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Poster 293 Facial Diplegia and Paresthesias as a Rare Guillain-Barré Variant: A Case Report
PM&R
and 35% of subjects had a PVR⬎50 mL. Linear correlation was found between PVR and ALS-FRS with a R2, 0.95 and P⫽.025. A linear correlation also was noted between PVR and lower limbs Ashworth Scale. Conclusions: Urinary retention is common in ALS. Urologic evaluation is indicated in patients with ALS and with prominent spasticity. Bladder disorders in subjects with ALS subjects be treated with therapies aimed at improving pelvic floor muscles activity (strength and spasticity). In cases in which retention is documented, self-intermittent catheterization should be considered.
Poster 292 Using the Siebens Domain Management Model for Rehabilitation Documentation. Woojae Kim, MD (West Los Angeles VA, Los Angeles, CA, United States); Eric Y. Chang, MD, Beny Charchian, MD, Armen J. Dumas, MD, Hyung Kim, MD, Mario Perez, MD, Hilary C. Siebens, MD. Disclosures: W. Kim, none. Objective: This study evaluated if use of the Siebens Domain Management Model (SDMM) improves resident discharge report content on an inpatient rehabilitation unit. Design: The SDMM organizes all of a patient’s health-related strengths, problems, and issues into 4 domains: I. Medical/Surgical Issues; II. Mental Status/Emotions/Coping; III. Physical Function; and IV. Living Environment. This standard structure had been incorporated into inpatient discharge reports at West Los Angeles Veterans Affairs Medical Center inpatient rehabilitation unit starting July 2008. The effects of this new approach was assessed through pre- and postretrospective chart review. Setting: A general rehabilitation inpatient unit in the West Los Angeles Veterans Affairs Health System. Participants: 40 retrospective chart discharge summaries completed by residents. Interventions: Scoring rules for the SDMM Documentation Review Form, 33 items that covered all 4 domains, were established. Each item or topic is scored as present or absent. Twenty pre-SDMM (controls) and 20 post-SDMM discharge reports were scored. Simple counts were calculated for pre- and post-SDMM results: a global score for items present and scores for each domain. Institutional review board approval was granted. Results: Interrater reliability for the review form was established, with 87% agreement. Global scores increased from 34% to 53% (P⬍.05). Domains I, II, III, and IV scores pre- and post- were 81% and 92% (P⫽.04), 9% and 47% (P⬍.0001), 25% and 34% (P⫽.06), and 24% to 44% (P⬍.0001), respectively. Conclusions: Use of the SDMM increased the amount of relevant information capture. However, reports are still lacking all information thought to be essential for inpatient rehabilitation discharge summaries.
Poster 293 Facial Diplegia and Paresthesias as a Rare Guillain-Barré Variant: A Case Report. Seth P. Swank, BS (Rehabilitation Institute of Chicago, Chicago, IL, United States); R. N. Harden, MD, Benjamin J. Marshall, BS. Disclosures: S. P. Swank, none.
Vol. 3, Iss. 10S1, 2011
S273
Patients or Programs: A 62-year-old man presented with bilateral leg paresthesias, bilateral hand paresthesias, and bilateral facial palsy. Program Description: The patient presented with 4 days of lower extremity paresthesias, 2 days of upper extremity paresthesias, and 1 day of slurred speech. On examination, sensation was impaired in bilateral palms and lower legs, mild dysarthria was noted, cranial nerves were intact, strength was 5/5 throughout upper and lower extremities, and reflexes were 1⫹ throughout. Magnetic resonance imaging was negative, and the patient was admitted for observation. On day 2 of hospitalization, examination showed new bilateral facial palsy, significant dysarthria, impaired proprioception, and absent reflexes. Setting: Tertiary care hospital. Results: Cerebrospinal fluid analysis showed albuminocytologic dissociation. Electromyography revealed mixed sensorimotor axon loss. The patient was diagnosed with facial diplegia and paresthesias and began intravenous immunoglobulin treatment. Rehabilitation was prescribed to facilitate goals of improved proprioception, functional mobility, strength, balance, and compensatory speech strategies. The patient made significant functional gains during 7 days of acute inpatient rehabilitation. Discussion: Facial diplegia and paresthesias is a rare variant of Guillain-Barré syndrome. It results from microbial molecular mimicry and autoimmune destruction of nervous system tissue. Initial limb numbness is typically followed by facial palsy 3-10 days later and is accompanied by hyporeflexia or areflexia and dysphagia or dysarthria. Electromyography shows demyelinating changes, and cerebrospinal fluid analysis confirms diagnosis with albuminocytologic dissociation. Most patients have a favorable outcome with time, particularly when intravenous immunoglobulin or plasmapheresis is combined with interdisciplinary rehabilitation. Rehabilitation should include facial expression exercises, repetitive range-of-motion exercises to redevelop coordination, and sensory reintegration. Conclusions: Facial diplegia and paresthesias is a rare GuillainBarré syndrome variant characterized by bilateral facial paralysis, distal paresthesias, and decreased reflexes. After plasmapheresis or intravenous immunoglobulin, maximal functional outcome is achieved by a comprehensive rehabilitation program.
Poster 294 Failure of Anterior Cervical Corpectomy and Fusion in an Adult With Rheumatoid Arthritis and Type 1 Diabetes Mellitus: A Case Report. Jeannie Harden (University of Wisconsin Hospitals and Clinics, Madison, WI, United States); Tommy Yu, MD. Disclosures: J. Harden, none. Patients or Programs: A 74-year-old woman with a history a posterior laminectomy (levels C3-C7), rheumatoid arthritis (RA), and type 1 diabetes mellitus (T1DM), who was admitted to acute rehabilitation after undergoing anterior cervical corpectomy and decompression (ACCD) at levels C4-C6 with fusion along C3-C7 by using a fibular strut graft. Program Description: The patient presented with neck pain that was localized to the left lateral neck and scapular region, particularly after therapy sessions. The pain was not associated with any direction of shoulder movements. Cervical movement was limited due to cervical orthosis. The pain was the worst on postop-
and 35% of subjects had a PVR⬎50 mL. Linear correlation was found between PVR and ALS-FRS with a R2, 0.95 and P⫽.025. A linear correlation also was noted between PVR and lower limbs Ashworth Scale. Conclusions: Urinary retention is common in ALS. Urologic evaluation is indicated in patients with ALS and with prominent spasticity. Bladder disorders in subjects with ALS subjects be treated with therapies aimed at improving pelvic floor muscles activity (strength and spasticity). In cases in which retention is documented, self-intermittent catheterization should be considered.
Poster 292 Using the Siebens Domain Management Model for Rehabilitation Documentation. Woojae Kim, MD (West Los Angeles VA, Los Angeles, CA, United States); Eric Y. Chang, MD, Beny Charchian, MD, Armen J. Dumas, MD, Hyung Kim, MD, Mario Perez, MD, Hilary C. Siebens, MD. Disclosures: W. Kim, none. Objective: This study evaluated if use of the Siebens Domain Management Model (SDMM) improves resident discharge report content on an inpatient rehabilitation unit. Design: The SDMM organizes all of a patient’s health-related strengths, problems, and issues into 4 domains: I. Medical/Surgical Issues; II. Mental Status/Emotions/Coping; III. Physical Function; and IV. Living Environment. This standard structure had been incorporated into inpatient discharge reports at West Los Angeles Veterans Affairs Medical Center inpatient rehabilitation unit starting July 2008. The effects of this new approach was assessed through pre- and postretrospective chart review. Setting: A general rehabilitation inpatient unit in the West Los Angeles Veterans Affairs Health System. Participants: 40 retrospective chart discharge summaries completed by residents. Interventions: Scoring rules for the SDMM Documentation Review Form, 33 items that covered all 4 domains, were established. Each item or topic is scored as present or absent. Twenty pre-SDMM (controls) and 20 post-SDMM discharge reports were scored. Simple counts were calculated for pre- and post-SDMM results: a global score for items present and scores for each domain. Institutional review board approval was granted. Results: Interrater reliability for the review form was established, with 87% agreement. Global scores increased from 34% to 53% (P⬍.05). Domains I, II, III, and IV scores pre- and post- were 81% and 92% (P⫽.04), 9% and 47% (P⬍.0001), 25% and 34% (P⫽.06), and 24% to 44% (P⬍.0001), respectively. Conclusions: Use of the SDMM increased the amount of relevant information capture. However, reports are still lacking all information thought to be essential for inpatient rehabilitation discharge summaries.
Poster 293 Facial Diplegia and Paresthesias as a Rare Guillain-Barré Variant: A Case Report. Seth P. Swank, BS (Rehabilitation Institute of Chicago, Chicago, IL, United States); R. N. Harden, MD, Benjamin J. Marshall, BS. Disclosures: S. P. Swank, none.
Vol. 3, Iss. 10S1, 2011
S273
Patients or Programs: A 62-year-old man presented with bilateral leg paresthesias, bilateral hand paresthesias, and bilateral facial palsy. Program Description: The patient presented with 4 days of lower extremity paresthesias, 2 days of upper extremity paresthesias, and 1 day of slurred speech. On examination, sensation was impaired in bilateral palms and lower legs, mild dysarthria was noted, cranial nerves were intact, strength was 5/5 throughout upper and lower extremities, and reflexes were 1⫹ throughout. Magnetic resonance imaging was negative, and the patient was admitted for observation. On day 2 of hospitalization, examination showed new bilateral facial palsy, significant dysarthria, impaired proprioception, and absent reflexes. Setting: Tertiary care hospital. Results: Cerebrospinal fluid analysis showed albuminocytologic dissociation. Electromyography revealed mixed sensorimotor axon loss. The patient was diagnosed with facial diplegia and paresthesias and began intravenous immunoglobulin treatment. Rehabilitation was prescribed to facilitate goals of improved proprioception, functional mobility, strength, balance, and compensatory speech strategies. The patient made significant functional gains during 7 days of acute inpatient rehabilitation. Discussion: Facial diplegia and paresthesias is a rare variant of Guillain-Barré syndrome. It results from microbial molecular mimicry and autoimmune destruction of nervous system tissue. Initial limb numbness is typically followed by facial palsy 3-10 days later and is accompanied by hyporeflexia or areflexia and dysphagia or dysarthria. Electromyography shows demyelinating changes, and cerebrospinal fluid analysis confirms diagnosis with albuminocytologic dissociation. Most patients have a favorable outcome with time, particularly when intravenous immunoglobulin or plasmapheresis is combined with interdisciplinary rehabilitation. Rehabilitation should include facial expression exercises, repetitive range-of-motion exercises to redevelop coordination, and sensory reintegration. Conclusions: Facial diplegia and paresthesias is a rare GuillainBarré syndrome variant characterized by bilateral facial paralysis, distal paresthesias, and decreased reflexes. After plasmapheresis or intravenous immunoglobulin, maximal functional outcome is achieved by a comprehensive rehabilitation program.
Poster 294 Failure of Anterior Cervical Corpectomy and Fusion in an Adult With Rheumatoid Arthritis and Type 1 Diabetes Mellitus: A Case Report. Jeannie Harden (University of Wisconsin Hospitals and Clinics, Madison, WI, United States); Tommy Yu, MD. Disclosures: J. Harden, none. Patients or Programs: A 74-year-old woman with a history a posterior laminectomy (levels C3-C7), rheumatoid arthritis (RA), and type 1 diabetes mellitus (T1DM), who was admitted to acute rehabilitation after undergoing anterior cervical corpectomy and decompression (ACCD) at levels C4-C6 with fusion along C3-C7 by using a fibular strut graft. Program Description: The patient presented with neck pain that was localized to the left lateral neck and scapular region, particularly after therapy sessions. The pain was not associated with any direction of shoulder movements. Cervical movement was limited due to cervical orthosis. The pain was the worst on postop-