Abstract 13

A3 Intervention: All participants were treated with intranasal desmopressin, 10␮g daily at bedtime for 4 weeks. Main Outcome Measures: Total volume of daily nocturnal incontinence and serum electrolytes. Maximal bladder capacities were measured by urodynamic evaluation. Results: After intranasal desmopressin inhalation, mean volume of nocturnal incontinence decreased significantly in the large bladder capacity group (P⬍.05), but not in the small bladder capacity group (P⬎.05). The mean maximal bladder capacity of responders was larger than that of nonresponders (P⬍.05). Neither hyponatremia nor serum electrolytes abnormalities occurred. Conclusions: Intranasal desmopressin inhalation is safe and effective in symptomatic management of neurogenic bladder dysfunction in selected patients with SCI. Maximal bladder capacity is a valuable predictor of response to desmopressin. Key Words: Bladder capacity; Desmopressin; Neurogenic bladder; Rehabilitation; Spinal cord injuries. Abstract 10 Standing Induced Via Segmental Reflex Pathways of Persons With Spinal Paralysis: A Case Series. John G. Gianutsos, PhD (NYU School of Medicine, New York, NY); Joan T. Gold, MD; Michael Hutchinson, MD, PhD; Edwin F. Richter, MD; Jung H. Ahn, MD; Mitchell Batavia, PhD, e-mail: gianuj01popmail.med.nyu.edu. Disclosure: None. Setting: Urban hospital. Patients: 12 persons with paralysis of spinal origin. Case Description: Reflex standing is induced by means of whole body vibration in persons with paralysis of spinal origin. A case series of persons who had paralysis due to spinal infection, paraplegia after traumatic injury at the thoracic and lumbar levels, or quadriplegia after cervical trauma. Subjects were 1 year postonset, had stable skeletal systems, and tone in the thighs. Subjects reflexively stood on a vibratory device as muscles contracted and relaxed in response to segmental reflex loops triggered by vibration delivered at amplitudes ranging from 0 to 5.1mm, and frequencies ranging from 0 to 28Hz. Assessment/Results: Standing time with and without vibratory stimulaton; degree of volitional movement in trunk and limbs; and carry-over to voluntary standing and walking. Subjects were able to stand for periods (up to 30min) with vibration and for brief periods (1–3min) after vibration ceased. Some patients recovered the ability to stand and to ambulate. Discussion: Long periods of immobility and loss of sensation can produce skin breakdown with fatal consequences if left untreated. A sedentary life style resulting from a loss of voluntary movement and sensation may aggravate existing dysfunction of the bowel and bladder and lead to constipation and urinary infection, as well as increased vulnerability to pneumonia and respiratory infection. Spinal cord injury increases the vulnerability to chronic conditions such as cardiovascular disease, diabetes, and osteoporosis. Fitness has been improved through treadmill-induced reflex walking in humans for 2 decades. Likewise, the act of standing, be it for brief periods, benefits patients physically and provides a source of emotional, psychologic, and social satisfaction. Conclusion: Vibratory-induced standing represents a promising modality for use in the rehabilitation of persons with motor dysfunction of spinal origin. Key Words: Reflex; Rehabilitation; Spinal paralysis. Abstract 11 Effect of Medical Complications on Return to Work After Spinal Cord Injury. Henry E. Bridges Jr, MD (Medical College of Virginia, Richmond, VA); William O. McKinley, MD; David W. Hess, PhD, e-mail: [email protected]. Disclosure: None. Objective: To determine the effect of medical complications on return to work after spinal cord injury (SCI). Design: Retrospective analysis of case series. Setting: Multicenter study of national database of 20 Spinal Cord Injury Model Systems centers. Participants: Patients 18 to 55 years of age, admitted for acute SCI, and who were employed prior to injury. Interventions: Not applicable. Main Outcome Measure: Employment status. An analysis was performed of data collected at 1, 3, and 5 years postinjury for patients grouped as paraplegia (complete and incomplete) and tetraplegia (complete and incomplete). Categorical data (bladder management, grade of pressure ulcers, pulmonary embolism, deep vein thrombosis) was reduced to either present or not present, and analyzed using the Mann-Whitney U test for nonparametric data. Number of pressures ulcers was analyzed using a t test. Logistic regression was used to determine if the above variables had predictive power regarding employment status. Results: The incidence of return to work after SCI was 27%, 20%, and 23% at years 1, 3, and 5, respectively. Persons who returned to work at year 1 were less likely (P⬍.05) to have pressure ulcers. Persons who returned to work at year 3 were more likely (P⬍.05) to have normal bladder management. Logistic regression analysis revealed that only bladder management was significantly (P⬍.01) predictive of employment status at year 3 (for individuals with incomplete paraplegia or tetraplegia) and at year 5 (incomplete tetraplegia). Conclusions: Return to work rates after SCI were consistent with previous research. This study suggests that medical complications (eg, pressure ulcers, bladder management) which are associated with employability, will vary with time after injury and severity of injury. Further research is required to understand more fully the psychosocial implications of medical complications and how they affect employability after SCI. Key Words: Employment; Medical complications; Rehabilitation; Spinal cord injuries.

Abstract 12 Small Heat Shock Protein Gene Therapy to Protect Damaged Spinal Cord from Secondary Injury. Gary G. Wang, MD, PhD (SUNY Upstate Medical University, Syracuse, NY); Yaming Wang, MD, MSc; Le Zhang, MD, PhD; Sucharita Saha, MSc; Robert J. Weber, MD; Dennis J. Stelzner, PhD, e-mail: [email protected]. Disclosure: None. Objective: To test the hypothesis that overexpression of small heat shock protein (Hsp27) after spinal cord lesion protects neural cells from secondary injury. Design: Gene therapy study on animal models. Setting: Academic research center. Animals: Rats. Interventions: Not applicable. Main Outcome Measures: Clone human Hsp27 complementary deoxyribonucleic acid into a neural tropic recombinant herpes simples and adeno-associated virus hybrid vector; prepare amplicons carrying Hsp27 and green fluorescent protein (GFP) genes; induce rat spinal cord injury by weight-drop apparatus (10g, 25mm); microinject the injured and uninjured spinal cords with Hsp27

amplicons with GFP amplicons and saline as a control; observe the spinal cord target gene expressions, histology reaction, and neuron survival; and perform immunohistochemistry studies as well as apoptosis assay. Results: Hours after injection, obvious target gene expression was observed. The expression peaked at 48 hours and was quite constant, lasting ⬎8 weeks. The expression area was mainly around the site of injection. No obvious local inflammatory reaction induced any amplicons. Protective signs of neural tissue were observed in the Hsp27 group. 2 weeks after the contusion, about 30% more neurons survived around the lesion area in the Hsp27 therapy group than in the controls. Many Hsp27 labeled axon-like processes were found around the lesion site. There were fewer cells with apoptosis markers around the injury area in the Hsp27 group. The differences showed statistical significance. Conclusion: Hsp27 gene therapy may limit secondary injury in the rat spinal lesion model. Further studies on the underlying mechanisms and functional outcomes are suggested. Key Words: Gene therapy; Heat shock proteins; Rehabilitation; Spinal cord injuries.

10:30

Saturday, October 11, 2003 Continental A–Lobby Level

AM–12:00 PM,

Electrodiagnosis/Musculoskeletal Abstract 13 Use of Electromyography to Predict Functional Outcome After Epidural Spinal Injections for Lumbar Radiculopathy. David E. Fish, MD, MPH (UCLA School of Medicine, Los Angeles, CA); Pejman Shirazy, MD; Quynh Pham, MD, e-mail: [email protected]. Disclosure: None. Objective: To determine if electromyographic diagnostic evaluation can predict functional outcome in patients undergoing lumbar spinal injections. Design: Retrospective study of functional outcome in patients undergoing lumbar interforaminal epidural spinal injections (ESIs) after electromyographic testing. Setting: Clinic. Participants: 39 subjects with low back pain with radicular symptoms into the lower extremity were evaluated for functional improvement after electromyography and ESI. Interventions: Fluoroscopic guidance of interforaminal ESI in the lumbar region was performed where positive clinical or electromyographic levels were suspected. Main Outcome Measures: Oswestry Disability Index (ODI) and Verbal Rating Scale (VRS) for current pain severity. Results: Electromyography diagnosed 18 patients with a radiculopathy; 21 had a normal or negative examination. Patients were followed postinjection on average for 10.8⫾3.9 weeks. Pretreatment ODI scores ⫾ SD did not differ significantly between groups showing positive radiculopathy (72.3⫾12.7) or negative electromyographic findings (65.9⫾18.6) (P⬎.05). There was significantly greater improvement of ODI rating for electromyography positive radiculopathy (7.11⫾9.5) compared with negative electromyography (3.2⫾17.4) (P⬍.05). Positive radiculopathy subjects complained of more pain as measured on the VRS before ESI (8.1⫾1.0) than subjects with negative electromyographic findings (7.3⫾0.8) (P⬎.05). The VRS mean improvement did not differ significantly between the positive electromyography group (1.8⫾1.2) and the negative electromyography group (1.2⫾1.2) (P⬎.05). Conclusions: Subjects undergoing interforaminal ESI, who had a positive radiculopathy by electromyography prior to injection, showed significant improvement in functional outcome as measured by the ODI but not as measured by current pain intensity on the VRS. This study showed the importance and diagnostic value of electromyography for radiculopathy evaluation prior to spinal procedures and the difficulty of pain evaluation outcome by using the VRS. Key Words: Electromyography; Epidural; Radiculopathy; Rehabilitation.

Abstract 14 The Utility of Proximal Motor Latency in Ulnar Neuropathy at the Elbow. Ali Shakir, MD (Univeristy of Washington, Seattle, WA); Paula Micklesen, BS; Lawrence Robinson, MD, e-mail: [email protected]. Disclosure: None. Objective: To study sensitivity and specificity of above-elbow motor latency recorded at abductor digiti minimi (ADM) and first dorsal interosseous (FDI) in screening for ulnar neuropathy at the elbow (UNE). Design: Retrospective review of electrophysiologic data. Setting: Electromyography laboratory of a university hospital. Participants: Subjects having undergone ulnar motor conduction studies that included above-elbow motor latency simultaneously recorded at the ADM and FDI. Our “true-positive” group consisted of 74 subjects with the diagnosis of UNE. Our “true-negative” group consisted of 42 subjects with the diagnosis of carpal tunnel syndrome (CTS) and without clinical UNE. Diagnoses were based on clinical presentation and electrodiagnostic data. Interventions: Not applicable. Main Outcome Measures: Ulnar motor latency data were reviewed. Distribution curves constructed of above-elbow ulnar motor latency (AE-UML) recorded at the ADM and FDI. Receiver operator characteristic curves constructed to graphically represent the relationship between sensitivity and specificity as a function of the cutoff value for normal latency. Results: The mean AE-UML for the UNE group was 11.0ms at the ADM, 11.6ms at the FDI, and 11.3ms at the average of the ADM and FDI (COMB-ADM⫹FDI). The mean AE-UML for the CTS group was 8.6ms at the ADM, 9.2ms at the FDI, and 8.9ms at the COMB-ADM⫹FDI. The AE-UML cutoff to give 95% sensitivity was 7.9ms at the ADM, 8.4ms at the FDI, and 8.3ms at the COMB-ADM⫹FDI. The specificities were 24% at the ADM, 26% at the FDI, and 29% at the COMB-ADM⫹FDI. Conclusions: The AE-UML can be used as a highly sensitive screen in the electrodiagnostic evaluation of patients with possible UNE; however, its low specificity means that many of the patients undergoing full ulnar nerve testing will have normal studies. Recordings at the ADM and the FDI, as well as their average, resulted in similar specificities. Key Words: Electrodiagnosis; Rehabilitation; Ulnar neuropathies.

Arch Phys Med Rehabil Vol 84, September 2003