Poster 67 Runner’s Dystonia Presenting as Leg Pain: A Case Report

Abstracts / PM R 8 (2016) S151-S332 over the 4-year period. Pressure ulcer incidence and healing rate were reviewed by multidisciplinary team. Setting: A 90-bed acute rehabilitation institute affiliated with medical school. Participants: All admissions from 2012 through 2015. Interventions: Risk assessment, tracking system, staff and patient education, supplies accessibility, wound rounds, therapeutic surfaces, positioning, unit-based skin champions, orthotic assessment, nutritional management, performance monitoring and reporting, treatment guidelines. Main Outcome Measures: Pressure ulcer incidence per 1000 patient days, and healing rate of existing pressure ulcer each year from 2012 through 2015. Results: Pressure ulcer incidence was reduced by 50% in 2012 following the initiation of the multidisciplinary program, and maintained at 0-0.09 through the following years. Pressure ulcer healing rate was 76.92% in 2012, increased to 97.15% in 2013 after improvement in assessment/tracking system, staff/patient education, nutritional assessment, treatment supplies accessibility and collaboration with physicians. In 2014 we found no significant improvement after implementation of safe patient handling equipment and surfacing modification. In late 2014 we started developing the skin champions who were experts on skin care and acted as resources for their peers, we also enhanced multidisciplinary team with involvement of prosthetic and orthotic clinic to evaluate and adjust braces and casts. In 2015 healing rate reached 98.04%. Conclusions: Pressure ulcer prevention and treatment in acute rehabilitation represent a challenging problem. Successful implementation of a multidisciplinary team is crucial for effectively reducing pressure ulcer incidence, improving healing process, ensuring maximal functional gain and reasonable length of stay in acute rehabilitation centers. Level of Evidence: Level I Poster 67 Runner’s Dystonia Presenting as Leg Pain: A Case Report Abby L. Cheng, MD (McGaw Medical Center/Rehabilitation Institute of Chicago, Chicago, IL, United States), Stacey Bennis, MD, James A. Sliwa, DO Disclosures: Abby Cheng: I Have No Relevant Financial Relationships To Disclose Case/Program Description: A 55-year-old woman presented with 12 years of calf tingling and tightness. Symptom onset initially occurred while running half-marathons but progressed to occurring after walking several feet. She also began experiencing toe-walking, which was less painful and allowed her to walk faster. She could cycle without difficulty and denied other complaints. No family members had similar symptoms. On exam, she had normal strength, sensation, tone, reflexes, distal pulses, and coordination. Her gait was initially normal, but after 20 feet she began toe-walking. Prior workup included normal inflammatory, autoimmune, nutritious, and infectious serology and cerebrospinal fluid studies; brain and spine imaging; venous duplex scan; and hip injection. Setting: Outpatient clinic. Results: Pre- and post-exertion arterial duplex scan, lower extremity magnetic resonance imaging, and compartment pressures were normal. Electrodiagnostic studies were normal except for scattered fasciculations of bilateral gastrocnemius muscles. Upon re-examination, her toe-walk resolved while walking backwards. She was tentatively diagnosed with runner’s dystonia and was referred to a movement disorder specialist. With a trial of low-dose carbidopalevodopa, immediately her leg pain diminished and her toe-walking resolved. She was diagnosed with the dopamine-responsive subtype of

S183

runner’s dystonia, and normal copper studies ruled out secondary dystonia from Wilson’s disease. Discussion: Most task-specific dystonias affect the upper extremities, but runner’s dystonia is a rare subtype which occurs in avid runners, first develops while running, usually affects the lower extremities, and is associated with an otherwise normal physical examination. Some cases are dopamine-responsive, and others have responded to trihexyphenidyl, carbamazepine, botulinum toxin injection, and motor and sensory tricks. Conclusions: Runner’s dystonia is a rare form of dystonia and can present as leg pain, paresthesias, and abnormal gait in an otherwise healthy adult. In some cases, levodopa can provide dramatic symptom relief. Level of Evidence: Level V Poster 68 Feasibility of a Prehabilitation Program for Patients with Potentially Resectable Pancreatic Cancer: Pilot Study An Ngo-Huang, DO (University of Texas MD Anderson Cancer Center, Houston, TX, United States), Nathan Parker, MPH, Vanessa A. Martinez, BS, Maria QB. Petzel, RD, CSO, LD, CNSC, David Fogelman, MD, Holly M. Holmes, MD, Satinderpal S. Dhah, DO, Matthew Katz, MD Disclosures: An Ngo-Huang: I Have No Relevant Financial Relationships To Disclose Objective: The primary objective of this study is to assess the feasibility of a prehabilitation (prehab) program for patients undergoing preoperative therapy for resectable pancreatic cancer. Design: Single-arm prospective study. Setting: Tertiary cancer center. Participants: Twenty patients with newly-diagnosed, potentially resectable pancreatic adenocarcinoma who received neoadjuvant chemotherapy and/or chemoradiation. Interventions: The participants were screened for activity tolerance with the Physical Activity Readiness Questionnaire (PAR-Q) and PROMIS 12a Physical Function Short Form. They received a home-based, mixed-modality exercise program that included a walking and strengthening program. Their goal was to reach a moderate-intensity level of exercise for a total of 120 minutes per week. They were provided with resistance exercise tubes, exercise diagrams and logs, an instructional DVD, and a pedometer. The participants received recommendations from a clinical dietician and received an immuneenhancing supplement 5 days preoperatively. Main Outcome Measures: Adherence to the exercise regimen based on patient-reported time spent exercising. Results: From the 20 initial participants enrolled in this pilot study, the mean age was 64 years old, 45% were female, and the median duration of prehabilitation was 16 weeks. Fifteen participants completed the prehab program. Ten of these underwent pancreaticoduodenectomy. Through the 3 stages before surgery (chemotherapy, chemoradiation, and preoperative “rest” period), the 15 participants walked an average of 98.6 minutes per week and performed resistance exercises 57.4 minutes per week. Their physical activity was lowest during chemotherapy and was highest during the preoperative rest period. The 10 meter walk test decreased from baseline to the pre-operative visit; however, it recovered to baseline at the post-operative visit. There was no meaningful change in the Dynamic Gait Index. Conclusions: Walking and resistance exercises are feasible for patients undergoing an intensive preoperative therapy regimen for pancreatic cancer. Variable fatigue and treatment-related side effects affected the exercise adherence between the different stages of preoperative treatment. Level of Evidence: Level II