S205 S290
congenital absence of the upper and lower extremities, which pose a
great challenge to ambulation and activities of daily living of the
affected child. Specific deficiencies vary; hence prosthetic restoration
and physiatric interventions should be individualized.
Conclusions:
A comprehensive rehabilitation program helps patients
with congenital limb deficiencies achieve maximum functional
capacity.
Level of Evidence:
Level V
Poster 229:
Melodic Intonation Therapy: A Case Report
Kristopher Musgraves, MD (Marianjoy Rehab Hosp, Wheaton, IL),
Steven Bou, MD
Disclosures:
Kristopher Musgraves: I Have No Relevant Financial Re-
lationships To Disclose
Case/Program Description:
A 46-year-old man presented to acute
care hospital with right hemiplegia and difficulty with speech after
being found down at home by his wife. CT of the head without contrast
revealed a thrombus and hypodensity in the left middle cerebral ar-
tery area. Patient was determined not to be a candidate for tPA
therapy and eventually underwent left decompression hemi-
craniotomy for worsening edema with associated mid-line shift.
Referring documents revealed that patient was unable to follow
commands, demonstrate fluent or repetitive speech and was labeled
as globally aphasic. Although findings were consistent with presenta-
tion to acute inpatient rehab, patient was able to demonstrate
consistent non-verbal communication and communicative intent.
After evaluation by speech/language pathology, it was felt that pa-
tient’s speech difficulties were due more to verbal apraxia than
aphasia. A review of patient’s history revealed that he was a singer
prior to hospitalization. Speech therapist felt he was would be an
excellent candidate for melodic intonation therapy. When the thera-
pist played his favorite music, he was able to clearly sing along.
Setting:
Acute Inpatient Rehabilitation.
Results:
The patient participated in speech therapy 5 to 6 days per
week in 60 to 90 minute sessions for a total of 32 days. The therapist
was able to remodel repetition through melodic intonation therapy.
Carrier phrases were incorporated using rising intonation. The wife
also participated in therapy sessions. At the time of discharge, he was
able to provide appropriate responses using exaggerated intonation.
Discussion:
Melodic intonation therapy demonstrated the capability
to facilitate the brain’s ability to process communication proving to be
a valuable instrument in the rehabilitation of damaged left hemi-
sphere structures involved in language.
Conclusions:
Melodic intonation therapy should be routinely imple-
mented for speech disorders as it shows a profound ability to expedite
language recovery.
Level of Evidence:
Level V
Poster 230:
Acquired Neuromyotonia Secondary to
Acute Oxaliplatin Hyperexcitibility Syndrome:
A Case Report
Minh C. Nguyen (Rush University Medical Center, Chicago, IL, USA),
Andrew J. Patton, DO, Amir A. Rahnavard, MD
Disclosures:
Minh Nguyen: I Have No Relevant Financial Relationships
To Disclose
Case/Program Description:
This is a 62-year-old woman with past
medical history of pulmonary embolism on therapeutic Lovenox,
multiple thyroid nodules, and recently diagnosed pancreatic cancer
currently on Folfirinox (cycle 3 of 4) who presents with an acute fall
from home after suddenly losing feeling in both legs. Patient reports
no trauma to her lower extremity, recent surgery or history of acute
muscle weakness prior to hospital admission. Of note, patient did have
very mild symptoms of numbness and paresthesia after each cycle of
Folfirinox but never to the extent that she is experiencing now. The
day of her admission, patient had received her third dose of Folfirinox
through a chemo pump. The patient experienced moderate twitching
of her eyelids and face, slurred speech, and tingling sporadically in her
fingertips, knees and ankles bilaterally.
Setting:
Tertiary Rehabilitation Medical Center.
Results:
Neurology was consulted who noted decreased sensation at
the forefoot of both feet and twitching of the face that was classic for
Oxaliplatin side effect. Chemotherapy was stopped and patient un-
derwent aggressive therapy was discharged at modified independent
level.
Discussion:
Chemotherapy is notorious for having many side effects.
In this instance, this patient was receiving Folfirinox which is a cocktail
of chemo medication including Fluorouracil (5-FU), Leucovorin, Irino-
tecan and Oxaliplatin. Oxaliplatin belongs to the platin class of
chemotherapy. It has been theorized that a mutation in fast sodium
channels are functionally inactivated leading to prolonged refractory
periods. This produces neuron hyperexcitibility and myotonic spells.
From her history, this patient continued to have worsening side effects
and by her third infusion, this patient experienced an acute hyper-
excitability syndrome leading to her fall.
Conclusions:
Physiatrists may benefit by becoming more aware of
their patient’s medication and equipping them with the necessary
tools for possible side effects. Over time, her symptoms resolved in
acute rehab.
Level of Evidence:
Level V
Poster 231:
The Hidden Abscesses - Psoas and Epidural Abscess as
Complications of Epidural Injections: A Case Report
Kim I. Lam (Ross University School of Medicine, Mississauga, ON,
Canada), Jonathan V. Sukumar, DO
Disclosures:
Kim Lam: I Have No Relevant Financial Relationships To
Disclose
Case/Program Description:
Patient with significant medical history of
CAD, diabetes mellitus type II and chronic low back pain (LBP) pre-
sented to ED with worsened LBP. Patient had been doing renovations
and developed worsened back pain associated with right hip pain
radiating to the knee. He had failed conservative therapy as an
outpatient. He then received a total of 3 epidural injections over the
course of 1 week starting 11/18 that were “difficult” to inject with no
relief. On day 2 post-injection, his back pain worsened and he was
admitted. Previous outpatient MRI showed L2-L5 stenosis. Follow-up
MRI redemonstrated these findings plus foraminal stenosis of T4 to T6
and a new possible epidural abscess. Patient received lumbar
decompression, bilateral microforamenotomies and evacuation of the
epidural abscess and a right psoas abscess. Blood culture positive for
alpha streptococci. Hospital course was complicated by UTI, renal
failure and toxic metabolic encephalopathy requiring readmission. He
was then admitted for a second time to our facility for inpatient
rehabilitation due to weakness and pain with mobility.
Setting:
Acute Inpatient Rehabilitation Hospital.
Results:
Patient was previously independent in ADLs and ambulation.
Now he requires minimal-maximal assistance due to weakened lower
extremities and limited by pain. He is currently receiving inpatient
therapy. Further developments will be discussed.
Discussion:
Concomitant epidural and psoas muscle abscesses are a
rare complication of epidural injections. There are few reported cases
and none with this extent of systemic spread and atypical presentation
for infection.
Conclusions:
Infectious complications of epidural injections are un-
common but can have a significant impact on the patient. It is
important to understand the less common risks with this procedure
and physical implications for the patients.
Level of Evidence:
Level V
S205
Abstracts / PM R 9 (2017) S131-S290