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Poster 23 Comparison of Symptom Presentation Between Veterans with Blast-Related Versus Non-blast-Related Mild Traumatic Brain Injury (mTBI)
PM&R
pertonicity and dystonia. Multiple medications were tried but were unsuccessful. Symptoms had persisted for 41 days when an intrathecal baclofen trial was performed. The initial bolus 50 mcg flush trial resulted in temporary improvement in hypertension and agitation. A second trial was performed wherein an intrathecal catheter was externalized and infusion of baclofen solution was titrated. Setting: Tertiary care pediatric hospital and inpatient rehabilitation center. Results or Clinical Course: After reaching a rate of 550 mcg/ day, the symptoms of hyperhidrosis, agitation, hypertension, and fever improved. Intrathecal baclofen pump was implanted. Less spasticity was present by day 5 post-implantation at a rate of 150 mcg/day, choreaform dystonia improved by day 6 at 249.76 mcg/ mL, and vital signs normalized after 2 weeks of treatment at 349.85 mcg/day. Patient had a GCS of 10T during implantation of the pump. She was discharged from acute hospital being dependent for all care. She underwent inpatient rehabilitation for 8 weeks and was discharged ambulating 20 feet with Swedish walker with ⫹2 moderate to maximal assistance and is set-up for feeding. Discussion: There are only a few reported cases on the use of continuous intrathecal baclofen pump in acquired brain injury. There is also limited literature on its effect on the muscle tone, spasticity, and remaining functional strength in the upper extremities. Our study reports on the use of intrathecal baclofen in an adolescent brain injury patient in facilitating improvement in motor function of upper and lower limbs. Conclusions: Intrathecal baclofen facilitates recovery in motor function, thus improving quality of life in brain injury patients. Poster 23 Comparison of Symptom Presentation Between Veterans with Blast-Related Versus Non-blastRelated Mild Traumatic Brain Injury (mTBI). Deena Hassaballa, DO (Loyola University Medical Center, Maywood, IL, United States); Thea Rogers, MPH; Bridget Smith, PhD; Justin St. Andre, MA; Monica Steiner, MD. Disclosures: D. Hassaballa, No Disclosures. Objective: To describe characteristics of Veterans with confirmed mild traumatic brain injury (mTBI) and compare demographics, symptoms, and pain between blast and non-blast injury groups. Design: Retrospective cohort study. Setting: United States Veterans Health Care Administration Polytrauma Network Site. Participants: 246 Veterans with confirmed diagnosis of mTBI. Interventions: Not applicable. Main Outcome Measures: Self-reported symptoms and pain post TBI obtained during Neurobehavioral Symptom Inventory. Results: (roughly) Majority of participants were male Veterans (92%) with 65% having blast-related mTBI. There was no statistically significant difference between the characteristics of the groups or the symptom reporting. Loss of consciousness was reported in 54% of blast mTBI versus 57% of non-blast mTBI. Veterans of the Army accounted for 57% of the blast injured versus 52% of nonblast injured; Veterans of Navy accounted for 20% of non-blast injured mTBI versus 3% of blast-injured. Marine Corps accounted for 31% of blast injured versus 19% of the non-blast injured
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Veterans. TBI was reported to occur during combat in blast injury group (98%) vs non-blast group (72%) and most common blast exposure for blast injury group included Improvised Explosive Devices (73%), rocket propelled grenades (33%), and mortars (31%). Symptoms were overall reported at a slightly higher frequency in the non-blast group. The most frequently reported symptoms in the non-blast vs. blast group included: headaches (98 vs. 95%), forgetfulness (95% vs. 93%), fatigue (91% vs 86%), noise sensitivity (90% vs 80%), and difficulty sleeping (91% vs 93%). Similarities were noted in symptom interference with life at 73% of blast injured vs 74% of non-blast injured. More non-blast injured veterans reported pain (99%) versus blast injured (91%). Pain sites were similar in the blast vs non-blast group for headaches (73% vs 74%) and low back (39% vs 36%). Overall, pain interfered with quality of life for 95% of Veterans. Conclusions: Returning Veterans are presenting with pain and symptoms that interfere with quality of life. Although etiology of the mTBI is important, blast and non-blast groups’ treatment plans may be tailored similarly. In our sample size, symptom report was high for both groups. Knowledge of symptom frequency will allow for planning for ongoing Veteran needs. Poster 24 Age Matched Control Subjects for Comparison in the Evaluation of Balance Dysfunction: A Case Series. Elana L. Neshkes, BA (UCLA WLA-VA GLA HS, Los Angeles, CA, United States); Breda Carroll Michael Chen, MD; Dominique Peppers, DO; Sungchan Song, MD; Agnes Wallbom, MD, MS. Disclosures: E. L. Neshkes, No Disclosures. Objective: Ten male volunteers aged 22-35 y with no reported history of mild traumatic brain injury (mTBI) and normal neurologic examinations were referred for computerized posturography testing as comparison age-matched control subjects to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with balance complaints and mTBI in an earlier study. Design: Case series. Quantitative posturography testing using the NeuroCom Balance Master SOT protocol was used to analyze the vestibular, somatosensory and visual component of balance. During testing, patients were asked to maintain balance through 6 scenarios involving sensory challenges and sensory deprivation. Data from these scenarios were subsequently compared with data from historical pre-established controls (ages 22-59) with performance less than fifth percentile being considered a failure. Setting: Human performance lab. Participants: Ten male control subjects, ages 22-35, with no reported history of mild traumatic brain injury (mTBI). Interventions: Quantitative posturography testing using the NeuroCom Balance Master SOT protocol. Main Outcome Measures: Quantitative posturography testing using the NeuroCom Balance Master SOT protocol. Results: The results of the ten patients were not statistically significantly different from the pre-established historical control data. Conclusions: The intention of gathering more age-matched controls was to provide a more accurate performance comparison between Veterans with a history of mTBI and aged-matched male control subjects without history of mTBI. In the original case series it was suggested that computerized posturography increased sensi-
pertonicity and dystonia. Multiple medications were tried but were unsuccessful. Symptoms had persisted for 41 days when an intrathecal baclofen trial was performed. The initial bolus 50 mcg flush trial resulted in temporary improvement in hypertension and agitation. A second trial was performed wherein an intrathecal catheter was externalized and infusion of baclofen solution was titrated. Setting: Tertiary care pediatric hospital and inpatient rehabilitation center. Results or Clinical Course: After reaching a rate of 550 mcg/ day, the symptoms of hyperhidrosis, agitation, hypertension, and fever improved. Intrathecal baclofen pump was implanted. Less spasticity was present by day 5 post-implantation at a rate of 150 mcg/day, choreaform dystonia improved by day 6 at 249.76 mcg/ mL, and vital signs normalized after 2 weeks of treatment at 349.85 mcg/day. Patient had a GCS of 10T during implantation of the pump. She was discharged from acute hospital being dependent for all care. She underwent inpatient rehabilitation for 8 weeks and was discharged ambulating 20 feet with Swedish walker with ⫹2 moderate to maximal assistance and is set-up for feeding. Discussion: There are only a few reported cases on the use of continuous intrathecal baclofen pump in acquired brain injury. There is also limited literature on its effect on the muscle tone, spasticity, and remaining functional strength in the upper extremities. Our study reports on the use of intrathecal baclofen in an adolescent brain injury patient in facilitating improvement in motor function of upper and lower limbs. Conclusions: Intrathecal baclofen facilitates recovery in motor function, thus improving quality of life in brain injury patients. Poster 23 Comparison of Symptom Presentation Between Veterans with Blast-Related Versus Non-blastRelated Mild Traumatic Brain Injury (mTBI). Deena Hassaballa, DO (Loyola University Medical Center, Maywood, IL, United States); Thea Rogers, MPH; Bridget Smith, PhD; Justin St. Andre, MA; Monica Steiner, MD. Disclosures: D. Hassaballa, No Disclosures. Objective: To describe characteristics of Veterans with confirmed mild traumatic brain injury (mTBI) and compare demographics, symptoms, and pain between blast and non-blast injury groups. Design: Retrospective cohort study. Setting: United States Veterans Health Care Administration Polytrauma Network Site. Participants: 246 Veterans with confirmed diagnosis of mTBI. Interventions: Not applicable. Main Outcome Measures: Self-reported symptoms and pain post TBI obtained during Neurobehavioral Symptom Inventory. Results: (roughly) Majority of participants were male Veterans (92%) with 65% having blast-related mTBI. There was no statistically significant difference between the characteristics of the groups or the symptom reporting. Loss of consciousness was reported in 54% of blast mTBI versus 57% of non-blast mTBI. Veterans of the Army accounted for 57% of the blast injured versus 52% of nonblast injured; Veterans of Navy accounted for 20% of non-blast injured mTBI versus 3% of blast-injured. Marine Corps accounted for 31% of blast injured versus 19% of the non-blast injured
Vol. 4, Iss. 10S, 2012
S197
Veterans. TBI was reported to occur during combat in blast injury group (98%) vs non-blast group (72%) and most common blast exposure for blast injury group included Improvised Explosive Devices (73%), rocket propelled grenades (33%), and mortars (31%). Symptoms were overall reported at a slightly higher frequency in the non-blast group. The most frequently reported symptoms in the non-blast vs. blast group included: headaches (98 vs. 95%), forgetfulness (95% vs. 93%), fatigue (91% vs 86%), noise sensitivity (90% vs 80%), and difficulty sleeping (91% vs 93%). Similarities were noted in symptom interference with life at 73% of blast injured vs 74% of non-blast injured. More non-blast injured veterans reported pain (99%) versus blast injured (91%). Pain sites were similar in the blast vs non-blast group for headaches (73% vs 74%) and low back (39% vs 36%). Overall, pain interfered with quality of life for 95% of Veterans. Conclusions: Returning Veterans are presenting with pain and symptoms that interfere with quality of life. Although etiology of the mTBI is important, blast and non-blast groups’ treatment plans may be tailored similarly. In our sample size, symptom report was high for both groups. Knowledge of symptom frequency will allow for planning for ongoing Veteran needs. Poster 24 Age Matched Control Subjects for Comparison in the Evaluation of Balance Dysfunction: A Case Series. Elana L. Neshkes, BA (UCLA WLA-VA GLA HS, Los Angeles, CA, United States); Breda Carroll Michael Chen, MD; Dominique Peppers, DO; Sungchan Song, MD; Agnes Wallbom, MD, MS. Disclosures: E. L. Neshkes, No Disclosures. Objective: Ten male volunteers aged 22-35 y with no reported history of mild traumatic brain injury (mTBI) and normal neurologic examinations were referred for computerized posturography testing as comparison age-matched control subjects to Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans with balance complaints and mTBI in an earlier study. Design: Case series. Quantitative posturography testing using the NeuroCom Balance Master SOT protocol was used to analyze the vestibular, somatosensory and visual component of balance. During testing, patients were asked to maintain balance through 6 scenarios involving sensory challenges and sensory deprivation. Data from these scenarios were subsequently compared with data from historical pre-established controls (ages 22-59) with performance less than fifth percentile being considered a failure. Setting: Human performance lab. Participants: Ten male control subjects, ages 22-35, with no reported history of mild traumatic brain injury (mTBI). Interventions: Quantitative posturography testing using the NeuroCom Balance Master SOT protocol. Main Outcome Measures: Quantitative posturography testing using the NeuroCom Balance Master SOT protocol. Results: The results of the ten patients were not statistically significantly different from the pre-established historical control data. Conclusions: The intention of gathering more age-matched controls was to provide a more accurate performance comparison between Veterans with a history of mTBI and aged-matched male control subjects without history of mTBI. In the original case series it was suggested that computerized posturography increased sensi-