Setting: Academic Veterans Affairs hospital.Participants: All patients underwent electrodiagnostic testingand 21 enrolled. Inclusion criteria were age 18-90 years and withone of the following: distal motor latency, �4.2 ms; motor ampli-tude, �3.5 mA; antidromic distal sensory latency, �3.5 ms; anti-dromic sensory amplitude, �12 mA; antidromic median to ulnardistal sensory latency difference, �0.4 ms. Exclusion criteria wereosteoporosis; prior CTS surgery; allergy to local anesthetic, cortico-steroid, or ultrasound gel.Interventions: Carpal tunnel injections were performed with0.50 mL (20 mg) methylprednisolone and 0.50 mL of 1% lidocainewith a 25-gauge 1.5-in. needle, by using blind or ultrasound guid-ance. Blind injections were performed just ulnar to the palmarislongus tendon, inline with the ring finger. Ultrasound-guided injec-tions were performed by using a long-axis medial-to-lateral ap-proach, as described by Smith et al. 2008.Main Outcome Measures: VAS and Global Symptom Score at2, 4, and 8 weeks.Results: There was a significant decrease in VAS in the ultra-sound-guided group from baseline to 2 (P�.023) weeks and 8weeks (P�.028). Four weeks trended toward significance(P�.146). There was a trend toward significance in improvementof the weakness measure of the Global Symptom Score betweenthe 2 groups. There were no adverse reactions reported in eithergroup.Conclusions: Ultrasound-guided carpal tunnel injections aremore effective than blind at reducing pain at 2 and 8 weeks, and mayimprove subjective weakness.

Poster 51Patient Communication of CommunityAdaptations, High-kneel Mobility, in SpinalMuscular Atrophy Type 3 (Kugelberg-WelanderDisease or Juvenile Spinal Muscular Atrophy): ACase Report.Courtney Toomey, MD (Sinai Hospital, Baltimore, MD,United States); Henry S. York, MD.

Disclosures: C. Toomey, none.Patients or Programs: A 45-year-old man with spinal muscularatrophy (SMA) type 3.Program Description: The patient was diagnosed with SMAtype 3 at age 3 years, required crutches at age 13 years, lastwalked at age 18 years, and then adapted his mobility andactivities of daily living (ADL) tasks to a high-kneel position. Hewas admitted to an acute hospital for new onset limb weaknesswith head drop. A workup was significant for hypokalemia andepigastric pain (which resolved with Carafate); the weakness wasthought to be debility secondary to a metabolic disturbance. Hewas transferred to our acute rehabilitation facility, where resultsof an examination were significant for calluses overlying hispatellae, right medial hamstring pain, and severe limb atrophy,with preserved distal strength. By using his excellent artisticability, he illustrated his home environment and high-kneeltransfer techniques, which provided an illustrative guide for histherapy team on high-kneel positioning for mobility.Setting: A free-standing rehabilitation hospital.Results: After a month of inpatient rehabilitation, and assistancefrom his illustrations, he returned to his baseline level of function,

performing mobility and ADLs independently while in a high-kneelposition.Discussion: SMA is characterized by degeneration of anteriorhorn cells in the spinal cord and motor nuclei in the brainstemdue to a deficiency of a motor neuron protein, SMN, secondary toa faulty gene on chromosome 5. Type 3 is milder and diagnosedafter 18 months, typically before age 3 years. Walking is usuallymaintained through adolescence; a wheelchair is often requiredlater in life. Weakness is severe in proximal muscles, includingshoulders, hips, thighs, upper back, and the muscles of respira-tion. Spinal curvature often develops, and lifespan is considerednormal. This patient’s artistic talents enabled him to communi-cate his unique adaptive techniques, and ultimately allowed himto return to his baseline level of function in the community.Conclusions: The high-kneel position, as uniquely demon-strated by this patient with SMA type 3, can be an effective means formaintaining independence with mobility and ADLs.

Poster 52Predictive Validity of the WesthavenMultidimensional Pain Inventory.William L. Parkinson, PhD (McMaster University, Hamil-ton, ON, Canada); Jonathan Adachi, MD, Dinesh A.Kumbhare, MD, Anita Thompson, BA.

Disclosures: W. L. Parkinson, none.Objective: This study was conducted to investigate the predictivetype, criterion-related validity of the Multidimensional Pain Inven-tory (MPI) for the persistence of pain after motor vehicle collisions.Design: A measurement evaluation study.Setting: An interdisciplinary rehabilitation clinic in a teachinghospital in Hamilton, Ontario, Canada.Participants: Eleven women and 8 men with grade 1 or grade 2whiplash-associated disorders.Interventions: The third revision of the MPI (MPI-3) was admin-istered at 2 weeks, and 6 months after motor vehicle collisions. Thesubject scores on the 9 MPI subscales were entered into the analyses,including (1) Pain Severity, (2) Interference in Activities, (3) LifeControl, (4) Affective Distress, (5) General Activity, (6) Support bySignificant Others; and the Behavior of Significant Others, including(7) Punishing Responses, (8) Solicitous Responses (reinforcement ofillness role), and (9) Distracting Responses.Main Outcome Measures: Descriptive statistics were used tocompare the sample with pain patient norms. Multivariate logisticregression was used to test the independent contribution of eachMPI-3 construct in the acute stage, against Pain Severity, and painchange scores at 6 months.Results: At 6 months, in comparison with chronic pain norms,sample means were at the 26th percentile for Pain Severity, 41stpercentile for Affective Distress, 48th percentile for the Dysfunc-tional scale, and 56th percentile for Interpersonal Distress. Therewas a trend toward predictive validity between the MPI-3 at 2 weeksand Pain Severity at 6 months (r�0.85, P�.07). The MPI-3 at 2weeks was highly predictive of the changes in Pain Severity overtime (r�0.94, P�.01). A 6-month pain improvement was positivelycorrelated with acute stage Activity (P�.05) and use of Distraction(P�.03). No other social variable (Punishment, Solicitous Re-sponses, Support) was correlated with improvement.Conclusions: (1) The findings provide preliminary support forthe predictive validity of the MPI-3 for chronic pain development,

S194 PRESENTATIONS

(2) higher activity levels and higher distraction predicted betteroutcome, and (3) no support was found for punishment of painbehavior or avoiding social reinforcement of pain behavior.

Poster 53Therapeutic Intensity and Functional Gains DuringInpatient Rehabilitation.Hua Wang (Kaiser Foundation Rehabilitation Center,Vallejo, CA, United States); Michelle Camicia, Murali K.Mannava, Elizabeth Sandel, MD, Steve Sidney, JoeTerdiman, MD, PhD.

Disclosures: H. Wang, none.Objective: To study the effects of therapeutic intensity on func-tional gains.Design: A retrospective cohort study.Setting: An inpatient rehabilitation hospital (IRH) in northernCalifornia.Participants: 592 patients discharged from the IRH in 2007.Interventions: The average number of minutes of rehabilitationtherapy per day, including physical therapy (PT), occupation ther-apy (OT), speech therapy (ST), and total treatment.Main Outcome Measures: Functional gains measured byFunctional Independence Measure (FIM), including motor, cogni-tion, and total scores.Results: The study sample had a mean age of 60.5 years, and was41.9% women and 64.9% white. Two-thirds of patients had adiagnosis of stroke; 89.7% had one or more comorbid conditions.The median IRH stay was 20 days. The mean total therapy time was185.3 min/d (PT, 114.1 min/d; OT, 42.8 min/d; and ST, 32.3min/d). The mean total functional gain was 25.3 (motor, 18.4;cognition, 5.7). The patients who received total therapy of fewerthan 3 hours per day showed significantly lower total functionalgain than those treated for 3 hours or longer. However, there was nosignificant difference in total functional gain between patientstreated 3-3.5 hours and more than 3.5 hours per day. Intensities ofOT, PT, and ST also were significantly associated with correspond-ing motor and cognition functional gains. Multiple linear regressionmodels showed that young age, living alone before hospitalization,lower comorbidity scores, earlier admission to IRH, medical treat-ment, and longer IRH stay were independent predictors for func-tional improvement.Conclusions: The study demonstrated a significant effect of ther-apeutic intensity on functional gains during an IRH stay and evi-dence of treatment intensity thresholds for optimal functional out-comes.

Poster 54Barriers to Home Discharge After Acute InpatientRehabilitation in Patients With Parkinson Disease: ARetrospective Analysis.Kareen A. Velez, MD (Tufts Medical Center, Boston, MA,United States); Deniz Ozel, MD, Ajay Patel, MD.

Disclosures: K. A. Velez, none.Objective: To identify the main barriers to home discharge inpatients with Parkinson disease (PD) related deficits admitted to anacute inpatient rehabilitation facility (IRF).Design: Retrospective medical chart review.Setting: Free-standing IRF.

Participants: Patients with PD admitted to an IRF from January 1,2009 to December 31, 2009.Interventions: Multidisciplinary movement disorders program.Main Outcome Measures: Length of stay (LOS), admission anddischarge functional independence measure (FIM) scores, dischargedestination, and the need for caregiver assistance. Additional datacollected included age, gender, reason for admission, and Mini-MentalState Examination (MMSE) scores on admission. Barriers to homedischarge were identified in patients who were unable to return home.Results: Of 71 subjects admitted to an IRF from January 1, 2009 toDecember 31, 2009 for multidisciplinary movement disorders pro-gram, 6 patients had at least 1 readmission. The most commonreason for admission included falls secondary to gait disturbancesand changes in mental status. Three patients had an interruptedLOS due to medical complications. Of the remaining 62 patientswith ages that ranged from 67-86 years, 15 were unable to bedischarged home (28%). The main barrier to home discharge wascognitive impairments (59%), followed by lack of caregiver assis-tance (41%). The mean LOS in cognitively impaired subjects was10�6.5, with a mean MMSE on admission of 19.6/30�6.1. Nomale to female difference was noted.Conclusions: Patients with PD can manifest a variety of complexmedical and functional deficits that affect their independence andquality of life. Results of our study suggest that cognition plays a keyrole in maintaining function and independence in geriatric patientswith PD-related deficits admitted to IRF. It is also directly correlatedto home discharge rates, independent of MMSE scores on admissionor LOS. Hence, movement disorder rehabilitation programs arecrucial in ensuring that this population can return home safely afterinpatient rehabilitation program.

Poster 55A 28-Year-Old El Salvadorian Woman With AcuteMotor Axonal Neuropathy: A Case Report.Cheryl E. Daves, MD (Stony Brook University, StonyBrook, NY, United States); Jennifer M. Gray, DO.

Disclosures: C. E. Daves, none.Patients or Programs: A 28-year-old El Salvadorian womanwith no significant medical history.Program Description: A 28-year-old El Salvadorian womanwith acute motor axonal neuropathy (AMAN).Setting: Acute rehabilitation facility.Results: The patient made slow gains in strength, was decannu-lated, and began oral feedings. She was discharged home after 44days of intensive inpatient rehabilitation, ambulating 150 ft with arolling walker with minimal assistance and bilateral ankle footorthoses. At follow-up, she displayed improved facial movementand strength, and was ambulating 200 ft independently with arolling walker.Discussion: The patient was admitted to the hospital with bilat-eral lower extremity weakness, which ascended to involve bothupper extremities and her face. She denied any pain, numbness,paresthesias, recent illnesses or travel, or family history of neuro-muscular disorders. However, she had emigrated from El Salvador 3years earlier. She was subsequently intubated for ventilatory failure.A lumbar puncture was normal. She was diagnosed clinically withGuillain-Barré syndrome and received a 5-day course of IVIG. Atracheostomy was performed, and a percutaneous gastrostomy tubewas placed. She slowly regained motor function and was weaned off

S195PM&R Vol. 3, Iss. 10S1, 2011