S201 S290
Poster 215:
RehabilitationManagement and Functional Progression
of Patients with Quadruple Amputations (QA) Beyond
the Acute Rehabilitation Period: A Case Series
Evangeline P. Koutalianos, MD (SUNY Upstate Med Univ/Syracuse,
Syracuse, New York, United States), Shernaz K. Hurlong, DO,
Stephen R. Lebduska, MD
Disclosures:
Evangeline Koutalianos: I Have No Relevant Financial
Relationships To Disclose
Case/Program Description:
A 59-year-old woman with bilateral below
elbow and below knee amputations (BKA); 30-year-old woman with
bilateral BKA and partial hand amputations; 60-year-old man with
bilateral BKA and transradial amputations. These patients all sus-
tained QA secondary to sepsis. All participated in an acute inpatient
rehabilitation program. One year postoperatively, two patients
received pin-locking lower extremity (LE) prosthetics, one patient did
not receive prosthetics secondary to infection. Myoelectric upper
extremity (UE) prostheses enabled performance of fine motor tasks
and increased independence with activities of daily living (ADLs).
Upper limb hypersensitivity was treated with desensitization. Phan-
tom limb pain varied in onset and management in all patients, ma-
jority reported acute onset pain persisting beyond the acute
rehabilitation period. Residual limb and low back pain (LBP) seen in
overweight patients was treated with aquatic therapy, core
strengthening and stretching program.
Setting:
University Hospital.
Results:
On average, patients with QA achieved acute phantom limb
pain control; received their prosthetics 1 year postoperatively;
became independent with ADLs using myoelectric prostheses and with
ambulation using LE prosthetics 1-2 years postoperatively. Barriers to
receiving LE prosthetic sockets after 1 year included: poor healing,
infections, weight bearing restrictions, insurance authorization.
Overweight body habitus and poor activity participation were associ-
ated with pain and poorly fitting sockets.
Discussion:
More patients are surviving septic shock and sustain QA as
a result. To date there is a paucity of literature on long-term reha-
bilitation management and expectations in these patients. Due to this
growing population, it is vital to discuss cases such as these to
determine functional expectations and achievable goals for our
patients.
Conclusions:
This case series demonstrates long-term rehabilitation
management in patients with QA. Awareness of such cases will improve
rehabilitation management by optimizing pain control, carefully
considering prostheses options, and providing realistic goals to
improve functional independence.
Level of Evidence:
Level V
Poster 216:
Left Ventricular Assistive Device (LVAD) Placement as
Bridge to Transplant for Patients with Chronic
Inflammatory Viral Myocarditis: A Case Report
Eric I. Sun, DO (Marianjoy Rehab Hosp), Padma K. Srigiriraju, MD
Disclosures:
Eric Sun: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
A 60-year-old woman who had place-
ment of LVAD due to history of end-stage heart failure secondary to
viral myocarditis. She underwent placement of LVAD after failure of
optimized medical management. During inpatient rehab, patient
developed thrombosis within the LVAD as evidenced by increased
Pulsatility Index and decreased Flow as reported by LVAD monitors.
She was emergently sent back to where she underwent LVAD place-
ment for further interrogation of abnormal LVAD monitor values. She
underwent heparin protocol to anti-coagulate LVAD.
Setting:
Marianjoy Rehabilitation Hospital.
Results:
Patient displayed improvements in her ADLs and ambula-
tion from of total assist distance of 40 feet to minimal assistance to
contact guard assist with a distance of 200 feet. Patient success-
fully returned home safely despite shortened stay and is currently
on waiting list for transplant.
Discussion:
LVAD support significantly improved the pre-transplant
survival rates of heart transplant candidates waiting for a suitable
donor heart (71% for LVAD and 36% for medical therapy). LVADs have
been shown to allow patients with heart failure to perform ambula-
tion and rehabilitation as opposed to other short-term devices that
require patients to stay in bed allowing quicker initiation of reha-
bilitation and for better outcomes. The incidence of myocarditis in
the United States is estimated at 1-10 cases per 100,000 persons. In a
study performed by University of Pittsburgh from 1996-2003, of 154
adults that underwent LVAD placement, only three (1.9%) were due
to myocarditis. Due to the rarity of LVAD placement for viral
myocarditis, we hope to discuss safety monitoring for these patients
in acute rehabilitation.
Conclusions:
Acute inpatient rehab provides functional improve-
ment for patients with LVAD placement as bridge to transplant for
chronic inflammatory viral myocarditis. Close monitoring for com-
plications of LVAD placement while in acute rehabilitation and
addressing these complications in a timely manner allows for patient
to maintain functional gains.
Level of Evidence:
Level V
Poster 217:
Case Report on the use of Bilateral Myoelectric Elbow-
Wrist-Hand Orthoses for the Remediation of Upper
Extremity Paresis following a Spinal Cord Injury
Marlies Cabell (Ability Prosthetics and Orthotics, Inc., York, PA, USA)
Disclosures:
Marlies Cabell: I Have No Relevant Financial Relation-
ships To Disclose
Case/Program Description:
The patient was fit with custom bilateral
myoelectric elbow-wrist-hand orthoses (MEWHO) following a spinal
cord injury sustained in July 2008 during a gymnastics accident. Upon
initial evaluation he presented with paralysis, weakness and spasticity
in both upper extremities. He used a power wheelchair for mobility
and required caregiver assistance for all ADLs (activities of daily
living). Long term goals included self-feeding, brushing his teeth,
scratching his face and accessing/using his phone. This patient
received custom molded bilateral MEWHOs fabricated through Myomo
Inc. (Cambridge, MA) and worked with an Occupational Therapist (OT)
to complete a functional training and a home activity program.
Setting:
Outpatient prosthetic and orthotic clinic and therapy gym.
Results:
With the MEWHOs, the patient can complete self-grooming
tasks including brush his teeth, comb his hair and complete self-feeding
tasks. His shoulder strength and active range of motion (ROM) increased
bilaterally, and his left elbow flexion strength and active ROM increased
following use of the MEWHOs. The patient can now push automatic door
openers and operate light switches without the assistance of the device.
Discussion:
Myoelectric control was developed in the 1940s and
myoelectric prostheses have been available since the 1960s. This non-
invasive orthosis uses surface sensors, located over the bicep and
tricep, to detect the user’s electromyograph (EMG) signal. The EMG
signal activates the motor on the orthosis to move the elbow. The
MEWHO provides user-controlled, active assistance for the remedia-
tion of lost range of motion and upper extremity function.
Conclusions:
This patient experienced improvements in ADL inde-
pendence as well as strength and ROM gains through use of the
MEWHOs. In addition, the patient reported that the MEWHOs have
helped him mentally and emotional.
Level of Evidence:
Level III
S201
Abstracts / PM R 9 (2017) S131-S290