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Poster 451 Early Intervention With Intrathecal Baclofen Therapy in a Child with Anoxic Brain Injury: A Case Report
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tively. Subscale of MULL, goal keeping score and modified motor activity log for the game improved after intervention significantly. But muscle depth was not changed. Conclusions: Our results suggest that commercially available virtual reality games improved throwing motion and upper extremity coordination in hemiplegic cerebral palsy patients. But it was relatively short period of follow-up for muscle hypertrophy. Poster 451 Early Intervention With Intrathecal Baclofen Therapy in a Child with Anoxic Brain Injury: A Case Report. Shelly Rich, RN, LBSW (Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, United States); Tamara Zagustin, MD. Disclosures: S. Rich, No Disclosures. Case Description: Patient: A 4-year-old boy with an anoxic brain injury was admitted to acute inpatient rehabilitation to optimize neurorecovery regarding agitation, neurostorming and increased dystonia and spasticity with significant posturing. Case Description: Upon admission to inpatient rehabilitation the patient was on multiple medications with suboptimal management which was interfering with his rehabilitation. Seven weeks after his acute anoxic brain injury, an ITB bolus trial in our center was preformed with good results. The ITB pump system was implanted and within 4 weeks, measurable improvement was noted. Setting: Pediatric acute inpatient rehabilitation. Results or Clinical Course: Upon discharge from inpatient rehab at 6 weeks, all medications for agitation, neurostorming and dystonia/spasticity management were discontinued with the exception of the ITB therapy which was: 12mcg/hr basal rate, 150mcg bolus over 5 minutes every 3 hours for a total of 1528 mcg/day (flex mode). He was ambulating 150 feet with moderate assistance due to steppage gait and poor foot placement using a posterior rolling walker. He was awake, alert, interacting with his environment, mouthing words, and nodding his head appropriately in response to questions. Some minimal dystonia affecting his upper extremities was still noted. Discussion: ITB therapy using a programmable pump is clinically effective in patients with brain injury. Conclusions: Early intervention with ITB therapy using a programmable pump is clinically effective in optimizing acute inpatient rehabilitation outcomes, functional outcomes, and minimizing polypharmacy in this pediatric patient with acute anoxic brain injury. Poster 453 Dermatomyositis Causing New-Onset Weakness in a Child With Spastic Diplegia: A Case Report. Tobias J. Tsai, MD (Kennedy Krieger Institute, Baltimore, MD, United States); Frank S. Pidcock, MD; Suzanne Prestwich, MD. Disclosures: T. J. Tsai, No Disclosures. Setting: Pediatric rehabilitation hospital. Results or Clinical Course: A 13-year-old girl with spastic diplegia secondary to neonatal hypoxic-ischemic encephalopathy presented to clinic for new-onset weakness. Previously ambulatory, over the past 1-2 months she had increased falls and reluctance to walk; she also had increased difficulty swallowing. Subsequent
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evaluation showed creatine kinase (CK) of 23000, and she was treated for rhabdomyolysis. 1 month later, walking and swallowing difficulties persisted and CK remained elevated. She had less than anti-gravity strength in her proximal lower extremities and ankle reflexes were absent. Skin was without lesions. Brain magnetic resonance imaging (MRI) showed no new findings; spine MRI showed no syringomyelia. Lower extremity MRI showed diffusely increased T2 signal in pelvic and proximal lower extremity musculature, with perifascial edema. Electrodiagnostic evaluation revealed normal nerve conduction studies, but abnormal spontaneous activity and myopathic units in proximal and distal muscles. Muscle biopsy showed extensive perivascular inflammation with perifascicular necrosis and atrophy, with myofiber degeneration and regeneration, consistent with dermatomyositis. She was placed on steroids, admitted for comprehensive inpatient rehabilitation and subsequently regained ambulation. Discussion: Idiopathic inflammatory myopathies such as dermatomyositis or polymyositis may have a variable presentation, and may exist even in the presence of other causes of weakness. Despite the name, dermatomyositis may present even without cutaneous findings (or conversely, as in amyopathic dermatomyositis, without myopathic changes.) Symmetric proximal muscle weakness is a common finding, and may help differentiate these myopathies from other causes of weakness. Prompt identification and treatment can improve functional recovery. Conclusions: Even when weakness is known to exist from an underlying non-progressive lesion, new-onset weakness or functional change should prompt further investigation. Idiopathic inflammatory myopathies such as dermatomyositis may not always present with expected clinical findings, but should be considered when proximal or bulbar muscle weakness is noted; imaging, electrodiagnostic studies, and muscle biopsy may be helpful to confirm diagnosis.
PHYSIATRIC THERAPEUTICS Poster 456 The Effect of Epidural Low-Frequency Electrical Stimulation on Atrophied Skeletal Muscle in a Rat Model of Spinal Cord Injury. Jae-Young Lim, MD (Seoul National University College of Medicine, Seongnam, Korea, Republic of); Hye Jin Kim, MS; Na Rae Kim, BSc; Eun Sil Koh; Eun-Jeong Lee, PhD; Seung Yeol Lee, MD. Disclosures: J. Lim, No Disclosures. Objective: To investigate the effect of neuromodulation by epidural low-frequency electrical stimulation (ELFES) on the atrophic changes and the change of myosin heavy chain (MHC) isoform composition in rat skeletal muscles after spinal cord contusion inury. Design: In vivo, experimental, controlled study. Setting: Research laboratory. Participants: Animals: Male Sprague Dawley rats (n⫽21). Interventions: Sprague Dawley rats were allocated into 3 groups; control (C) (n⫽7), spinal cord injury (SCI) with sham (SCI-S) (n⫽7), and spinal cord injury with ELFES (SCI-E) (n⫽7). Spinal cord was injured by NYU impactor (New York University - Multicenter Animal Spinal Cord Injury Study). NYU impacter of 10mg weight rod was dropped from 20-25mm height to induce moderately severe grade of contusion injury. To SCI-E, fine needle elec-
tively. Subscale of MULL, goal keeping score and modified motor activity log for the game improved after intervention significantly. But muscle depth was not changed. Conclusions: Our results suggest that commercially available virtual reality games improved throwing motion and upper extremity coordination in hemiplegic cerebral palsy patients. But it was relatively short period of follow-up for muscle hypertrophy. Poster 451 Early Intervention With Intrathecal Baclofen Therapy in a Child with Anoxic Brain Injury: A Case Report. Shelly Rich, RN, LBSW (Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, United States); Tamara Zagustin, MD. Disclosures: S. Rich, No Disclosures. Case Description: Patient: A 4-year-old boy with an anoxic brain injury was admitted to acute inpatient rehabilitation to optimize neurorecovery regarding agitation, neurostorming and increased dystonia and spasticity with significant posturing. Case Description: Upon admission to inpatient rehabilitation the patient was on multiple medications with suboptimal management which was interfering with his rehabilitation. Seven weeks after his acute anoxic brain injury, an ITB bolus trial in our center was preformed with good results. The ITB pump system was implanted and within 4 weeks, measurable improvement was noted. Setting: Pediatric acute inpatient rehabilitation. Results or Clinical Course: Upon discharge from inpatient rehab at 6 weeks, all medications for agitation, neurostorming and dystonia/spasticity management were discontinued with the exception of the ITB therapy which was: 12mcg/hr basal rate, 150mcg bolus over 5 minutes every 3 hours for a total of 1528 mcg/day (flex mode). He was ambulating 150 feet with moderate assistance due to steppage gait and poor foot placement using a posterior rolling walker. He was awake, alert, interacting with his environment, mouthing words, and nodding his head appropriately in response to questions. Some minimal dystonia affecting his upper extremities was still noted. Discussion: ITB therapy using a programmable pump is clinically effective in patients with brain injury. Conclusions: Early intervention with ITB therapy using a programmable pump is clinically effective in optimizing acute inpatient rehabilitation outcomes, functional outcomes, and minimizing polypharmacy in this pediatric patient with acute anoxic brain injury. Poster 453 Dermatomyositis Causing New-Onset Weakness in a Child With Spastic Diplegia: A Case Report. Tobias J. Tsai, MD (Kennedy Krieger Institute, Baltimore, MD, United States); Frank S. Pidcock, MD; Suzanne Prestwich, MD. Disclosures: T. J. Tsai, No Disclosures. Setting: Pediatric rehabilitation hospital. Results or Clinical Course: A 13-year-old girl with spastic diplegia secondary to neonatal hypoxic-ischemic encephalopathy presented to clinic for new-onset weakness. Previously ambulatory, over the past 1-2 months she had increased falls and reluctance to walk; she also had increased difficulty swallowing. Subsequent
Vol. 4, Iss. 10S, 2012
S345
evaluation showed creatine kinase (CK) of 23000, and she was treated for rhabdomyolysis. 1 month later, walking and swallowing difficulties persisted and CK remained elevated. She had less than anti-gravity strength in her proximal lower extremities and ankle reflexes were absent. Skin was without lesions. Brain magnetic resonance imaging (MRI) showed no new findings; spine MRI showed no syringomyelia. Lower extremity MRI showed diffusely increased T2 signal in pelvic and proximal lower extremity musculature, with perifascial edema. Electrodiagnostic evaluation revealed normal nerve conduction studies, but abnormal spontaneous activity and myopathic units in proximal and distal muscles. Muscle biopsy showed extensive perivascular inflammation with perifascicular necrosis and atrophy, with myofiber degeneration and regeneration, consistent with dermatomyositis. She was placed on steroids, admitted for comprehensive inpatient rehabilitation and subsequently regained ambulation. Discussion: Idiopathic inflammatory myopathies such as dermatomyositis or polymyositis may have a variable presentation, and may exist even in the presence of other causes of weakness. Despite the name, dermatomyositis may present even without cutaneous findings (or conversely, as in amyopathic dermatomyositis, without myopathic changes.) Symmetric proximal muscle weakness is a common finding, and may help differentiate these myopathies from other causes of weakness. Prompt identification and treatment can improve functional recovery. Conclusions: Even when weakness is known to exist from an underlying non-progressive lesion, new-onset weakness or functional change should prompt further investigation. Idiopathic inflammatory myopathies such as dermatomyositis may not always present with expected clinical findings, but should be considered when proximal or bulbar muscle weakness is noted; imaging, electrodiagnostic studies, and muscle biopsy may be helpful to confirm diagnosis.
PHYSIATRIC THERAPEUTICS Poster 456 The Effect of Epidural Low-Frequency Electrical Stimulation on Atrophied Skeletal Muscle in a Rat Model of Spinal Cord Injury. Jae-Young Lim, MD (Seoul National University College of Medicine, Seongnam, Korea, Republic of); Hye Jin Kim, MS; Na Rae Kim, BSc; Eun Sil Koh; Eun-Jeong Lee, PhD; Seung Yeol Lee, MD. Disclosures: J. Lim, No Disclosures. Objective: To investigate the effect of neuromodulation by epidural low-frequency electrical stimulation (ELFES) on the atrophic changes and the change of myosin heavy chain (MHC) isoform composition in rat skeletal muscles after spinal cord contusion inury. Design: In vivo, experimental, controlled study. Setting: Research laboratory. Participants: Animals: Male Sprague Dawley rats (n⫽21). Interventions: Sprague Dawley rats were allocated into 3 groups; control (C) (n⫽7), spinal cord injury (SCI) with sham (SCI-S) (n⫽7), and spinal cord injury with ELFES (SCI-E) (n⫽7). Spinal cord was injured by NYU impactor (New York University - Multicenter Animal Spinal Cord Injury Study). NYU impacter of 10mg weight rod was dropped from 20-25mm height to induce moderately severe grade of contusion injury. To SCI-E, fine needle elec-