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Polycystic Ovarian Syndrome (PCOS), Headache and Temporomandibular Degeneration (TMJ); A Case Study
Research Posters with patients. Most surveyed endorsed psychologists and physicians as the most valuable occupation for discussing sexual concerns (96% for both). The occupation that was endorsed the least in addressing sexual functioning was speech language pathology (61%) followed by recreational therapy (63%). Conclusions: This study sought to evaluate health care provider comfort level in addressing sexual functioning within an inpatient rehabilitation setting as well as the impact sexual education would have on increasing comfort. The findings are limited by the small sample size, which contributed to the non-significant results of the total SABS score. Nevertheless, results of the present study revealed that age was a potential factor, as younger providers were more comfortable addressing patient sexual functioning, regarding patient demographics, providers identified individuals with amputation as the population with the largest need to address sexual functioning during recovery. Potential concerns include changes in positioning during sexual performance and drastic change to the patients physical appearance, potentially affecting sexual functioning. Furthermore, psychologists and physicians were rated as the disciplines most suitable to address sexual functioning concerns during inpatient rehabilitation, while speech therapists and recreational therapists were rated as the least suitable discipline to address sexual functioning. Suggestions for future research include the assessment of patients concerns and attitudes regarding their sexual functioning and comfort in discussing issues with providers. Key Words: Sexual functioning, health care providers, rehabilitation Disclosures: None disclosed. Research Poster 699 Polycystic Ovarian Syndrome (PCOS), Headache and Temporomandibular Degeneration (TMJ); A Case Study Toni Hanson (Mayo Clinic), Rand Redfern Research Objectives: To increase early diagnosis and enhance collaborative management of PCOS related headaches and TMJ degeneration. Design: A case study format is employed. Setting: An outpatient clinical setting. Participants: The patient and her clinicians. Interventions: A 22 yo female was referred to clinic for evaluation and treatment of “migrainous headache”, facial and cervical pain. She had been treated with medications for head and neck pain. She was diagnosed with PCOS at age 17 and treated with birth control pills and Metformin. Her headaches, which began at age 13, had progressed despite medications. Her physical appearance did not fit the usual findings associated with PCOS. She had no central obesity and was not hirsute, so she would be considered “skinny” PCOS. She had orthodontic treatment at age 14 with a good cosmetic result. However, she noticed a gradual change in her dental occlusion with a progressive “open bite”. CT of the skull base and TMJs revealed degenerative changes of the mandibular condyles. MRI revealed dislocation of the articular discs, synovial tissue changes and effusion in the capsules. She was instructed in techniques to reduce the use/load on the injured joints. A protective maxillary brace was fabricated for mutually protective occlusion. The patient was instructed to wear the brace 24 hours per day with breaks for excellent dental hygiene. Physical therapy was initiated for muscular symptoms. Main Outcome Measure(s): A visual analogue scale was used for patient symptom assessment. Clinical palpation of the muscles of mastication (masseters, temporalis, anterior pterygoids and sternocleidomastoids) and range of motion assessment was conducted. A significant improvement in pain from 10/10 to 2-3/10 occurred, she was able to greatly reduce medication use and her quality of life improved, although she was not 100% compliant with brace use. Results: A clinical collaborative approach (DDS, gynecology, radiology and PMR) to a patient with PCOS, TMJ and head pain resulted in a significant improvement in the patient’s headaches, reduced TMJ stress, decreased her pain medication use and enhanced her quality of life. Conclusions: The role of hormonal imbalance on the TMJs needs to be further elucidated. Headaches in young girls/women may be an early sign of hormonal disturbance including PCOS. Increased awareness to establish
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e111 earlier diagnosis, appropriate management and decrease morbidity is a collaborative approach. Further research is clearly indicated. Key Words: Headache, Pain, Polycystic ovarian disease, Temporomandibular joints, Degenerative joint changes Disclosures: None disclosed. Research Poster 700 Identification of Traumatic Brain Injury in Spinal Cord Injury Across the Continuum of Care Seema Sikka (Baylor Institute for Rehabilitation), Librada Callender, Angela Vrooman, David Salisbury, Simon Driver, David Le Research Objectives: To explore how TBI is screened among SCI patients across the continuum of care. Design: Retrospective chart review. Setting: Emergency department, trauma, inpatient rehabilitation. Participants: 325 patients with SCI admitted to inpatient rehabilitation facility (IRF) between March 1, 2011 and December 31, 2014 were screened. 49 eligible subjects had a traumatic SCI and received care in the adjoining acute care (AC) hospital. Interventions: Not applicable. Main Outcome Measure(s): Demographic characteristics and variables that capture diagnosis of TBI/SCI included documentation from ambulance, emergency department, AC, and IRF which included ICD-9 codes, altered mental status, loss of consciousness (LOC), Glasgow Coma Score (GCS), Post Traumatic Amnesia (PTA), neuroimaging, and cognitive assessments. Results: Participants were male (81%), white (55%), privately insured (49%), and aged 39.318.0 years with 51% paraplegic and 49% tetraplegic. Mechanisms of injury were gunshot wound (31%), fall (29%), and motor vehicle accident (20%). TBI occurred in 65% of SCI individuals, and documentation of identification of TBI varied in AC H&P (29%), AC discharge note (24%), IRF H&P (29%), AC ICD-9 (37%), and IRF ICD-9 (30%). LOC was recorded in the ER note (22%), EMS report (14%), AC H&P (31%), and IRF H&P (33%). TBI was identified in AC CT imaging (20%). PTA was identified in the AC psychology note (20%). Cognitive assessments were performed on 16% of subjects. Conclusions: Documentation showed variability between AC and IRF and among disciplines. Imaging and GCS were more consistently documented than LOC and PTA. As a result, there is a need to standardize screening processes between AC and IRF to identify those that need specialized intervention. Processes identified to improve care among TBI/SCI individuals include standardizing screening and documentation so the TBI/ SCI treatment protocol can be activated across the continuum. Key Words: Spinal cord injury, traumatic brain injury, dual diagnosis Disclosures: None disclosed. Research Poster 701 Relationship of Hopkins Rehabilitation Engagement Rating Scale to Baseline Cognition and FIM Change in Acute Inpatient Stroke Rehabilitation Michael Taub (Weill Cornell Medicine) Research Objectives: To examine the relationship between patient engagement, baseline cognition, and functional outcome. Design: Correlative, retrospective analysis of clinical database. Setting: Inpatient rehabilitation unit (IRU) in an academic medical center. Participants: We examined 251 persons with stroke on the IRU, of whom 126 had complete data (50.2%). Those subjects included tended to be closer to date of stroke, had lower National Institute of Health Stroke Scale (NIHSS) scores, higher Montreal Cognitive Assessment (MoCA) scores, mean age of 68.1 (SDZ15.3), NIHSS of 6.4 (SDZ6.0), 8.5 days post-stroke (SDZ7.7), and rehabilitation length of stay (LOS) of 15 days (SDZ8.1), with 82.5% having an ischemic, and 71.4% having their first stroke. Interventions: N/A.
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e111 earlier diagnosis, appropriate management and decrease morbidity is a collaborative approach. Further research is clearly indicated. Key Words: Headache, Pain, Polycystic ovarian disease, Temporomandibular joints, Degenerative joint changes Disclosures: None disclosed. Research Poster 700 Identification of Traumatic Brain Injury in Spinal Cord Injury Across the Continuum of Care Seema Sikka (Baylor Institute for Rehabilitation), Librada Callender, Angela Vrooman, David Salisbury, Simon Driver, David Le Research Objectives: To explore how TBI is screened among SCI patients across the continuum of care. Design: Retrospective chart review. Setting: Emergency department, trauma, inpatient rehabilitation. Participants: 325 patients with SCI admitted to inpatient rehabilitation facility (IRF) between March 1, 2011 and December 31, 2014 were screened. 49 eligible subjects had a traumatic SCI and received care in the adjoining acute care (AC) hospital. Interventions: Not applicable. Main Outcome Measure(s): Demographic characteristics and variables that capture diagnosis of TBI/SCI included documentation from ambulance, emergency department, AC, and IRF which included ICD-9 codes, altered mental status, loss of consciousness (LOC), Glasgow Coma Score (GCS), Post Traumatic Amnesia (PTA), neuroimaging, and cognitive assessments. Results: Participants were male (81%), white (55%), privately insured (49%), and aged 39.318.0 years with 51% paraplegic and 49% tetraplegic. Mechanisms of injury were gunshot wound (31%), fall (29%), and motor vehicle accident (20%). TBI occurred in 65% of SCI individuals, and documentation of identification of TBI varied in AC H&P (29%), AC discharge note (24%), IRF H&P (29%), AC ICD-9 (37%), and IRF ICD-9 (30%). LOC was recorded in the ER note (22%), EMS report (14%), AC H&P (31%), and IRF H&P (33%). TBI was identified in AC CT imaging (20%). PTA was identified in the AC psychology note (20%). Cognitive assessments were performed on 16% of subjects. Conclusions: Documentation showed variability between AC and IRF and among disciplines. Imaging and GCS were more consistently documented than LOC and PTA. As a result, there is a need to standardize screening processes between AC and IRF to identify those that need specialized intervention. Processes identified to improve care among TBI/SCI individuals include standardizing screening and documentation so the TBI/ SCI treatment protocol can be activated across the continuum. Key Words: Spinal cord injury, traumatic brain injury, dual diagnosis Disclosures: None disclosed. Research Poster 701 Relationship of Hopkins Rehabilitation Engagement Rating Scale to Baseline Cognition and FIM Change in Acute Inpatient Stroke Rehabilitation Michael Taub (Weill Cornell Medicine) Research Objectives: To examine the relationship between patient engagement, baseline cognition, and functional outcome. Design: Correlative, retrospective analysis of clinical database. Setting: Inpatient rehabilitation unit (IRU) in an academic medical center. Participants: We examined 251 persons with stroke on the IRU, of whom 126 had complete data (50.2%). Those subjects included tended to be closer to date of stroke, had lower National Institute of Health Stroke Scale (NIHSS) scores, higher Montreal Cognitive Assessment (MoCA) scores, mean age of 68.1 (SDZ15.3), NIHSS of 6.4 (SDZ6.0), 8.5 days post-stroke (SDZ7.7), and rehabilitation length of stay (LOS) of 15 days (SDZ8.1), with 82.5% having an ischemic, and 71.4% having their first stroke. Interventions: N/A.