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Poster 11 A Rare Case of Chronic Inflammatory Demyelinating Polyneuropathy in the Setting of SLE: A Case Report
S164
Abstracts / PM R 8 (2016) S151-S332
Discussion: This is the first functionally relevant reported case, to our knowledge, of HO in the hips following lung transplant. There is one prior report of bilateral HO in the gluteus minimus found incidentally in a patient with no symptoms or movement limitation. Conclusions: Prolonged ICU stay post lung transplant should be investigated as a risk factor/cause of HO. Here vascular access for ECMO may have been a trigger for HO, but that was only unilateral. HO should be screened for in this population as more treatments become available. Level of Evidence: Level V Poster 10 Successful Rehabilitation Outcome from Rare Brain Tumor (Intracranial Follicular Dendritic Cell Sarcoma): A Case Report Brian W. Lee, DO (Albert Einstein College of Medicine, New York, New York, United States), Steve A. Sparr, MD, Grigory Syrkin, MD Disclosures: Brian Lee: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 62-year-old woman was admitted for frequent falls, difficult performing daily tasks and gradual onset of waxing and waning confusion/headache for 4 months. MRI and CT of the brain showed right frontal multifocal dural based masses with acute hemorrhage. She underwent craniotomy and resection of the frontal masses. The rehabilitation team provided therapy programs and the patient was ultimately able to ambulate 200 feet without devices and was able to go up and down with a handrail with modified independence. Patient’s memory and cognition also significantly improved. Setting: Tertiary Medical Center. Results: A month after discharge from inpatient rehabilitation, the final biopsy result confirmed intracranial follicular dendritic cell sarcoma (FDCS). Even though MRI showed metastatic-like lesions, it turned out to be multi-centric primary lesions of the dura, right frontal lobar region. As an outpatient, the patient learned to compensate for paratonic gait pattern with more hip flexion on swinging side (steppage gait). She subsequently developed another regrowth of FDCS at the same site but there was no associated cognitive-motor decline after surgery. Discussion: This is only the third case of primary FDCS found in the dura matter reported in the USA and, to our knowledge, the first case to apply rehabilitation. FDCS is a malignant neoplasm usually present with cervical or axillary lymphadenopathy. Lymphedema is very frequent after chemotherapy and radiation. However, our patient did not develop significant edema and had successful rehabilitation outcomes. The patient will require close follow-up to monitor for possible regrowth of tumor and side effects of chemotherapy-radiation. Conclusions: Even though FDCS is usually nodal disease, it can be found as a primary intracranial lesion. Early rehabilitation can lead to better outcome for intracranial FDCS. Level of Evidence: Level V Poster 11 A Rare Case of Chronic Inflammatory Demyelinating Polyneuropathy in the Setting of SLE: A Case Report Totka Koutzeva, MD (Montefiore Medical Center, Bronx, New York, United States), John S. Georgy, MD, MBA, Francis J. Lopez, MD Disclosures: Totka Koutzeva: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 24-year-old woman, recently diagnosed with SLE and ITP presented with worsening proximal > distal weakness of upper and lower extremities along with difficulty swallowing and blurry vision for 3-4 weeks. She subsequently developed worsening muscular weakness and respiratory distress and required intubation for imminent respiratory failure. PEG tube was placed for adequate nutrition. Because of the progressive nature of her weakness a diagnosis of Guillain-Barre ´ / CIDP syndrome in the setting of an SLE was made and led to treatment with pulse steroids, IVIG and
plasmapheresis. Treatment with Mycophenolate Mofetil (CellCeptÒ) was started and oral prednisone was continued. IVIG was scheduled monthly to prevent further exacerbations. On admission to acute inpatient rehab, patient was unable to ambulate and required max assist of 2 for ADLs. Physical exam was notable for 2/5 strength in upper extremities except 0/5 in wrist and hand intrinsics, and 1/5 in lower extremities. The patient had a prolonged stay in acute inpatient rehabilitation, progressively improved and was discharged with modified independence with ambulation and min assist with ADLs. Setting: Acute inpatient rehabilitation unit. Results: An MRI of the brain and spine showed abnormal nerve roots and cauda equina enhancement. An EMG was consistent with sensory motor demyelinating polyneuropathy. Discussion: Chronic inflammatory demyelinating polyneuropathy (CIDP) considered the chronic equivalent of Guillain-Barre ´ syndrome, is an uncommon sequelae of SLE flares. CIDP in the setting of SLE can have devastating functional consequences and must be identified, addressed, and treated early in the onset. Doing so will allow the optimization of function in the acute inpatient rehab setting. Conclusions: Although rare, CIDP in the setting of an SLE flare must be identified, addressed, and treated. Physiatry management of the comprehensive rehabilitation program including nutrition, speech, physical and occupational therapy is essential to maximize functional outcome and quality of life. Level of Evidence: Level V Poster 12 Three-Dimensional (3D) Printed Prosthetics Offer Functional Improvement in Individuals with Upper Extremity Limb Loss: A Case Series Cesar Colasante, MD (Jacobi Medical Center, Bronx, NY, United States), Kyle Silva, DO, Yuxi Chen, MD, Matthew N. Bartels, MD, MPH Disclosures: Cesar Colasante: I Have No Relevant Financial Relationships To Disclose Objective: To determine if the use of custom, in-house, 3D printed prostheses offer functional improvement for patients with upper extremity limb loss. Design: Prospective Case Series. Setting: Academic Medical System. Participants: Patients with upper extremity limb loss that received a custom-made, 3D printed prosthesis n¼4 (still recruiting). Interventions: Each prosthesis was designed and/or modified using Computer Assisted Design (CAD) which allowed for the design to be custombuilt for each patient depending on their functional limitations. The Upper Extremity Functional Index (UEFI) was administered prior to the placement of the 3D printed upper extremity prosthesis and post-placement of the prosthesis at set intervals (1 week, 1 month and 3 months). Orthotics and Prosthetics Userse Survey (OPUS) and the Trinity Amputation and Prosthesis Experience Scales (TAPES) were also administered. Main Outcome Measures: Upper Extremity Functional Index (UEFI), Orthotics and Prosthetics Userse Survey (OPUS) and the Trinity Amputation and Prosthesis Experience Scales (TAPES). Results: 3D printed prostheses improve the functional status of patients with partial upper limb loss. UEFI score prior to prosthesis 28-70. UEFI changed approximately +5% one week after implantation of the device. Conclusions: Our data suggest that custom, in-house 3D printed prostheses are an inexpensive option for mildly improving the quality of life and independence for patients with partial upper extremity limb loss, either as a temporary prosthesis, bridge to a permanent prosthesis or as a permanent device for those without access to prosthetic care. Issues with functionality and possible sores created from the prosthesis need to be addressed to improve further outcomes. It is our hope that 3D printing will improve patient access to prosthetics on a global level and significantly reduce the cost of prosthetic care; all without compromising functionality. Level of Evidence: Level IV
Abstracts / PM R 8 (2016) S151-S332
Discussion: This is the first functionally relevant reported case, to our knowledge, of HO in the hips following lung transplant. There is one prior report of bilateral HO in the gluteus minimus found incidentally in a patient with no symptoms or movement limitation. Conclusions: Prolonged ICU stay post lung transplant should be investigated as a risk factor/cause of HO. Here vascular access for ECMO may have been a trigger for HO, but that was only unilateral. HO should be screened for in this population as more treatments become available. Level of Evidence: Level V Poster 10 Successful Rehabilitation Outcome from Rare Brain Tumor (Intracranial Follicular Dendritic Cell Sarcoma): A Case Report Brian W. Lee, DO (Albert Einstein College of Medicine, New York, New York, United States), Steve A. Sparr, MD, Grigory Syrkin, MD Disclosures: Brian Lee: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 62-year-old woman was admitted for frequent falls, difficult performing daily tasks and gradual onset of waxing and waning confusion/headache for 4 months. MRI and CT of the brain showed right frontal multifocal dural based masses with acute hemorrhage. She underwent craniotomy and resection of the frontal masses. The rehabilitation team provided therapy programs and the patient was ultimately able to ambulate 200 feet without devices and was able to go up and down with a handrail with modified independence. Patient’s memory and cognition also significantly improved. Setting: Tertiary Medical Center. Results: A month after discharge from inpatient rehabilitation, the final biopsy result confirmed intracranial follicular dendritic cell sarcoma (FDCS). Even though MRI showed metastatic-like lesions, it turned out to be multi-centric primary lesions of the dura, right frontal lobar region. As an outpatient, the patient learned to compensate for paratonic gait pattern with more hip flexion on swinging side (steppage gait). She subsequently developed another regrowth of FDCS at the same site but there was no associated cognitive-motor decline after surgery. Discussion: This is only the third case of primary FDCS found in the dura matter reported in the USA and, to our knowledge, the first case to apply rehabilitation. FDCS is a malignant neoplasm usually present with cervical or axillary lymphadenopathy. Lymphedema is very frequent after chemotherapy and radiation. However, our patient did not develop significant edema and had successful rehabilitation outcomes. The patient will require close follow-up to monitor for possible regrowth of tumor and side effects of chemotherapy-radiation. Conclusions: Even though FDCS is usually nodal disease, it can be found as a primary intracranial lesion. Early rehabilitation can lead to better outcome for intracranial FDCS. Level of Evidence: Level V Poster 11 A Rare Case of Chronic Inflammatory Demyelinating Polyneuropathy in the Setting of SLE: A Case Report Totka Koutzeva, MD (Montefiore Medical Center, Bronx, New York, United States), John S. Georgy, MD, MBA, Francis J. Lopez, MD Disclosures: Totka Koutzeva: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 24-year-old woman, recently diagnosed with SLE and ITP presented with worsening proximal > distal weakness of upper and lower extremities along with difficulty swallowing and blurry vision for 3-4 weeks. She subsequently developed worsening muscular weakness and respiratory distress and required intubation for imminent respiratory failure. PEG tube was placed for adequate nutrition. Because of the progressive nature of her weakness a diagnosis of Guillain-Barre ´ / CIDP syndrome in the setting of an SLE was made and led to treatment with pulse steroids, IVIG and
plasmapheresis. Treatment with Mycophenolate Mofetil (CellCeptÒ) was started and oral prednisone was continued. IVIG was scheduled monthly to prevent further exacerbations. On admission to acute inpatient rehab, patient was unable to ambulate and required max assist of 2 for ADLs. Physical exam was notable for 2/5 strength in upper extremities except 0/5 in wrist and hand intrinsics, and 1/5 in lower extremities. The patient had a prolonged stay in acute inpatient rehabilitation, progressively improved and was discharged with modified independence with ambulation and min assist with ADLs. Setting: Acute inpatient rehabilitation unit. Results: An MRI of the brain and spine showed abnormal nerve roots and cauda equina enhancement. An EMG was consistent with sensory motor demyelinating polyneuropathy. Discussion: Chronic inflammatory demyelinating polyneuropathy (CIDP) considered the chronic equivalent of Guillain-Barre ´ syndrome, is an uncommon sequelae of SLE flares. CIDP in the setting of SLE can have devastating functional consequences and must be identified, addressed, and treated early in the onset. Doing so will allow the optimization of function in the acute inpatient rehab setting. Conclusions: Although rare, CIDP in the setting of an SLE flare must be identified, addressed, and treated. Physiatry management of the comprehensive rehabilitation program including nutrition, speech, physical and occupational therapy is essential to maximize functional outcome and quality of life. Level of Evidence: Level V Poster 12 Three-Dimensional (3D) Printed Prosthetics Offer Functional Improvement in Individuals with Upper Extremity Limb Loss: A Case Series Cesar Colasante, MD (Jacobi Medical Center, Bronx, NY, United States), Kyle Silva, DO, Yuxi Chen, MD, Matthew N. Bartels, MD, MPH Disclosures: Cesar Colasante: I Have No Relevant Financial Relationships To Disclose Objective: To determine if the use of custom, in-house, 3D printed prostheses offer functional improvement for patients with upper extremity limb loss. Design: Prospective Case Series. Setting: Academic Medical System. Participants: Patients with upper extremity limb loss that received a custom-made, 3D printed prosthesis n¼4 (still recruiting). Interventions: Each prosthesis was designed and/or modified using Computer Assisted Design (CAD) which allowed for the design to be custombuilt for each patient depending on their functional limitations. The Upper Extremity Functional Index (UEFI) was administered prior to the placement of the 3D printed upper extremity prosthesis and post-placement of the prosthesis at set intervals (1 week, 1 month and 3 months). Orthotics and Prosthetics Userse Survey (OPUS) and the Trinity Amputation and Prosthesis Experience Scales (TAPES) were also administered. Main Outcome Measures: Upper Extremity Functional Index (UEFI), Orthotics and Prosthetics Userse Survey (OPUS) and the Trinity Amputation and Prosthesis Experience Scales (TAPES). Results: 3D printed prostheses improve the functional status of patients with partial upper limb loss. UEFI score prior to prosthesis 28-70. UEFI changed approximately +5% one week after implantation of the device. Conclusions: Our data suggest that custom, in-house 3D printed prostheses are an inexpensive option for mildly improving the quality of life and independence for patients with partial upper extremity limb loss, either as a temporary prosthesis, bridge to a permanent prosthesis or as a permanent device for those without access to prosthetic care. Issues with functionality and possible sores created from the prosthesis need to be addressed to improve further outcomes. It is our hope that 3D printing will improve patient access to prosthetics on a global level and significantly reduce the cost of prosthetic care; all without compromising functionality. Level of Evidence: Level IV