THE RELATIONSHIP BETWEEN THE FUNCTIONALITY OF CHILDREN WITH DISABILITIES AND ITS EFFECTS ON PARENTS DURING THE COVID-19 PANDEMIC PROCESS.

Purpose: The aim of this study was to investigate the relationship between the functionality of disabled children and its effects on parents during the Covid-19 pandemic. Method(s): A total of 168 people, including 84 disabled children and 84 mothers, were included in the study. The Pediatric Disability Assessment Inventory (PEDI) and Gross Motor Function Classification System (GMFCS) were used for children with disabilities. The Zarit Burden Scale (ZBS), Fatigue Severity Scale (FSS) and The Nordic Musculoskeletal Questionnaire (NMQ) were applied to the mothers to question musculoskeletal disorders. Result(s): There was no correlation between care burden score and PEDI, total score, self-care and mobility scores (p>0.05). A moderately negative (r=-0.306;p<0.01) significant linear relationship was found between care burden score and social function score. There was no significant linear relationship between the fatigue severity score and PEDI total score, self-care, mobility and social function scores (p>0.05). No correlation was found between care burden score and fatigue severity score (p>0.05). For the last 12 months, only the pain in the lumbar region of the parents prevented them from doing their usual work. It was determined that the most aching body parts of the parents who complained of musculoskeletal pain during the last 12 months were in the waist, neck, shoulder, back, and knee regions. Conclusion(s): As a result, no relationship was found between the functionality of disabled children and their parents' influences during the Covid-19 pandemic.Copyright © 2022 Turkish Physiotherapy Association. All rights reserved.

Maternal Mental Health during the COVID-19 Pandemic and Its Impact on Child Cognitive Development

Introduction: The COVID-19 pandemic has had a significant impact on pregnant persons' mental health. Prepandemic data reports an impact of depression, anxiety, and stress on the emotional and behavioral development of the child. Objective(s): We aimed to evaluate the impact of gestational maternal depression, anxiety, and stress during the COVID-19 pandemic on the child's cognitive development at 18 months. Method(s): The CONCEPTION study is a prospective mother-child cohort, established since June 23, 2020, during the COVID-19 pandemic. Depression and anxiety were assessed during pregnancy using validated tools in French and English (Edinburgh Postnatal Depression Scale [EPDS] and General Anxiety Disorder-7 [GAD-7]) as well as stress and antidepressant consumption. The child's cognitive development was reported by the mother using the third edition of Ages and stages questionnaires (ASQ-3) at 18 months of age. Data on other covariates were collected electronically. Multivariate linear regression models were built to assess the association between prenatal maternal depression, anxiety, stress, and child development across domains: communication, gross motor, fine motor, problem solving, and personal-social domains while adjusting for covariates. In addition, sensitivity analyses have been added like COVID-19 diagnosis. Result(s): Overall, 445 mother-child dyads were included in analyses (mean gestational age at delivery 39.2 weeks +/-1.8). Mean gestational scores were, for depression (EDPS, 7.8+/-5.4), anxiety (GAD-7, 4.4+/-4.0), and stress (4.3+/-2.1). Adjusting for potential confounders, as well as for maternal depression and anxiety during pregnancy, maternal prenatal stress was associated with communication skills (adjusted beta = 1.5, CI 95 % (0.34, 2.7)) and fine motor skills (adjusted beta = 1.06, CI 95 % (0.02, 2.6)) at 18 months age. Gestational depression, anxiety, and antidepressants use were not associated with any of the ASQ-3's domains. In addition, no significant association was found in stratified analysis for COVID-19 diagnosis. Conclusion(s): During the COVID-19 pandemic, gestational maternal stress was associated with some aspects of childhood cognitive problems, including communication and fine motor skills. Our results highlight the need to continue following-up on children until kindergarten to better understand the impact of maternal mental health during pregnancy on the child's cognitive development in the era of COVID-19.

The eXtraordinarY BABIES STUDY: EARLY SOCIAL COMMUNICATION SKILLS IN INFANTS WITH SEX CHROMOSOME TRISOMY (SCT)

Purpose of Study: The eXtraordinarY Babies Study is a natural history study of health and neurodevelopment in infants with a prenatal diagnosis of SCT. Given the increased risk for social difficulties and autism in SCT in later childhood and beyond, the study explores trajectories of early social communication development to identify early predictors of outcomes, and relationship of social communication skills to developmental profiles. Methods Used: A subset of 56 participants (XXY=43, XYY=4, XXX=9) from the eXtraordinarY Babies Study completed the Autism Diagnostic Observation Schedule- 2nd edition (ADOS-2), Toddler Module as part of the 12-month visit and The Bayley-3 Scales of Infant and Toddler Development. The ADOS-2 provides ratings of 0 (typical development), 1 (mild atypicality), and 2 (atypical) for communication, social interaction, and other behavior items, and an algorithm classifies total score into categories of: Little-No Concern, Mild-Moderate Concern, Moderate-Severe Concern. Analyses were limited to those who completed the assessment prior to COVID19 mask/shield requirements. Summary of Results: High rates of delayed or atypical development of early social communication skills were identified, with >75% of the sample showing scores of 1 or 2 in frequency of babbling, spontaneous vocalizations, gesture use, and pointing. 58% of the sample showed unusual eye contact and vocalizations. Over 50% received atypical scores on items assessing the quality of eye contact. Participants showed few restricted and repetitive behaviors. Results of ADOS-2 total scores: Little-no concern 50%, Mild-Moderate concern 35.7%, Moderate-severe concern 14.3%. No one was assigned a clinical diagnosis of ASD. For this group, Bayley-3 results showed average Cognitive (scaled score 10.8 sd1.9) and Fine motor skills (9.3 sd2.3), followed by lower Receptive (8.2 sd2.4) and Expressive Language (8.9 sd3.0) and below average Gross Motor skills (7.9 sd2.6). Receptive language scores negatively correlated with ADOS-2 Social Affect (r= -.38, p = < .001) and Overall Total (r= -.41, p = < .001). Conclusion(s): Even at an early age, toddlers with SCT are at increased risk for language, communication, and social interaction delays. While no participants were diagnosed with ASD at 12 months of age, social communication deficits known to be "red flags" for later diagnosis of ASD were seen in a subset of young children with SCT. Prospective follow-up will allow us to determine the trajectory of these deficits and those that may predict higher risk for more significant clinical symptoms.

BRAIN AND BEHAVIOR PREDICTORS OF SARS-CoV-2 INFECTION AMONG PEOPLE WITH HIV

Background: Recent findings from the UK Biobank revealed that healthy adults who later became infected with SARS-CoV-2 had lower brain volumes in regions involved in risk-taking behavior and olfaction compared to individuals who did not become infected. We examined if similar pre-existing differences in brain regions correspond to SARS-CoV-2 infection among people with HIV (PWH) receiving suppressive ART. Method(s): Participants included adult Thai MSM enrolled in the acute HIV (AHI) cohort (RV254/SEARCH010) in Bangkok, Thailand. Participants underwent 3T MRI and clinical assessments (i.e., HIV disease metrics, cognitive testing, and self-reported mood and substance use). ART initiation occurred within 5 days of the MRI (median=same day). Regional brain volumes were summed across hemispheres and corrected for head size. Brain volumes and clinical indices were compared between participants with laboratory confirmed SARS-CoV-2 and those without a diagnosis of SARS-CoV-2 following ART initiation. Machine learning was utilized to identify variables at the time of enrollment into the cohort that predicted subsequent SARS-CoV-2 infection status. Result(s): 112 participants were included in the analysis. All study participants achieved viral suppression after ART and received SARS-CoV-2 vaccinations. Fifty-four participants became infected with SARS-CoV-2 during the observation period (median=79 weeks from ART initiation). Study participants who became infected with SARS-CoV-2 after ART had lower volumes at the time of enrollment in several subcortical brain regions with the most pronounced effect in the pallidum (p=.025). There were no associations between brain volumes and ratings of mood, demographics, or HIV disease indices. SARS-CoV-2 infection was two-fold higher among individuals who reported use of amyl nitrites (i.e., poppers) during chemsex. Machine learning with repeated cross validation revealed that lower orbital and medial frontal lobe, anterior cingulate, pallidum, vermis, and olfactory volumes, worse motor function, and higher education collectively predicted co-infection status (average AUC of 85%). Conclusion(s): Study findings point toward a risk phenotype for SARS-CoV-2 infection among PWH defined by pre-existing differences in brain volumes relevant to risk-taking behavior, emotion, and neuroHIV as well as behavioral factors such as inhalant use and lack of social distancing during chemsex. (Table Presented).

Cognitive, Motor, & Negative Valence Systems in Neurologic Pasc: A Preliminary Study

Background: Nervous system post-acute sequelae of COVID-19 (NS-PASC) include cognitive and mental health symptoms. To further define these, we applied a Research Domain Criteria (RDoC) approach to examine motor, positive valence (PV) and negative valence (NV) systems, and social processing data in The COVID Mind Study of NS-PASC. Method(s): NS-PASC participants (>3 months after COVID-19) referred from a NeuroCOVID Clinic and non-COVID controls from New Haven, CT and Baltimore, MD completed an RDoC test battery for cognition (language, declarative and working memory, cognitive control, perception), motor, PV, NV, and social processes. To date, 3T MRI with diffusion tensor imaging was performed in 11 NS-PASC to assess white matter integrity (global white matter fractional anisotropy [FA]) as a contributor to alterations identified on the RDoC tests. Analysis of Covariance examined group differences after adjusting for sex, race, ethnicity, age, and years of education. Result(s): 25 NS-PASC participants (age 43.4+/-11.3 yrs, 76% female, 402 days after COVID-19 symptom onset) and 29 controls (age 46.2.6+/-13.1 yrs, 66% female) completed the battery. Controls were more racially diverse and less educated than NS-PASC (43% vs. 12% Black, p=0.005;14.5 vs. 16.1 yrs of education, p< 0.05). Means and statistics for RDoC between NS-PASC and controls are shown in Table. NS-PASC performed worse in language, verbal working and declarative memory, and perception and reported greater cognitive control difficulties (e.g., behavioral inhibition, set shifting) without issues on performance-based metrics (Stroop, Trail Making Test-Part B), and had slower motor function. NS-PASC reported more NV issues including greater symptoms of depression, rumination in response to depressive mood, apathy, childhood trauma, anxiety, and perceived stress. There were no differences in PV and social processing. In a subset of NS-PASC participants who underwent MRI, there was a dynamic range of FA values with a mean of 0.509 (IQR 0.481 - 0.536). Conclusion(s): Our findings extend previous PASC studies characterizing cognitive and mental health alterations, indicating that additional RDoC assessments warrant focus, including alterations in motor and the negative valence system. In future analyses, we will examine white matter integrity as a pathophysiologic contributor to these RDoC systems.

2023 Western Medical Research Conference

The proceedings contain 549 papers. The topics discussed include: interleukin-2 kinase-mediated T-cell receptor signaling is critical in the development of type 1 diabetes by OT-1 T-cells;the effect of the COVID-19 pandemic on anxiety and depression in adolescents in the military population;dollars sense: a school-based effort to increase financial literacy in high school students;fostering the next generation of healthcare leaders in a pandemic world;walkability of San Bernardino county?s elementary schools in relation to various school characteristics;placebo-controlled trial in tanner 2-3 males with Klinefelter syndrome: effect of testosterone gel versus placebo in motor skills outcomes;my implant is expiring: a national secret shopper study of extended use of the contraceptive implant;comparing the effects of aerobic exercise and yoga on stress levels in college students;and are patients with a history of chest radiation therapy at higher risk for sternal wound problems after heart transplant?.

First in-neonate use of non-invasive transcutaneous auricular vagus nerve stimulation: 18-month neurodevelopmental and sensory follow-up

Objective: Non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) paired with oral feeding is a novel intervention for infants with feeding delays that may improve feeding and help avoid a gastrostomy tube (Gtube). However, the long-term impact of this neurostimulation on infant's development remains unknown. We investigated the neurodevelopmental and sensory outcomes of infants who received taVNS paired with bottle feeding. Method(s): Twenty-one of 35 toddlers who participated in the open label trial of taVNS paired with one or two feeds a day for 2-3 weeks, underwent comprehensive developmental assessments at 18 months of age using Cognitive Adaptive Test, Clinical Linguistics and Auditory Milestone, and Peabody gross motor scores. Twelve of those assessed achieved full oral feeds ('responders') and 9 had G-tube placed for feeds ('non-responders'). Before COVID, 12 toddlers (5 responders, 7 non-responders) were also assessed in the home using the Bayley-III and Sensory Profile (SP-2) assessments. Area deprivation index (ADI) was used to measure resource poor environments and relate to test scores. We used Fishers exact test and Pearson correlation coefficients to compare neurodevelopmental and sensory performance in responders versus non-responders. Result(s): taVNS responders showed significantly better general sensory processing in SP-2 than did non-responders (p =0.04). There were no significant differences in Bayley-III or CAT/CLAMS/ASQ scores in areas of cognition, receptive language, fine motor, and gross motor skills in this small sample size, but are similar to published scores for preterm infants who received G-tubes. ADI was not significantly associated with neurodevelopmental scores. Conclusion(s): These results suggest that taVNS paired with feeding may have a potential long-term positive neurodevelopmental effect on sensory processing in neonates with poor feeding. The current open-label results need testing in randomized controlled trials of taVNS paired with oral feeding in developmentally delayed infants failing oral feeds. Research Category and Technology and Methods Clinical Research: 12. Vagus Nerve Stimulation (VNS) Keywords: Neurodevelopment, taVNS, feeding, developmental delaysCopyright © 2023

The possibilities of using the effects of ozone therapy in neurology

OBJECTIVES: The beneficial effects of ozone therapy consist mainly of the promotion of blood circulation: peripheral and central ischemia, immunomodulatory effect, energy boost, regenerative and reparative properties, and correction of chronic oxidative stress. Ozone therapy increases interest in new neuroprotective strategies that may represent therapeutic targets for minimizing the effects of oxidative stress. METHOD(S): The overview examines the latest literature in neurological pathologies treated with ozone therapy as well as our own experience with ozone therapy. The effectiveness of treatments is connected to the ability of ozone therapy to reactivate the antioxidant system to address oxidative stress for chronic neurodegenerative diseases, strokes, and other pathologies. Application options include large and small autohemotherapy, intramuscular application, intra-articular, intradiscal, paravertebral and epidural, non-invasive rectal, transdermal, mucosal, or ozonated oils and ointments. The combination of different types of ozone therapy stimulates the benefits of the effects of ozone. RESULT(S): Clinical studies on O2-O3 therapy have been shown to be efficient in the treatment of neurological degenerative disorders, multiple sclerosis, cardiovascular, peripheral vascular, orthopedic, gastrointestinal and genitourinary pathologies, fibromyalgia, skin diseases/wound healing, diabetes/ulcers, infectious diseases, and lung diseases, including the pandemic disease caused by the COVID-19 coronavirus. CONCLUSION(S): Ozone therapy is a relatively fast administration of ozone gas. When the correct dose is administered, no side effects occur. Further clinical and experimental studies will be needed to determine the optimal administration schedule and to evaluate the combination of ozone therapy with other therapies to increase the effectiveness of treatment.Copyright © 2021 Neuroendocrinology Letters.

Motor Coordination and Its Importance in Practicing Performance Movement

The training of good motor coordination optimizes the motor skills, and these, over time, lead to the improvement of the motor skills specific to the practiced movement. The purpose of this study was to assess the capacity and speed of learning coordinated movements in the context of working in an online system. At the same time, we set out to evaluate the level of motor coordination achieved through training using the eLearning platform Hudl and the Teaching Games for Understanding approach. Thus, three groups of students were analyzed whose motor histories were different. The analysis of the three tested groups was performed in the first year of study and in the third year of study. The training programs have been adjusted/modified according to the COVID-19 pandemic situation, which has determined their application in the online system as well. The results of this study confirm that by assisting learning through computer programs, in the online system, these workouts can be effective. At the same time, the study shows us that, in addition to the natural evolution from childhood and adolescence, an advanced form of motor coordination appears, which is installed through the action of learning. © 2023 by the authors.

Physiotherapy results of a patient with critical illness polyneuropathy due to COVID-19: A case report

The aim of this study is to examine the results of physiotherapy in a patient with critical illness polyneuropathy (CIP) due to coronavirus disease 2019 (CO-VID-19). The 48-year-old male patient with CIP due to COVID-19 was enrolled in a physiotherapy program for 3 months with 5 sessions/week. Pain intensity, motor skills, daily living activities, fatigue level, cognitive status, and decubitus ulcer were evaluated with a visual analogue scale, the Medical Research Coun-cil-Sum Score, the Functional Independence Scale, the Fatigue Severity Scale, the Standardized Mini-Mental Test, and pressure wound staging, respectively. Positive improvements were achieved in functional level, fatigue, pain, and pressure sores with the physiotherapy program for this patient with CIP due to COVID-19. This report provides an idea about the effects of physiotherapy programs for COVID-19-related CIP to academics and clinicians working in this field.Copyright © 2022, Derman Medical Publishing. All rights reserved.

A novel approach to low-energy calcaneal tuberosity avulsion fractures in patients with fragile bone quality: A report of two cases

Maintaining reduction of a calcaneal tuberosity avulsion fracture is challenged by the powerful force exerted upon the bone fragment by the Achilles tendon. Low-demand, elderly patients with osteoporotic bone usually undergo a low-energy mechanism when this fracture pattern occurs. Likely attributable to poor bone quality, the rate of early fixation failure has been documented to be as high as 40%. We present the cases of two 65-year-old female patients who each sustained a calcaneal tuberosity avulsion fracture. Both patients underwent a low-energy mechanism of injury and had a medical history of many comorbidities. The first patient underwent a partial calcaneal ostectomy and tenotomy after failing open reduction internal fixation (ORIF). The second patient primarily underwent a partial calcaneal ostectomy and tenotomy. Postoperatively, after the incision site was fairly healed, both patients could bear weight as tolerated. This method of excision and release may allow for decreased risk of skin compromise and return trips to the operating room for failed ORIF. In low-demand patients with low-energy calcaneal avulsion type fractures and osteoporotic bone, this technique may be the preferred surgical option.Copyright © 2022 The Author(s)

The impact of a 12 month Music Therapy pilot on patients and staff within a NHS, in-patient, neurorehabilitation unit during the Covid-19 pandemic

Introduction: The UK Stroke pathway has been well developed since the introduction of the National Stroke Strategy in 2007 (Department of Health, 2007). Music Therapy (MT) is an AHP that has less presence within the current stroke pathway. In line with the national guidelines for Stroke rehabilitation (NICE, 2013), music therapy targets specific patient rehabilitation goals integrating a multi-disciplinary approach to therapy. Chiltern Music Therapy funded a 12-month, 1 day a week pilot MT service at Buckinghamshire Neuro Rehab Unit between 2020-2021. Method(s): The MT service comprised of a mixture of individual and group sessions. 27 patients were seen. Demographics, techniques, outcomes and feedback data was collected by the therapist, aiming to identify the benefits of MT for patients during the pandemic and how the pilot service enhanced standard therapies. Result(s): Patients accessed 86.5 hours of face-to-face (FtF) MT during the Covid-19 pandemic. 72% of SMART goals were fully or partially achieved. Data suggests MT reduces stress and anxiety, improves mood, and helps patients feel hopeful about the future;MT enhances patient engagement with therapy interventions;MT input increases patient's positive development in the areas of communication, cognition, motor skills, emotional expression, sense of self and behaviour. Staff and patient feedback was overwhelmingly positive. Conclusion(s): Introducing a MT service into existing therapy provision for stroke patients provided opportunities for FtF interaction during the Covid-19 pandemic. MT meets multiple national standards and guidelines for stroke. MT enhances patient engagement with therapy interventions, assists achieving rehab goals whilst reducing stress and anxiety and improving mood.

'Exploring the Effect of Mirror Therapy versus Constraint Induced Movement Therapy in an Older Adult Post Stroke Population'

Introduction: The Covid-19 pandemic resulted in the closure of community therapy services in Ireland. The need for the provision of upper limb rehabilitation for stroke survivors remained. A new method of service provision was developed and evaluated. Aim- To deliver an upper limb rehabilitation programme to older adults post stroke through virtual means and to compare the stroke interventions of mirror therapy (MT) and constraint induced movement therapy (CIMT). Method(s): 21 participants recruited. The investigator recorded 36 upper limb rehabilitation sessions (12 MT, 12 CIMT and 12 control) which were sent electronically to participants- 6 week therapy programme. Participants were assessed pre and post intervention using the DASH, OSA-SF, JAMAR Hand Function Test, 9 Hole Peg Test and Dynamometer. Statistical significance for CIMT group in grip strength and minimal fine motor skills improvement. MT showed significance in both fine and gross motor skills, grip and pinch strength and overall participants self-perceptions of function. Result(s): 21 participants completed upper limb rehabilitation programmes in their own homes successfully. The MT group showed greater significance than CIMT when completed through virtual means. Telehealth may be a means of service delivery going forward and MT has proven effective as virtual intervention. Conclusion(s): Further evaluation of this intervention through virtual means is needed. Implications for practice- The incorporation of telehealth into upper limb stroke rehabilitation practice can alleviate waiting lists through allowing multiple patients access to interventions at once and also can provide a stroke service in a timely manner.

Sarcopenia in Children with Liver Disease: A Pilot Study

Background and Aims Sarcopenia can be defined as loss of muscle mass, strength and function and has been shown to be associated with increased morbidity and mortality in the adult population. Sarcopenia has been assessed by decreased psoas muscle surface area (PMSA) on Computer tomography (CT) and has been validated in paediatric studies. The impact of Sarcopenia in children with end stage liver disease and oncological conditions is now being recognised. There is scarce literature on the effect of sarcopenia on motor function. CT imaging exposes children to radiation and hence is done in a select group of children at the time of transplant assessment. The aim of this audit was to assess the prevalence of Sarcopenia in children undergoing liver transplant assessment and its relationship on laboratory variables, functional activity and clinical outcomes. Methods Retrospective single centre case review of patients with liver disease undergoing transplant assessment and CT imaging between 2018-2020. Psoas muscle was analysed at the level of L4/L5. The z-Scores were calculated using ageand gender-specific reference values. Sarcopenia was defined as tPMA z score less than -2. We assessed the relationship of Sarcopenia to the biochemical parameters, nutritional status, effect on motor delay/physical abilities (assessed by a range of age appropriate standardised developmental and physical assessments due to COVID pandemic isolation restrictions) and post-transplant complications. Results Thirty one children that met the inclusion criteria were included. Sarcopenia was prevalent in 17 children (6 males: 11 females), with a median age of 3.5 years (SD = 4.9). The common conditions were biliary atresia (n= 11, 35%), hepatoblastoma (n=6, 19%), Autoimmune hepatitis (n=3) etc. Twenty- four patients required additional nutritional support (77% nasogastric feeding, 13% PN and 6% oral supplementation). Mean tPMA z-score was -2.27. Data for the assessment of physical abilities/functional activity was available in 21 children. Impairment of motor skills/physical abilities was overall noted in 14/21 children (67%);9/13 (69%) in the sarcopenic group (6 significant impairment) vs 5/8 (63%) in non sarcopenic group (4 significant impairment). Sarcopenia was associated with increased complications (27 vs 7, p = 0.005) and hypoalbuminaemia (p=0.01), but was not statistically significant (p> 0.05) for the overall length of stay (total and intensive care). Discussion Sarcopenia was commonly identified in children with liver diseases undergoing transplant assessment. Reduction in physical abilities/functional activity was observed in both groups which may be a consequence of loss of muscle mass in children secondary to liver diseases or underlying oncological conditions leading to delay in gross motor skills. Although there was no statistical difference in the duration of stay or impairment of motor skills, complications were higher in the sarcopenic group. Conclusion In this pilot study, sarcopenia is prevalent in children being assessed for liver transplantation and was associated with increased complications. Better non-invasive methods (aside from CT scan) of assessing sarcopenia needs to be developed and validated for the paediatric age group, which would help to better characterise the true incidence and prevalence of sarcopenia in children with chronic liver disease. There is a need to offer nutritional support and assess physical function early in the pre transplant period in order to initiate appropriate physiotherapy interventions to halt and even reverse the progression of sarcopenia.

Emotional distress and quality of life among adults with developmental coordination disorder during COVID-19

Introduction: Individuals with developmental coordination disorder frequently report emotional and functional difficulties. A stressful era as COVID-19 pandemic may enhance emotional load. The present study aimed to (1) examine the emotional distress and quality of life among adults with developmental coordination disorder during COVID-19 as compared to typical controls, and (2) examine the relationships between these factors in adults with developmental coordination disorder. Method: Participants were 317 adults, aged 18–66, recruited during the first year of COVID-19: 227 were included in the developmental coordination disorder group, and 90 in the control group (normal motor performance) based on the Adult Developmental Co-ordination Disorders/Dyspraxia Checklist cutoff score. Participants completed a sociodemographic health status/daily life under COVID-19 questionnaire and self-reports about their emotional status (depression, anxiety, stress) and a quality of life. Results: The developmental coordination disorder group had significantly greater depression, anxiety, stress, and lower quality of life. Participants with developmental coordination disorder who were infected by COVID-19 or reported reduction of working hours due to COVID-19 had the lowest social and environmental quality of life. Depression significantly predicted reduced quality of life and mediated between developmental coordination disorder severity and quality of life. Conclusions: Prevention and intervention programs for adults with developmental coordination disorder should be elaborated, with reference to emotional load and to implications on daily life, especially in times of crisis, like COVID-19.

Monitoring Post-Stroke Fatigue, Sleep Quality and Therapy Participation during in-Patient Rehabilitation: A Feasibility Study

Background: Despite similar motor recovery of limbs in research, clinically the lower limb is observed to demonstrate greater recovery than the upper limb (UL). Understanding the relation between the post-stroke rehabilitation experience in the hospital environment and neuroplasticity and motor recovery of the UL may provide insight into how to optimize the hospital and promote recovery. Aim(s): This feasibility study aimed to collect cross-sectional data from inpatients who were clinically receiving UL motor training within a rehabilitation hospital to determine the feasibility of our protocol as well as describe the factors and potential associations between motor performance and therapy participation, fatigue, stress and sleep. Method(s): Inpatients were recruited across two rehabilitation wards;inclusion criteria were broad (stroke diagnosis and clinically identified UL motor impairment). Therapy session duration and frequencies were recorded prior to assessing sleep quality and amount over one night (Actiwatch, Phillips Respironics, USA)). Participants rated their perceived fatigue (Fatigue Severity Scale-FSS) and sleep quality (Leeds Sleep Evaluation Questionnaire-LSEQ), and overnight nursing documentation of sleep was extracted from the medical record. Motor performance was assessed via the box and block test. All data were collected across a 24h period. Result(s): N=14 participants participated (age 71+/-11y) at a mean+/-SD 32+/-23 days post-stroke and 22+/-21 days since admission to rehabilitation. Participants received motor training 10+/-3 times per week, and sessions were 51+/-18min in length. Mean+/-SD sleep duration was 9.5+/-1.9h with 1.1+/-0.7h awake-time during the night. All participants reported fatigue, with mean FSS (37+/-16), and identified issues with respect to getting to sleep as well as quality of sleep on the LSEQ. All data were feasible to collect, however COVID restrictions and bed-numbers influenced recruitment rate. Conclusion(s): Findings provide key feasibility data to better understand targetable factors to optimise the post-stroke rehabilitation experience, neuroplasticity and UL motor recovery after stroke.

Acute Kidney Injury Is Associated With Increased In-Hospital Mortality And With Impairment Of Kidney, Lung, Motor and Immune Function 1 Year After Discharge for COVID-19

Background and aims: Acute Kidney Injury (AKI) is the most frequent complication after respiratory failure in COVID-19 patients. AKI increases mortality risk, length of hospital stay and healthcare costs with possibile progression toward CKD. Study aims: 1) evaluation of AKI incidence in 1020 COVID-19 hospitalized patients;2) comparison of AKI incidence in COVID-19 vs. pre-pandemic period;3) establishment of out-patient follow-up for monitoring kidney, lung, motor and immune function;4) creation of a biobank for biomarker discovery studies. Methods: AKI incidence was calculated matching laboratory and administrative data of 26214 hospitalized patients in 2018-2019 and in 1020 COVID-19 patients in 2020-2021: KDIGO algorithms were applied for AKI grading. After 12 months from discharge, 232 COVID AKI patients and relative controls matched for age and gender were evaluated for kidney (eGFR, biomarkers of tubular damage NGAL, CCl-14, DKK-3), lung (DLCO, CT scan) and neuro-motor (SPPB, 2-min walking test, post-traumatic stress test-IES) function. Results: Before pandemic, in-hospital AKI incidence was 18% (10% KDIGO 1, 5% KDIGO 2, 3% KDIGO 3): median age of AKI patients was 69. In-hospital mortality was 3.5 % in non-AKI group vs. 15% in AKI group in accordance with KDIGO stages. In COVID patients, AKI incidence increased to 37% (20% KDIGO 1,11% KDIGO 2, 6% KDIGO 3): median age of patients was 54. In-hospital mortality was 31 % in AKI group. After 12 months from hospital discharge, COVID AKI patients showed a persistent reduction of respiratory function (severe DLCO impairment <60%) related to the extent of CT scan abnormalities. AKI patients also presented motor function impairment and a worse posttraumatic stress response. GFR reduction was 1.8 ml/min in non AKI vs. 9.7 ml/min in AKI COVID patients not related to age. Urinary DKK-3 and CCL-14 were also higher in the AKI group. Last, IgG response after SARS-CoV-2 vaccination was significantly lower in the AKI group. Conclusion: AKI incidence was significantly increased during COVID-19 in respect to pre-pandemic period with an association with higher mortality in class 2-3 KDIGO. In the post-COVID follow-up, AKI was associated with lung and neuro-motor function impairment, a defective antibody response and a sudden GFR decline concomitant to the persistence of tubular injury biomarkers. These results suggest the importance of a nephrological and multidisciplinary follow-up of frail patients who developed AKI during hospitalization for COVID-19.

COGNITIVE and PSYCHOSOCIAL OUTCOME in CHILDREN with MULTISYSTEM INFLAMMATORY SYNDROME FOLLOWING SARS-COV-2 INFECTION

Background: Despite the low rate of neurological defcits following the SARS-COV-2 infection in the pediatric population, children and adolescents who develop multisystem infammatory syndrome (MIS-C) after being infected with SARS-COV-2 are at a higher risk for neurological abnormalities and brain injury, increasing the risk of adverse cognitive and psychiatric outcome. Objectives: Given the increased risk of central nervous system impairment we chose to conduct a prospective study looking at the cognitive and psychosocial outcome of patients with MIS-C. Methods: Our study included 27 of the 29 patients between 2 to 18 years of age (M = 11.1, SD = 4.4) who were treated for MIS-C from the onset of the SARS-COV-2 pandemic until the beginning of May 2021 at the only tertiary care pedi-atric immunology center in Slovenia. We assessed these patients 6 months after diagnosis using the age-appropriate Wechsler intelligence scales and a battery of neuropsychological test measuring attention, executive function, memory and fne motor skills. We also asked parents to report on patients' psychosocial outcome using the Achenbach Child Behavior Checklist. Results: By using Bayesian statistics to take into account parental education and any potential pre-morbid learning difficulties we found no evidence of impairment on measures of intelligence. However, the posterior distribution of scores on neuropsychological measures indicated that a signifcant proportion of patients scored 1SD bellow expected levels on measures of attention (31%), executive function (28%) and visual memory (35%). Increased symptoms of depression, anxiety and attention difficulties were also reported by parents, although their extent did not rise to a clinically signifcant level. Conclusion: The fndings from our cohort suggest that the cognitive and psychosocial outcome of patients with MIS-C is generally favorable, although up to 35% may experience specifc neuropsychological defcits more than 6 months after diagnosis. The most commonly impaired cognitive domains seem to be attention, executive function and visual memory.

Establishment of Hong Kong Neuromuscular Disorder Patient Registry

Introduction: Neuromuscular disorders (NMDs) are a group of diseases affecting the peripheral nervous system (1). Many NMDs cause disability or even premature death (2). We aim to design and establish a robust NMD patient registry in Hong Kong. Methods: By modelling international NMD patient registries, we designed patient-professional reported questionnaires to collect the demographic, clinical c haracteristics, genetic details, family history, investigation findings and specific treatment of NMD patients. Patients were recruited through Hong Kong West Cluster (DKCH, QMH) and Kowloon Central Cluster (HKCH). We also developed self-registration online platform. p<0.05 was considered statistically significant. Findings: Since June 2019, 125 NMD patients have been enrolled in the registry with 12 participants registered online. The registry recruited 13 types of NMDs, including spinal muscular atrophy (SMA) (n=31), Duchenne muscular dystrophy (DMD) (n=19) and congenital myopathy (n=18). The age range was 7 months to 63 years old. 65.6% of those enrolled were children (<18 years old). 63.2% were male. 64.8% of the patients had genetic diagnosis. The registry has contributed to two studies. The first one is a prospective study of clinical efficiency of Nusinersen in SMA patients (n=22). 14/16 SMA patients showed improvement in at least one of motor performance (CHOP intend/RULM/HINE/HFMSE) and health-related quality of life after 1st year of treatment. The second study is the reactogenicity and immunogenicity study of the COVID-19 vaccine in DMD patients (n=4). Data will be available in October. Conclusion: Hong Kong Patient registry has contributed to ongoing and new research study to optimise medical care.

Efficacy of a Home Visiting Program on Child Outcomes: A Randomized Controlled Trial

Background: High-quality home visiting programs are designed to improve child health and support expecting and new parents. These programs can assist families in developing skills and garnering the resources necessary to raise healthy children. A non-profit organization operating in the Southwestern United States provides a universal home visiting program to families having their first child (first-time for either the mother or father), including child by birth, adoption, or child placement. The program includes participant advocacy, home-based visits, and an enhanced referral program. The present study examines the effects of the program on child development outcomes at 12- month follow-up. Methods: Data were collected as part of a larger randomized controlled trial in which first-time families were randomly assigned to the home visiting program (n = 179) or a business-as-usual control group (n =164). This study follows the family and the child until the child graduates from high school or turns 19. The Ages •Stages Questionnaire (ASQ) was used to assess five domains of child development. Although this outcome was measured at 2, 6, 12, 18, 24, and 36-month, the present study focuses on the five domain outcomes at 12 months. Results: Results of independent-sample t-tests showed that, compared to controls, children in the home visiting program reported significantly better communication (t(280)=2.328, p=0.02, d=.277 [small effect]), gross motor skills (t(280)=2.601, p=0.01, d=.306 [small effect]), fine motor skills (t(280)= 3.010, p=.008, d=.357 [small effect]), problem-solving (t(280)=5.218), p<.001, d=.631 [moderate effect]), and personalsocial functioning (t(280)=3.355, p=.002, d=.404 [small effect]) at 12-month follow-up. Conclusion: The 12-month follow-up showed promising evidence of the effectiveness of the home visiting program under investigation. It is important to continue to follow these children to determine longer-term outcomes. As this study is ongoing, we will be able to examine the degree to which these early childhood outcomes are predictive of school readiness, broader dimensions of health functioning, and decreased criminal justice involvement. Graph of non-significant trend for interaction between social support and COVID-19 Family Impact. This was in direction of a stronger link between COVID Family Impact and EPDS Depression subscale for mothers with less social support.