Eye–hand coordination and its relationship with sensori-motor impairments in stroke survivors

Effects of Astaxanthin, Lutein, and Zeaxanthin on Eye-Hand Coordination and Smooth-Pursuit Eye Movement after Visual Display Terminal Operation in Healthy Subjects: A Randomized, Double-Blind Placebo-Controlled Intergroup Trial

(1) Background: The impairment of eye-hand coordination and smooth-pursuit eye movement caused by visual display terminal (VDT) operation is thought to impair daily living activities, for which no effective methods are currently known. On the other hand, various food ingredients, including astaxanthin, lutein, and zeaxanthin, are known to help improve the eye health of VDT operators. This study aimed to test the hypothesis that the combination of astaxanthin, lutein, and zeaxanthin can prevent the impairment of eye-hand coordination and smooth-pursuit eye movement caused by VDT operation. (2) Methods: We conducted a randomized, placebo-controlled, parallel-group clinical trial. Healthy subjects who regularly worked with VDTs were randomly assigned to the active and placebo groups. All of the subjects took soft capsules containing 6 mg of astaxanthin, 10 mg of lutein, and 2 mg of zeaxanthin or placebo soft capsules once daily for eight weeks. We evaluated the eye-hand coordination, smooth-pursuit eye movements, and macular pigment optical density (MPOD) at 0, two, four, and eight weeks after soft-capsule intake. (3) Results: The active group showed significantly improved eye-hand coordination after VDT operation at eight weeks. However, there was no clear improvement in the effect of the supplementation on smooth-pursuit eye movements. The active group also showed a significant increase in MPOD levels. (4) Conclusions: Consumption of a supplement containing astaxanthin, lutein, and zeaxanthin mitigates the decline of eye-hand coordination after VDT operation.

Vision and Visuomotor Performance Following Acute Ischemic Stroke

Background

As measurable sensory and motor deficits are key to the diagnosis of stroke, we investigated the value of objective tablet based vision and visuomotor capacity assessment in acute mild-moderate ischemic stroke (AIS) patients.

Methods

Sixty AIS patients (65 ± 14 years, 33 males) without pre-existing visual/neurological disorders and acuity better than 6/12 were tested at their bedside during the first week post-stroke and were compared to 40 controls (64 ± 11 years, 15 males). Visual field sensitivity, quantified as mean deviation (dB) and visual acuity (with and without luminance noise), were tested on MRFn (Melbourne Rapid Field-Neural) iPad application. Visuomotor capacity was assessed with the Lee-Ryan Eye-Hand Coordination (EHC) iPad application using a capacitive stylus for iPad held in the preferred hand.Time to trace 3 shapes and displacement errors (deviations of >3.5 mm from the shape) were recorded. Diagnostic capacity was considered with Receiver Operating Characteristics. Vision test outcomes were correlated with National Institutes of Health Stroke Scale (NIHSS) score at the admission.

Results

Of the 60 AIS patients, 58 grasped the iPad stylus in their preferred right hand even though 31 had left hemisphere lesions. Forty-one patients (68%) with better than 6/12 visual acuity (19 right, 19 left hemisphere and 3 multi-territorial lesions) returned significantly abnormal visual fields. The stroke group took significantly longer (AIS: 93.4 ± 60.1 s; Controls: 33.1 ± 11.5 s, p < 0.01) to complete EHC tracing and made larger displacements (AIS: 16,388 ± 36,367 mm; Controls: 2,620 ± 1,359 mm, p < 0.01) although both control and stroke groups made similar numbers of errors. EHC time was not significantly different between participants with R (n = 26, 84.3 ± 55.3 s) and L (n = 31, 101.3 ± 64.7 s) hemisphere lesions. NIHSS scores and EHC measures showed low correlations (Spearman R: −0.15, L: 0.17). ROC analysis of EHC and vision tests found high diagnostic specificity and sensitivity for a fail at EHC time, or visual field, or Acuity-in-noise (sensivity: 93%, specificity: 83%) that shows little relationship to NIHSS scores.

Conclusions

EHC time and vision test outcomes provide an easy and rapid bedside measure that complements existing clinical assessments in AIS. The low correlation between visual function, NIHSS scores and lesion site offers an expanded clinical view of changes following stroke.

Effects of Horticultural Activities on Attitudes toward Aging, Sense of Hope and Hand-Eye Coordination in Older Adults in Residential Care Facilities

This study investigated the effects of an 8-week horticultural activity intervention on attitudes toward aging, sense of hope, and hand-eye coordination in 88 older adults in residential care facilities. In the experimental group, the mean score for "attitudes toward aging" increased from 3.81 before the intervention to 4.74 points after the intervention (standard deviation SD = 0.24 and 0.27, respectively), and the control group dropped from 3.75 to 3.70 (standard deviations, respectively SD = 0.27 and 0.28). The mean score for "sense of hope" increased from 3.28 before the intervention to 3.81 points after the intervention (SD = 0.49 and 0.26, respectively). In contrast to the control group, the mean score gradually declined from 3.26 to 3.16 points (standard deviation SD = 0.54 and 0.48, respectively). In the test of hand-eye coordination, the time required to complete the cup stacking test significantly decreased from 33.56 to 25.38 s in the experimental group but did not significantly change in the control group. Generalized estimating equation analysis revealed a significant interaction between group and time (p < 0.001). The data trends revealed significant differences in outcomes between the experimental group and the control group. At 3 months after the end of the study, the effect size in the experimental group remained higher than that in the control group.

Visual processing speed in hemianopia patients secondary to acquired brain injury: a new assessment methodology

Background

There is a clinical need to identify diagnostic parameters that objectively quantify and monitor the effective visual ability of patients with homonymous visual field defects (HVFDs). Visual processing speed (VPS) is an objective measure of visual ability. It is the reaction time (RT) needed to correctly search and/or reach for a visual stimulus. VPS depends on six main brain processing systems: auditory-cognitive, attentional, working memory, visuocognitive, visuomotor, and executive. We designed a new assessment methodology capable of activating these six systems and measuring RTs to determine the VPS of patients with HVFDs.

Methods

New software was designed for assessing subject visual stimulus search and reach times (S-RT and R-RT respectively), measured in seconds. Thirty-two different everyday visual stimuli were divided in four complexity groups that were presented along 8 radial visual field positions at three different eccentricities (10^o, 20^o, and 30^o). Thus, for each HVFD and control subject, 96 S- and R-RT measures related to VPS were registered. Three additional variables were measured to gather objective data on the validity of the test: eye-hand coordination mistakes (ehcM), eye-hand coordination accuracy (ehcA), and degrees of head movement (dHM, measured by a head-tracker system). HVFD patients and healthy controls (30 each) matched by age and gender were included. Each subject was assessed in a single visit. VPS measurements for HFVD patients and control subjects were compared for the complete test, for each stimulus complexity group, and for each eccentricity.

Results

VPS was significantly slower (p < 0.0001) in the HVFD group for the complete test, each stimulus complexity group, and each eccentricity. For the complete test, the VPS of the HVFD patients was 73.0% slower than controls. They also had 335.6% more ehcMs, 41.3% worse ehcA, and 189.0% more dHMs than the controls.

Conclusions

Measurement of VPS by this new assessment methodology could be an effective tool for objectively quantifying the visual ability of HVFD patients. Future research should evaluate the effectiveness of this novel method for measuring the impact that any specific neurovisual rehabilitation program has for these patients.

Populations Norms for "SLURP"-An iPad App for Quantification of Visuomotor Coordination Testing

Currently the integrity of brain function that drives behavior is predominantly measured in terms of pure motor function, yet most human behavior is visually driven. A means of easily quantifying such visually-driven brain function for comparison against population norms is lacking. Analysis of eye-hand coordination (EHC) using a digital game-like situation with downloadable spatio-temporal details has potential for clinicians and researchers. A simplified protocol for the Lee-Ryan EHC (Slurp) Test app for iPad® has been developed to monitor EHC. The two subtests selected, each of six quickly completed items with appeal to all ages, were found equivalent in terms of total errors/time and sensitive to developmental and aging milestones known to affect EHC. The sensitivity of outcomes due to the type of stylus being used during testing was also explored. Populations norms on 221 participants aged 5 to 80⁺years are presented for each test item according to two commonly used stylus types. The Slurp app uses two-dimensional space and is suited to clinicians for pre/post-intervention testing and to researchers in psychological, medical, and educational domains who are interested in understanding brain function.

Sensory-motor impairments of ipsilesional extremities and its impact on activity limitations following stroke

Background/Aims

Stroke can result in various motor and sensory impairments on contralesional as well as ipsilesional limbs. This study examined the impact on activity limitations as a result of sensory and motor impairments of ipsilesional limbs following stroke.

Methods

A cross-sectional study was used to assess 50 adults with stroke (acute: n=6, subacute: n=10, chronic: n=34) and 50 age- and gender-matched typically healthy adults. The Modified Ashworth Scale, the Brunnstrom Approach, Nottingham Sensory Assessment, Star Cancellation Test, Right-Left Orientation Test, Trunk Impairment Scale, Single Leg Stance Test, and the Fugl Mayer Assessment were used to measure outcomes for ipsilesional side impairments. Activity limitations were scored using the Wisconsin Gait Scale and the Motor Assessment Scale.

Results

A comparison of all impairments: tonal, voluntary control, sensation, perception, sitting and standing balance, and coordination of the ipsilesional extremity of persons with hemiparesis with corresponding extremity of typically healthy adults using unpaired t-test, showed significant impairment (P<0.05). Every participant with stroke had at least one impairment on their ipsilesional side, with 8% of participants having only one impairment, 36% had two impairments, 28% had three impairments, 18% had four impairments, 8% had five impairments and 2% had all six impairments on their ipsilesional side. The percentage of participants with stroke presenting with trunk impairment was highest (100%) and that of voluntary control impairment was lowest (24%) on their ipsilesional side. The relationship between identified impairments and activity limitations was calculated using Pearson’s correlation at 0.05 level, which showed a moderate negative correlation with the Wisconsin Gait Scale and a moderate positive correlation with the Motor Assessment Scale.

Conclusions

Ipsilesional impairments present in people with hemiparesis have a significant impact on the activity limitation; hence it is necessary to address ipsilesional impairments along with contralesional impairments.

Impact of Vision Therapy on Eye-hand Coordination Skills in Students with Visual Impairment

Purpose:

To evaluate the enhancing effects of vision therapy on eye–hand coordination skills in students with visual impairments.

Methods:

Thirty-five visually impaired patients who underwent vision therapy comprised the treatment group, and 35 patients with impaired vision who received no treatment comprised the control group. Full ophthalmic examinations were performed, including biomicroscopy, retinoscopy, and assessments of subjective refraction and visual acuity. Eye–hand coordination was evaluated using the Frostig test. Vision therapy in the treatment group was performed using the Bernell–Marsden ball, perceptual-motor pen, random blink test, and random shape assessment.

Results:

Data were analyzed for the 35 visually impaired patients and 35 control participants. The mean age was 11.51 ± 3.5 and 11.09 ± 3.1 years in the treatment and control groups, respectively. Female participants comprised 80% of the treatment group and 57% of the control group. Before treatment, the mean scores on the Frostig test were 22.74 ± 4.32 and 21.60 ± 4.10 in the treatment and control groups, respectively, and after treatment, the mean Frostig test scores were 24.69 ± 3.99 and 21.89 ± 3.92, respectively. Statistically significant intergroup differences were found in eye–hand coordination (P < 0.05). No significant intergroup differences were noted in the distance and near visual acuity values.

Conclusion:

The results demonstrated that vision therapy could significantly improve eye–hand coordination, but no enhancement was found in near or distance visual acuity.

One year after ischemic stroke: Changes in leg movement path stability in a speed-accuracy task but no major effects on the hands

First year after the stroke is essential for motor recovery. The main motor control strategy (i.e., faster movement production at the expense of lower movement accuracy and stability, or greater movement accuracy and stability at the expense of slower movement) selected by poststroke patients during a unilateral speed-accuracy task (SAT) remains unclear. We aimed to investigate the poststroke (12 months after stroke) effects on the trade-off between movement speed and accuracy, and intraindividual variability during a motor performance task. Healthy right-handed men (n = 20; age ∼ 66 years) and right-handed men after ischemic stroke during their post rehabilitation period (n = 20; age ∼ 69 years) were asked to perform a simple reaction task, a maximal velocity performance task and a SAT with the right and left hand, and with the right and left leg. In the hand movement trial, reaction time and movement velocity (V_max) in the SAT were slower and time to V_max in the SAT was longer in the poststroke group (P < .01). In the leg movement trial, poststroke participants reached a greater V_max in the SAT than the healthy participants (P < .01). The greatest poststroke effect on intraindividual variability in movements was found for movement path in the SAT, which was significantly greater in the legs than in the hands. Poststroke patients in the first year after stroke mainly selected an impulsive strategy for speed over hand and leg motor control, but at the expense of lower movement accuracy and greater variability in movement.

Eye Control Deficits Coupled to Hand Control Deficits: Eye-Hand Incoordination in Chronic Cerebral Injury

It is widely accepted that cerebral pathology can impair ocular motor and manual motor control. This is true in indolent and chronic processes, such as neurodegeneration and in acute processes such as stroke or those secondary to neurotrauma. More recently, it has been suggested that disruptions in these control systems are useful markers for prognostication and longitudinal monitoring. The utility of examining the relationship or the coupling between these systems has yet to be determined. We measured eye and hand-movement control in chronic, middle cerebral artery stroke, relative to healthy controls, in saccade-to-reach paradigms to assess eye-hand coordination. Primary saccades were initiated significantly earlier by stroke participants relative to control participants. However, despite these extremely early initial saccades to the target, reaches were nevertheless initiated at approximately the same time as those of control participants. Control participants minimized the time period between primary saccade onset and reach initiation, demonstrating temporal coupling between eye and hand. In about 90% of all trials, control participants produced no secondary, or corrective, saccades, instead maintaining fixation in the terminal position of the primary saccade until the end of the reach. In contrast, participants with stroke increased the time period between primary saccade onset and reach initiation. During this temporal decoupling, multiple saccades were produced in about 50% of the trials with stroke participants making between one and five additional saccades. Reaches made by participants with stroke were both longer in duration and less accurate. In addition to these increases in spatial reach errors, there were significant increases in saccade endpoint errors. Overall, the magnitude of the endpoint errors for reaches and saccades were correlated across participants. These findings suggest that in individuals with otherwise intact visual function, the spatial and temporal relationships between the eye and hand are disrupted poststroke, and may need to be specifically targeted during neurorehabilitation. Eye-hand coupling may be a useful biomarker in individuals with cerebral pathology in the setting of neurovascular, neurotraumatic, and neurodegenerative pathology.

Upper limb and eye movement coordination during reaching tasks in people with stroke

PURPOSE

To enhance understanding of the relationship between upper limb and eye movements during reaching tasks in people with stroke.

METHODS

Eye movements were recorded from 10 control participants and 8 chronic stroke participants during a visual orienting task (Experiment 1) and a series of reaching tasks (Experiment 2). Stroke participants completed the reaching tasks using (i) their less impaired upper limb, (ii) their more impaired upper limb without support, and (iii) their more impaired upper limb, with support (SaeboMAS gravitational support and/or electrical stimulation). Participants were tested individually and completed both experiments in the same session.

RESULTS

Oculomotor control and the coordination between the upper limb and the oculomotor system were found to be intact in stroke participants when no limb movements were required, or when the less impaired upper limb was used. However, when the more impaired upper limb was used, success and accuracy in reaching decreased and patterns of eye movements changed, with an observed increase in eye movements to the limb itself. With upper limb support, patterns of hand-eye coordination were found to more closely resemble those of the control group.

CONCLUSION

Deficits in upper limb motor systems result in changes in patterns of eye movement behavior during reaching tasks. These changes in eye movement behavior can be modulated by providing upper limb support. Implications for Rehabilitation Deficits in upper limb motor systems can result in changes in patterns of eye movement behavior during reaching tasks. Upper limb support can reduce deficits in hand-eye coordination. Stroke rehabilitation outcomes should consider motor and oculomotor performance.

The Intersection between Ocular and Manual Motor Control: Eye-Hand Coordination in Acquired Brain Injury

Acute and chronic disease processes that lead to cerebral injury can often be clinically challenging diagnostically, prognostically, and therapeutically. Neurodegenerative processes are one such elusive diagnostic group, given their often diffuse and indolent nature, creating difficulties in pinpointing specific structural abnormalities that relate to functional limitations. A number of studies in recent years have focused on eye-hand coordination (EHC) in the setting of acquired brain injury (ABI), highlighting the important set of interconnected functions of the eye and hand and their relevance in neurological conditions. These experiments, which have concentrated on focal lesion-based models, have significantly improved our understanding of neurophysiology and underscored the sensitivity of biomarkers in acute and chronic neurological disease processes, especially when such biomarkers are combined synergistically. To better understand EHC and its connection with ABI, there is a need to clarify its definition and to delineate its neuroanatomical and computational underpinnings. Successful EHC relies on the complex feedback- and prediction-mediated relationship between the visual, ocular motor, and manual motor systems and takes advantage of finely orchestrated synergies between these systems in both the spatial and temporal domains. Interactions of this type are representative of functional sensorimotor control, and their disruption constitutes one of the most frequent deficits secondary to brain injury. The present review describes the visually mediated planning and control of eye movements, hand movements, and their coordination, with a particular focus on deficits that occur following neurovascular, neurotraumatic, and neurodegenerative conditions. Following this review, we also discuss potential future research directions, highlighting objective EHC as a sensitive biomarker complement within acute and chronic neurological disease processes.

[Restoration of the complicated locomotor functions of the upper extremities in the patients surviving ischemic stroke]

During the late and residual periods of stroke, it is necessary to pay attention to the training of complex spatial movements along with the traditional restoration of the balance and strength of para-articular muscles and the mobility of the paretic limb joints. The objective of the present study was to evaluate the effectiveness of robotic therapy for the recovery of the functions of the upper extremities in the late and residual periods of stroke. The study involved 52 patients who had survived ischemic stroke in the middle cerebral artery. The patients were divided randomly into 2 groups. All of them performed therapeutic physical exercises based on the standard technique during 5 days a week for 3 weeks. In addition, the treatment included massage, laser and pulsed current therapy. The patients of the main group (n=36) were additionally trained to perform complex spatial movements with special emphasis on their speed, fluidity, precision, and agility with the use of the Multi Joint System (MJS) robotic electromechanical device (40 min, 5 days/wk x 3wk). The analysis of the results of the study has demonstrated the statistically significant difference in the degree of improvement of the range of motion (ROM) in the elbow and shoulder joints, the speed and the accuracy of these movements between the patients of the main and control groups. It is concluded that the instrumental restoration of complex spatial movements of the upper extremities during the late and residual periods of stroke contributes not only to the improvement of the functional capabilities but also to the enhancement of independence and personal adjustment of the stroke patients.

Development of a novel approach to the assessment of eye-hand coordination

BACKGROUND

Current methods to measure eye-hand coordination (EHC) have been widely applied in research and practical fields. However, some aspects of the methods, such as subjectivity, high price, portability, and high appraisal contribute to difficulties in EHC testing.

NEW METHODS

The test was developed on an Apple iPad(®) and involves tracing up to 13 shapes with a stylus pen. The time taken to complete each trace and the spatial accuracy of the tracing is automatically recorded. The difficulty level for each shape was evaluated theoretically based on the complexity and length of outline. Ten adults aged 31.5±7.8 years and five children aged 9.4±1.1 years with normal vision participated.

RESULTS

In adults, the time taken to trace and number of errors significantly decreased from the first to the second attempt (p<0.05) but not thereafter, suggesting a learning effect with repeatability after a practice attempt. Time taken and number of errors in children were both higher in monocular than binocular viewing conditions (p=0.02 and p<0.01, respectively) while adults' performance was similar in both viewing conditions.

COMPARISON WITH EXISTING METHODS

Existing EHC tests are subjective in clinics and require higher skills and cost in research, and measure gross EHC. This novel test has been developed to address some of the limitations.

CONCLUSIONS

The test is engaging for children and adults and is an objective method with potential for the assessment of fine EHC, suited to clinic-based and research use in ophthalmic or brain trauma settings, and in developmental disorders.

Validation of the brief International Classification of Functioning, Disability, and Health (ICF) core set for hand conditions

STUDY DESIGN

Cross-sectional multi-centre study.

INTRODUCTION

The ICF Core Sets for Hand Conditions (HC) have been developed to describe functioning of patients with HC.

PURPOSE OF THE STUDY

To study the content validity of the Brief ICF Core Set for HC.

METHODS

Patients with HC were interviewed using the Comprehensive ICF Core Set for HC. ICF categories that best explained variation in patients' general health were identified using multiple regression methods.

RESULTS

Overall, 12 of the 23 ICF categories of the Brief ICF Core Set could be validated. Our analyzes further revealed that the categories "b134 Sleep functions", "s830 Structure of nails", "e225 Climate" as well as categories referring to "e4 Attitudes" also deserve consideration when assessing functioning in patients with HC.

CONCLUSIONS

Clinicians are encouraged to complement the Brief ICF Core Set for HC by adding sleep functions, structure of nails, climate and attitudes, especially when following patients over time.

LEVEL OF EVIDENCE

Level 3.

Clinical effects of combined bilateral arm training with functional electrical stimulation in patients with stroke

Cerebral vascular disease (or stroke) is the main cause of disabilities in adults. Upper-limb dysfunction after stroke usually exists, leading to severe limits of motor capabilities as well as daily activities. Therefore, effective treatment interventions for upper-limb rehabilitation after stroke are needed. Based on the neurophysiological evidence and clinical measures, combined bilateral arm training (BAT) with functional electric stimulation (FES) could improve hand function in stroke patients. In this study, we attempt to combine BAT with FES applying to the post-stroke paretic arm. A linear guide platform with FES feedback control was developed to execute the training of bilateral reaching movements. 35 stroke subjects were recruited and divided into two groups (BAT with FES and BAT alone). 23 participants completed this experiment with 3-week intervention. According to our preliminary results, a favorable trend toward improvement in experimental group (BAT with FES) existed after treatment and at follow-up. Further analysis would be conducted to investigate the kinematic change on motor performance. Moreover, various treatment doses as well as more functional approaches would also be considered for better effects of upper limb rehabilitation after stroke.

Clinical application of computerized evaluation and re-education biofeedback prototype for sensorimotor control of the hand in stroke patients

Background

Hemianaesthesia patients usually exhibit awkward and inefficient finger movements of the affected hands. Conventionally, most interventions emphasize the improvement of motor deficits, but rarely address sensory capability and sensorimotor control following stroke. Thus it is critical for stroke patients with sensory problems to incorporate appropriate strategies for dealing with sensory impairment, into traditional hand function rehabilitation programs. In this study, we used a custom-designed computerized evaluation and re-education biofeedback (CERB) prototype to analyze hand grasp performances, and monitor the training effects on hand coordination for stroke patients with sensory disturbance and without motor deficiency.

Methods

The CERB prototype was constructed to detect momentary pinch force modulation for 14 sub-acute and chronic stroke patients with sensory deficiency and 14 healthy controls. The other ten chronic stroke patients (ranges of stroke period: 6–60 months) were recruited to investigate the effects of 4-weeks computerized biofeedback treatments on the hand control ability. The biofeedback procedures provide visual and auditory cues to the participants when the interactive force of hand-to-object exceeded the target latitude in a pinch-up-holding task to trigger optimal motor strategy. Follow-up measurements were conducted one month after training. The hand sensibility, grip forces and results of hand functional tests were recorded and analyzed.

Results

The affected hands of the 14 predominant sensory stroke patients exhibited statistically significant elevation in the magnitude of peak pinch force (p = 0.033) in pinching and lifting-up tasks, and poor results for hand function tests (p = 0.005) than sound hands did. In addition, the sound hands of patients were less efficient in force modulation (p = 0.009) than the hands of healthy subjects were. Training with the biofeedback system produced significant improvements in grip force modulation (p = 0.020) and better performances in the subtests of pin insertion (p = 0.019), and lifting of lightweight objects (p = 0.005).

Conclusions

The CERB prototype can provide momentary and interactive information for quantitative assessing and re-educating force modulation appropriately for stroke patients with sensory deficits. Furthermore, the patients could transfer the learned strategy to improve hand function.

Efficacy of inpatient burn rehabilitation: a prospective pilot study examining range of motion, hand function and balance

PURPOSE

To examine the effect of inpatient rehabilitation therapy on range of motion, hand function and balance in the burn population.

METHODS

This study utilizes a prospective longitudinal design. Inclusion criteria are adults admitted to a regional inpatient rehabilitation hospital with a primary diagnosis of burn injury. Demographic and medical data are collected. Primary outcomes include range of motion at four joints (shoulder, elbow, hip, knee), hand function (Jebsen Taylor Hand Test) and balance (Berg Balance Scale). Outcomes are measured at admission and discharge. Students't-test is used to determine significant differences in outcomes from admission to discharge.

RESULTS

Eleven subjects meet inclusion criteria. The mean age is 50 years, rehabilitation length of stay is 35 days and total body surface area burned is 41%. Subjects demonstrate significant improvements in range of motion, hand function and balance from admission to discharge (p<0.05).

CONCLUSIONS

Specific functional measures, range of motion, hand function and balance, demonstrate significant improvement during inpatient rehabilitation. Future work is needed to investigate other functional benefits of rehabilitation and to compare the impact of inpatient rehabilitation to other therapeutic interventions.