Poster 33 assessment of function of survivors of pediatric sarcomas. Lynn Gerber, MD (Natl Inst Health, Bethesda, MD); Karen Hoffman; Elizabeth Augustine, PT; Martha Bernad, PhD; Seth Steinberg, PhD; Patrick Mansky, MD; et al, e-mail: [email protected]

2004 Academy Annual Assembly Abstracts patients with TBI. Key Words: Age groups; Brain injuries; Geriatrics; Rehabilitation; Treatment outcome. Poster 30 Demographics and Epidemiology of Golf-Related Head Trauma. Angela M. Krull, MD (Univ Virginia, Charlottesville, VA); Susan A. Miller, MD; Paul T. Diamond, MD, e-mail: [email protected]. Disclosure: A.M. Krull, None; S.A. Miller, None; P.T. Diamond, None. Objective: To examine the demographics and epidemiology of golf-related head trauma. Design: Retrospective analysis of golf-related injuries reported to the National Electronic Injury Surveillance System over a 1-y period and the Consumer Product Safety Commission (CPSC) Death Certificate File over a 10-y period. Setting: General community. Participants: 1100 persons who presented to emergency departments with golf-related trauma. Interventions: Not applicable. Main Outcome Measures: Type and location of injury, mechanism of injury, and treatment disposition. Results: Trauma to the head and face region represented the most common site (42%) of all golf-related injuries. Injuries included lacerations and abrasions (86%), closed head injury (12%), and skull and facial fracture (2%). The median age of persons with closed head injury was 10y (range, 2– 87y), and 73% were men. The primary mechanism of closed head injury for all ages was evenly divided between direct contact with the golf club and impact by a golf ball. However, in children age 10y and younger, the majority of head injuries resulted from being struck by a golf club (74%). Only 1% of persons presenting with head trauma required hospitalization. Of 19 deaths reported to the CPSC Death Certificate File over a 10-y period, 10 deaths resulted from head trauma, 6 of which occurred after being struck by a golf ball. Median age of death from closed head injury was 13y (range, 4 – 67y). Conclusions: Injuries to the head and face are prevalent among persons with golf-related trauma. The majority of head trauma in young children appears to be caused by standing too near to a swinging golf club. Most golf-related head injuries are mild and do not require hospitalization. However, a small percentage is serious. Head injury was the most common cause of golf-related death. Key Words: Athletic injuries; Craniocerebral trauma; Golf; Rehabilitation. Poster 31 Controversy Regarding Prophylaxis Against Late-Onset Seizures in a Penetrating Brain Injury Patient Resulting From a Gunshot Wound: A Case Report. Billy Smith, MD; Clinton Faulk, MD (Pitt County Memorial Hosp, Greenville, NC); David Epperson, MD; Jacinta McElligott, MD, e-mail: [email protected]. Disclosure: B. Smith, None; C. Faulk, None; D. Epperson, None; J. McElligott, None. Setting: Acute rehabilitation hospital. Patient: Young adult man after penetrating head injury. Case Description: The head injury resulted in bilateral frontal lobe injury requiring a craniotomy with de´ bridement of the frontal lobes. Head computerized axial tomography showed retained bone and bullet fragments intracranially, particularly in the left frontal lobe. This patient was admitted to the traumatic brain injury rehabilitation unit 10d postinjury on phenytoin for seizure prophylaxis. Assessment/Results: Patients with penetrating head injuries have the greatest risk for seizures. About 30% to 50% will develop seizures, and 80% occur during the first 2y postinjury. A literature search showed that seizure prophylaxis decreases the risk of early posttraumatic seizures (seizures occurring ⬍1wk postinjury) in penetrating head injuries, but does not demonstrate a benefit for continued seizure prophylaxis beyond 1wk postinjury. Discussion: Studies show that seizure rates in severe head injuries approach 50%, depending on the injury type, with seizures more prevalent in penetrating head injuries. Most patients who develop posttraumatic seizures after the first week of injury will have recurrent seizures and use of anticonvulsant therapy is indicated in documented cases. A review of several meta-analyses showed that the rates of seizures were significant and relatively the same regardless of the site of brain injury, mode of injury, or number of lobes involved (unless ⱖ3). However, the more severe the penetrating head injury, based on a lower Glasgow Coma Scale score (range, 3–5), the higher the rate of late-onset seizures. Conclusions: Patients with penetrating head injuries are at a significantly higher risk for late-onset seizures than those with closed head injuries. The literature is controversial on use of phenytoin beyond 1wk to prevent late-onset seizures in penetrating head injuries. Clinicians should consider extended seizure prophylaxis in patients with severe penetrating head injuries when the risk from seizures outweighs the risk from continued prophylaxis. Key Words: Head injuries, penetrating; Rehabilitation; Seizures.

Poster 32 A Practice Survey of Deep Vein Thrombosis Management in the Traumatic Brain Injury Model Systems: A Program Survey. Mary C. Carlile, MD (Baylor Inst Rehabil, Dallas, TX); W. Jerry Mysiw, MD; Stuart Yablon, MD, e-mail: [email protected]. Disclosure: M.C. Carlile, None; W. Mysiw, None; S. Yablon, None. Setting: 14 rehabilitation centers within the Traumatic Brain Injury Model System (TBIMS). Program: Practice patterns of deep vein thrombosis (DVT) management in the TBIMS. Program Description: 14 of the 16 TBIMS centers responded to a survey on current practice patterns of screening, prophylaxis, and treatment of DVT in patients with traumatic brain injury (TBI) in the acute rehabilitation setting. Respondents were surveyed on the use of duplex ultrasound, pneumatic compression devices, compression stockings, inferior vena cava filters, and anticoagulation for DVT screening, prophylaxis, and treatment. Treatment of calf DVTs and the interval of bedrest after acute DVT were queried as well as the number of fatal pulmonary emboli in TBI patients witnessed in the years of practice of each reporting physician. Assessment/Results: 64% of the respondents were routinely screened for DVT on admission to rehabilitation using venous Doppler. 57% of the respondents routinely initiated anticoagulation for DVT prophylaxis in the rehabilitation setting. 59 fatal pulmonary emboli were reported in TBI patients in 158 practice years, for an occurrence rate of 0.4 fatal pulmonary emboli per practice year. Discussion: There was no current consensus concerning appropriate methods of screening, prophylaxis, or treatment of DVT in TBI patients as confirmed by the significant variability in practice patterns revealed by this survey of the TBIMS sites. Conclusions: The number of fatal pulmonary emboli in TBI patients reported among these centers emphasizes the need to develop evidence-based clinical practice guidelines for the prevention and treatment of venous thromboembolism. The substantial variability in practice patterns

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revealed by this survey supports the value of conducting a prospective study to determine the efficacy and cost effectiveness of DVT prevention and management methods. Key Words: Brain injuries; Rehabilitation; Venous thrombosis.

Cancer Poster 33 Assessment of Function of Survivors of Pediatric Sarcomas. Lynn Gerber, MD (Natl Inst Health, Bethesda, MD); Karen Hoffman; Elizabeth Augustine, PT; Martha Bernad, PhD; Seth Steinberg, PhD; Patrick Mansky, MD; et al, e-mail: [email protected]. Disclosure: L. Gerber, None; K. Hoffman, None; E. Augustine, None; M. Bernad, None; S. Steinberg, None; P. Mansky, None. Objective: To assess impairments, functional limitations, health status, quality of life, and vocational histories of survivors of pediatric sarcomas. Design: Prospective, cross-sectional study of late effects of sarcoma treatment in survivors of pediatric sarcomas. Setting: Biomedical research hospital. Participants: Survivors of pediatric sarcomas. Interventions: Not applicable. Main Outcome Measures: Impairments: joint range of motion (ROM), manual muscle test, and grip strength. Function/performance: Assessment of Motor and Process Skills (AMPS) measures motor and process in performance of daily routines, 6-min walk test (6MWT), and Human Activity Profile (HAP) questionnaire. Leisure satisfaction measure (LSM), Sickness Impact Profile, and SF-36v2, as well as the Goldberg Scale of Vocational Development (GSVD) were used. Patients and norms were compared. Significance was determined using the Wilcoxon signed-rank 2-sided P values, unadjusted for multiple comparisons. Results: 17 men and 15 women (median age at diagnosis, 15y; range, 7–34y) participated. Median age at follow-up was 37.2y (range, 17.5–55.4y). Median time since treatment was 17.3y (range, 3–32y). 22 subjects had ⬎40% loss of signal joint ROM. 7 had moderate to severe strength deficits. Grip strength did not differ from matched norms. 28 performed the 6MWT; 9 had a velocity ⬍90% of predicted; 4 (3 amputees) were unable to perform. Level of activity (HAP) was lower than that for matched norms (P⬍.05). Motor portion of the AMPS was lower than that for matched controls (P⬍.0001). SF-36 physical competency scale trended lower (P⫽.065) and mental competency trended higher (P⫽.058) than scores for normals. Sickness impact was perceived as minimal. Overall LSM was higher than that for controls (P⬍.001). Preliminary GSVD evaluation indicated an increase in postdisability work values, with a shift toward greater intrinsic work satisfaction. 7 of 22 reported illness negatively impacted work behavior. Conclusions: Survivors of pediatric sarcomas have persistent impairment of strength and ROM. Level of activity in daily routines, fitness, and perceived physical competency were reduced when compared with norms; however, subjects do not perceive this as significant with respect to leisure satisfaction, mental competency, or work satisfaction. Key Words: Pediatrics; Rehabilitation; Sarcoma; Survivors. Poster 34 Physical Performance and Perceived Psychosocial Stress in Pediatric Sarcoma Survivors. Usha G. Chaudhry, MD (Natl Inst Health, Bethesda, MD); Lynn Gerber, MD; Gloria Furst, OTRL, MPH; Lori Wiener, PhD, DCSW; Patrick Mansky, MD; Elizabeth Augustine, MSPT, e-mail: [email protected]. Disclosure: U.G. Chaudhry, None; L. Gerber, None; G. Furst, None; L. Wiener, None; P. Mansky, None; E. Augustine, None. Objective: To determine whether long-term survivors of pediatric sarcomas who reported anxiety, depression, anger, family discord, and financial stress during their treatment have lower physical performance than those who did not. Design: Prospective cross-sectional study of longterm survivors of pediatric sarcomas. Setting: Biomedical research facility. Participants: 17 men and 15 women with survivors of pediatric sarcoma, with a median age of 15y at the time of diagnosis and 37.2y at follow-up. Interventions: Not applicable. Main Outcome Measures: Standardized psychosocial questionnaires and structured interview by the social worker, SF-36v2 physical composite score (PCS), Human Activity Profile (HAP), maximum activity score, and adjusted activity score, 6-minute walk test (velocity), grip strength, and the Assessment of Motor and Processing Skills, a measure of daily routines. Data were analyzed using Kruskal-Wallis dichotomous variables and Spearman correlation coefficient. Results: Age at the time of diagnosis did not correlate with performance variables; but at follow-up older age had a negative correlation with all measures of physical activity including the PCS (Pⱕ.0001), maximum activity score (P⫽.004), and adjusted activity score (P⫽.002). Men had higher grip strength for the right (P⫽.0008) and left hands (P⫽.02) and velocity (P⫽.02). Those who reported greater anger during treatment had higher velocity (P⫽.004), higher PCS (P⫽.007) and HAP values, for both maximum activity score and adjusted activity score (P⫽.02). Patients who reported no discord with parents and siblings had higher velocity (P⫽.02) and adjusted activity score (P⫽.02). Anxiety, depression, and financial status did not correlate with any of the performance variables. Conclusions: Long-term survivors of pediatric sarcomas who had good relationships with family (parents, siblings) scored higher on performance measures than those who did not. Patients who recall being angry during the initial treatment of their sarcoma also had higher performance measures. Older subjects reported lower levels of physical activity. Key Words: Pediatrics; Rehabilitation; Sarcoma; Survivors. Poster 35 Functional Outcome in a Patient With Radical Sacrectomy and Sacral Cord Resection: A Case Report. Ramnik Singh, MD (New York-Presbyterian Hosp, New York, NY); Christian Custodio, MD; Paula Lidestri, MD; Michael Stubblefield, MD, e-mail: Ramnik_singh@ hotmail.com. Disclosure: R. Singh, None; C. Custodio, None; P. Lidestri, None; M. Stubblefield, None. Setting: Tertiary care hospital. Patient: A 22-yo woman with radiation-induced chondrosarcoma. Case Description: 10y after resection and external beam radiation for an ependymoma, the patient developed left leg weakness and decreased sensation over the lateral aspect of her left foot, posterior calf, and posterior thigh. An expansile lytic lesion of the left sacrum with epidural and

Arch Phys Med Rehabil Vol 85, September 2004