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Poster 324: Quadruple Amputee: A Case Report
PM&R
healing at the time of discharge scoring consistently higher. There was no significant difference between the two groups on the Houghton score Conclusions: The results of this study show that patients who undergo late prosthesis fitting do experience some decline in their level of functionality. Although there was a significant difference between the two groups only on 3 PEQ scales, patients with delayed wound healing did score consistently lower in all PEQ measures and were noted to be on average less optimistic and more concerned about the outcome of their amputation and rehabilitation training. Keywords: Amputee, Lower limb, Wound healing, Prosthesis.
Vol. 1, Iss. 9S, 2009
S245
step program is described, with details on wound care, edema control, rehabilitation and prosthetic management. The importance of promptly identifying a patient’s psychosocial needs is stressed. Conclusions: The integrated rehabilitation program for a patient presenting as a quadruple amputee can facilitate a return to functional independence. Keywords: Rehabilitation, Amputation, Prostheses.
SPINAL CORD INJURY Poster 325
Quadruple Amputee: A Case Report. Michal R. Sheps, DO (NYU Langone Medical Center, New York, NY); Jeffrey M. Cohen, MD; Susan Maltser.
A Rare Case of Spinal Cord Transection Following Intrathecal Baclofen Pump Catheter Placement in a Spastic Tetraplegic: A Case Report. Kimberley L. Wong, MD (Medical College of WI, Milwaukee, WI).
Disclosures: M. R. Sheps, None. Patients or Programs: A 32-year-old woman presenting as a quadruple amputee. Program Description: The patient presented to the acute rehabilitation hospital as a quadruple amputee. This followed a complicated course at her local hospital notable for urosepsis, septic emboli, respiratory failure and the need for vasopressor support. She developed gangrene in all limbs requiring bilateral trans-radial and bilateral trans-tibial amputations. The rehabilitation of this patient comprised 3 phases. For the initial phase, the focus was on meticulous wound care, edema control and pain control. The second phase focused on fabricating and training with bilateral transtibial prostheses. Upper extremity functional skills were enhanced through the use of a universal cuff as well as a wash mitt placed on her residual forearms. The third phase involved training the patient to use body powered upper extremity terminal devices. In addition, biofeedback to isolate individual muscles in her forearms required for the operation of myoelectric controlled terminal devices was begun as well as the fabrication of these devices. Setting: Tertiary care hospital Results: This patient made tremendous gains while in the acute rehabilitation facility. Despite being faced with many challenges, she slowly overcame each one of them with her positive attitude and strong family support. She progressed to independence in ambulation with bilateral trans-tibial prostheses, thus conquering her goal of being able to walk out of the hospital on her day of discharge. She also advanced to independence in feeding herself, brushing her teeth and washing her face using a universal cuff and wash mitt. Discussion: A carefully designed rehabilitation program, incorporating a team approach, can lead to a successful rehabilitation outcome (physically, emotionally, and socially) in a patient who is a quadruple amputee. This step by
Disclosures: K. L. Wong, None. Patients or Programs: A 47-year-old man with history of C4-American Spinal Injury Association Impairment Scale-C tetraplegia since November 2007 from a motor vehicle collision. Program Description: The patient had an intrathecal baclofen pump placed for spasticity in all extremities and inability to tolerate side effects of oral baclofen. Postoperatively, the patient developed right foot drop, with manual muscle test rating of 0/5 for dorsiflexion. Preoperatively it had been 4/5. Magnetic resonance imaging of the thoracic and lumbar spine showed the baclofen catheter entering the thecal sac near the T12-L1 disk and transversing the central aspect of the spinal cord, and then coursing anterior to the spinal cord with the tip terminating ventrally and somewhat to the left at the level of the T9 vertebral body. Setting: Inpatient rehabilitation unit of academic medical center (Froedtert Hospital and Medical college of Wisconsin). Results: The patient underwent urgent revision of the baclofen pump catheter, with repositioning within the thecal sac. The newly placed catheter entered at L1-L2 with the tip positioned near T1. Following the revision, right dorsiflexion manual muscle test rating gradually improved to 2/5. At 4 months post-revision, it had improved to 3/5. Discussion: Intrathecal baclofen pump placement is an effective and relatively safe procedure for treatment of spasticity in patients with spinal cord injury and other upper motor neuron diseases. Infection, cerebrospinal fluid collection, spinal headache and cerebrospinal fluid leak are some of the common complications of intrathecal baclofen pump placement. Damage to spinal cord during this procedure is relatively rare and to our knowledge, this is the first reported case of spinal cord transection by an intrathecal baclofen pump catheter. The importance of catheter positioning in
Poster 324
healing at the time of discharge scoring consistently higher. There was no significant difference between the two groups on the Houghton score Conclusions: The results of this study show that patients who undergo late prosthesis fitting do experience some decline in their level of functionality. Although there was a significant difference between the two groups only on 3 PEQ scales, patients with delayed wound healing did score consistently lower in all PEQ measures and were noted to be on average less optimistic and more concerned about the outcome of their amputation and rehabilitation training. Keywords: Amputee, Lower limb, Wound healing, Prosthesis.
Vol. 1, Iss. 9S, 2009
S245
step program is described, with details on wound care, edema control, rehabilitation and prosthetic management. The importance of promptly identifying a patient’s psychosocial needs is stressed. Conclusions: The integrated rehabilitation program for a patient presenting as a quadruple amputee can facilitate a return to functional independence. Keywords: Rehabilitation, Amputation, Prostheses.
SPINAL CORD INJURY Poster 325
Quadruple Amputee: A Case Report. Michal R. Sheps, DO (NYU Langone Medical Center, New York, NY); Jeffrey M. Cohen, MD; Susan Maltser.
A Rare Case of Spinal Cord Transection Following Intrathecal Baclofen Pump Catheter Placement in a Spastic Tetraplegic: A Case Report. Kimberley L. Wong, MD (Medical College of WI, Milwaukee, WI).
Disclosures: M. R. Sheps, None. Patients or Programs: A 32-year-old woman presenting as a quadruple amputee. Program Description: The patient presented to the acute rehabilitation hospital as a quadruple amputee. This followed a complicated course at her local hospital notable for urosepsis, septic emboli, respiratory failure and the need for vasopressor support. She developed gangrene in all limbs requiring bilateral trans-radial and bilateral trans-tibial amputations. The rehabilitation of this patient comprised 3 phases. For the initial phase, the focus was on meticulous wound care, edema control and pain control. The second phase focused on fabricating and training with bilateral transtibial prostheses. Upper extremity functional skills were enhanced through the use of a universal cuff as well as a wash mitt placed on her residual forearms. The third phase involved training the patient to use body powered upper extremity terminal devices. In addition, biofeedback to isolate individual muscles in her forearms required for the operation of myoelectric controlled terminal devices was begun as well as the fabrication of these devices. Setting: Tertiary care hospital Results: This patient made tremendous gains while in the acute rehabilitation facility. Despite being faced with many challenges, she slowly overcame each one of them with her positive attitude and strong family support. She progressed to independence in ambulation with bilateral trans-tibial prostheses, thus conquering her goal of being able to walk out of the hospital on her day of discharge. She also advanced to independence in feeding herself, brushing her teeth and washing her face using a universal cuff and wash mitt. Discussion: A carefully designed rehabilitation program, incorporating a team approach, can lead to a successful rehabilitation outcome (physically, emotionally, and socially) in a patient who is a quadruple amputee. This step by
Disclosures: K. L. Wong, None. Patients or Programs: A 47-year-old man with history of C4-American Spinal Injury Association Impairment Scale-C tetraplegia since November 2007 from a motor vehicle collision. Program Description: The patient had an intrathecal baclofen pump placed for spasticity in all extremities and inability to tolerate side effects of oral baclofen. Postoperatively, the patient developed right foot drop, with manual muscle test rating of 0/5 for dorsiflexion. Preoperatively it had been 4/5. Magnetic resonance imaging of the thoracic and lumbar spine showed the baclofen catheter entering the thecal sac near the T12-L1 disk and transversing the central aspect of the spinal cord, and then coursing anterior to the spinal cord with the tip terminating ventrally and somewhat to the left at the level of the T9 vertebral body. Setting: Inpatient rehabilitation unit of academic medical center (Froedtert Hospital and Medical college of Wisconsin). Results: The patient underwent urgent revision of the baclofen pump catheter, with repositioning within the thecal sac. The newly placed catheter entered at L1-L2 with the tip positioned near T1. Following the revision, right dorsiflexion manual muscle test rating gradually improved to 2/5. At 4 months post-revision, it had improved to 3/5. Discussion: Intrathecal baclofen pump placement is an effective and relatively safe procedure for treatment of spasticity in patients with spinal cord injury and other upper motor neuron diseases. Infection, cerebrospinal fluid collection, spinal headache and cerebrospinal fluid leak are some of the common complications of intrathecal baclofen pump placement. Damage to spinal cord during this procedure is relatively rare and to our knowledge, this is the first reported case of spinal cord transection by an intrathecal baclofen pump catheter. The importance of catheter positioning in
Poster 324