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Abstracts for the Posters 105 The association between acceptance and psychosocial adjustment outcomes: A systematic review Mr Anders Aaby1,2, Ms Sophie Lykkegaard Ravn1,2, Mrs Britta Quistgaard2, Dr Tonny Elmose Andersen1 1Department of Psychology, University Of Southern Denmark, Odense, Denmark, 2SpecialHospitalet, Rødovre, Denmark Poster Presentation Day 2, September 14, 2018 Introduction: A spinal cord injury (SCI) is a severe condition causing changes in almost all aspects of life. Accordingly, studies have shown lower quality of life, poor social participation, and higher levels of psychological morbidities among individuals with SCI compared to the general population. There is, however, a considerable share who adjusts well to their new life circumstances. The degree to which a person finds acceptance of the injury has been associated with favorable adjustment. However, much of its importance relies on theory rather than systematic empirical evidence. The issue within this research field is that acceptance is often subsumed into the construct of coping. This results in a rather unfocused research field. It also makes it difficult for the research field to move in a united direction to solve its methodological and conceptual limitations. The present study aims to address these challenges by providing a systematic review of the evidence of acceptance’s relationship with psychosocial adjustment outcomes. Methods: Systematic searches were conducted in five online databases. Quantitative empirical studies investigating the association between acceptance and psychosocial adjustment in an adult population of spinal cord injured persons were included. Data was synthesized qualitatively. Results: Higher degrees of acceptance were related to greater quality of life, well-being, life satisfaction, social adjustment, positive psychological growth, and with lower levels of depression, anxiety, and PTSD. Acceptance was not related to pain adjustment and neither relationship satisfaction nor sexual adjustment had been investigated. The findings indicated the presence of mediators and moderators, and that time since injury had an impact on the associations. Conclusions: Individuals with a higher degree of acceptance showed a more favorable adjustment process following a SCI. Furthermore, acceptance might function as a catalyst initiating a process of favorable adjustment while not maintaining the same direct influence as time goes on. 264 Improving Clinical Care through use of the Sacral Autonomic Standards Dr Chloe Slocum2,4, Dr Marcalee Alexander1,2, Dr Jean-Gabriele Previnaire3, Dr Elise De2,4 1University of Alabama SOM, Birmingham, United States, 2 Spaulding Rehabilitation Hospital, Boston, USA, 3Centre Calvé, Fondation Hopale , Berck-sur-Mer, France, 4Harvard Medical School , Boston, USA Poster Presentation Day 1, September 13, 2018 Outline Presenters will discuss use of the sacral autonomic standards for version 2 and the proposed version 3. In this interactive workshop participants will be educated in performance of the standards and their clinical and prognostic value. Three common clinical cases will be discussed by each presenter to explain how code the standards with respect to bladder, bowel and sexual function. The course will end with the audience having three cases to test themselves on and the presenters will discuss the correct responses and prognostic concerns. Intro: Alexander-5 min De-15 min Physical and Neurologic Examination and Bladder Function Sacral function, The autonomic standards with regards to lower urinary tract function will be reviewed. Indications for urology referral based on mechanism of injury, physical exam, and specific signs. Reasons for urodynamics, key components and what happens during a urodynamic study will be discussed from the patient standpoint and basic interpretations will be made of tracings. Common cases will be reviewed regarding lower urinary tract function. Slocum-15 min Neurologic Function and Retention of Voluntary Bowel Function Literature relating neurological exam and bowel function will be reviewed. Pathophysiology of the distal bowel and surrogate metrics (sensory and motor) of autonomic control of the distal bowel will be reviewed. Attention will be dedicated to “red flags” that require further evaluation both acutely and months or years after SCI initial injury. Common cases will be reviewed regarding bowel function. Previnaire-15 min Reflex Responses and Fertility Concerns The bulbocavernosus reflex (BCR) is useful to test integrity of the sacral reflex arc. The BCR helps distinguish upper motor neuron (UMN) lesions from lower motor neuron (LMN) lesions, which has important prognostic and therapeutic implications for bowel, bladder, and sexual function. With regard to the sexual function, men with LMN lesions (absent BCR) are poor responders to penile vibratory stimulation for ejaculation and phosphodiesterase inhibitors for erectile dysfunction. The dartos reflex (DR) is a somato-autonomic reflex that depends on the T11-L2 sympathetic segment. Stimuli such as local cold will produce unilateral elevation of the testis with vermicular contraction of the scrotal skin and penile retraction. A recent study showed that patients with a lesion of the T11-L2 and absent DR were more prone to retrograde or absent ejaculation and loss of psychogenic erection. Common cases will be reviewed regarding reflexes. Alexander-15 min Using the neurologic exam to maximize sexual pleasure The ISNCSCI exam and sacral reflex testing can be used to determine the potential for psychogenic and reflex arousal and orgasm after SCI. Furthermore, the autonomic standards and determining a person’s actual versus projected sexual responses can help determine the need for treatment. Common cases will be reviewed regarding arousal and orgasm. Educational Cases 30 min. To summarize the course, three additional cases will be presented for the audience to test their knowledge of the sacral autonomic standards. Subsequently, the presenters will discuss scoring of the cases and how this information can help determine prognosis for recovery of bladder, bowel and sexual function after SCI. 217 Electrical Stimulation for treating pressure ulcers: A Cochrane Systematic Review Dr Mohit Arora1,2, Prof Lisa Harvey1,2, Dr Joanne Glinsky1,2, Dr Lianne Nier3, Ms Licija Lavrencic3, Dr Annette Kifley1,2, Prof Ian Cameron1,2 1The University of Sydney, Sydney, Australia, 2John Walsh Centre for Rehabilitation Research, Kolling Building, Royal North Shore Hospital, St. Leonards, Australia, 3Spinal Unit, Royal North Shore Hospital, St. Leonards, Australia Poster Presentation Day 2, September 14, 2018 Introduction: Pressure ulcers (PU) are a disabling consequence of immobility. There is an initial evidence to suggest that ES is therapeutic. This is based on small number of non-Cochrane reviews and clinical guidelines; however, it is not clear whether these recommendations are justified because the reviews and studies that they are based upon have methodological limitations. Therefore we undertook this systematic review to determine the effectiveness of ES for the treatment of PU and to know quality of the evidence that underpins any recommendation for ES. Methods: Randomised controlled trials were included with no restrictions with respect to language, date of publication or study setting. In May 2017, a thorough search was conducted as per the Cochrane standards. Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. There were 4 primary and 4 secondary outcomes of interest (e.g. proportion of PU healed, time to complete healing of PU and adverse events). Meta-analyses were conducted and the quality of the evidence for the main outcomes was assessed using GRADE. Results: We identified 166 records from the electronic searches. Of these, 17 studies with 932 PU (772 participants) met the inclusion criteria. ES may slightly increase the proportion of PU healed when compared to control (RR 1.84, 95% CI 1.26 to 2.68). The evidence was downgraded to low quality. It is uncertain whether ES decreases the time to complete healing of PU when compared to control (HR 1.06, 95% CI 0.47 to 2.41). The evidence was downgraded to very low quality. It is uncertain whether ES has associated adverse events when compared to control. Conclusions: ES may slightly increase the proportion of PU healed (low-quality evidence) but its effect on time to complete healing is uncertain (very low-quality evidence), compared to no ES. 148 A useful process of translation and validation of the ISCoS international Quality of Life and Activity & Participation basic data sets into Swedish Dr Marika Augutis1,2, Dr Kerstin Wahman2,3, Dr Elisabet Åkesson2,4, Dr Kersti Samuelsson5, Dr Wolfram Antepohl5 1Research and Development, Västernorrlands County Council , Sundsvall, Sweden, 2Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet , Stockholm, Sweden, 3Rehab Station Stockholm/Spinalis R&D Unit , Solna, Sweden, 4Stockholms Sjukhem, R&D Unit, Stockholm, Sweden, 5Department of Rehabilitation Medicine, and Department of Medical and Health Sciences, Linköping University , Linköping, Sweden Poster Presentation Day 1, September 13, 2018 INTRODUCTION: Since 2012 the International Spinal Cord Society (ISCoS) has developed data sets that will facilitate consistent collection and reporting of areas affecting a person with a Spinal Cord Injury (SCI). None of the datasets have previously been translated
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