- Email: [email protected]
Poster 251 Refer to abstract 23 in the spinal cord injury poster grand rounds for full abstract [email protected]
2004 Academy Annual Assembly Abstracts diminished in intensity and were largely absent by day 43. It is unclear how the transplants of BDNF/NT3 expressing fibroblasts impacted the natural history, but 1 possibility is that grafts ameliorated postinjury physiologic conditions in motoneurons. Conclusions: Spontaneous potentials occur after SCI in animals as well as in humans and they appear to be conserved across mammalian species (rats, cats, humans). Key Words: Electromyography; Muscle denervation; Rehabilitation; Spinal cord injuries.
Poster 251: Refer to Abstract 23 in the Spinal Cord Injury Poster Grand Rounds for full abstract. e-mail: [email protected].
Poster 252: Refer to Abstract 24 in the Spinal Cord Injury Poster Grand Rounds for full abstract. e-mail: [email protected].
Poster 253 Is Monitoring Intragastric pH Necessary in Spinal Cord Injury Patients Receiving Famotidine Infusion? Chiwai E. Chan, DO (Stanford Univ Med Ctr/Santa Clara Valley Med Ctr, Palo Alto, CA); Agnes S. Wallbom, MD, e-mail: [email protected]. Disclosure: C.E. Chan, None; A.S. Wallbom, None. Objective: To determine whether monitoring intragastic pH has any effect on preventing stress ulcers in patients with acute spinal cord injury (SCI) who are receiving famotidine infusion. Design: A retrospective study from January to December 2003. Setting: Tertiary care, university-affiliated spinal cord trauma unit. Participants: 10 acute traumatic SCI patients admitted to a rehabilitation trauma center. Interventions: Not applicable. Main Outcome Measures: pH values and guaiac results. Results: There was no correlation between gastric pH and gastric Hemoccult occult blood test results. There was a predominance of positive guaiac in 75/87 (86%) tests performed. 84% of all guaiac tests were positive regardless of pH. Within the subgroup of pH ⬎7, 90% of guaiac tests were positive. The administration of aluminum-magnesium hydroxide suspension in an attempt to increase gastric pH failed to maintain negative Hemoccult test consistently. There were 4 (40%) patients who never had a negative guaiac result within the 48-h study period. The proportion of negative guaiac results did not differ significantly when compared by pH group (z ratio for proportions). All 10 subjects had no clinical symptoms of stress ulcers. Conclusions: It does not appear that gastric pH monitoring and administration of aluminum-magnesium hydroxide suspension are steps needed to prevent stress ulcers during famotidine infusion of acute SCI patients. Key Words: pH; Rehabilitation; Spinal cord injuries; Stress; Ulcers.
Poster 254 Assessing the Sensitivity of an Annual Abdominal Roentgenogram in Screening for Pathology in Chronic Spinal Cord Injury. Douglas B. Barber, MD (Univ Texas Health Sci Ctr, San Antonio, TX); Suzanne L. Woodbury, MD; Mark D. Fredrickson, MD; Gary L. Campbell, DO, e-mail: [email protected]. Disclosure: D.B. Barber, None; S.L. Woodbury, None; M.D. Fredrickson, None; G.L. Campbell, None. Objective: To assess the sensitivity of an annual abdominal roentgenogram (kidneys, ureters, bladder [KUB]). Design: Retrospective chart review. Setting: Department of Veterans Affairs Spinal Cord Injury Center. Participants: 318 patients who received an annual medical assessment including KUB in the 12mo before the study. Interventions: Not applicable. Main Outcome Measure: KUB read by board-certified radiologists. Results: 117 of 318 (37%) KUBs were read as “normal.” Pathology involving the skeleton (eg, previous fracture, heterotopic ossification, osteomyelitis) was described in 102 (32%). Gastrointestinal tract findings (eg, ileus, colonic distention, fecal impaction) were noted in 53 (17%). Probable phlebolith and vascular calcification were reported in 48 (15%). Possible calcification involving the renal system was noted in 42 (13%). Gallstones were noted in 5 (2%). No patients were reported to have received any negative sequelae from undergoing KUB. Conclusions: The prevalence of potential pathology involving the skeletal, gastrointestinal tract, and urinary tract systems suggests that there is value in performing surveillance KUBs annually in patients with SCI. Key Words: Rehabilitation; Spinal cord injuries.
Poster 255 Microarray Study of Gene Expression Profile After Acute Spinal Cord Injury. Leslie R. Morse, DO (Boston Med Ctr, Boston, MA); Ricardo A. Battaglino, PhD; Martha Joe; David Meguerdichian; Hajime Sasaki, DDS, PhD; Steve Williams, MD, e-mail: leslie.morse@ bmc.org. Disclosure: L.R. Morse, None; R.A. Battaglino, None; M. Joe, None; D. Meguerdichian, None; H. Sasaki, None; S. Williams, None. Objective: To perform a large-scale gene profiling of acute spinal cord injury (SCI) in humans. Design: Case-control study. Setting: Acute inpatient rehabilitation unit. Participants: 4 patients with acute, complete cervical SCI and 4 sex- and age-matched neurologically intact patients. Interventions: Not applicable. Main Outcome Measure: Differential gene expression in white blood cells as determined by the hybridization patterns of a microarray containing 12,000 human genes. Results: Preliminary data suggest that over 215 genes are differentially expressed in white blood cells derived from patients with acute SCI. Many genes are known immunoregulators, cell cycle regulators, and mediators of inflammation. Of these genes, approximately two thirds are suppressed and one third are overexpressed when compared with healthy controls. Of interest, several novel genes have been identified with differential expression patterns in this population. Conclusions: We have identified several genes whose expression appears to be altered in humans after acute SCI. We anticipate that this approach will help define the pathophysiology of this condition, and identify future areas of investigation and new treatment targets. Key Words: DNA microarray; Gene expression profiling; Rehabilitation; Spinal cord injuries
E51
Poster 256: Refer to Abstract 25 in the Spinal Cord Injury Poster Grand Rounds for full abstract. e-mail: [email protected]. Poster 257 Breathlessness During Daily Activities in Spinal Cord Injury. Noel F. Grandas, MD (VAMC Boston HealthCare Syst, West Roxbury, MA); Nitin Jain, MBBS, MSPH; Robert Brown, MD; Carlos G. Tun, MD; Eric Garshick, MD, MOH, e-mail: [email protected]. Disclosure: N.F. Grandas, None; N. Jain, None; R. Brown, None; C.G. Tun, None; E. Garshick, None. Objective: To assess factors associated with breathlessness during daily activities in chronic spinal cord injury (SCI). Design: Cross-sectional. Settings: Subjects recruited from Veterans Affairs SCI service and the community. Participants: Between 1994 and 2003, 441 subjects ⱖ1y after SCI and free from acute illness were recruited for assessment of respiratory health. Interventions: Respiratory questionnaire, spirometry, and neurologic exam. Data included injury date and extent, ability to get around (walk unassisted, walk with an aid, by hand-propelled wheelchair, by motorized wheelchair [MWC]), respiratory illnesses and symptoms, cigarette smoking, occupational exposures, and comorbid medical conditions. Main Outcome Measure: Breathlessness during eating, talking, and dressing. Results: Among 85 subjects who used MWC, the prevalence of breathlessness while eating, talking, or dressing was 24% versus 6% in 356 others (P⬍.0001). The main activity associated with breathlessness in MWC users was talking (18%). Among MWC users, the relative odds of current and former cigarette smokers reporting breathlessness while talking, eating, or dressing was 4.2 (95% CI, 0.9 – 41.0) as compared with never smokers. The relative odds increased by 1.02 (95% CI, 1.00 –1.03) per pack-year. Breathlessness was associated with chronic cough (OR⫽7.8; 95% CI, 2.0 –32.7) and wheeze (OR⫽3.5; 95% CI, 1.04 –13.6). In MWC users, heart disease, percentage of predicted forced vital capacity and forced expiratory volume in 1s, chest illness in the past year, SCI level, and maximal inspiratory pressures were not related to breathlessness. Conclusions: Breathlessness during selected daily activities (most commonly, talking) was greatest among SCI subjects who were most impaired with regard to mobility and was associated with cough, wheeze, and cigarette smoking. Therefore, therapy to relieve breathlessness may include smoking cessation, treatment of wheeze, and improvement of breathing patterns during speech. Key Words: Dyspnea; Activities of daily living; Rehabilitation; Spinal cord injuries
Stroke Poster 258 Crossed Cerebrocerebellar Diaschisis and Motor Weakness of Upper Extremity After Stroke. In Sung Choi (Chonnam National Univ Med Sch & Hosp, Gwangju, Republic of Korea); Sam Gyu Lee; So Young Lee; Jae Hyung Kim, e-mail: [email protected]. Disclosure: I. Choi, None; S. Lee, None; S. Lee, None; J. Kim, None. Objectives: To investigate the correlation between motor evoked potentials (MEPs) and crossed cerebrocerebellar diaschisis (CCD) and to study the relationship between CCD and the severity and prognosis of stroke. Design: Retrospective case series. Setting: Tertiary hospital-based, acute stroke rehabilitation center in Korea. Participants: 32 patients with first-ever stroke and 31 healthy control subjects. Interventions: MEPs were recorded from the abductor pollicis brevis and the abductor hallucis by stimulating the motor cortex relevant to the hand and foot. The localization and the volumetric analysis of brain lesion were performed by a radiologist. The existence of CCD was evaluated by single-photon emission computed tomography of brain. Main Outcome Measures: Central motor conduction times of upper and lower extremities, the existence of CCD, National Institutes of Health Stroke Scale score, FIM instrument score, and Motricity Index (MI). Results: The presence of CCD correlated significantly with “not evoked” MEPs in the upper extremity (22⫽10.667, P⫽.005), but not in the lower extremity (22⫽2.143, P⫽.343). There was no significant correlation between lesion locations and the existence of CCD (P⫽.563). There was a significant correlation between the absence of CCD and higher MI score of the upper extremity (P⫽.048). There were significant correlations between MI score and MEP findings of upper and lower extremities at 1 mo after onset (P⫽.033, P⫽.012). Conclusions: The existence of CCD would reflect the severe insult on descending motor pathways and the severity of paralysis of upper extremity. Key Words: Evoked potentials, motor; Rehabilitation; Stroke. Poster 259: Refer to Abstract 35 in the Stroke Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 260: Refer to Abstract 33 in the Stroke Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 261 Recovery of Hemiplegic Upper-Limb Functions After the Amputation of Unaffected Upper Limb: A Case Report. Divakara Kedlaya, MD (Corona Regional Med Ctr, Corona, CA); Murray Brandstater, MD, PhD, e-mail: [email protected]. Disclosure: D. Kedlaya, None; M. Brandstater, None. Setting: Community acute rehabilitation unit. Patient: A 50-yo woman with a history of protein C deficiency and stroke. Case Description: The patient suffered a stroke 8y ago, with left hemiplegia. Magnetic resonance imaging at that time showed right posterior parietal lobe infarction. She was also found to have protein C deficiency and was treated with long-term anticoagulation. Although she had some neurologic recovery of left upper limb, it was nonfunctional. She suffered an acute arterial thrombotic event in her right upper limb, which resulted in right below elbow amputation. She had 2wk of acute rehabilitation, focusing on functional use of the left upper limb, and was discharged home at a stand-by assistance level in all aspect of self-care when using the left upper limb. Assessment/Results: The Modified Wolf Motor Test was performed at admission and at discharge. Discussion: Amputation of the unaffected upper limb in our stroke patient forced her
Arch Phys Med Rehabil Vol 85, September 2004
Poster 251: Refer to Abstract 23 in the Spinal Cord Injury Poster Grand Rounds for full abstract. e-mail: [email protected].
Poster 252: Refer to Abstract 24 in the Spinal Cord Injury Poster Grand Rounds for full abstract. e-mail: [email protected].
Poster 253 Is Monitoring Intragastric pH Necessary in Spinal Cord Injury Patients Receiving Famotidine Infusion? Chiwai E. Chan, DO (Stanford Univ Med Ctr/Santa Clara Valley Med Ctr, Palo Alto, CA); Agnes S. Wallbom, MD, e-mail: [email protected]. Disclosure: C.E. Chan, None; A.S. Wallbom, None. Objective: To determine whether monitoring intragastic pH has any effect on preventing stress ulcers in patients with acute spinal cord injury (SCI) who are receiving famotidine infusion. Design: A retrospective study from January to December 2003. Setting: Tertiary care, university-affiliated spinal cord trauma unit. Participants: 10 acute traumatic SCI patients admitted to a rehabilitation trauma center. Interventions: Not applicable. Main Outcome Measures: pH values and guaiac results. Results: There was no correlation between gastric pH and gastric Hemoccult occult blood test results. There was a predominance of positive guaiac in 75/87 (86%) tests performed. 84% of all guaiac tests were positive regardless of pH. Within the subgroup of pH ⬎7, 90% of guaiac tests were positive. The administration of aluminum-magnesium hydroxide suspension in an attempt to increase gastric pH failed to maintain negative Hemoccult test consistently. There were 4 (40%) patients who never had a negative guaiac result within the 48-h study period. The proportion of negative guaiac results did not differ significantly when compared by pH group (z ratio for proportions). All 10 subjects had no clinical symptoms of stress ulcers. Conclusions: It does not appear that gastric pH monitoring and administration of aluminum-magnesium hydroxide suspension are steps needed to prevent stress ulcers during famotidine infusion of acute SCI patients. Key Words: pH; Rehabilitation; Spinal cord injuries; Stress; Ulcers.
Poster 254 Assessing the Sensitivity of an Annual Abdominal Roentgenogram in Screening for Pathology in Chronic Spinal Cord Injury. Douglas B. Barber, MD (Univ Texas Health Sci Ctr, San Antonio, TX); Suzanne L. Woodbury, MD; Mark D. Fredrickson, MD; Gary L. Campbell, DO, e-mail: [email protected]. Disclosure: D.B. Barber, None; S.L. Woodbury, None; M.D. Fredrickson, None; G.L. Campbell, None. Objective: To assess the sensitivity of an annual abdominal roentgenogram (kidneys, ureters, bladder [KUB]). Design: Retrospective chart review. Setting: Department of Veterans Affairs Spinal Cord Injury Center. Participants: 318 patients who received an annual medical assessment including KUB in the 12mo before the study. Interventions: Not applicable. Main Outcome Measure: KUB read by board-certified radiologists. Results: 117 of 318 (37%) KUBs were read as “normal.” Pathology involving the skeleton (eg, previous fracture, heterotopic ossification, osteomyelitis) was described in 102 (32%). Gastrointestinal tract findings (eg, ileus, colonic distention, fecal impaction) were noted in 53 (17%). Probable phlebolith and vascular calcification were reported in 48 (15%). Possible calcification involving the renal system was noted in 42 (13%). Gallstones were noted in 5 (2%). No patients were reported to have received any negative sequelae from undergoing KUB. Conclusions: The prevalence of potential pathology involving the skeletal, gastrointestinal tract, and urinary tract systems suggests that there is value in performing surveillance KUBs annually in patients with SCI. Key Words: Rehabilitation; Spinal cord injuries.
Poster 255 Microarray Study of Gene Expression Profile After Acute Spinal Cord Injury. Leslie R. Morse, DO (Boston Med Ctr, Boston, MA); Ricardo A. Battaglino, PhD; Martha Joe; David Meguerdichian; Hajime Sasaki, DDS, PhD; Steve Williams, MD, e-mail: leslie.morse@ bmc.org. Disclosure: L.R. Morse, None; R.A. Battaglino, None; M. Joe, None; D. Meguerdichian, None; H. Sasaki, None; S. Williams, None. Objective: To perform a large-scale gene profiling of acute spinal cord injury (SCI) in humans. Design: Case-control study. Setting: Acute inpatient rehabilitation unit. Participants: 4 patients with acute, complete cervical SCI and 4 sex- and age-matched neurologically intact patients. Interventions: Not applicable. Main Outcome Measure: Differential gene expression in white blood cells as determined by the hybridization patterns of a microarray containing 12,000 human genes. Results: Preliminary data suggest that over 215 genes are differentially expressed in white blood cells derived from patients with acute SCI. Many genes are known immunoregulators, cell cycle regulators, and mediators of inflammation. Of these genes, approximately two thirds are suppressed and one third are overexpressed when compared with healthy controls. Of interest, several novel genes have been identified with differential expression patterns in this population. Conclusions: We have identified several genes whose expression appears to be altered in humans after acute SCI. We anticipate that this approach will help define the pathophysiology of this condition, and identify future areas of investigation and new treatment targets. Key Words: DNA microarray; Gene expression profiling; Rehabilitation; Spinal cord injuries
E51
Poster 256: Refer to Abstract 25 in the Spinal Cord Injury Poster Grand Rounds for full abstract. e-mail: [email protected]. Poster 257 Breathlessness During Daily Activities in Spinal Cord Injury. Noel F. Grandas, MD (VAMC Boston HealthCare Syst, West Roxbury, MA); Nitin Jain, MBBS, MSPH; Robert Brown, MD; Carlos G. Tun, MD; Eric Garshick, MD, MOH, e-mail: [email protected]. Disclosure: N.F. Grandas, None; N. Jain, None; R. Brown, None; C.G. Tun, None; E. Garshick, None. Objective: To assess factors associated with breathlessness during daily activities in chronic spinal cord injury (SCI). Design: Cross-sectional. Settings: Subjects recruited from Veterans Affairs SCI service and the community. Participants: Between 1994 and 2003, 441 subjects ⱖ1y after SCI and free from acute illness were recruited for assessment of respiratory health. Interventions: Respiratory questionnaire, spirometry, and neurologic exam. Data included injury date and extent, ability to get around (walk unassisted, walk with an aid, by hand-propelled wheelchair, by motorized wheelchair [MWC]), respiratory illnesses and symptoms, cigarette smoking, occupational exposures, and comorbid medical conditions. Main Outcome Measure: Breathlessness during eating, talking, and dressing. Results: Among 85 subjects who used MWC, the prevalence of breathlessness while eating, talking, or dressing was 24% versus 6% in 356 others (P⬍.0001). The main activity associated with breathlessness in MWC users was talking (18%). Among MWC users, the relative odds of current and former cigarette smokers reporting breathlessness while talking, eating, or dressing was 4.2 (95% CI, 0.9 – 41.0) as compared with never smokers. The relative odds increased by 1.02 (95% CI, 1.00 –1.03) per pack-year. Breathlessness was associated with chronic cough (OR⫽7.8; 95% CI, 2.0 –32.7) and wheeze (OR⫽3.5; 95% CI, 1.04 –13.6). In MWC users, heart disease, percentage of predicted forced vital capacity and forced expiratory volume in 1s, chest illness in the past year, SCI level, and maximal inspiratory pressures were not related to breathlessness. Conclusions: Breathlessness during selected daily activities (most commonly, talking) was greatest among SCI subjects who were most impaired with regard to mobility and was associated with cough, wheeze, and cigarette smoking. Therefore, therapy to relieve breathlessness may include smoking cessation, treatment of wheeze, and improvement of breathing patterns during speech. Key Words: Dyspnea; Activities of daily living; Rehabilitation; Spinal cord injuries
Stroke Poster 258 Crossed Cerebrocerebellar Diaschisis and Motor Weakness of Upper Extremity After Stroke. In Sung Choi (Chonnam National Univ Med Sch & Hosp, Gwangju, Republic of Korea); Sam Gyu Lee; So Young Lee; Jae Hyung Kim, e-mail: [email protected]. Disclosure: I. Choi, None; S. Lee, None; S. Lee, None; J. Kim, None. Objectives: To investigate the correlation between motor evoked potentials (MEPs) and crossed cerebrocerebellar diaschisis (CCD) and to study the relationship between CCD and the severity and prognosis of stroke. Design: Retrospective case series. Setting: Tertiary hospital-based, acute stroke rehabilitation center in Korea. Participants: 32 patients with first-ever stroke and 31 healthy control subjects. Interventions: MEPs were recorded from the abductor pollicis brevis and the abductor hallucis by stimulating the motor cortex relevant to the hand and foot. The localization and the volumetric analysis of brain lesion were performed by a radiologist. The existence of CCD was evaluated by single-photon emission computed tomography of brain. Main Outcome Measures: Central motor conduction times of upper and lower extremities, the existence of CCD, National Institutes of Health Stroke Scale score, FIM instrument score, and Motricity Index (MI). Results: The presence of CCD correlated significantly with “not evoked” MEPs in the upper extremity (22⫽10.667, P⫽.005), but not in the lower extremity (22⫽2.143, P⫽.343). There was no significant correlation between lesion locations and the existence of CCD (P⫽.563). There was a significant correlation between the absence of CCD and higher MI score of the upper extremity (P⫽.048). There were significant correlations between MI score and MEP findings of upper and lower extremities at 1 mo after onset (P⫽.033, P⫽.012). Conclusions: The existence of CCD would reflect the severe insult on descending motor pathways and the severity of paralysis of upper extremity. Key Words: Evoked potentials, motor; Rehabilitation; Stroke. Poster 259: Refer to Abstract 35 in the Stroke Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 260: Refer to Abstract 33 in the Stroke Poster Grand Rounds for the full abstract. e-mail: [email protected]. Poster 261 Recovery of Hemiplegic Upper-Limb Functions After the Amputation of Unaffected Upper Limb: A Case Report. Divakara Kedlaya, MD (Corona Regional Med Ctr, Corona, CA); Murray Brandstater, MD, PhD, e-mail: [email protected]. Disclosure: D. Kedlaya, None; M. Brandstater, None. Setting: Community acute rehabilitation unit. Patient: A 50-yo woman with a history of protein C deficiency and stroke. Case Description: The patient suffered a stroke 8y ago, with left hemiplegia. Magnetic resonance imaging at that time showed right posterior parietal lobe infarction. She was also found to have protein C deficiency and was treated with long-term anticoagulation. Although she had some neurologic recovery of left upper limb, it was nonfunctional. She suffered an acute arterial thrombotic event in her right upper limb, which resulted in right below elbow amputation. She had 2wk of acute rehabilitation, focusing on functional use of the left upper limb, and was discharged home at a stand-by assistance level in all aspect of self-care when using the left upper limb. Assessment/Results: The Modified Wolf Motor Test was performed at admission and at discharge. Discussion: Amputation of the unaffected upper limb in our stroke patient forced her
Arch Phys Med Rehabil Vol 85, September 2004