S163 S290
electromyography, electrical stimulation and ultrasound), electromy-
ography was the most frequently used (39.5%
e
61.5% of treatment
sessions). Across all treatments, 91.1% of physicians and 82.3% of pa-
tients reported being satisfied or extremely satisfied that treatment
helped manage spasticity; 84.6% of physicians and 74.8% of patients
reported that the treatment benefit was sustained, and 97.4% of
physicians and 89.8% of patients would definitely or probably continue
onabotulinumtoxinA. 28.0% (n
¼
205) of patients reported 1 adverse
event (AE) and 10.3% (n
¼
75) reported a serious AE. No new safety
concerns were identified.
Conclusions:
One-year results demonstrate the safety and effective-
ness of onabotulinumtoxinA for spasticity in clinical practice. Further
analyses will explore clinical and burden outcomes and differences
across etiology and presentation.
Level of Evidence:
Level IV
Poster 80:
Feasibility and Validity of a Low-Cost Simulator in
Driver Assessment after Stroke
David B. Carr, MD (Washington Univ in St. Louis, Saint Louis, Missouri,
United States), Annie C. Harmon, PhD, Tina Nolte, BA, James Stowe,
PhD
Disclosures:
David B. Carr, MD: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
This study compares and contrasts the use of research
and racing simulation in a stroke sample and determined their cor-
relates with psychometric tests associated with impaired driving
performance. This work is designed to lay groundwork for future
rehabilitation efforts for adoption in the home setting or during
recovery of acute neurologic illnesses such as stroke and brain
injury.
Design:
Observational analytic, cross-sectional design.
Setting:
Outpatient rehabilitation facility using paper/pencil and
computer-based psychometric testing, a research driving simulator,
and a low-cost racing simulator.
Participants:
43 adults with stroke were recruited and 39 were
retained for analyses (4 participants failed screening criteria on psy-
chometric tests).
Interventions:
Not applicable.
Main Outcome Measures:
Patients were assessed on clinical exam
(NIHSS, Motricity Index; vision; hearing screen; stroke severity);
psychometric tests (cognition, psychomotor processing speed, vi-
suospatial ability, executive function, and attention); on the
research simulator that evaluated traffic safety behavior in a vari-
ety of scenarios (collision avoidance, appropriate judgment, etc);
and on a low-cost racing simulator that evaluated driving
performance parameters (lap time, standard deviation of lateral
position, etc).
Results:
In general, psychometric performance was related to per-
formance in both the research and racing simulators (e.g., Montreal
Cognitive Assessment [MoCA]) scores and mean racing simulator lap
time [rs
¼
-.44, p
¼
.025]). Binary Logistic Regression was used to
understand the value of simulator telemetry data in predicting a low-
risk classification on a psychometric battery known to be related to on-
road driving assessment outcomes (pass/fail). Using simulator data,
81.8% of participants were correctly classified as being either low- or
high-risk of failing an on-road evaluation, and the model explained
68.2% (Nagelkerke R2) of the variance.
Conclusions:
Low-cost, high-fidelity simulation has matured in
recent years, and this technology should be studied as a potential
rehabilitation screen to return individuals to safe and active
driving.
Level of Evidence:
Level III
Poster 81:
PM&R Consults for Combined TBI/SCI Patients in the
Shock Trauma ICU Impact Ventilation Days, Morbidity,
and Disposition: A Retrospective Study
Cole R. Linville, DO, MBA (Univ of TX-UT Houston, Houston, Texas,
United States), Meggan Morris, SLP, Jay J. Chacko, MS-IV,
Monica Verduzco-Gutierrez, MD, FAAPMR, Argyrios Stampas, MD
Disclosures:
Cole Linville: I Have No Relevant Financial Relationships
To Disclose
Objective:
Determine differences in characteristics, complications,
length of stay and disposition for combined traumatic brain injury and
spinal cord injury (SCI) patients admitted to the shock trauma inten-
sive 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 days 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 spinal cord injury diagnosis were included in this study. General
characteristics, complications and disposition were then recorded and
analyzed for these patients.
Setting:
Level I Trauma Center.
Participants:
36 patients met inclusion criteria.
Interventions:
Not applicable.
Main Outcome Measures:
Demographics, characteristics, complica-
tions, length of stay, disposition.
Results:
36 patients had a combined TBI/SCI. There were no signifi-
cant differences in patient characteristics if PMR was or was not
consulted. Complications for combined TBI/SCI patients with a PMR
consult, compared to those without a PMR consult
e
dysphagia
requiring PEG/PEJ placement: 15 vs. 0 (p
¼
.01). There were no other
significant differences in other complications including pneumonia,
UTI, PE, DVT, or tracheostomy placement. There were no significant
differences in length of stay, however, patients with a PMR consult had
more ventilation free days compared to those without a PMR consult:
13.5 vs. 8.5 (p
¼
.04). Disposition for combined TBI/SCI patients with a
PMR consult, compared to those without a PMR consult - Inpatient
rehabilitation: 14 vs. 0 (p
¼
.01); LTAC: 5 vs. 4 (p
¼
.08); SNF: 3 vs.
0 (p
¼
1); home: 3 vs. 2 (p
¼
.1).
Conclusions:
This retrospective study shows combined TBI/SCI pa-
tients with a PMR consult were more likely to require gastrostomy tube
placement, had more ventilation free days, and were more likely to
discharge to inpatient rehabilitation.
Level of Evidence:
Level II
Poster 82:
Patient-Centered Technique for Ultrasound-Guided
Muscle Injections in the Forearm of Patients with
Severe Spasticity
George Deng (Univ of Manitoba)
Disclosures:
George Deng: I Have No Relevant Financial Relationships
To Disclose
Objective:
This project serves to demonstrate the relative muscle
positioning under ultrasound between a forearm in a modified
anatomical position and in an upper motor neuron injury pattern to
create a teaching resource.
Design:
Videos of the ultrasound probe and ultrasound image are
recorded while systematically activating the flexor digitorum brevis,
flexor digitorum longus, and flexor carpi ulnaris muscle. Video and
raster graphic editors are used to synchronize the two videos and to
highlight each forearm muscle.
Setting:
Videos were taken in a spasticity clinic.
S163
Abstracts / PM R 9 (2017) S131-S290