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discovered, this was a case that could potentially lead to permanent
nerve injury. The Orthopedic Surgery team ultimately decided that
any surgery, even if just to relocate the ulnar nerve, would result in
further trauma that could possibly trigger more heterotopic bone
formation.
Discussion:
This is the first reported case, to our knowledge of
myositis ossificans causing an ulnar compression neuropathy.
Conclusions:
Even if heterotopic bone formation is causing poten-
tially permanent complications, if not life threatening, surgery is often
times withheld until the bone has matured, due to the risk of more
trauma from surgery resulting in further bone formation.
Level of Evidence:
Level V
Poster 206:
A Multi-Disciplinary Approach to Managing Functional
Movement Disorders within the Acute Rehab Setting:
A Case Report
Tasso Papagiannopoulos (Rush University Medical Center Physical,
Naperville, IL, USA)
Disclosures:
Tasso Papagiannopoulos: I Have No Relevant Financial
Relationships To Disclose
Case/Program Description:
A 37-year-old woman with a history of
depression and recently diagnosed functional movement disorder that
was refractory to outpatient treatment modalities. The patient re-
ported a steady decline in her functional abilities. Specifically, wors-
ening lower extremity weakness, and antalgic gait pattern with poor
truncal balance. She also developed tremors in the right upper ex-
tremity causing difficulty with her activities of daily living (ADLs). Her
functional decline left her with worsening depression.
Setting:
Tertiary Care Hospital.
Results:
She was admitted with plans to focus on correcting her
mind-body disconnect. She worked closely with physiatrists and
psychiatry while receiving therapy. She was diagnosed with gener-
alized anxiety disorder (GAD). Over the course of her admission, the
patient gained insight into how higher levels of stress would correlate
with worsening symptoms. Psychiatry initiated escitalopram 10mg
daily. By discharge, the patient went from a maximal assistance level
for transfers, ambulation, and ADLs, to a minimal assistance/super-
vision level. Her anxiety also improved. Of note, it was too early to
attribute all her success to the use of escitalopram. However, upon
follow-up 4 weeks later, as the medication reached therapeutic
levels, she had continued improvement in her anxiety and functional
status.
Discussion:
Functional Movement Disorders is a general term for dis-
orders that manifest with abnormal movements (tremor, dystonia, gait
disorders) but with no evidence of underlying organic abnormalities.
Thus, they are generally described as being due to psychological fac-
tors. Due to the poor understanding of the underlying mechanism of
disease, there has been a long-standing ambiguity about whether
neurology or psychiatry should be managing these patients. As a result,
there is little evidence available to guide treatment.
Conclusions:
This case supports the use of inpatient multi-disciplinary
therapy for the management of functional movement disorders when
outpatient treatment fails. Further studies are needed to investigate
additional therapeutic modalities to manage this debilitating condition.
Level of Evidence:
Level V
Poster 207:
Foot Drop and Scapular Stabilizer Weakness in Late
Onset FSH Muscular Dystrophy: A Case Report
Hugh T. McDermott, MD (Loyola University Department of Orthopedics
and Rehabilitation, Naperville, IL, United States)
Disclosures:
Hugh McDermott: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 51-year-old man with fas-
cioscapulohumeral muscular dystrophy presented with a complaint of
increasing difficulty sleeping due to pain from worsening upper ex-
tremity weakness. He was diagnosed 10 years prior with the presenting
symptoms of bilateral foot drop. His foot drop, secondary to profound
tibialis anterior weakness, continued to worsen. He is increasingly
fatigued throughout the day. Additionally, he had developed paroxysmal
atrial flutter secondary to a disorder of mitochondrial respiratory chain
complexes. On examination, he had atrophy of bilateral scapular sta-
bilizers, andwinging of both scapulae. General upper extremity strength
wasmaintained through compensatorymechanisms. On lower extremity
examination, the patient had 2/5 dorsiflexion strength with marked
atrophy of bilateral tibialis anterior muscles. Without use of flexible
ankle foot orthotics, he demonstrated steppage gait, with compensa-
tory excessive lumbar lordosis and forward riding hips. He was provided
with a physical therapy program for increasing flexibility to scapular
girdle and lower extremity, as well as proper positioning techniques for
energy conservation. His goal is to try and maintain current strength and
range of motion or at least postpone some of his disease progression.
Setting:
Musculoskeletal Clinic.
Results:
After physical therapy, he increased flexibility and improved
ability to avoid activity that irritates upper extremities.
Discussion:
90% of people initially present with symptoms during or
before their twenties. He was 41. His presenting symptoms were foot
drop. While winging was appreciated, his upper extremities were largely
spared compared to his lower extremities. Following a literature search,
we determined that aerobic exercise improves morbidity, not worsen.
Conclusions:
Novel case of FSH muscular dystrophy due to the age and
original presenting symptoms. One of his complaints is fatigue. The
prescription focuses on flexibility and energy conservation techniques
to improve daily function. After literature search, we should incor-
porate an aerobic exercise component to benefit his endurance
training and strengthening.
Level of Evidence:
Level V
Poster 208:
Chronic Post-Hypoxic Myoclonus (Lance-Adams
Syndrome) After Cardiac Arrest: A Case Report
Sameer A. Siddiqui, MD (Detroit Med Ctr/Wayne State University),
Zainab A. Naji, MD
Disclosures:
Sameer Siddiqui: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
A 64-year-old woman with a past medical
history of hypertension and end-stage renal disease on hemodialysis
(HD) who was admitted to an acute care hospital following a witnessed
cardiac arrest 11 days prior to arrival to inpatient rehabilitation (IPR).
Cardiopulmonary resuscitation (CPR) was started in the field and she
was successfully resuscitated. Patient was extubated one day after
admission and was awake, alert and following commands 2 days later.
Once transferred to the regular medical floor, she began complaining
of “shaking” of her left upper and lower extremities. She was evalu-
ated by neurology who diagnosed her with Lance-Adams syndrome and
started her on levetiracetam (off-label use). This dose was continued
in IPR, and was increased once therapists noted that her myoclonus
was interfering with her ability to complete therapeutic exercises. The
increased dose of levetiracetam seemed to worsen the myoclonus, so
it was decreased back to the original dose.
Setting:
Academic Rehabilitation Hospital.
Results:
During her 15-day IPR admission, this patient benefited from
weighted exercises along with traditional therapy techniques. Be-
tween admission and discharge, the mean of the Functional Indepen-
dence Measure (FIM) scores for eating, grooming, bathing, upper
extremity dressing and lower extremity dressing as assessed by occu-
pational therapy improved from 4.6 to 5. On admission, physical
therapy assessed the patient’s gait to be 15 feet on a level surface
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Abstracts / PM R 9 (2017) S131-S290