S164 S290
Participants:
Two normal controls.
Interventions:
No applicable.
Main Outcome Measures:
Creation of video and picture of the alter-
native view.
Results:
In a forearm held in the resting UMN injury pattern, the FDP is
close to the top of the image just volar to the ulna, the FDS is deep to
the FCU, and FDS and FCU are both lateral to FDP.
Conclusions:
A new teaching resource was developed to demonstrate
the relative forearm muscle position in a more clinically relevant
context for teaching US-guided forearm muscle injections.
Level of Evidence:
Level V
Poster 83:
Is It Possible to Diagnose Borderline Mild Carpal
Tunnel Syndrome in Nerve Conduction Studies with
Normal Median Motor and Sensory Latencies Without
Using the Combined Sensory Index?
Marc A. Raj, DO (LSU Health Med Cntr), Stephen Kishner, MD,
Elena Khoutorova, Medical Student 4, Casey A. Murphy, MD
Disclosures:
Marc Raj: I Have No Relevant Financial Relationships To
Disclose
Objective:
To determine criteria which can accurately predict or rule
out borderline carpal tunnel syndrome in symptomatic patients with
normal Median nerve sensory and motor latencies without the need to
perform combined sensory indices using only Median to Ulnar motor
and sensory latency differences.
Design:
Retrospective chart review.
Setting:
Outpatient PM&R clinic.
Participants:
499 nerve conduction studies in 300 patients over a
period of 9 years.
Interventions:
Not Applicable.
Main Outcome Measures:
Both Median to Ulnar nerve sensory and
Median to Ulnar motor latency differences were calculated. Sensory,
motor, and combined sensory/motor latency differences were corre-
lated to the results of combined sensory index for their respective
study using regression analysis. The regression analysis was then used
to determine which latency differences would provide accurate pre-
dictions of the combined sensory index.
Results:
A combined Median to Ulnar nerve motor and sensory latency
difference greater than 1.4ms (n
¼
113) had a specificity of 94% with a
positive predictive value of 87% in predicting positive combined sensory
indices. A combined Median to Ulnar nerve motor and sensory latency
difference less than0.5ms (n
¼
107) had a sensitivity of 90%witha negative
predictive value of 75% in predicting negative combined sensory indices.
These criteria were present in n
¼
220 (approximately 44% of studies).
Conclusions:
A combined Median to Ulnar nerve motor and sensory
latency difference greater than 1.4ms can accurately predict border-
line mild carpal tunnel syndrome without the need for combined
sensory indices. Caution should be used in ruling out borderline mild
carpal tunnel syndrome based on a combined Median to Ulnar nerve
motor and sensory latency difference of less than 0.5ms as there is a
relatively high false positive value of 25%.
Level of Evidence:
Level II
Poster 86:
Disorders of Consciousness due to Anoxic Brain
Injury: A Case Series of 8 Patients
Mark A. Linsenmeyer, MD (University of Pittsburgh Medical Center),
Shanti M. Pinto, MD, Gary N. Galang, MD
Disclosures:
Mark Linsenmeyer: I Have No Relevant Financial Re-
lationships To Disclose
Objective:
To characterize common medical complications, treat-
ments, and recovery in patients with disorders of consciousness (DOC)
due to anoxic brain injury (ABI).
Design:
Retrospective case series.
Setting:
Academic inpatient rehabilitation (IPR) center.
Participants:
Eight patients with current or recent DOC due to ABI
without history of head trauma who were admitted to IPR from 2015-
2016.
Interventions:
Not applicable.
Main Outcome Measures:
Primary outcome measures included
change in function (as measured by FIM score) and level of con-
sciousness (as measured by JFK/CRS-R score). Secondary outcome
measures included medical comorbidities (paroxysmal sympathetic
hyperactivity [PSH], spasticity, movement disorders, seizures, or in-
fections) and discharge destination.
Results:
On admission to IPR, 5 patients were vegetative and 3 had
recently emerged from minimally conscious state (MCS). During IPR
course, 2 vegetative patients emerged, 1 became minimally conscious,
and 2 remained vegetative. FIM scores on admission were 18 or below
for all patients and improved in 4 patients by an average of 40 points.
Scores did not improve for the remaining 4. All patients were given
neuropharmacologic medications for arousal and attention. PSH
affected 6/8 patients and clinically resolved for 2 patients prior to
discharge. 6/8 patients had spasticity, resolving in 3 by discharge. 5/8
patients exhibited movement disorders, primarily myoclonus. 7/8
patient developed urinary tract infections. No patients developed
seizures during IPR admission, but 2/8 patients experienced status
epilepticus prior to IPR. Overall, 6/8 patients were discharged to
home.
Conclusions:
In IPR, patients with DOC due to ABI presented with
prominent neurological and cognitive deficits, for which they were
prescribed neuropharmacologic agents in conjunction with therapies.
Common limitations to rehabilitation include the severity of deficits
in arousal and cognition, PSH, spasticity, movement disorders, and a
high rate of infection; however, many patients were frequently dis-
charged to the home setting. Further investigation into predictors of
outcome and optimal medical management for this population is
warranted.
Level of Evidence:
Level IV
Poster 87:
Effect of Neurodynamic Mobilizations on Fluid
Dispersion on Median Nerve at the Level of the Carpal
Tunnel: A Cadaveric Study
Mathieu Boudier-Reveret (Universite´ du Que´bec a` Trois-Rivie`res,
Trois-Rivie`res, Que´bec, Canada), Ste´phane Sobzack, PT, MSc, PhD,
Kerry K. Gilbert, PT, ScD, Jean-Michel Brismee, PT, ScD,
Pierre-Michel PM. Dugailly, PhD, Ve´ronique Freipel, PhD,
Mehdi Moussadyk, Msc, Dorra Rakia DR. Allegue, pht, MSc
Disclosures:
Mathieu Boudier-Reveret: I Have No Relevant Financial
Relationships To Disclose
Objective:
To evaluate the effect of neurodynamic mobilizations on
an artificially induced intraneural edema in the median nerve at the
level of the carpal tunnel in fresh cadavers, and to assess if
tensioning and sliding techniques induce the same effect on fluid
dispersion.
Design:
A biomimetic solution was injected under the epineurium of
the median nerve at the level of the transverse carpal ligament. The
initial dye spread was allowed to stabilize and measured with a digital
caliper.
Setting:
Cadaver laboratory.
Participants:
Fourteen upper extremities of seven cadavers were
used.
Interventions:
Once the initial longitudinal dye spread stabilized, a
randomized crossover design was applied. Tensioning and sliding
techniques were applied randomly and sequentially to each upper
extremity and performed for a total of five minutes each.
S164
Abstracts / PM R 9 (2017) S131-S290