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Poster 346: The Impact of Body Mass Index on Achievement of Functional Changes During Inpatient Rehabilitation for Lower Limb Amputees
PM&R
Poster 346 The Impact of Body Mass Index on Achievement of Functional Changes During Inpatient Rehabilitation for Lower Limb Amputees. Nate Olafsen, BA (University of Missouri, Columbia, MO); Fred Murdock, PhD; Gregory M. Worsowicz, MD, MBA. Disclosures: N. Olafsen, None. Objective: To evaluate the impact of body mass index (BMI) on functional outcomes during inpatient rehabilitation for patients with lower limb amputations. Design: A retrospective chart review was conducted by using a computerized medical record database. Setting: Inpatient rehabilitation facility. Participants: Records of 124 patients with lower limb amputations admitted for inpatient rehabilitation from 2002 to 2009 were reviewed. The most recent admission data were used for each patient because of the heterogeneous nature of such factors as number of admissions and cause of admission. Interventions: Not applicable. Main Outcome Measures: Functional independence measure (FIM), length of stay (LOS), height, weight, age, gender, reason for inpatient admission, and etiology and location of amputation were obtained from medical records. FIM change (⫽FIM discharge - FIM admission) and FIM efficiency (⫽FIM change/LOS) were calculated for each patient. Patients were grouped based on BMI category: underweight (BMI ⬍18.5), normal weight (BMI, 18.5-24.9), overweight (BMI, 25.0-29.9), and obese (BMI ⬎ 30.0). Group means and 95% confidence intervals were calculated. Results: Based on calculation of the 95% confidence interval for the difference among means, there was no significant difference among any BMI group for any variable. No statistically significant differences were seen for FIMchange (total, motor, and cognitive), LOS, FIM efficiency, or age among BMI categories. There was no difference observed in gender, etiology of amputation and admission, and location of amputation among BMI categories. Conclusions: Patients with lower limb amputations in the underweight, overweight, and obese BMI categories achieved comparable functional gains to those in the normal BMI category. This study supports the benefits of inpatient rehabilitation for all amputees regardless of BMI.
Poster 347 Botulinum Toxin as a Treatment for SelfMutilation in Lesch-Nyhan Syndrome: A Case Series. Edward Dabrowski, MD (Children's Hospital of Michigan, Detroit, MI); Christopher Dionne, MS; Jimmie P. Leleszi, DO; Lindsey Morgan, MD; Curt D. Ralstrom, DDS MS.
Vol. 2, Iss. 9S, 2010
S153
Disclosures: E. Dabrowski, None. Patients or Programs: 15-year-old boy, 8-year-old boy, and 6-year-old boy, all with confirmed Lesch Nyhan syndrome (LNS) and self-mutilating behaviors, including biting of the hands, tongue, and lips. Program Description: Botulinum toxin A (BTX-A) was injected into masseter muscles bilaterally at 2-3 sites each. Each masseter was injected with a total of 40-80 units of BTX-A, which was reconstituted with normal saline solution. Electromyography guidance was occasionally used to ensure effective injection. Setting: Tertiary care pediatric hospital, regional institute. Results: Within days after the injections, biting behaviors were lessened, and there was no observed effects on eating or swallowing because of the BTX-A administration. Improvements in speech articulation were observed, and the patients exhibited a decrease in aggressive behaviors. Results lasted from 10-12 weeks, with injections being repeated as necessary. Discussion: These patients are among the first known to be treated in this manner with BTX-A, and, although the exact mechanism remains unclear, findings suggest that BTX-A treatment may affect both the central and peripheral nervous systems to decrease the self-mutilating behavior. Conclusions: This case series suggests that BTX-A is a safe and effective treatment in patients with LNS and self-mutilating behaviors, and serves as an alternative to medication and tooth extraction. BTX-A may be acting on the peripheral nervous system as well as acting indirectly on the CNS to modulate the behavioral pathway that causes the self-mutilation.
PRACTICE MANAGEMENT Poster 348 A Proposal for a Clinical Model of Care for the Treatment and Secondary Prevention of Running Injuries. Kevin R. Vincent, MD, PhD (University of Florida, Gainesville, FL); Bryan Conrad, PhD; Scott Greenberg, DPT; Kelley M. Lamb; Amanda Stevenson; Heather K. Vincent, PhD. Disclosures: K. R. Vincent, Genzyme, Speakers bureau; Ferring, Speakers bureau. Objective: To present a multidisciplinary model of care for the treatment and secondary prevention of runningrelated injuries. Design: Ongoing prospective study. Setting: Interdisciplinary Orthopaedics and Sports Medicine Institute; houses a running medicine clinic, human dynamics research testing laboratory, an affiliated physical therapy clinic. Participants: Recreational and competitive runners (age
Poster 346 The Impact of Body Mass Index on Achievement of Functional Changes During Inpatient Rehabilitation for Lower Limb Amputees. Nate Olafsen, BA (University of Missouri, Columbia, MO); Fred Murdock, PhD; Gregory M. Worsowicz, MD, MBA. Disclosures: N. Olafsen, None. Objective: To evaluate the impact of body mass index (BMI) on functional outcomes during inpatient rehabilitation for patients with lower limb amputations. Design: A retrospective chart review was conducted by using a computerized medical record database. Setting: Inpatient rehabilitation facility. Participants: Records of 124 patients with lower limb amputations admitted for inpatient rehabilitation from 2002 to 2009 were reviewed. The most recent admission data were used for each patient because of the heterogeneous nature of such factors as number of admissions and cause of admission. Interventions: Not applicable. Main Outcome Measures: Functional independence measure (FIM), length of stay (LOS), height, weight, age, gender, reason for inpatient admission, and etiology and location of amputation were obtained from medical records. FIM change (⫽FIM discharge - FIM admission) and FIM efficiency (⫽FIM change/LOS) were calculated for each patient. Patients were grouped based on BMI category: underweight (BMI ⬍18.5), normal weight (BMI, 18.5-24.9), overweight (BMI, 25.0-29.9), and obese (BMI ⬎ 30.0). Group means and 95% confidence intervals were calculated. Results: Based on calculation of the 95% confidence interval for the difference among means, there was no significant difference among any BMI group for any variable. No statistically significant differences were seen for FIMchange (total, motor, and cognitive), LOS, FIM efficiency, or age among BMI categories. There was no difference observed in gender, etiology of amputation and admission, and location of amputation among BMI categories. Conclusions: Patients with lower limb amputations in the underweight, overweight, and obese BMI categories achieved comparable functional gains to those in the normal BMI category. This study supports the benefits of inpatient rehabilitation for all amputees regardless of BMI.
Poster 347 Botulinum Toxin as a Treatment for SelfMutilation in Lesch-Nyhan Syndrome: A Case Series. Edward Dabrowski, MD (Children's Hospital of Michigan, Detroit, MI); Christopher Dionne, MS; Jimmie P. Leleszi, DO; Lindsey Morgan, MD; Curt D. Ralstrom, DDS MS.
Vol. 2, Iss. 9S, 2010
S153
Disclosures: E. Dabrowski, None. Patients or Programs: 15-year-old boy, 8-year-old boy, and 6-year-old boy, all with confirmed Lesch Nyhan syndrome (LNS) and self-mutilating behaviors, including biting of the hands, tongue, and lips. Program Description: Botulinum toxin A (BTX-A) was injected into masseter muscles bilaterally at 2-3 sites each. Each masseter was injected with a total of 40-80 units of BTX-A, which was reconstituted with normal saline solution. Electromyography guidance was occasionally used to ensure effective injection. Setting: Tertiary care pediatric hospital, regional institute. Results: Within days after the injections, biting behaviors were lessened, and there was no observed effects on eating or swallowing because of the BTX-A administration. Improvements in speech articulation were observed, and the patients exhibited a decrease in aggressive behaviors. Results lasted from 10-12 weeks, with injections being repeated as necessary. Discussion: These patients are among the first known to be treated in this manner with BTX-A, and, although the exact mechanism remains unclear, findings suggest that BTX-A treatment may affect both the central and peripheral nervous systems to decrease the self-mutilating behavior. Conclusions: This case series suggests that BTX-A is a safe and effective treatment in patients with LNS and self-mutilating behaviors, and serves as an alternative to medication and tooth extraction. BTX-A may be acting on the peripheral nervous system as well as acting indirectly on the CNS to modulate the behavioral pathway that causes the self-mutilation.
PRACTICE MANAGEMENT Poster 348 A Proposal for a Clinical Model of Care for the Treatment and Secondary Prevention of Running Injuries. Kevin R. Vincent, MD, PhD (University of Florida, Gainesville, FL); Bryan Conrad, PhD; Scott Greenberg, DPT; Kelley M. Lamb; Amanda Stevenson; Heather K. Vincent, PhD. Disclosures: K. R. Vincent, Genzyme, Speakers bureau; Ferring, Speakers bureau. Objective: To present a multidisciplinary model of care for the treatment and secondary prevention of runningrelated injuries. Design: Ongoing prospective study. Setting: Interdisciplinary Orthopaedics and Sports Medicine Institute; houses a running medicine clinic, human dynamics research testing laboratory, an affiliated physical therapy clinic. Participants: Recreational and competitive runners (age