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Poster 251 Cognitive Decline from Bilateral Deep Brain Stimulator Placement: A Case Report
S242
Abstracts / PM R 8 (2016) S151-S332
ganglia calcifications with associated atrophy without evidence of acute stroke. Setting: Acute rehabilitation hospital. Results: We attempted to use computer programs on a portable device to help elicit communication with only mild improvement. Patient required moderate to max assist for scanning and selecting icons but did participate independently. His ability to answer biographical questions with simple yes/no gestures had an accuracy of about 70%. He only seemed to vocalize with family using single words or moans but that was heard by us on occasion, indicating severe dysarthria. Discussion: PPA is a rare neurologic condition that degenerates the language dominate hemisphere in the brain. Patient initially have deficits in word finding, word usage, and word comprehension. It can progress into cognitive decline as well. Intensive speech therapy needs to be initiated, along with assistive devices to help with communication. Conclusions: PPA is a unique condition and formal therapies are not yet well established. Technology and verbal exercises may help to slow the rapid progression of this disease. Level of Evidence: Level V Poster 251 Cognitive Decline from Bilateral Deep Brain Stimulator Placement: A Case Report Mezgebe D. Abegaz, MD (Marianjoy Rehab Hosp, Batavia, Illinois, United States), Padma K. Srigiriraju, MD Disclosures: Mezgebe Abegaz: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 68-year-old man with a significant medical history of Parkinson’s disease had bilateral deep brain stimulator placement to control symptoms. Patient then had fevers prompting removal of the left deep brain stimulator due to infection. After the patient was treated he starting having progressive right upper extremity tremor so it was decided to reinsert the stimulator into leftsubstantia nigra. Postoperative course was complicated with tremors, dyskinesias, encephalopathy, and respiratory distress from aspiration pneumonia. Neurology consult recommended EEG which turned out to be unremarkable. Sinemet was reduced. Setting: Acute rehabilitation hospital. Results: Patient’s hospital course was complicated with orthostatic hypotension (changes of >80 in systolic blood pressure), moments of unresponsiveness, and occasional worsening of tremors. Cognition improved, particularly in speech and recall, fine motor skills improved, and he was able to walk a distance of 150’’ with a rolling walker and gait belt at a minimum assist level. After surgery, the patient was far below his baseline cognition. He demonstrates moderate-marked cognitive impairments characterized by deficits in delayed recall, remote memory, attention/concentration, problem solving and reasoning, visual-spatial abilities, and calculations. Discussion: Deep brain stimulator placement is becoming ever more popular among a wide array of patients. They offer a chance of normalcy, but they are not without risk. Many patients have lasting affects from the procedure including strokes, seizures, confusion, infections, speech, balance problems, and even unwanted mood changes. Deep brain stimulators do not improve cognitive symptoms in Parkinson’s disease and may even worsen them. Care must be taken to assess the benefits and risks of such a procedure. Conclusions: Deep brain stimulators are helpful in some patient populations, but may be detrimental to cognition in others. The patient exemplifies the consequences associated with deep brain stimulator placement. Ongoing speech therapy should help minimize the cognitive dysfunction. Level of Evidence: Level V
Poster 252 Use of Fitbit Charge HR for Management of Post-Concussive Syndrome: A Case Report Leroy R. Lindsay, MD (Washington Hospital Center/Georgetown University, Washington, DC, United States), Heechin Chae, MD Disclosures: Leroy Lindsay: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 43-year-old woman with Hashimoto’s thyroiditis presented to outpatient clinic with diagnosis of postconcussive syndrome for the past 1.5 years. She had had a short course of physical and cognitive therapy but returned to work and had full decompensation and resumption of concussive symptoms. She continued to experience significant headaches, sleep disturbance, decreased processing speed, and concentration deficits. Additionally, she had labile blood pressures, tachycardia, and intermittent sweating episodes. Despite normal TSH, free T4 levels, and a negative tilt table test, these symptoms persisted. She purchased a Fitbit Charge HR and began a sub-aerobic workout regimen. Clonidine 0.1 mg was prescribed to be taken twice a day to treat suspected dysautonomia and results were obtained via the Fitbit software. Setting: Academic outpatient practice. Results: Using the Fitbit Charge HR we were able to visualize and quantify the effect of clonidine on her suspected dysautonomia symptoms. The heart rate and heart rate variability response were graphically represented. Additionally, we objectively measured hours of sleep increase, and noted fewer episodes of restlessness. Discussion: This is the first documented use of the Fitbit Charge HR in this capacity. This technology allows us to collect larger amounts of data that helps us more objectively measure response to interventions. While Fitbit data is not the gold standard, the information gathered is likely more detailed and objective than the self reporting. Conclusions: Fitbit Charge HR is a novel and affordable technology that may have a significant role in informing patient-physician interaction. More specifically, the technology transforms what was originally a patient’s subjective and static measurement of response to an objective and dynamic assessment, empowering both patients and physicians with immediate and easily accessible data. Level of Evidence: Level V Poster 253 Implanted Brain-Computer Interface Controlling a Neuroprosthetic for Increasing Upper Limb Function in a Human with Tetraparesis Marcie Bockbrader, MD, PhD (The Ohio State University Medical Center, Delaware, Ohio, United States), Matthew J. Kortes, MD, Nicholas Annetta, MEng, Connor Majstorovic, Gaurav Sharma, PhD, David A. Friedenberg, PhD, Austin Morgan, Herb Bresler, W. Mysiw, Ali R. Rezai Disclosures: Marcie Bockbrader: I Have No Relevant Financial Relationships To Disclose Objective: To demonstrate feasibility of improving upper limb motor control in tetraparetic humans with an intracortical brain-computer interface (BCI) linked to a non-invasive neuromuscular electrical stimulation (NMES) neuroprosthetic. Design: Prospective, open-label, uncontrolled trial. Setting: Outpatient Neuromodulation Clinic at a University Teaching Hospital. Participants: Patients with complete tetraparesis from cervical spinal cord injury (SCI). First of 5 patients is reported: 24-year-old male with C5 ASIA A SCI with ZZP to C6. Interventions: The patient underwent implantation of FDA IDEapproved intradural microelectrode array (MEA) in his left primary
Abstracts / PM R 8 (2016) S151-S332
ganglia calcifications with associated atrophy without evidence of acute stroke. Setting: Acute rehabilitation hospital. Results: We attempted to use computer programs on a portable device to help elicit communication with only mild improvement. Patient required moderate to max assist for scanning and selecting icons but did participate independently. His ability to answer biographical questions with simple yes/no gestures had an accuracy of about 70%. He only seemed to vocalize with family using single words or moans but that was heard by us on occasion, indicating severe dysarthria. Discussion: PPA is a rare neurologic condition that degenerates the language dominate hemisphere in the brain. Patient initially have deficits in word finding, word usage, and word comprehension. It can progress into cognitive decline as well. Intensive speech therapy needs to be initiated, along with assistive devices to help with communication. Conclusions: PPA is a unique condition and formal therapies are not yet well established. Technology and verbal exercises may help to slow the rapid progression of this disease. Level of Evidence: Level V Poster 251 Cognitive Decline from Bilateral Deep Brain Stimulator Placement: A Case Report Mezgebe D. Abegaz, MD (Marianjoy Rehab Hosp, Batavia, Illinois, United States), Padma K. Srigiriraju, MD Disclosures: Mezgebe Abegaz: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 68-year-old man with a significant medical history of Parkinson’s disease had bilateral deep brain stimulator placement to control symptoms. Patient then had fevers prompting removal of the left deep brain stimulator due to infection. After the patient was treated he starting having progressive right upper extremity tremor so it was decided to reinsert the stimulator into leftsubstantia nigra. Postoperative course was complicated with tremors, dyskinesias, encephalopathy, and respiratory distress from aspiration pneumonia. Neurology consult recommended EEG which turned out to be unremarkable. Sinemet was reduced. Setting: Acute rehabilitation hospital. Results: Patient’s hospital course was complicated with orthostatic hypotension (changes of >80 in systolic blood pressure), moments of unresponsiveness, and occasional worsening of tremors. Cognition improved, particularly in speech and recall, fine motor skills improved, and he was able to walk a distance of 150’’ with a rolling walker and gait belt at a minimum assist level. After surgery, the patient was far below his baseline cognition. He demonstrates moderate-marked cognitive impairments characterized by deficits in delayed recall, remote memory, attention/concentration, problem solving and reasoning, visual-spatial abilities, and calculations. Discussion: Deep brain stimulator placement is becoming ever more popular among a wide array of patients. They offer a chance of normalcy, but they are not without risk. Many patients have lasting affects from the procedure including strokes, seizures, confusion, infections, speech, balance problems, and even unwanted mood changes. Deep brain stimulators do not improve cognitive symptoms in Parkinson’s disease and may even worsen them. Care must be taken to assess the benefits and risks of such a procedure. Conclusions: Deep brain stimulators are helpful in some patient populations, but may be detrimental to cognition in others. The patient exemplifies the consequences associated with deep brain stimulator placement. Ongoing speech therapy should help minimize the cognitive dysfunction. Level of Evidence: Level V
Poster 252 Use of Fitbit Charge HR for Management of Post-Concussive Syndrome: A Case Report Leroy R. Lindsay, MD (Washington Hospital Center/Georgetown University, Washington, DC, United States), Heechin Chae, MD Disclosures: Leroy Lindsay: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 43-year-old woman with Hashimoto’s thyroiditis presented to outpatient clinic with diagnosis of postconcussive syndrome for the past 1.5 years. She had had a short course of physical and cognitive therapy but returned to work and had full decompensation and resumption of concussive symptoms. She continued to experience significant headaches, sleep disturbance, decreased processing speed, and concentration deficits. Additionally, she had labile blood pressures, tachycardia, and intermittent sweating episodes. Despite normal TSH, free T4 levels, and a negative tilt table test, these symptoms persisted. She purchased a Fitbit Charge HR and began a sub-aerobic workout regimen. Clonidine 0.1 mg was prescribed to be taken twice a day to treat suspected dysautonomia and results were obtained via the Fitbit software. Setting: Academic outpatient practice. Results: Using the Fitbit Charge HR we were able to visualize and quantify the effect of clonidine on her suspected dysautonomia symptoms. The heart rate and heart rate variability response were graphically represented. Additionally, we objectively measured hours of sleep increase, and noted fewer episodes of restlessness. Discussion: This is the first documented use of the Fitbit Charge HR in this capacity. This technology allows us to collect larger amounts of data that helps us more objectively measure response to interventions. While Fitbit data is not the gold standard, the information gathered is likely more detailed and objective than the self reporting. Conclusions: Fitbit Charge HR is a novel and affordable technology that may have a significant role in informing patient-physician interaction. More specifically, the technology transforms what was originally a patient’s subjective and static measurement of response to an objective and dynamic assessment, empowering both patients and physicians with immediate and easily accessible data. Level of Evidence: Level V Poster 253 Implanted Brain-Computer Interface Controlling a Neuroprosthetic for Increasing Upper Limb Function in a Human with Tetraparesis Marcie Bockbrader, MD, PhD (The Ohio State University Medical Center, Delaware, Ohio, United States), Matthew J. Kortes, MD, Nicholas Annetta, MEng, Connor Majstorovic, Gaurav Sharma, PhD, David A. Friedenberg, PhD, Austin Morgan, Herb Bresler, W. Mysiw, Ali R. Rezai Disclosures: Marcie Bockbrader: I Have No Relevant Financial Relationships To Disclose Objective: To demonstrate feasibility of improving upper limb motor control in tetraparetic humans with an intracortical brain-computer interface (BCI) linked to a non-invasive neuromuscular electrical stimulation (NMES) neuroprosthetic. Design: Prospective, open-label, uncontrolled trial. Setting: Outpatient Neuromodulation Clinic at a University Teaching Hospital. Participants: Patients with complete tetraparesis from cervical spinal cord injury (SCI). First of 5 patients is reported: 24-year-old male with C5 ASIA A SCI with ZZP to C6. Interventions: The patient underwent implantation of FDA IDEapproved intradural microelectrode array (MEA) in his left primary