services in addressing poststroke sexual adjustment issues. Design: Qualitative ethnographic interviews. Setting: Outpatient rehabilitation clinic. Participants: 29 subjects (15 stroke survivors and 14 partners). Intervention: Individual semi-structured interviews were used to gain information about perceived rehabilitation needs, personal and sys- temic barriers to care, and perspectives on the best ways to provide such care in a rehabilitation setting. Main Outcome Measure: The- matic analysis of transcript data. Results: 7 primary themes were identified, 2 relating to the effects of stroke on sexual adjustment and 5 specific to addressing sexual issues in the process of rehabilitation. Participants acknowledged that sexual functioning is significantly af- fected by physical, functional, and relationship changes. Participants believed that it was difficult for both patients and providers to talk about sexual matters. Provider rapport and competence, along with individualized care, were viewed as critical to addressing sensitive sexual issues in the rehabilitation setting. Conclusions: This research suggests a need for rehabilitation programs to evaluate the level of training and services provided to address poststroke sexual adjustment issues. Development of clinically useful poststroke sexual adjustment assessment tools is warranted. Key Words: Rehabilitation; Stroke. Poster 24 Ashworth Scale Score Changes From Baseline in Patients With Poststroke Upper-Limb Spasticity Treated With Botulinum Toxin Type A: Screening for Covariate Effects. Stuart Yablon (Method- ist Rehabilitation Center, Jackson, MS), Amanda VanDenburgh, Jon Wagg, Tatiana Khariton, Steve Hua, Susan Abu-Shakra, Frederick Beddingfield III. Disclosure: Supported by Allergan. Objective: To screen the improvement from baseline in Ashworth Scale wrist (Ashworth change from baseline) scores in patients with poststroke upper-limb spasticity treated with botulinum toxin type A (BTX-A) (Botox) for major covariate effects. Design: Data from 7 double-blind, placebo-controlled trials were pooled. Setting: Multi- center. Participants: Adult (N=577) patients with poststroke spastic- ity. Patients receiving 100U or higher in the wrist flexors (n=202) were used in the subset analysis of wrist data. Intervention: At least 1 BTX-A treatment (360U in distal limb, 200U in wrist or finger). Main Outcome Measures: Regressions of age, time since stroke, sex, race, and body mass index (BMI) were compared with 6-week wrist Ashworth change from baseline for covariate effects. Mean 6-week wrist Ashworth change from baseline  SE were plotted by sex and race and by quartiles of age, time since stroke, and BMI. Results: Baseline mean wrist Ashworth scores were 2.960.60. Week 6 Ash- worth change from baseline were robust. Covariate screening by linear regression found no effects for age, time since stroke, sex, race, or BMI on the 6-week wrist responses (Ashworth change from baseline). Conclusions: BTX-A treatment in the upper limb produced robust improvements in 6-week wrist Ashworth scores. Age, time since stroke, sex, race, and BMI do not appear to have a major effect on the size of 6-week wrist Ashworth change from baseline. Key Words: Botulinum toxin type A; Muscle spasticity; Rehabilitation; Stroke. Poster 25 Cortical Plasticity Following Motor Skill Learning During Mental Practice in Stroke. Stephen J. Page (University of Cincinnati, Cincinnati, OH), Jerzy Szaflarski, James Eliassen, Hai Pan. Disclosure: None declared. Objective: To determine the efficacy and neural mechanisms of mental practice when administered to chronic stroke patients. Design: Case series. Setting: Outpatient rehabilitation hospital. Participants: 10 chronic stroke patients (mean, 36.7mo) exhibiting stable, moderate motor deficits. Intervention: Subjects received 30-minute therapy sessions for their affected arms, occurring 3 days a week for 10 weeks, and emphasizing valued activities of daily living (ADLs). Directly after therapy, subjects received 30-minute mental practice sessions, which required mental practice of the ADLs performed during therapy. Main Outcome Measures: Behavioral outcomes were evaluated by a blinded rater using the Action Research Arm Test (ARAT) and the upper-extremity section of the Fugl-Meyer Assessment (FMA). Func- tional magnetic resonance imaging (fMRI) was administered before and after intervention to assess cortical changes. Results: Before the intervention, subjects exhibited stable motor deficits. After interven- tion, subjects exhibited marked ARAT and FMA score increases (+5.3 and +4.2, respectively), and clinically significant new abilities to perform valued ADLs. Postintervention fMRI revealed significant increases in activation to wrist flexion and extension of the affected hand in the premotor area and primary motor cortex ipsi- and con- tralaterally to the affected hand, and superior parietal cortex ipsilateral to the affected hand. Decreased activations were noted in the parietal cortex of the hemisphere ipsilateral to the affected hand. These changes correlated with anatomic regions in which behavioral changes were observed via the ARAT and FMA. Conclusions: Mental practice is an easy-to-use, cost-effective strategy that was again shown to improve affected arm outcomes after stroke. This is the first study suggesting alteration in the cortical map as a possible mental practice mechanism for the affected arm. Key Words: Hemiplegia; Rehabili- tation; Stroke. Poster 26 Activity Poststroke: Characteristics and Clinical Significance of Gait in Everyday Life in Patients With Subacute Stroke. Sanjay Prajapati (University of Toronto, Toronto, ON), William Gage, Dina Brooks, William McIlroy. Disclosure: None declared. Objective: To develop an understanding for the pattern of walking activity, the quality of walking, and associated cardiovascular re- sponses over the day of stroke patients during inpatient rehabilitation. Design: Cohort study. Setting: Teaching rehabilitation hospital. Par- ticipants: People at the subacute stage of stroke. Intervention: Pa- tients were assessed for 12 consecutive waking hours during the day, across multiple days, using the Accelerometry for the Bilateral Lower Extremities system and a heart rate monitor. Main Outcome Mea- sure: Percentage of total time walking, frequency and duration of walking bouts, and temporal stance gait symmetry and duration (in minutes) that heart rate was within the calculated cardiovascular training range. Results: Percentage of total walking time ranged from 8.6% to 17.9% with mild-to-severe temporal stance asymmetry. Av- erage number of walking bouts recorded was 67, with an average duration of 39.5 seconds. Total duration within training zone was, on average, less than 10 minutes. Conclusions: Nominal levels of walk- ing activity, coupled with insignificant cardiovascular gains over ex- tended periods of time, exemplifies the largely sedentary lifestyle of inpatients during rehabilitation. This study emphasizes the need to promote activity beyond conventional therapy in order to maximize recovery potential during inpatient rehabilitation. Key Words: Car- diovascular system; Gait; Rehabilitation. Poster 27 Black and White Disparities in Inpatient Stroke Rehabilitation Outcomes. Koen Putman (Vrije Universiteit Brussel, Brussels, Belgium), Randall Smout, Susan Horn, Gerben DeJong. Disclosure: None declared. Objective: To assess racial disparities in functional outcome on discharge from inpatient rehabilitation. Design: Multicenter prospec- E15 CONGRESS ANNUAL CONFERENCE ABSTRACTS Arch Phys Med Rehabil Vol 89, October 2008