Institute of Radioelectronics, Faculty of Electronics & Information Technology, Warsaw University of Technology, Warsaw, POLAND3, CHU Mont-Godinne UCL (Université catholique de Louvain) Neurology Department / Institute of NeuroScience (IoNS), UCL, Yvoir, BELGIUM4, C.H.C. Site Saint-Joseph, Neurology Department, Liège, BELGIUM5, Clinique Saint-Pierre, Neurology Department, Ottignies, BELGIUM6, Cliniques Universiatires St Luc UCL, Unité neuro-vasculaire, Service de Neurologie, Brussels, BELGIUM7, CHU Mont-Godinne UCL (Université catholique de Louvain), Scientific Support Unit, Yvoir, BEL-GIUM8, Mont-Godinne UCL (Université catholique de Louvain) Neurology Department / Institute of NeuroScience (IoNS), UCL, Yvoir, BELGIUM9 Background. Motor skill learning is a key factor for recovery after stroke since patients have to (re-) learn how to perform movements. We recently demonstrated that dual-hemispheres transcranial di-rect current stimulation (dual-tDCS) improves online motor skill learning and retention in chronic stroke patients. The neural mechanisms underlying dual-tDCS-induced motor skill learning en-hancement were explored using functional magnetic resonance imaging (fMRI). Methods. 13 chronic stroke patients participated in a cross-over, placebo-controlled, double-blind study. Each patient participated in two series. Each series consisted of one motor skill learning ses-sion (“circuit game”, 30 min) during which real or sham dual-tDCS was applied, and one recall ses-sion one week later during fMRI. 8 patients could perform the recall within the 3T MRI scanner; the 5 others were evaluated outside the MRI scanner. The recall session consisted in two “active” runs. Each run consisted in performing with a fMRI-compatible mouse (1) the “circuit game” learned one week before, and (2) an “easy motor” task. The “circuit game” consisted in moving the pointer along a complex circuit as quickly and accurately as possible; the “easy motor” task in moving the pointer between two large targets at a comfortable speed. Results. In chronic stroke patients, dual-tDCS induced a significant (RM-ANOVA p=0.021) im-provement of motor skill learning over time compared to sham, which was maintained one week later (n=13). The recall fMRI analysis (n=8) pointed out a network involving the ipsilesional and contralesional primary motor cortex (M1), the supplementary motor area and the contralesional cer-ebellum. Brain activation was increased in ipsilesional M1 after real dual-tDCS compared to sham (p=0.03) during the “easy motor” task; other contrasts were not (yet) different. Conclusion. The enhancement of motor skill retention at one week driven by dual-tDCS was associ-ated with a functional brain reorganisation.
Karger_ESC London_2013
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