S161 S290
Poster 74:
Predicting Ambulatory Aid Need with Disease
Progression in Pediatric Genetic Neuropathy
Jacob J. Moore (A.T. Still University School of Osteopat, Mesa, AZ,
USA), Sindhu Ramchandren, MD, Joseph E. Hornyak, MD, PhD, FAAPMR
Disclosures:
Jacob Moore: I Have No Relevant Financial Relationships
To Disclose
Objective:
To develop predictive scales in pediatric patients with
Charcot-Marie-Tooth (CMT) that correlate changes in the Charcot-
Marie-Tooth neuropathy score (CMTNS) with type of ambulatory aid
used.
Design:
This is a retrospective cross-sectional study. Data collected
included demographics, CMTNS, type of ambulatory aid used, foot
surgery, difficulty with buttons, and difficulty with eating utensils.
Mean scores and standard deviations for CMTNS were calculated for
every ambulatory aid used to develop predictive scales.
Setting:
An integrated group of academic medical centers.
Participants:
625 patients, 270 male and 269 female, who were con-
sented through the Inherited Neuropathy Consortium as part of the
natural history clinical registry trial [NCT01193075] were assessed in
this study, and of these, 539 were included in the analysis. Mean age
was 13 years old, range 8-18, SD 2.9. 84% of the patients were
Caucasian.
Interventions:
Not applicable.
Main Outcome Measures:
Not applicable.
Results:
There was a strong correlation between ambulatory aid used
and CMTNS score (0.63, p
<
.0001); smaller correlations were seen
between ambulatory aid used and foot surgery (0.16, p
¼
.007), but-
tons (0.31, p
<
.0001) and eating utensils (0.33, p
<
.0001). No
ambulatory aid use and minimal (shoe inserts, custom shoes, night-
splints) ambulatory aid use had equivalent mean CMTNS at 8.4. Mean
CMTNS for use of one or more of the following ambulatory aids:
supramalleolar orthosis (SMO), supramalleolar ankle foot orthosis
(SMAFO), ankle foot orthosis (AFO), molded ankle foot orthotics
(MAFO), Arizona brace was calculated at 10.5. Mean CMTNS for using a
wheelchair or scooter was 23.
Conclusions:
We have identified predictive scales that correlate
CMTNS values with progressive functional needs. We recommend
prospective validation of our predictive scales in a CMT clinic
population.
Level of Evidence:
Level II
Poster 75:
Headache Prevalence 30 Years After Severe Traumatic
Brain Injury (TBI): Results From a Comparative Cohort
Study
Gabrielle Meyer, DO (University of Minnesota, Saint Paul, Minnesota,
United States), Molly E. Hubbard, MD, Kathleen Vonderhaar, MD,
Gaylan L. Rockswold, MD, Uzma Samadani, MD
Disclosures:
Gabrielle Meyer: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
Headache is the most common pain complaint following
traumatic brain injury (TBI), occurring in up to 30-90% of patients.
However, the time course and contributing factors are not well
established following severe TBI. Clinical studies report that head-
aches occur less frequently after severe TBI as compared to mild
TBI. This inverse relationship is often attributed to associated higher
rates of cognitive impairment following severe TBI. However, sup-
porting evidence of this claim is limited. Here we describe subjects’
report of headache three decades after severe TBI and examine
potential association with cognitive status and psychological
comorbidities.
Design:
Long-term outcome, comparative cohort study. Participants
completed a detailed health questionnaire and Telephone Interview
for Cognitive Status-modified (TICS-m). Analyses were done by Pear-
son’s Chi-Square test. Statistical significance was accepted at a p value
<
.05.
Setting:
Level One Trauma Center.
Participants:
A cohort of patients sustaining severe TBI (n
¼
32)
compared to age and gender matched controls.
Interventions:
Not applicable.
Main Outcome Measures:
Headache prevalence with relation to
cognition (TICS-m) and psychological comorbidities.
Results:
Headache was reported in 39% of severe TBI participants and
compared against a controlled population. Headache in severe TBI was
correlated with comorbid depression (p
¼
.02, 66% vs. 22%) and
insomnia (p
¼
.008, 92% vs. 42%). Nearly 53% of severe TBI participants
had abnormal cognitive status (TICS-m score 32). In the severe TBI
cohort, no correlation was found between level of cognition and
complaint of headache (p
¼
.55), depression (p
¼
.52), anxiety (p
¼
.67)
or insomnia (p
¼
.65).
Conclusions:
Headache is a prominent pain complaint three decades
after severe TBI and may be more chronic and persistent than previ-
ously thought. Our analysis examines headache outcome in severe TBI
as compared to controls. Cognition level was not correlated with
report of symptoms. In severe TBI patients, headache was correlated
with depression and insomnia and may lead to the development of
these comorbid conditions.
Level of Evidence:
Level IV
Poster 76:
PMR Consults Impact Disposition for Brain Injury
Patients with a Prolonged Shock Trauma ICU Stay: A
Retrospective Study
Cole R. Linville, DO, MBA (Univ of TX-UT Houston, Houston, Texas,
United States), Natasha Bhatia, MSIV, Monica Verduzco-Gutierrez,
MD, FAAPMR
Disclosures:
Cole Linville: I Have No Relevant Financial Relationships
To Disclose
Objective:
Determine differences in characteristics, complications,
length of stay, and disposition for Brain Injury (BI) patients admitted
to the shock trauma intensive care unit (STICU) who received and
did not receive a Physical Medicine and Rehabilitation (PMR)
consult.
Design:
A retrospective clinical study was conducted of acute
trauma patients admitted to the STICU at a Level 1 trauma center
with acute care stay of at least 14 days. Patients admitted from
January 1, 2013, through December 31, 2013, who were 16 years of
age or older with a brain injury diagnosis were included in this study.
General characteristics, complications, and disposition were recor-
ded and analyzed.
Setting:
Level I Trauma Center.
Participants:
PM&R Physicians.
Interventions:
Not applicable.
Main Outcome Measures:
Characteristics, Complications, Disposition.
Results:
61 patients met study inclusion criteria. There were no sig-
nificant differences in patient characteristics, length of stay, or
complication rates between patients for whom PMR was and was not
consulted. Disposition for TBI patients with a PMR consult, compared
to those without a PMR consult
e
Inpatient rehabilitation: 26 vs.
0 (p
¼
.0004); LTAC: 11 vs. 5 (p
¼
.26); SNF: 4 vs. 1 (p
¼
.94); home: 4 vs. 4
(p
¼
.03); other: 3 vs. 3 (p
¼
.07). There was no statistical significance
between groups related to payment source.
Conclusions:
This retrospective study shows TBI patients with a PMR
consult had no significant differences in patient characteristics, injury
severity, or complications when compared to patients without a PMR
consult. BI patients with a PMR consult were more likely to be dis-
charged to inpatient rehabilitation, regardless of funding source. Of
the patients who did not receive a PMR consult in the ICU, zero were
sent to inpatient rehabilitation at discharge. This patient cohort would
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Abstracts / PM R 9 (2017) S131-S290