- Email: [email protected]
Poster 194: Handicapped Parking: A Privilege or a Right?
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
further investigation, deoxyribonucleic acid (DNA) sequencing is underway. We plan to present DNA sequencing of collagen type VI from this patient to identify an abnormality in collagen type VI synthesis. This could explain the phenotype of Bethlem myopathy in this patient despite the presence of collagen type VI on muscle biopsy. If no mutation is found, we can then present a new case of Bethlem myopathy phenotype without collagen type VI abnormality. Conclusions: Bethlem myopathy is a slowly progressive muscle disorder that is inherited through autosomal dominance. To correctly diagnose this patient, genetic sequencing is being done because of the presence of collagen type VI on muscle biopsy. This information will be useful for physicians caring for children and adults with myopathies. This diagnosis could have been missed if only the muscle biopsy had been utilized. A correct diagnosis is needed in order to educate patients with Bethlem myopathy about their diagnosis, future quality of life expectations, and the risk of passing this disorder onto their children. We will show that DNA sequencing should be done for patients with clinical signs of Bethlem myopathy but with presence of collagen type VI on muscle biopsy. Key Words: Contracture; Myopathy; Rehabilitation. Poster 192 Gadolinium-Induced Nephrogenic Systemic Fibrosis and Rehabilitation Management: A Case Report. Paulinder S. Rai, DO, MPH (SUNY Downstate [SUNY Health Science Center at Brooklyn], New York, NY); Melissa Kong, MS; Jack A. Mensch, MD. Disclosures: M. Kong, none; J.A. Mensch, none; P.S. Rai, none. Setting: University academic teaching hospital. Patient: 41-yearold woman. Case Description: The patient with medical history significant for end-stage renal disease on hemodialysis, with anemia, hypertension, pulmonary embolism, and asthma presented to the emergency department with complaint of lightheadedness. Patient underwent magnetic resonance imaging (MRI) with intravenous gadolinium as part of neurological workup. Within several weeks patient began developing progressive skin changes and muscle stiffness. Muscle biopsy confirmed the diagnosis of nephrogenic systemic fibrosis. Results: A rehabilitation team was consulted for evaluation and treatment. The patient had significant functional improvement after intensive inpatient and outpatient rehabilitation. Conclusions: Nephrogenic systemic fibrosis is a serious systemic disease that has been linked to exposure to gadolinium during MRI. Gadolinium-containing contrast agents should be used only if clearly necessary in patients with renal failure. The physical consequences of fibrosis of skin and muscle tissues can lead to severe impairments in physical functioning for affected patients. The aggressive rehabilitation management of patients diagnosed with nephrogenic systemic fibrosis is a critical part of the treatment process. Key Words: Gadolinium; Rehabilitation. Poster 193 Goal Setting During Inpatient Rehabilitation: A Pilot Evaluation of Function and Length of Stay. Patrick Kortebein, MD (University of Arkansas, Little Rock, AR); David C. Culver, DO; Horace J. Spencer, MS. Disclosure: D.C. Culver, none; P. Kortebein, none; H.J. Spencer, none. Objective: To determine the accuracy of FIM goal setting and estimated length of stay (LOS) during acute inpatient rehabilitation. The FIM is the standard method of assessing functional change during acute inpatient rehabilitation. A FIM rating evaluation is performed at admission and discharge. The admitting therapist(s) develop FIM goals at admission. Similarly, the admitting physicians make an estimate, in days (LOS), of how long they feel the patient will need acute inpatient rehabilitation. However, it is not known how accurate ther-
E83
apists and physicians are at predicting FIM goals and LOS, respectively. Design: Retrospective chart review of patients admitted for acute inpatient rehabilitation between January 1, 2007 and February 28, 2007. FIM goal ratings and estimated LOS from admission were compared with actual discharge FIM ratings and actual LOS (days). Setting: Private inpatient rehabilitation facility. Participants: The charts of 334 adults were reviewed. Patients who died or were transferred during inpatient rehabilitation were excluded. Interventions: Not applicable. Main Outcome Measures: (1) FIM ratings: A total FIM rating difference of greater than 6 between the FIM admission goal and the actual discharge FIM rating was considered significant. (2) LOS: A difference of greater than 30% between maximum estimated LOS and actual LOS was considered significant. Statistics: Wilcoxon signed-rank test. Results: Total FIM rating goals did not differ significantly from actual discharge FIM ratings (9⫾19 and 87⫾23). The same nonsignificant relationship was noted for LOS (estimated: 13⫾6d, actual: 12⫾8d). Conclusions: Our findings indicate that rehabilitation thereapists and physicians of a single private inpatient rehabilitation facility are relatively accurate in developing functional goals and LOS for patients admitted for acute inpatient rehabilitation. This should be reassuring information for patients’ families and third party payors. Key Words: Function; Rehabilitation; Therapy. Poster 194 Handicapped Parking: A Privilege or a Right? Matthew Grimm, MD (Beaumont Hospital, Birmingham, MI); Myron M. LaBan, MD, MMsc. Disclosure: M. Grimm, none; M.M. LaBan, none. Objective: A survey of local communities and their law enforcement administrators to ascertain the level of abuse of the handicappedparking privilege. Design: Following a review of both national and state guidelines for issuing disability parking placards, police officials were interviewed relative to problems of enforcement. Setting: 3 cities. Participants: Prescribing physicians, police officials, and disabled patients. Interventions: Not applicable. Main Outcome Measures: For the 3 cities surveyed, the annual number of overall trafficrelated violations remained constant over the last 7 years. Handicapped parking tickets as a percentage of the whole during this period also remained relatively unchanged. Conclusions: On an annual basis, an estimated one third of all the disability placards are being used by the nondisabled. Although an acknowledged problem that is rapidly increasing by an aging population as the 79 million boomers grow older, enforcement, as this review suggests, remains a critical issue. A reallocation of significant enforcement resources, including police personnel, improved technologic resources, and increased penalties, would expedite this process. Public education, as well as targeting, those physicians who signed the initial and subsequent renewals for disabled parking placards, are also critical to dealing with this problem. Key Words: Rehabilitation. Poster 195 Health Literacy and Parkinson Disease: A Prospective Analysis. Ryan Wetzel, MD (Virginia Commonwealth University, Richmond, VA); William Carne, PhD; David X. Cifu, MD; Patrick Jehle, PhD. Disclosure: W. Carne, none; D.X. Cifu, none; P. Jehle, none; R. Wetzel, none. Objective: Health literacy is a paramount issue in the Parkinson disease (PD) patient, given the complex medication schedule required for treatment. This study examined functional health literacy in the largely unexamined patient population of geriatric individuals diagArch Phys Med Rehabil Vol 89, November 2008
further investigation, deoxyribonucleic acid (DNA) sequencing is underway. We plan to present DNA sequencing of collagen type VI from this patient to identify an abnormality in collagen type VI synthesis. This could explain the phenotype of Bethlem myopathy in this patient despite the presence of collagen type VI on muscle biopsy. If no mutation is found, we can then present a new case of Bethlem myopathy phenotype without collagen type VI abnormality. Conclusions: Bethlem myopathy is a slowly progressive muscle disorder that is inherited through autosomal dominance. To correctly diagnose this patient, genetic sequencing is being done because of the presence of collagen type VI on muscle biopsy. This information will be useful for physicians caring for children and adults with myopathies. This diagnosis could have been missed if only the muscle biopsy had been utilized. A correct diagnosis is needed in order to educate patients with Bethlem myopathy about their diagnosis, future quality of life expectations, and the risk of passing this disorder onto their children. We will show that DNA sequencing should be done for patients with clinical signs of Bethlem myopathy but with presence of collagen type VI on muscle biopsy. Key Words: Contracture; Myopathy; Rehabilitation. Poster 192 Gadolinium-Induced Nephrogenic Systemic Fibrosis and Rehabilitation Management: A Case Report. Paulinder S. Rai, DO, MPH (SUNY Downstate [SUNY Health Science Center at Brooklyn], New York, NY); Melissa Kong, MS; Jack A. Mensch, MD. Disclosures: M. Kong, none; J.A. Mensch, none; P.S. Rai, none. Setting: University academic teaching hospital. Patient: 41-yearold woman. Case Description: The patient with medical history significant for end-stage renal disease on hemodialysis, with anemia, hypertension, pulmonary embolism, and asthma presented to the emergency department with complaint of lightheadedness. Patient underwent magnetic resonance imaging (MRI) with intravenous gadolinium as part of neurological workup. Within several weeks patient began developing progressive skin changes and muscle stiffness. Muscle biopsy confirmed the diagnosis of nephrogenic systemic fibrosis. Results: A rehabilitation team was consulted for evaluation and treatment. The patient had significant functional improvement after intensive inpatient and outpatient rehabilitation. Conclusions: Nephrogenic systemic fibrosis is a serious systemic disease that has been linked to exposure to gadolinium during MRI. Gadolinium-containing contrast agents should be used only if clearly necessary in patients with renal failure. The physical consequences of fibrosis of skin and muscle tissues can lead to severe impairments in physical functioning for affected patients. The aggressive rehabilitation management of patients diagnosed with nephrogenic systemic fibrosis is a critical part of the treatment process. Key Words: Gadolinium; Rehabilitation. Poster 193 Goal Setting During Inpatient Rehabilitation: A Pilot Evaluation of Function and Length of Stay. Patrick Kortebein, MD (University of Arkansas, Little Rock, AR); David C. Culver, DO; Horace J. Spencer, MS. Disclosure: D.C. Culver, none; P. Kortebein, none; H.J. Spencer, none. Objective: To determine the accuracy of FIM goal setting and estimated length of stay (LOS) during acute inpatient rehabilitation. The FIM is the standard method of assessing functional change during acute inpatient rehabilitation. A FIM rating evaluation is performed at admission and discharge. The admitting therapist(s) develop FIM goals at admission. Similarly, the admitting physicians make an estimate, in days (LOS), of how long they feel the patient will need acute inpatient rehabilitation. However, it is not known how accurate ther-
E83
apists and physicians are at predicting FIM goals and LOS, respectively. Design: Retrospective chart review of patients admitted for acute inpatient rehabilitation between January 1, 2007 and February 28, 2007. FIM goal ratings and estimated LOS from admission were compared with actual discharge FIM ratings and actual LOS (days). Setting: Private inpatient rehabilitation facility. Participants: The charts of 334 adults were reviewed. Patients who died or were transferred during inpatient rehabilitation were excluded. Interventions: Not applicable. Main Outcome Measures: (1) FIM ratings: A total FIM rating difference of greater than 6 between the FIM admission goal and the actual discharge FIM rating was considered significant. (2) LOS: A difference of greater than 30% between maximum estimated LOS and actual LOS was considered significant. Statistics: Wilcoxon signed-rank test. Results: Total FIM rating goals did not differ significantly from actual discharge FIM ratings (9⫾19 and 87⫾23). The same nonsignificant relationship was noted for LOS (estimated: 13⫾6d, actual: 12⫾8d). Conclusions: Our findings indicate that rehabilitation thereapists and physicians of a single private inpatient rehabilitation facility are relatively accurate in developing functional goals and LOS for patients admitted for acute inpatient rehabilitation. This should be reassuring information for patients’ families and third party payors. Key Words: Function; Rehabilitation; Therapy. Poster 194 Handicapped Parking: A Privilege or a Right? Matthew Grimm, MD (Beaumont Hospital, Birmingham, MI); Myron M. LaBan, MD, MMsc. Disclosure: M. Grimm, none; M.M. LaBan, none. Objective: A survey of local communities and their law enforcement administrators to ascertain the level of abuse of the handicappedparking privilege. Design: Following a review of both national and state guidelines for issuing disability parking placards, police officials were interviewed relative to problems of enforcement. Setting: 3 cities. Participants: Prescribing physicians, police officials, and disabled patients. Interventions: Not applicable. Main Outcome Measures: For the 3 cities surveyed, the annual number of overall trafficrelated violations remained constant over the last 7 years. Handicapped parking tickets as a percentage of the whole during this period also remained relatively unchanged. Conclusions: On an annual basis, an estimated one third of all the disability placards are being used by the nondisabled. Although an acknowledged problem that is rapidly increasing by an aging population as the 79 million boomers grow older, enforcement, as this review suggests, remains a critical issue. A reallocation of significant enforcement resources, including police personnel, improved technologic resources, and increased penalties, would expedite this process. Public education, as well as targeting, those physicians who signed the initial and subsequent renewals for disabled parking placards, are also critical to dealing with this problem. Key Words: Rehabilitation. Poster 195 Health Literacy and Parkinson Disease: A Prospective Analysis. Ryan Wetzel, MD (Virginia Commonwealth University, Richmond, VA); William Carne, PhD; David X. Cifu, MD; Patrick Jehle, PhD. Disclosure: W. Carne, none; D.X. Cifu, none; P. Jehle, none; R. Wetzel, none. Objective: Health literacy is a paramount issue in the Parkinson disease (PD) patient, given the complex medication schedule required for treatment. This study examined functional health literacy in the largely unexamined patient population of geriatric individuals diagArch Phys Med Rehabil Vol 89, November 2008