Poster 120 Modified Berg Balance Scale for Use in Fall Prediction Among Patients with Lumbar Spine...

PM&R Vol. 6, Iss. 9S, 2014 S225

She failed initial decatheterization and developed fever. EmpiricCiprofloxacin was started for suspected UTI. She continued to havelow grade fever. Urine culture revealed Klebsiella pneumoniaesensitive only to Colistin (minimal inhibitory concentration of 0.5).Infectious disease consultation was requested. Blood cultures werenegative and repeat urine studies were collected. She was started onColistin and serial urine cultures reported decreasing organismburden with the last negative for infection. Center for DiseaseControl (CDC) analysis of urine culture confirmed NDM beta-lac-tamase-mediated resistance.Discussion: Multi-drug resistant (MDR) organisms are anincreasing concern in hospitals and post-acute care facilities due tohigh associated morbidity and mortality. New Delhi Metallo-B-lactamase producing Klebsiella pneumoniae (NDM-1) is a relativelynew pathogen. The first incident in the United States occurred inColorado in 2012. The first world report occurred in Sweden in2009. This is first reported NDM-1 producing Klebsiella pneumoniaeUTI in AIR setting.Conclusions: The CDC, acute care hospitals, and Long-TermAcute Care are developing isolation regulations to help preventspread of these new MDR organisms. AIR facilities share the riskfor encountering new MDR organisms and should have an activerole in collaborating to identify and prevent spread of theseorganisms.

Poster 119Four Extremity Gangrene Leading to AmputationPresents a Challenging Rehabilitation Course:A Case Report.Andrew J. Chrisman, MD (William Beaumont Hospital,Royal Oak, MI, United States); Sherry Viola, MD;Nikhil Shetty, MD; Mathew P. Jones, MD.

Disclosures: A. J. Chrisman, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: A 53-year-old Caucasian woman developedseptic shock secondary to nephrolithiasis. She underwent emergentcystoscopy with stent placement. Postoperatively she requiredmultiple vasopressors and intubation. Her hospital course wasfurther complicated by a myocardial infarction as well as drygangrene of her bilateral hands and feet.Setting: Tertiary Care Hospital.Results or Clinical Course: The patient was originally admittedto the Inpatient Rehabilitation Service prior to any surgical inter-vention. She required maximal assistance of 2 people for transfers.She was discharged to the surgical service twice; first for an upperextremity amputation of the left second through fifth digits andlater for a right below the knee amputation (BKA). Her rehabilita-tion goals included wound care, increasing strength and endurance,and maximizing functional use of her residual limbs in preparationfor future surgery.Discussion: From the time of the initial consult this patientwas particularly challenging. In order to preserve as muchfunctional tissue as possible, the treating surgeons recom-mended performing multiple amputations spread over severalmonths with continuation of intensive therapy and whirlpooldebridement between operations. Several discussions with herinsurance company were necessary to educate them of thebenefit of proceeding in this manner. Had all of her surgeriesbeen performed at once, her thumb would not have been

spared and her BKA would likely have been an above the kneeamputation. The anticipation of being discharged with ampu-tations in all four extremities led to an emotional burden thatmanifested as severe anxiety, making pain control difficult. Itwas not until discharge planning was complete that adequatepain control was achieved.Conclusions: In this case the Physical Medicine and Rehabilita-tion team functioned as patient advocate, pain managementspecialist, counselor and care management coordinator. Theimportance of communication in this case cannot be over-emphasized as her successful rehabilitation will continue to requireteamwork among multiple medical specialists, surgical specialists,therapists and prosthetists as well as the continued financialsupport of her insurance company.

Poster 120Modified Berg Balance Scale for Use in FallPrediction Among Patients with Lumbar SpinePrecautions.Argy Stampas, MD (The Burke Rehabilitation Hospital,White Plains, NY, United States); Libi Galmer, DO;Alexander J. Martinez, MD;Elizabeth A. Dominick, DPT, MS, NCS;Michael V. Gramuglia, DO; Jessica F. Elder, MPH, PhD.

Disclosures: A. Stampas, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Objective: To test the hypothesis that a modified version of theBerg Balance Scale (BBS) can be used to discriminate fall risk amongpatients with lumbar spine precautions. The BBS was modified(BBSm) to eliminate two items, ‘retrieving object from floor’ and‘turning to look behind’, as these movements are contraindicated inthis patient population. This modified scale ranges from 0-48 withhigher scores indicating greater balance, strength and mobility.Design: Prospective, observational studySetting: Rehabilitation Hospital in White Plains, NYParticipants: 50 consecutive, ambulatory patients with lumbarspine precautions, admitted to an inpatient rehabilitation facility.Interventions: N/AMain Outcome Measures: Fall incidence from time ofadmission to 6 months.Results or Clinical Course: Among 50 participants, 18 (36%)fell and 32 (64%) did not. While non-fallers had higher dischargeBBSm scores, no statistically significant difference was foundbetween non-fallers (32.7 [SD, 10.3]) and fallers (27.4 [SD, 13.3])using a Wilcoxon two-sample test (p¼0.23). Using logisticregression the BBSm yielded non-significant results for predictionof fall risk. An AUC of 0.61 generated from a Receiver OperatorCharacteristic (ROC) curve further suggests a lack of discriminativeability of BBSm between fallers and non-fallers. Those who fellhowever, tended to be younger (64.7 [SD, 14.4] vs. 72.3 [SD,11.1]) and were more likely to use assistive devices (OR 6.2, (95%CI [1.2, 31.7]).Conclusions: While the BBS has been shown to be a validmeasurement to assess fall risk in the elderly and in stroke patients,even after modifying the scale to facilitate its use among patientswith lumbar spine precautions, no evidence was found to supportits use in discriminating fall risk in this population. Furtherresearch is needed to understand what factors exist for prediction offalls in this population.