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Poster 321: Inpatient Stroke Rehabilitation Measures and Racial Differences
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ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Poster 318 Rehabilitation Access, Utilization, and Satisfaction of Poststroke Survivors. Gerard E. Francisco, MD (University of Texas Health Science Ctr, Houston, TX). Disclosure: G.E. Francisco, None. Objective: To describe the rehabilitation access, utilization, and satisfaction of stroke survivors and caregivers. Design: Telephone and web-based survey conducted in early 2006. Setting: Survey. Participants: Stroke survivors with persistent motor or speech difficulties randomly selected from the database of a national stroke organization. 440 stroke survivors (ischemic, 74%; white, 85%; mean number of strokes, 1.5; mean stroke duration, 3.3y). 63% had most recent stroke at least 3.3 years ago. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: Although 58% claimed they did not need assistance for activities of daily living (ADLs), about half still had difficulty with various tasks, such as ambulation, hand movement, and instrumental ADLs. 44% identified neurologists as the primary doctors involved with poststroke recovery, while 23% named primary care physicians. Only 15% named physiatrists. 86% received rehabilitation intervention: physical (93%), occupational (79%), and speech (65%) therapies. 68% of those who did not receive rehabilitation were not given a prescription even though they felt they needed therapies. 14% claimed they did not need rehabilitation services and 14% declined rehabilitation recommendations. 6% lacked financial resources for rehabilitation. Respondents identified recovery of walking as the most important goal (26%), followed by improved ADLs (8%) and speech (8%). 57% felt that rehabilitation was extremely or very successful in achieving personal recovery goals. Among those who were not satisfied with rehabilitation, 34% identified lack of progress as the reason, while 32% identified lack of funding, 15% medical comorbidities, and 12% spasticity. Conclusions: The majority of stroke survivors surveyed had received rehabilitation and were satisfied with these services in relation to achieving their personal recovery goals. An alarmingly low proportion of the survivors identified physiatrists as the physicians responsible for their rehabilitation care. Key Words: Cerebrovascular accident; Drug utilization; Personal satisfaction; Rehabilitation. Poster 319 Bone Quantitative Ultrasound in Hemiparetic Upper Limb and Level of Dexterity. Giovanni Iolascon, MD, PhD (Second University of Naples, Naples, Italy); Francesca Gimigliano, MD; Raffaele Di Blasio, MD; Tommaso Valentino, MD; Raffaele Gimigliano, MD, PhD. Disclosure: G. Iolascon, None; F. Gimigliano, None; R. Di Blasio, None; T. Valentino, None; R. Gimigliano, None. Objectives: To evaluate the difference in bone mineral assessment, using phalangeal quantitative ultrasound (QUS), between the paretic and nonaffected upper limb in subacute stroke patients and between the dominant and nondominant upper limb in subacute stroke patients and in a group of healthy people; to correlate amplitude-dependent speed of sound and the dexterity in the hemiparetic upper limb; and to investigate the bone mineral status of stroke patients. Design: Observational cohort study. Setting: Rehabilitative care unit for subacute patients. Participants: 30 hemiparetic patients (mean age, 67y; range, 28⫺95y): 14 men (mean age, 66y) and 16 women (mean age, 69y). Mean time from onset of stroke was 81 days (range, 33⫺187d). 30 healthy subjects (mean age, 66y; range, 45⫺81y): 14 men and 16 women. Interventions: Not applicable. Main Outcome Measures: Phalangeal QUS, Motricity Index, and arm function test. Results: 80% (24/30) of our cohort population presented amplitude-dependent speed of sound values of less than ⫺3.2 SD (T score), considered the cutoff for the diagnosis of osteoporosis; in the healthy control group, the Arch Phys Med Rehabil Vol 88, September 2007
percentage of osteoporotic subjects was the 27%. There was no significant difference in amplitude-dependent speed of sound between the affected and unaffected side. There was no significant difference in amplitude-dependent speed of sound between the dominant and nondominant hand in both groups. There was no correlation between the phalangeal amplitude-dependent speed of sound and the level of dexterity of the hemiparetic hand. Conclusions: The bone status evaluation performed by QUS can be important in the investigation of the wide range of stroke risk factors. We did not find any significant correlation between the recovery of dexterity level and bone mineral ultrasound data. Key Words: Bone mineral density; Rehabilitation; Stroke; Ultrasound. Poster 320 Passive and Active Functional Tasks Are the Main Reasons for Treatment of Upper-Limb Spasticity in Poststroke Patients Among Neurologists, Physiatrists, and Primary Care Physicians. Amanda M. VanDenburgh, PhD (Allergan, Irvine, CA); Susan Abu-shakra, MD; Mitchell F. Brin, MD; Frederick Beddingfield III, MD, PhD. Disclosure: A.M. VanDenburgh, Employee: Allergan; S. Abu-shakra, Employee: Allergan; M.F. Brin, Employee: Allergan; F. Beddingfield, III, Employee: Allergan. Objective: To determine the major reasons for the treatment of upper-limb spasticity in poststroke patients among the leading 3 specialties that evaluate and manage these patients. Design: Physician survey conducted by Beta Research Corp. Setting: Internet-based. Participants: 523 physicians were contacted. A total of 50 neurologists, 50 physiatrists, and 300 primary care physicians (PCPs) fulfilled eligibility criteria and completed the survey. Interventions: Not applicable. Main Outcome Measures: Physician demographics and patient population characteristics pertaining to poststroke spasticity were collected. Results: The average number of adult stroke patients evaluated per month was 23.8 for neurologists, 17.9 for physiatrists, and 38.6 for PCPs. Approximately half of these patients had spasticity in the upper and/or lower limb (10.3, 10.0, 12.5, respectively). A majority of the upper-limb spasticity patients presented with a clenched fist. The main treatment goals in this population were: relief of pain and discomfort and improved access to the palm for hygiene purposes (passive function goals), or to improve the ability to grasp and hold objects (active function goals). Conclusions: The major reasons cited for treatment were improvement in passive function (pain and discomfort, hand hygiene) and active function (grasping, holding). Key Words: Hygiene; Muscle spasticity; Pain; Rehabilitation; Stroke. Poster 321 Inpatient Stroke Rehabilitation Measures and Racial Differences. Scott Davidoff, MD (Temple University, Philadelphia, PA); Ian Maitin, MD, MBA; Robert Ruchinskas, PsyD. Disclosure: S. Davidoff, None; I. Maitin, None; R. Ruchinskas, None. Objective: To examine outcomes between races after inpatient stroke rehabilitation. Design: Retrospective study using the Uniform Data System. Setting: Inpatient rehabilitation unit at an urban-based university hospital. Participants: 469 patients (305 black, 85 white, 79 Hispanic) admitted with a stroke to acute rehabilitation between January 2002 and August 2006. Interventions: Not applicable. Main Outcome Measures: Functional gains at the time of discharge were measured by FIM change and FIM efficiency, defined as FIM change per length of stay days. Other variables used in analysis were length of stay (LOS), disposition, and marital status. Etiologic diagnosis was categorized as hemorrhagic, ischemic, or late-effect stroke via ICD-9
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
codes. Results: Analysis of variance revealed no significant differences among black, white, or Hispanic groups for their FIM admission, FIM change, or FIM efficiency scores. Regression analyses showed that demographic variables, such as race and marital status, had no predictive power when determining FIM change, FIM efficiency, or disposition location. Additionally, neither marital status nor stroke type was associated with LOS, disposition, or FIM efficiency. However, as expected, FIM change (r⫽⫺.419) and FIM efficiency (r⫽⫺.341) correlated significantly (P⬍.001) and were predictive of discharge location, meaning that those with poorer functional outcomes were less likely to return home. Conclusions: In contrast to previous studies, our data show no significant racial disparities in functional gains or any measured variable after stroke rehabilitation. This lack of effect may be due to similarities in functional status on admission, or the fact that all of our patients came from similar levels of socioeconomic status. The setting in an urban-based university hospital affords the opportunity to compare a diverse population of stroke patients. Eliminating any preconceived bias of racial disparities is beneficial toward achieving rehabilitative goals. Key Words: Race; Rehabilitation; Stroke. Poster 322 Electric Stimulation to Prolong the Duration of Botulinum Toxin Type A Effect on Spasticity: A Double-Blind, Placebo-Controlled Study. Alberto Esquenazi, MD (MossRehab, Elkins Park, PA); Nathaniel Mayer, MD. Disclosure: A. Esquenazi; N. Mayer, unrestricted educational grant from Allergan. Objective: To demonstrate the potential temporal-enhancing effect of electric stimulation on the clinical effects of botulinum toxin type A (BTX-A) in patients with spasticity. Design: Double-blind, placebocontrolled trial. Setting: Gait and motor control analysis laboratories. Participants: 34 subjects with hemiparesis from stroke or traumatic brain injury and elbow or ankle Ashworth Scale score of more than 2/4. Interventions: After treatment with BTX-A (Botox) to elbow flexors or ankle plantarflexors with a dose of 180 to 400U of BTX-A, patients were randomized to active electric stimulation (muscle contraction) or sham electric stimulation (sensory stimulus) for 30 minutes to the injected muscles and repeated twice daily in 1 month. Active electric stimulation parameters: 20Hz, 200s, 20 seconds on and off, at an intensity of 22 to 90mA. Sham stimulus intensity was greater than 19mA. Patients were contacted every week and maintained a log. Main Outcome Measures: Ashworth and Tardieu scale scores were obtained before injection and every 2 weeks until return to baseline. Results: Increased duration of effect, based on Ashworth or Tardieu scales was evident in patients receiving active electric stimulation when compared with the sham group and with clinical experience. Elbow effect duration increased from 16 weeks (11⫺20) for the control group to 28 weeks for the intervention group (14⫺46). The ankle treatment had shorter duration for both the control (9wk, 4⫺12) and active groups (20wk, 11⫺30). Conclusions: Electric stimulation produced muscle contraction of BTX-A injected muscles within 1 hour of injection and continuing it for 30 minutes twice daily increases the duration of effect. Electric stimulation appears to be beneficial and should be considered as a tool to enhance the valuable effects of BTX-A in the management of upper motoneuron syndrome⫺related muscle overactivity. Further studies are needed to optimize duration of electric stimulation and further elucidate the differences between the ankle and elbow. Key Words: Botulinum toxins; Electric stimulation; Muscle spasticity; Rehabilitation.
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Poster 323 Do Recurrent Stroke Patients Have Poorer Functional Outcomes Compared With First-Time Stroke Patients After Inpatient Rehabilitation? Yee Sien Ng, MRCP (Singapore General Hospital, Singapore, Singapore); Heeyoune Jung, MD; Yi Chiong, MRCP; Peter A. Lim, MD. Disclosure: Y. Ng, None; H. Jung, None; Y. Chiong, None; P.A. Lim, None. Objectives: To establish the demographics and functional outcome data for patients with recurrent stroke and to compare these data with first-time stroke patients. Design: Prospective cohort study. Setting: Inpatient rehabilitation unit within a tertiary teaching hospital. Participants: 94 consecutive recurrent stroke patients over a 4-year period. Interventions: Not applicable. Main Outcome Measure: FIM instrument. Results: Recurrent strokes constitute 9.5% (94/992) of all strokes admitted for inpatient rehabilitation in our unit. The mean age was 63.6⫾12.5 years and 58.9% were men. The mean number of cerebrovascular risk factors was 2.19⫾0.11 and hypertension (91.5%) was the most common risk factor. The admission and discharge total FIM scores were 65.8⫾24.5 and 77.9⫾25.4, respectively, and this gain was highly significant (P⬍.001). The mean FIM efficiency was .724⫾.066 points/d. The mean rehabilitation length of stay (LOS) was 18.3 days and 85.1% of these patients were discharged to home. When recurrent stroke and first-time stroke patients were compared, recurrent stroke patients were older (P⫽.007) and significantly more were hypertensive (P⫽.004) or had diabetes mellitus (P⫽.001). However, the recurrent stroke and first-time stroke cohorts did not differ in rehabilitation LOS (P⫽.520), the absolute number of risk factors (P⫽.258), the number of medical complications during rehabilitation (P⫽.225), frequency of depression in rehabilitation (P⫽.883), or rates of home discharge (P⫽.278). Compared with first-time stroke patients, recurrent stroke patients had similar admission total FIM scores (P⫽.344), but had lower discharge total FIM scores (P⫽.002), FIM gain (P⬍.001), and FIM efficiencies (P⫽.003). Conclusions: Recurrent stroke patients make significant functional gains and can still benefit from comprehensive rehabilitation. However, their poorer functional outcomes compared with first-time stroke patients indicate that stroke recurrence is important in the prognostication, rehabilitation, and discharge planning for this stroke subset. Key Words: Rehabilitation; Stroke; Treatment outcome. Poster 324 Amantadine to Improve Rehabilitation in Chronic Stroke Patients: A Case Report. Jun Zhang, MD (Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ); Uri Adler, MD; Anna Barrett, MD. Disclosure: J. Zhang, None; U. Adler, None; A. Barrett, None. Setting: University-based rehabilitation institution. Patient: A 70year-old woman with multiple medical problems including diabetes and cerebrovascular accident, with continuously decreased activities of daily living (ADLs) and frequent falls. Case Description: The patient, with multiple medical problems including diabetes, right middle cerebral artery infarct with left hemiparesis 2 years ago, decreased ADLs, and frequent falls, was admitted to hospital for mental status change status post fall at home. The computed axial tomography and magnetic resonance imaging scans of brain were negative for acute change. She was transferred to an acute rehabilitation facility because of functional decline. Fatigue was not reported. Assessment/Results: The patient was found to have mild weakness on the left side and gait ataxia. The patient was difficult with both physical therapy (PT) and occupational therapy (OT) because of a lack of attention span. Neurophysiologic evaluation showed significant cognitive deficit; findings included: Mini-Mental State Examination (MMSE) score of 18/30, and Arch Phys Med Rehabil Vol 88, September 2007
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Poster 318 Rehabilitation Access, Utilization, and Satisfaction of Poststroke Survivors. Gerard E. Francisco, MD (University of Texas Health Science Ctr, Houston, TX). Disclosure: G.E. Francisco, None. Objective: To describe the rehabilitation access, utilization, and satisfaction of stroke survivors and caregivers. Design: Telephone and web-based survey conducted in early 2006. Setting: Survey. Participants: Stroke survivors with persistent motor or speech difficulties randomly selected from the database of a national stroke organization. 440 stroke survivors (ischemic, 74%; white, 85%; mean number of strokes, 1.5; mean stroke duration, 3.3y). 63% had most recent stroke at least 3.3 years ago. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: Although 58% claimed they did not need assistance for activities of daily living (ADLs), about half still had difficulty with various tasks, such as ambulation, hand movement, and instrumental ADLs. 44% identified neurologists as the primary doctors involved with poststroke recovery, while 23% named primary care physicians. Only 15% named physiatrists. 86% received rehabilitation intervention: physical (93%), occupational (79%), and speech (65%) therapies. 68% of those who did not receive rehabilitation were not given a prescription even though they felt they needed therapies. 14% claimed they did not need rehabilitation services and 14% declined rehabilitation recommendations. 6% lacked financial resources for rehabilitation. Respondents identified recovery of walking as the most important goal (26%), followed by improved ADLs (8%) and speech (8%). 57% felt that rehabilitation was extremely or very successful in achieving personal recovery goals. Among those who were not satisfied with rehabilitation, 34% identified lack of progress as the reason, while 32% identified lack of funding, 15% medical comorbidities, and 12% spasticity. Conclusions: The majority of stroke survivors surveyed had received rehabilitation and were satisfied with these services in relation to achieving their personal recovery goals. An alarmingly low proportion of the survivors identified physiatrists as the physicians responsible for their rehabilitation care. Key Words: Cerebrovascular accident; Drug utilization; Personal satisfaction; Rehabilitation. Poster 319 Bone Quantitative Ultrasound in Hemiparetic Upper Limb and Level of Dexterity. Giovanni Iolascon, MD, PhD (Second University of Naples, Naples, Italy); Francesca Gimigliano, MD; Raffaele Di Blasio, MD; Tommaso Valentino, MD; Raffaele Gimigliano, MD, PhD. Disclosure: G. Iolascon, None; F. Gimigliano, None; R. Di Blasio, None; T. Valentino, None; R. Gimigliano, None. Objectives: To evaluate the difference in bone mineral assessment, using phalangeal quantitative ultrasound (QUS), between the paretic and nonaffected upper limb in subacute stroke patients and between the dominant and nondominant upper limb in subacute stroke patients and in a group of healthy people; to correlate amplitude-dependent speed of sound and the dexterity in the hemiparetic upper limb; and to investigate the bone mineral status of stroke patients. Design: Observational cohort study. Setting: Rehabilitative care unit for subacute patients. Participants: 30 hemiparetic patients (mean age, 67y; range, 28⫺95y): 14 men (mean age, 66y) and 16 women (mean age, 69y). Mean time from onset of stroke was 81 days (range, 33⫺187d). 30 healthy subjects (mean age, 66y; range, 45⫺81y): 14 men and 16 women. Interventions: Not applicable. Main Outcome Measures: Phalangeal QUS, Motricity Index, and arm function test. Results: 80% (24/30) of our cohort population presented amplitude-dependent speed of sound values of less than ⫺3.2 SD (T score), considered the cutoff for the diagnosis of osteoporosis; in the healthy control group, the Arch Phys Med Rehabil Vol 88, September 2007
percentage of osteoporotic subjects was the 27%. There was no significant difference in amplitude-dependent speed of sound between the affected and unaffected side. There was no significant difference in amplitude-dependent speed of sound between the dominant and nondominant hand in both groups. There was no correlation between the phalangeal amplitude-dependent speed of sound and the level of dexterity of the hemiparetic hand. Conclusions: The bone status evaluation performed by QUS can be important in the investigation of the wide range of stroke risk factors. We did not find any significant correlation between the recovery of dexterity level and bone mineral ultrasound data. Key Words: Bone mineral density; Rehabilitation; Stroke; Ultrasound. Poster 320 Passive and Active Functional Tasks Are the Main Reasons for Treatment of Upper-Limb Spasticity in Poststroke Patients Among Neurologists, Physiatrists, and Primary Care Physicians. Amanda M. VanDenburgh, PhD (Allergan, Irvine, CA); Susan Abu-shakra, MD; Mitchell F. Brin, MD; Frederick Beddingfield III, MD, PhD. Disclosure: A.M. VanDenburgh, Employee: Allergan; S. Abu-shakra, Employee: Allergan; M.F. Brin, Employee: Allergan; F. Beddingfield, III, Employee: Allergan. Objective: To determine the major reasons for the treatment of upper-limb spasticity in poststroke patients among the leading 3 specialties that evaluate and manage these patients. Design: Physician survey conducted by Beta Research Corp. Setting: Internet-based. Participants: 523 physicians were contacted. A total of 50 neurologists, 50 physiatrists, and 300 primary care physicians (PCPs) fulfilled eligibility criteria and completed the survey. Interventions: Not applicable. Main Outcome Measures: Physician demographics and patient population characteristics pertaining to poststroke spasticity were collected. Results: The average number of adult stroke patients evaluated per month was 23.8 for neurologists, 17.9 for physiatrists, and 38.6 for PCPs. Approximately half of these patients had spasticity in the upper and/or lower limb (10.3, 10.0, 12.5, respectively). A majority of the upper-limb spasticity patients presented with a clenched fist. The main treatment goals in this population were: relief of pain and discomfort and improved access to the palm for hygiene purposes (passive function goals), or to improve the ability to grasp and hold objects (active function goals). Conclusions: The major reasons cited for treatment were improvement in passive function (pain and discomfort, hand hygiene) and active function (grasping, holding). Key Words: Hygiene; Muscle spasticity; Pain; Rehabilitation; Stroke. Poster 321 Inpatient Stroke Rehabilitation Measures and Racial Differences. Scott Davidoff, MD (Temple University, Philadelphia, PA); Ian Maitin, MD, MBA; Robert Ruchinskas, PsyD. Disclosure: S. Davidoff, None; I. Maitin, None; R. Ruchinskas, None. Objective: To examine outcomes between races after inpatient stroke rehabilitation. Design: Retrospective study using the Uniform Data System. Setting: Inpatient rehabilitation unit at an urban-based university hospital. Participants: 469 patients (305 black, 85 white, 79 Hispanic) admitted with a stroke to acute rehabilitation between January 2002 and August 2006. Interventions: Not applicable. Main Outcome Measures: Functional gains at the time of discharge were measured by FIM change and FIM efficiency, defined as FIM change per length of stay days. Other variables used in analysis were length of stay (LOS), disposition, and marital status. Etiologic diagnosis was categorized as hemorrhagic, ischemic, or late-effect stroke via ICD-9
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
codes. Results: Analysis of variance revealed no significant differences among black, white, or Hispanic groups for their FIM admission, FIM change, or FIM efficiency scores. Regression analyses showed that demographic variables, such as race and marital status, had no predictive power when determining FIM change, FIM efficiency, or disposition location. Additionally, neither marital status nor stroke type was associated with LOS, disposition, or FIM efficiency. However, as expected, FIM change (r⫽⫺.419) and FIM efficiency (r⫽⫺.341) correlated significantly (P⬍.001) and were predictive of discharge location, meaning that those with poorer functional outcomes were less likely to return home. Conclusions: In contrast to previous studies, our data show no significant racial disparities in functional gains or any measured variable after stroke rehabilitation. This lack of effect may be due to similarities in functional status on admission, or the fact that all of our patients came from similar levels of socioeconomic status. The setting in an urban-based university hospital affords the opportunity to compare a diverse population of stroke patients. Eliminating any preconceived bias of racial disparities is beneficial toward achieving rehabilitative goals. Key Words: Race; Rehabilitation; Stroke. Poster 322 Electric Stimulation to Prolong the Duration of Botulinum Toxin Type A Effect on Spasticity: A Double-Blind, Placebo-Controlled Study. Alberto Esquenazi, MD (MossRehab, Elkins Park, PA); Nathaniel Mayer, MD. Disclosure: A. Esquenazi; N. Mayer, unrestricted educational grant from Allergan. Objective: To demonstrate the potential temporal-enhancing effect of electric stimulation on the clinical effects of botulinum toxin type A (BTX-A) in patients with spasticity. Design: Double-blind, placebocontrolled trial. Setting: Gait and motor control analysis laboratories. Participants: 34 subjects with hemiparesis from stroke or traumatic brain injury and elbow or ankle Ashworth Scale score of more than 2/4. Interventions: After treatment with BTX-A (Botox) to elbow flexors or ankle plantarflexors with a dose of 180 to 400U of BTX-A, patients were randomized to active electric stimulation (muscle contraction) or sham electric stimulation (sensory stimulus) for 30 minutes to the injected muscles and repeated twice daily in 1 month. Active electric stimulation parameters: 20Hz, 200s, 20 seconds on and off, at an intensity of 22 to 90mA. Sham stimulus intensity was greater than 19mA. Patients were contacted every week and maintained a log. Main Outcome Measures: Ashworth and Tardieu scale scores were obtained before injection and every 2 weeks until return to baseline. Results: Increased duration of effect, based on Ashworth or Tardieu scales was evident in patients receiving active electric stimulation when compared with the sham group and with clinical experience. Elbow effect duration increased from 16 weeks (11⫺20) for the control group to 28 weeks for the intervention group (14⫺46). The ankle treatment had shorter duration for both the control (9wk, 4⫺12) and active groups (20wk, 11⫺30). Conclusions: Electric stimulation produced muscle contraction of BTX-A injected muscles within 1 hour of injection and continuing it for 30 minutes twice daily increases the duration of effect. Electric stimulation appears to be beneficial and should be considered as a tool to enhance the valuable effects of BTX-A in the management of upper motoneuron syndrome⫺related muscle overactivity. Further studies are needed to optimize duration of electric stimulation and further elucidate the differences between the ankle and elbow. Key Words: Botulinum toxins; Electric stimulation; Muscle spasticity; Rehabilitation.
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Poster 323 Do Recurrent Stroke Patients Have Poorer Functional Outcomes Compared With First-Time Stroke Patients After Inpatient Rehabilitation? Yee Sien Ng, MRCP (Singapore General Hospital, Singapore, Singapore); Heeyoune Jung, MD; Yi Chiong, MRCP; Peter A. Lim, MD. Disclosure: Y. Ng, None; H. Jung, None; Y. Chiong, None; P.A. Lim, None. Objectives: To establish the demographics and functional outcome data for patients with recurrent stroke and to compare these data with first-time stroke patients. Design: Prospective cohort study. Setting: Inpatient rehabilitation unit within a tertiary teaching hospital. Participants: 94 consecutive recurrent stroke patients over a 4-year period. Interventions: Not applicable. Main Outcome Measure: FIM instrument. Results: Recurrent strokes constitute 9.5% (94/992) of all strokes admitted for inpatient rehabilitation in our unit. The mean age was 63.6⫾12.5 years and 58.9% were men. The mean number of cerebrovascular risk factors was 2.19⫾0.11 and hypertension (91.5%) was the most common risk factor. The admission and discharge total FIM scores were 65.8⫾24.5 and 77.9⫾25.4, respectively, and this gain was highly significant (P⬍.001). The mean FIM efficiency was .724⫾.066 points/d. The mean rehabilitation length of stay (LOS) was 18.3 days and 85.1% of these patients were discharged to home. When recurrent stroke and first-time stroke patients were compared, recurrent stroke patients were older (P⫽.007) and significantly more were hypertensive (P⫽.004) or had diabetes mellitus (P⫽.001). However, the recurrent stroke and first-time stroke cohorts did not differ in rehabilitation LOS (P⫽.520), the absolute number of risk factors (P⫽.258), the number of medical complications during rehabilitation (P⫽.225), frequency of depression in rehabilitation (P⫽.883), or rates of home discharge (P⫽.278). Compared with first-time stroke patients, recurrent stroke patients had similar admission total FIM scores (P⫽.344), but had lower discharge total FIM scores (P⫽.002), FIM gain (P⬍.001), and FIM efficiencies (P⫽.003). Conclusions: Recurrent stroke patients make significant functional gains and can still benefit from comprehensive rehabilitation. However, their poorer functional outcomes compared with first-time stroke patients indicate that stroke recurrence is important in the prognostication, rehabilitation, and discharge planning for this stroke subset. Key Words: Rehabilitation; Stroke; Treatment outcome. Poster 324 Amantadine to Improve Rehabilitation in Chronic Stroke Patients: A Case Report. Jun Zhang, MD (Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ); Uri Adler, MD; Anna Barrett, MD. Disclosure: J. Zhang, None; U. Adler, None; A. Barrett, None. Setting: University-based rehabilitation institution. Patient: A 70year-old woman with multiple medical problems including diabetes and cerebrovascular accident, with continuously decreased activities of daily living (ADLs) and frequent falls. Case Description: The patient, with multiple medical problems including diabetes, right middle cerebral artery infarct with left hemiparesis 2 years ago, decreased ADLs, and frequent falls, was admitted to hospital for mental status change status post fall at home. The computed axial tomography and magnetic resonance imaging scans of brain were negative for acute change. She was transferred to an acute rehabilitation facility because of functional decline. Fatigue was not reported. Assessment/Results: The patient was found to have mild weakness on the left side and gait ataxia. The patient was difficult with both physical therapy (PT) and occupational therapy (OT) because of a lack of attention span. Neurophysiologic evaluation showed significant cognitive deficit; findings included: Mini-Mental State Examination (MMSE) score of 18/30, and Arch Phys Med Rehabil Vol 88, September 2007