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P OSTER
A BSTRACTS
C135 Encore Presentation
Wheelchair Wrist Drop among Nursing Home Residents.
A. Komiyama. General Internal Medicine, Kawasaki Municipal Tama
Hospital, Kawasaki, Japan.
Background: In 1982 Hartigan first reported radial neuropathy
in nursing home residents that was associated with the use of a wheelchair
and later termed “wheelchair wrist drop”. Two additional case
reports have been published, bringing the total to 14 patients. Unfortunately,
the most recent study published in 2009 was unaware of previous
ones; thus wheelchair wrist drop appears to remain underrecognized.
Furthermore, although cases of wheelchair wrist drop may be
relatively common and overlooked in nursing homes, neither its frequency
nor demographics of the study population has been documented.
Objectives: To prospectively delineate frequency and contributing
factors of wheelchair wrist drop as well as clinical characteristics
of the study population in a nursing home.
Methods: Subjects were 311 elderly residents, mean age 81.9 and
female 63.7%, admitted to a nursing home from February 2005 to December
2008. During this period of 47 months the residents were subjected
to a comprehensive geriatric assessment at admission and 3-
month intervals and watched for any adverse events. Radial nerve
palsy was diagnosed clinically by the characteristic features including
selective weakness of wrist and finger extensors; precise sensory findings
were difficult to interpret in this population. The residents with
wheelchair wrist drop did not undergo an EMG in consideration of
their overall condition.
Results: Examination of the study population shows moderate
dementia with a mean Mini-Mental State Examination score of
10.6/30 and impaired mobility and dependence with a mean score of
29.6/91 on the motor domain of Functional Impairment Measure; 193
residents (62.1%) routinely used wheelchair. Several months after
admission, five female residents (2.6% of wheelchair users) developed
radial neuropathy, resulting from leaning against the armrest.
The contributing factors appeared to be immobility and lateral body
tilt due to frailty in three and those due to parkinsonism in two. All
but one improved one month later; one markedly frail resident experienced
recurrence with residual weakness. For 23 months from February
2007 no more wrist drop occurred in wheelchair users.
Conclusion: 2.6% of wheelchair users suffered from wrist drop in
the first half of the observation period in a nursing home. Recognition
of wheelchair wrist drop and its risk factors among care staffs could
likely have prevented from further development of this syndrome.
C136
The contribution of executive function and brain volume to gait
speed in older adults with and without cerebral infarction.
B. Manor, V. Novak. Harvard Medical School, Boston, MA.
Background: Gait impairment is common in older adults, especially
following cerebral infarction. The compensatory role of central
locomotor circuits on the control of gait remains unclear. We examined
the dependence upon executive function and non-infarcted regional
brain tissue volumes for the control of gait speed in healthy
older adults and those with right or left-hemisphere middle cerebral
artery (MCA) infarct. Methods: Healthy older adults (n=55,
age=65±8 years) and individuals with right MCA infarct (n=19,
age=65±8 years, 7±6 years post-stroke) or left MCA infarct (n=20,
age=65±8 years, 7±6 years post-stroke) were recruited. Gait speed
was calculated from an indoor walk at preferred speed. Executive
function was measured with the trail making test. Cortical gray matter
volumes within non-infarcted brain regions (i.e., the cerebellum
and occipital lobes) were quantified from anatomical 3T MRIs. Results:The
right and left infarct groups had similar infarct volumes and
time since stroke. Gait speeds were slower (p