Poster 207

2005 ACADEMY ANNUAL ASSEMBLY ABSTRACTS Objective: To identify the incidence, etiology, and risk factors for fevers in individuals with traumatic spinal cord injury (SCI). Design: Retrospective review. Setting: Tertiary care, level I trauma center. Participants: Consecutive adult traumatic SCI admissions to acute care (n⫽48) and rehabilitation (n⫽40). Interventions: Not applicable. Main Outcome Measures: Incidence, etiology, mean maximum elevation, and duration of fevers (temperature ⬎99.9°F). Results: The incidence of fever was 60% and 50% (acute care n⫽58 and rehabilitation n⫽66, respectively). Most commonly identified fever etiologies were respiratory (acute care) and urinary tract (rehabilitation). Fever episodes in both the acute and rehabilitation settings did not have an identifiable etiology in 66% and 56% of cases, respectively. In both the acute and rehabilitation setting, significant differences (P⬍.05) were found between identified versus unidentified fever etiology groups for mean maximal temperature (102.5°F vs 101.1°F on acute, 101.5°F vs 100.7°F on rehabilitation), duration of fever (10.3d vs 2.2d on acute, 2.8d vs 1.3d on rehabilitation), fevers above 101.4°F (75% vs 29% on acute, 40% vs 8% on rehabilitation), cause of injury (gunshot wound), and American Spinal Injury Association (ASIA) classification (ASIA grade A on rehabilitation). Conclusions: This study suggests that fevers occur frequently in patients with SCI, with respiratory and urinary tract etiologies being the most commonly identified. Specific causes are not always diagnosed, especially when associated with lower temperature elevation and shorter fever duration. Causation and completeness of injury may constitute risk factors. These factors should be taken into account when initiating cost-efficient fever workup and management of individuals with SCI. Key Words: Fever; Infection; Rehabilitation; Spinal cord injuries. Poster 207 Pattern of Injury and Recovery of Lumbosacral Roots in Cauda Equina Syndrome. HyunYoon Ko, MD, PhD (Pusan National University College of Medicine, Busan, Republic of Korea); Yong Beom Shin, MD, PhD; Hyun Choong Lee, MD, e-mail: [email protected]. Disclosure: None. Objective: To observe pattern of injury and neurologic recovery of the lumbosacral roots in patients with cauda equina syndrome. Design: Retrospective review of consecutive admissions of patients with cauda equina syndrome. Setting: University teaching hospital. Participants: 39 consecutive patients with cauda equina syndrome (28 men, 11 women; mean age, 40.8y) were evaluated. All traumatic cauda equina injuries (n⫽29) caused by spinal fracture of the lumbosacral spines. The nontraumatic cauda equina syndromes (n⫽10) consisted of spinal stenosis (n⫽4) and herniated lumbosacral disks (n⫽6). Interventions: Not applicable. Main Outcome Measures: We performed serial manual muscle tests of L2 to S1 key muscles and anal contraction examinations (S2-4) on patients with cauda equina syndrome. Kruskal-Wallis test was used to analyze rank of the involved roots and changes of muscle grade between initial admissions and final follow-ups (mean, 12.1mo). Results: In patients with traumatic cauda equina syndrome, the lower levels showed higher involvement than the upper level roots (P⬍.001). The upper roots were more involved in the nontraumatic cauda equina syndromes (P⬍.05). However, no significant differences in the severities and changes of muscle grades among the injured roots in the traumatic and nontraumatic cauda equina syndromes were found (P⬎.05). Conclusions: The results are strongly supporting that patterns of cauda equina syndrome caused by spinal fracture or nontraumatic lesions are related with typical organization of the lumbosacral roots in the spinal canal and direction of the injury. However, affecting factors showing no significant differences in the severity and recovery among the injured roots should be investigated. Key Words: Cauda equina syndrome; Recovery; Rehabilitation; Severity. Poster 208 A Wheelchair Seating System for Spinal Cord Injury Individuals With Decubitus Ulcers. Sanjeev Agarwal, MD (NUMC, East Meadow, NY); Lyn D. Weiss, MD; Thomas Pobre, MD; Arthur Ezra, PhD; Lee Jacknow, e-mail: [email protected]. Disclosure: None. Objective: To evaluate a seating system that would allow people suffering from decubitus ulcers to sit up while encouraging the ulcers to heal. Design: The alternating pressure relief wheelchair seating system (APRWS) consists of 6 slats that can completely remove seating pressure sequentially at all points of the seat every 3.5 minutes for a period of 8 seconds. In every cycle, the pressure relief starts in the front of the seat and moves sequentially to the rear removing the physical contact and therefore seating pressure at every point of the cushion. In addition to providing pressure relief, it also provides a massaging action in the direction of the ulcer, which is believed to stimulate blood flow toward the pressure ulcer allowing it to heal with the patient seated. Participants: The system was tested on 1 tetraplegic and 1 paraplegic individual living in a skilled nursing facility. Interventions: Not applicable. Main Outcome Measures: The pressure drops below the 32mmHg required to improve healing and allow for blood flow. Results: The seating system was tested on a 60-year-old diabetic tetraplegic with stage 4 ulcer measuring 5.3⫻1.6⫻4cm under ischial tuberosity. His ulcer healed completely in 700 cumulative hours. A 2.0⫻0.5⫻2cm wound under ischial tuberosity in a 40-year-old paraplegic individual with healed with approximately 190 hours of sitting. Conclusions: The alternating pressure relief wheelchair seating system appears to promote healing while giving the SCI patient an opportunity to sit up and thus preventing the adverse effects of prolonged bed rest. Key Words: Pressure ulcers; Rehabilitation; Seating system; Spinal cord injuries; Wheelchairs.

Poster 209 Utility of Creatinine Clearance in Persons With Spinal Cord Injury. Farhad Sepahpanah, MD (Medical College of Wisconsin, Milwaukee, WI), e-mail: [email protected]. Disclosure: None. Objective: To identify if creatinine clearance is a useful screening test to detect renal insufficiency in a spinal cord injury (SCI) population. Design: Retrospective chart review. Setting: Inpatient spinal cord injury unit at VA Puget Sound Health Care System. Participants: 70 randomly selected medical records were selected for review from among 664 veterans enrolled in the SCI clinic. All patient charts had to have at least 5 creatinine clearance tests performed within 10 years of the review. Interventions: Not applicable. Main Outcome Measures: Development of clinically

E41

apparent renal insufficiency and change in medical management of the patient, based on the results of the creatinine clearance test. Results: The results of 24-hour creatinine clearance were highly variable from 1 evaluation to the next. No medical management decisions were made based on the result of the 24-hour creatinine clearance. Results of serum creatinine and kidney ultrasound, along with the patient’s symptoms were the major factors in changing medical management with regard to renal function preservation. Conclusions: There is no benefit of the 24-hour urine creatinine clearance as a routine screening test for renal disease in SCI patients. Key Words: Creatinine clearance; Spinal cord injuries; Rehabilitation; Renal insufficiency. Poster 210 Relationship Between Abnormal Cardiovascular Control and Severity of Acute Spinal Cord Injury in Multicenter Study of 760 Patients. Andrei Krassioukov, MD, PhD (University of British Columbia, Vancouver, BC, Canada); Sagun Tuli, MD; Jayshree Tuli, MS; William Coleman, PhD; Fred Geisler, MD, e-mail: [email protected]. Disclosure: Krassioukov, Research Grant from Christopher Reeve Paralysis Foundation; Other authors: None. Objective: To examine the relationship between the severity of spinal cord injury (SCI), evaluated with the American Spinal Injury Association (ASIA) score, and cardiovascular parameters in the acute period of SCI. Design: Sygen multicenter randomized controlled trial. Participants: Total of 760 patients from 28 centers in North America were included into the study. Interventions: Not applicable. Main Outcome Measures: A post hoc analysis of data collected during Sygen study was conducted. Cardiovascular parameters were collected at 3 different time points of patients’ management: first emergency department, SCI acute care facility, and at the time of randomization. On average, the mean time lapsed since the injury to the last measurements was 6.2⫾10.6 hours. Results: The majority of included patients were men (80.1%; 609 men, 151 women). The median age of subjects was 30 years. Most individuals sustained cervical SCI. Initially, marked hypotension (109⫾22mmHg) and bradycardia (73⫾17bpm) were observed in individuals with severe cervical SCI (ASIA grades A and B, Pⱖ.03). Hemodynamic parameters in individuals with thoracic SCI were within the normal range (Pⱖ0.4). Baseline cardiovascular parameters taken at the time of randomization were improved significantly from the values recorded in the initial stages of SCI. For example, in individuals with complete cervical SCI, the mean systolic blood pressure, measured in first emergency department, increased significantly by 11% by the time of randomization. However, the hemodynamic parameters of individuals with the thoracic SCI did not show any changes. Conclusions: Marked hypotension with bradycardia was a predominant feature of the severe cervical SCI. Although with time after SCI, amelioration of the blood pressure was observed in these individuals, and bradycardia persisted to the time of randomization. Loss of sympathetic drive to the heart (T1-4) and predominant vagal control probably is a cause for this persistent low heart rate. Key Words: Cardiovascular control; Rehabilitation; Spinal cord injuries. Poster 211 Determination of the Neurologic Level Using Abdominal Electromyography in Lower Thoracic Spinal Cord Injury. Hyun-Yoon Ko, MD, PhD (Pusan National University College of Medicine, Busan, Republic of Korea); Hyun Joo Shon, MD; Yong Beom Shin, MD, PhD, e-mail: [email protected]. Disclosure: None. Objectives: To determine motor level of injury using abdominal electromyography and to compare it with the sensory level of injury in patients with lower thoracic spinal cord injury (SCI). Design: Prospective, descriptive study. Setting: University teaching hospital Participants: 13 consecutive patients with lower thoracic SCI (10 men, 3 women; mean age, 44.2) between T8 to T12. Intervention: The patients underwent needle electromyographic examinations of bilateral rectus abdominalis muscles, segmentally corresponding the sensory level defined in American Spinal Injury Association (ASIA) standards. Main Outcome Measures: The lowest level that is not disclosing abnormal spontaneous activities or significant abnormality in the recruitment pattern of the motor units in needle electromyography was defined as the motor level of injury. Differences of the motor and sensory level of injury were evaluated. Results: Neurologic levels of injury evaluated by ASIA standard were 1 at T8, 1 at T9, 6 at T10, 4 at T11, and 1 at T12. The motor level determined by abdominal electromyography was 1 or 2 levels higher (maximum 4 levels higher) compared with the sensory level in 20 (77.0%) (P⬍.05). 6 (23%) were the same in motor and sensory levels. There was no case with lower sensory level than motor level. Conclusions: This method applying abdominal electromyography in determining the motor level of injury in patients with lower thoracic spinal cord has a potential use. However, further investigation including anatomical study on segmental innervation to the rectus abdominalis is required to have more clarified determination of the motor level of injury in lower thoracic SCI. Key Words: Electromyography; Neurological level of injury; Rectus abdominalis; Rehabilitation.

Poster 212 A Bile Excretion Function by Scintigraphy in Patients With Spinal Cord Injury. Min-Cheol Joo (Wonkwang University Hospital, Iksan, Republic of Korea), e-mail: mcjoo@ wonkwang.ac.kr. Disclosure: None. Objective: To check whether bile juice excretion is delayed in patients with spinal cord injury (SCI). Setting: University hospital. Participants: 8 patients, who had been treated at our university hospital and who were completely injured in the higher than the T10 cords, and 8 able-bodied persons. Intervention: After non-per-oral 6 hours, the time activity curve was drawn with scintigraphy taken by 99mTc-DISIDA scanning. Main Outcome Measures: A fat diet was served, and then the time of 50% excretion (T1/2) of radiation and the ejection fraction were calculated in the interesting area of the gall bladder (GB). Results: The peak time in the time activity curve and the size of the GB at the moment were not significant. 30 minutes after a fat diet, the ejection fraction was 53.12⫾9.19 minutes in the patient group and 68.25⫾21.06 minutes in the control group (P⬎.05). The T1/2 was 27.45⫾.18 minutes in the patient group and 14.74⫾.46 minutes in the control group (P⬍.05). Conclusions: It represents the possibility that the delay of bile juice

Arch Phys Med Rehabil Vol 86, September 2005