Poster 26: Intradiskal electrothermal therapy for treatment of chronic lumbar diskogenic pain: a minimum 2-year clinical outcome study

Objective: To determine the long-term efficacy of intradiskal electrothermal therapy (IDET) in the treatment of chronic lumbar diskogenic pain. Design: Prospective case series clinical outcome study. Setting: Academic-affiliated private physiatry practice. Participants: 62 consecutive patients with chronic diskogenic pain of >6 months in duration and consecutively enrolled in a nonrandomized prospective fashion. Inclusion criteria included constant moderate to severe low back pain (LBP) for >6 months; failure of conservative management; and positive diskogram with or without disk protrusion of <5mm. Exclusion criteria included severe disk space narrowing; disk extrusion or sequestered fragment; severe spinal stenosis; and segmental instability. Intervention: IDET using standard technique and heating protocol. Main Outcome Measures: Visual numeric pain scale (VNS) for LBP and lower-extremity pain, Roland-Morris Disability Questionnaire (RMDQ), and North American Spine Society (NASS) patient satisfaction index. Results: 51 of 62 patients (82%) were available for a minimum of 2-year follow-up. Average age was 41.4 years; average symptom duration was 46 months; and average follow-up was 34 months. Overall, there was statistically significant improvement in LBP VNS, RMDQ, and lower-extremity pain scores of 3.2, 6.6, and 2.3 (P<.001), respectively. 27 of 51 patients (53%) demonstrated clinically significant VNS and RMDQ improvements of >2. On the NASS index, 63% (32/51) responded positively. Neither the number of disk levels treated nor the insurance status of patients affected outcome. Patients with history of a microdiskectomy (n=3) responded favorably, with mean LBP VNS, RMDQ, and lower-extremity improvement of 6.3, 20.7, and 8.0 (P<.05), respectively. Those with spondylolisthesis (n=4) did not improve (P>.05). 68% of patients reported using fewer oral analgesics and 25% reported using the same amount. Conclusion: IDET appears to be an effective treatment for chronic lumbar diskogenic pain in a well-selected group of patients with favorable long-term outcome.     

Abstract 2: Efficacy of epidural steroid injections

Objectives: To test the efficacy of epidural steroid injections (ESIs) for the relief of radicular-, facet joint-, and lumbar stenosis-related pain 3 months postinjections and to demonstrate whether the presence of litigation and smoking influenced the response to treatment. Design: Prospective survey. Setting: Community-based hospital. Participants: 300 patients who received steroid injections for radicular-, facet joint-, and lumbar stenosis-related pain. Interventions: All participants had clinical and diagnostic evidence of lumbar radiculopathy, spinal stenosis, or facet pain. Each was then treated with a series of ESIs. Each patient filled out a preinjection survey to determine the duration and distribution of their pain. A 10-point analog pain scale determined their pre-injection pain. Factors also evaluated were the etiology of pain, the presence of a lawsuit, and if the patient was a habitual smoker. At 3 months postinjection, each participant received a survey to rate their current pain and declare other interventions such as physical therapy and surgery. Main Outcome Measures: Percentage of participants who received pain relief from their ESIs and specifically which etiology of back pain showed a better response. Results: 3 months after ESIs, approximately 80% of patients had a decrease in their symptoms by 2 or more points on the 10-point analog pain scale. Patients who experienced the most pain relief were those with radicular or stenotic symptoms, nonsmoking, or without concomitant litigation. Conclusion: Steroid injections for back pain of radicular or stenotic nature (not facet), especially for nonsmokers or those without litigation, are an effective means of treating low back pain (LBP) in the first 3 months. This study will be followed by a 6 month and 12 month survey to determine the long-term efficacy of steroid injections for LBP.     

Abstract 1: Are fluoroscopic caudal epidural steroid injections effective in the management of chronic low back pain?

Objective: To determine the efficacy of fluoroscopic caudal epidural steroid injections (ESIs) as a conservative treatment in patients with presumably chronic lumbar diskogenic pain. Design: Retrospective follow-up study. Setting: Physiatric interventional spine practice in a large, urban, academic institution. Participants: 97 patients from chart review meeting inclusion criteria: (1) predominately axial low back pain of >3 months in duration, (2) failure of conservative treatment (ie, nonsteriodal anti-inflammatory drugs, physical therapy), (3) clinical presentation and magnetic resonance imaging findings consistent with central lumbar disk protrusion and/or degeneration at L4-5 or L5-S1 without stenosis. Intervention: At least 1 fluoroscopically guided caudal ESI. Main Outcome Measures: Successful outcome was determined as follows: (1) pre-post ESI change in Roland-Morris Disability Questionnaire score of ≥2 points, decrease in visual numeric pain scale rating of >50%, and North American Spine Society patient satisfaction score of 1 to 2. Results: Only 19 patients (23%) were determined to have a successful long-term (>2y) outcome and 65 (77%) were deemed failures. Average follow-up was 28.6±15.6 months. Successes were found to differ significantly from failures in preinjection pain scores (8.53 vs 9.09, P=.04) and patient satisfaction (P<.001). There were no significant differences between diagnostic groups (disk herniations=64, degenerative disk without herniation=33). Overall patient satisfaction was 45%. Conclusions: At more than 2 years of follow-up, the efficacy of fluoroscopically guided caudal ESI in patients with chronic lumbar diskogenic pain is limited. Patient satisfaction exceeded the reported rate of efficacy. Patients responding to injection had significantly lower preinjection pain scores. Despite these low success rates, fluoroscopic caudal ESIs remain a viable option to more invasive treatment options for 1 in 4 patients from this population and the offer of at least a single injection should remain part of the treatment algorithm.     

Abstract 13: Use of electromyography to predict functional outcome after epidural spinal injections for lumbar radiculopathy.

Objective: To determine if electromyographic diagnostic evaluation can predict functional outcome in patients undergoing lumbar spinal injections. Design: Retrospective study of functional outcome in patients undergoing lumbar interforaminal epidural spinal injections (ESIs) after electromyographic testing. Setting: Clinic. Participants: 39 subjects with low back pain with radicular symptoms into the lower extremity were evaluated for functional improvement after electromyography and ESI. Interventions: Fluoroscopic guidance of interforaminal ESI in the lumbar region was performed where positive clinical or electromyographic levels were suspected. Main Outcome Measures: Oswestry Disability Index (ODI) and Verbal Rating Scale (VRS) for current pain severity. Results: Electromyography diagnosed 18 patients with a radiculopathy; 21 had a normal or negative examination. Patients were followed postinjection on average for 10.8±3.9 weeks. Pretreatment ODI scores ± SD did not differ significantly between groups showing positive radiculopathy (72.3±12.7) or negative electromyographic findings (65.9±18.6) (P>.05). There was significantly greater improvement of ODI rating for electromyography positive radiculopathy (7.11±9.5) compared with negative electromyography (3.2±17.4) (P<.05). Positive radiculopathy subjects complained of more pain as measured on the VRS before ESI (8.1±1.0) than subjects with negative electromyographic findings (7.3±0.8) (P>.05). The VRS mean improvement did not differ significantly between the positive electromyography group (1.8±1.2) and the negative electromyography group (1.2±1.2) (P>.05). Conclusions: Subjects undergoing interforaminal ESI, who had a positive radiculopathy by electromyography prior to injection, showed significant improvement in functional outcome as measured by the ODI but not as measured by current pain intensity on the VRS. This study showed the importance and diagnostic value of electromyography for radiculopathy evaluation prior to spinal procedures and the difficulty of pain evaluation outcome by using the VRS.     

Poster 35: High-resolution electroencephalography and reorganization of posterior cortical potentials

Objective: To test whether reorganization after spinal cord lesions is “unfavorable” because of a takeover of cortical areas representing weak or paralyzed muscles. Design: Randomized study of electroencephalograms. Setting: Spinal cord research laboratory. Participants: 16 patients with spinal cord lesions and 10 normal controls. Interventions: Subjects were instructed in moving their right middle or index fingers. The fingers were also moved in a similar manner by an operator. Voluntary movement was monitored by electromyography. Main Outcome Measures: Movement-related cortical potentials and passive movements. Results: Posterior cortical reorganization represented reinforcement of residual motor pathways from somatosensory cortex (S1) to the spinal cord, and facilitated rehabilitation. Conclusion: Motor potentials can be generated by active and passive measurements of the fingers. Reorganization of somatosensory cortex is important in deriving potentials from proprioceptive input and creating the necessary templates to activate the motor networks and electroencephalographic activity.     

Article 9: Sensitivity of H-reflex in detecting response to complex-continuous mode of intrathecal baclofen delivery

Objective: To determine sensitivity of H-reflex in assessing spinal cord responsiveness before and after programming complex-continuous mode of intrathecal baclofen (ITB) delivery. Design: Prospective, consecutive sample. Setting: Traumatic Brain Injury Model Systems inpatient rehabilitation center. Participants: 7 patients with dysfunctional spasticity due to acquired brain injury underwent serial soleus H-reflex recordings before and 4 hours after the ITB delivery mode was changed from simple- to complex-continuous. Intervention: 25- to 125-μg ITB boluses during complex-continuous mode. Main Outcome Measures: The ratio between maximum H-reflex and maximum M wave (H/M). Results: Initial simple-continuous dose ranged from 150 to 490μg/d with the corresponding H/M ratios from 33% to 82%. After bolus administration, the H/M ratio decreased in 5 subjects from 10% to 60% in a dose-dependent manner. Corresponding change in mean Ashworth Scale score (n=3) was <0.7. In the remaining 2 subjects, only minimal change in H/M occurred; malfunctioning pumps were later found. Conclusions: Our results indicate that the H-reflex is a sensitive technique for monitoring spinal cord responsiveness to complex-continuous mode of ITB delivery. H-reflex recordings may be useful for ensuring proper pump function, especially when clinical spasticity is decreased due to simple-continuous ITB delivery and, therefore, less detectable by clinical evaluation.     

Poster 25: Validation of the chronic pain coping inventory for the veteran population

Objective: To validate the Chronic Pain Coping Inventory (CPCI) for use with veterans suffering from chronic pain. Design: Patients completed study questionnaires prior to multidisciplinary treatment. Factor analysis was used to examine the factor structure of the 64-item CPCI. A series of hierarchical multiple regression analyses were performed with depression, pain interference, general activity level, disability, and pain severity as the criterion variables and the 8 CPCI factors as the predictor variables, controlling for pain severity and demographic variables. Setting: A Veterans Affairs medical center, a tertiary teaching hospital, in Texas. Participants: 554 patients with chronic nonmalignant pain. Interventions: Not applicable. Main Outcome Measures: The CPCI, the Center for Epidemiological Studies Depression Scale, the Roland-Morris Disability Scale, and the pain severity, interference, and general activity subscales of the West Haven-Yale Multidimensional Pain Inventory. Results: The CPCI assesses 8 coping factors. Regression analyses indicated that these factors accounted for unique variance in depression, pain interference, general activity level, disability, and pain severity above and beyond what is accounted for by the demographic variables and pain severity. Conclusion: The results confirmed the validity of the CPCI for use with the veterans.     

Poster 31: Community-acquired pneumonia in veterans with spinal cord injury

Objective: To describe the characteristics of community-acquired pneumonia (CAP) in persons with spinal cord injury (SCI) and how management is related to outcomes. Design: Cross-sectional retrospective review of administrative and clinical data. Setting: Department of Veterans Affairs (VA) facilities, and for substudy, 3 VA SCI centers (October 1998-September 2000). Participants: Veterans with SCI: 260 inpatients with CAP; in the substudy, 41 inpatients and outpatients with CAP from 3 sites. Interventions: Not applicable. Main Outcome Measures: Percentage of patients with an etiologic diagnosis, mortality rate, mean length of stay (LOS), and number and types of procedures and treatments. Results: Of the 260 inpatients with SCI identified from administrative data with CAP, only 24% had an etiologic diagnosis. Etiologic diagnosis was not associated with mortality after adjusting for several factors (OR=1.38; CI, 0.45-4.20), however, it was associated with an increase in LOS (P=.024). For the substudy, almost 75% of the 41 patients were hospitalized (mean LOS=16.3d) and 3 patients died. Most received chest radiographs (85%), but up to 54% did not receive other tests standard for management of CAP during the first day of care (eg, blood cultures, CHEM 7). Of the 16 patients with sputum cultures, an organism was identified in 44% through microbiology testing. Over 90% received antibiotics within 24 hours of admission. Conclusions: Many patients do not receive the minimum recommended testing. Empiric treatment appears to have been the predominant type of management used in this population. Further research to assess the relationship between clinical characteristics and management with patient outcomes is     

Abstract 18: Plantar fasciitis: a new treatment approach.

Objective: To evaluate the efficacy of a new approach that shortens the duration of plantar fasciitis treatment. Design: Randomized controlled study. Setting: Outpatient clinic. Participants: 64 patients were randomly assigned to intensive conventional physical therapy (PT) (n=34) or needling and infiltration of the myofascial trigger points at the proximal portion of the medial gastrocnemius muscle (n=30). Interventions: Patients in the PT group received ultrasound and electric stimulation at the origin of the plantar fascia followed by stretching exercises of the gastrocnemius muscle. The other group was treated by needling and infiltration (1% lidocaine) of the taut band at the proximal portion of the medial gastrocnemius muscle of the involved limb(s). Injections were performed at weekly intervals. PT was administered for 3 consecutive days after the injections. Patients were instructed to perform stretching of the gastrocnemius muscles and of the plantar fascia at home twice a day. Main Outcome Measures: Visual analog scale and hindfoot functional test (American Orthopaedic Foot and Ankle Society Hindfoot Questionnaire) were performed before and after treatment by an independent evaluator. Duration of treatment was compared between the 2 groups. Results: Statistically significant reduction of pain and improvement in function were observed in both groups, without any differences between them. The time required to achieve the same improvement was significantly less (80%) in the injected group than in the control group (P<.001). The number of PT sessions needed was also significantly reduced (P<.001). Postinjection soreness and local hematoma were found in 30% of the patients. No local infection or other major complications were noticed in any cases. Conclusions: Although treatment in both groups was equally successful, needling and infiltration of the medial gastrocnemius muscle provided faster pain relief and functional recovery in patients with plantar fasciitis.     

Poster 27: Acute rehabilitation: comparison of functional outcomes of liver transplant and stroke patients

Objectives: To determine the functional outcomes of liver transplant patients with acute rehabilitation and to compare outcomes with those of stroke patients. Design: Retrospective study. Setting: Acute rehabilitation unit in a university hospital. Participants: Inpatient charts of 13 liver transplant patients and 13 stroke patients were reviewed. Interventions: The charts of 13 patients who underwent inpatient rehabilitation after liver transplants were reviewed to assess their functional gains. Their functional progress was measured on the FIM™ instrument at admission, weekly, and at discharge. Progress was compared with 13 age-matched stroke patients. Main Outcome Measures: FIM efficiency ratio of liver transplant patients was obtained by dividing the total FIM gain by the length of stay (LOS). This ratio was compared with that of the stroke patients. Results: The average age of the liver transplant patients was 56 years and that of the stroke patients was 55 years. The average admission FIM scores for transplant patients was 50 and discharge FIM scores was 76, compared with 51 and 72, respectively, for the stroke patients. The average LOS of the transplant patients was 20 days; it was 21 days for the stroke patients. The efficiency ratio was 1.35 for transplant patients and 1.33 for the stroke patients. The Student t test, with 24 degrees of freedom, showed no statistically significant differences between the liver transplant and stroke patients for their average admission and discharge FIM scores and efficiency ratios. There was also no significant difference in the average LOS. Conclusion: Patients with liver transplants made functional gains similar to those of stroke patients of similar age.     

Poster 5: Short-term effects of locomotor-oriented rehabilitation on postarthroplasty hip impairments and functional ability

Objective: To evaluate the effects of intensive rehabilitation offered 6 months after total hip arthroplasty (THA). Design: Intervention pilot study, before-after trial. Setting: Ambulatory care. Patients: 10 patients were evaluated 7.2±0.5 months after THA (pretest) and 2 months later (posttest). Intervention: 12 supervised sessions and unsupervised home exercises. Main Outcome Measures: Functional ability measured with Western Ontario and McMaster Universities Osteoarthritis Index (pain and disability scales), clinical locomotor tests, and laboratory gait evaluation. Hip strength and mobility impairments were also quantified. Comparisons were made with Wilcoxon signed-rank tests. Results: At posttest, patients had less pain (-56%) and less difficulty in performing daily activities (disability scale, −42%), and they performed better during the 10m walk (15%), 6-minute walk (16%), and timed stair (17%) tests, as compared with pretest. No differences were revealed in gait kinematics and kinetics or impairment measures on the operated limb. Significant changes were found in the movements of the sound limb. Conclusions: The intervention promoted better functional ability. Functional gains seem related to more efficient compensations with the sound limb and better locomotor endurance. These results stress the importance of measuring joint-specific outcomes and using bilateral measures to understand changes in global functional outcomes.     

Abstract 12: Small heat shock protein gene therapy to protect damaged spinal cord from secondary injury.

Objective: To test the hypothesis that overexpression of small heat shock protein (Hsp27) after spinal cord lesion protects neural cells from secondary injury. Design: Gene therapy study on animal models. Setting: Academic research center. Animals: Rats. Interventions: Not applicable. Main Outcome Measures: Clone human Hsp27 complementary deoxyribonucleic acid into a neural tropic recombinant herpes simples and adeno-associated virus hybrid vector; prepare amplicons carrying Hsp27 and green fluorescent protein (GFP) genes; induce rat spinal cord injury by weight-drop apparatus (10g, 25mm); microinject the injured and uninjured spinal cords with Hsp27 amplicons with GFP amplicons and saline as a control; observe the spinal cord target gene expressions, histology reaction, and neuron survival; and perform immunohistochemistry studies as well as apoptosis assay. Results: Hours after injection, obvious target gene expression was observed. The expression peaked at 48 hours and was quite constant, lasting >8 weeks. The expression area was mainly around the site of injection. No obvious local inflammatory reaction induced any amplicons. Protective signs of neural tissue were observed in the Hsp27 group. 2 weeks after the contusion, about 30% more neurons survived around the lesion area in the Hsp27 therapy group than in the controls. Many Hsp27 labeled axon-like processes were found around the lesion site. There were fewer cells with apoptosis markers around the injury area in the Hsp27 group. The differences showed statistical significance. Conclusion: Hsp27 gene therapy may limit secondary injury in the rat spinal lesion model. Further studies on the underlying mechanisms and functional outcomes are suggested.     

Article 10: Effect of cognitive retraining on reorganization of attention network in patients with traumatic brain injury

Objective: To identify the areas of reorganization in the neural network for attention after cognitive retraining in the patients with traumatic brain injury (TBI) using functional MRI (fMRI). Design: Controlled clinical trials. Setting: Department of physical medicine and rehabilitation in general hospital. Participants: Ten TBI patients and 12 healthy volunteers participated. Interventions: Patients had received computer-assisted cognitive retraining to practice diverse attention skills for 3 to 4 weeks. Main Outcome Measures: fMRI was performed on a 3T ISOL Forte scanner with single-shot echoplanar imaging sequences before and after the intervention using a modified Posner paradigm as an activation task. Data were analyzed using Statistical Parametric Mapping 99. Results: The accuracy was lower and reaction time was slower in the patient group (P<.001). fMRI results showed more activation in the right prefrontal and less activation in the cingulate, occipitotemporal, and cerebellar regions in the patients than in the normal group. After cognitive retraining, reaction time improved significantly (P<.05). fMRI analysis showed a decrease in activation of the bilateral frontal and an increase in activation of the medial frontal areas after cognitive retraining. Conclusion: The effect of cognitive retraining was accompanied by reorganization of attention networks in frontal areas.     

Poster 25: Intrathecal baclofen therapy in ambulatory patients with multiple sclerosis: effect on gait speed

Objective: To evaluate whether intrathecal baclofen (ITB) therapy causes a decrease in gait speed in ambulatory patients with multiple sclerosis (MS). Design: Longitudinal pre-post intervention study (24-wk follow-up). Setting: Spasticity clinic within a large outpatient comprehensive care center for MS. Participants: Patients with intractable lower-extremity spasticity, definitively diagnosed with MS and able to walk at least 25ft with or without support. Intervention: Implantation of a programmable ITB infusion system. All patients received inpatient and/or outpatient physical therapy after surgery. Main Outcomes Measure: Gait speed calculated from the Timed 25-Foot Walk. Results: 8 patients were analyzed (75% women; mean age, 37.4±6.1y; mean disease duration, 9.7±7.9y; median Expanded Disability Status Scale [EDSS] score, 6.5). There was no significant change in EDSS score during the study. There was statistically significant improvement of Modified Ashworth Scale scores between baseline and all follow-up visits. There was no statistically significant change in gait speed. Average gait speed was .48±.35m/s at baseline, .46±.41m/s at 4 weeks, .41±.37m/s at 12 weeks, and .48±.40m/s at 24 weeks. Conclusions: Our results suggest that ITB therapy improves severe spasticity, but does not affect gait speed measured on a short distance in ambulatory MS patients, up to 6 months after surgery. Further study is needed to assess the effect of ITB on gait endurance, gait quality, and patient quality of life.     

Poster 27: Pressure ulcer history and spinal cord injury

Objective: To identify risk and protective factors associated with a history of recurrent pressure ulcers after spinal cord injury (SCI). Design: Cross-sectional. Setting: Large southeastern US specialty hospital. Participants: 826 nonambulatory adults with traumatic SCI of at least 5 years in duration. Interventions: Not applicable. Main Outcome Measures: Outcomes included current pressure ulcers, pressure ulcers within the past years, days adversely impacted by pressure ulcers, pressure ulcer surgeries, and pressure ulcer history (recurrent vs nonrecurrent). Results: 69% failed to report recurrent pressure ulcers, whereas 13% reported a clear pattern of recurring pressure ulcers of 1 or more per year (18% could not be classified). Logistic regression identified several general protective behaviors for recurrent pressure ulcers (eg, lifestyle, exercise, diet), none of which included those generally recommended during inpatient rehabilitation to prevent pressure ulcers (eg, skin checks, weight shifts). Fewer risk behaviors were associated with pressure ulcer history, although several proxy variables were related to pressure ulcer history. Conclusions: Pressure ulcer history is a more viable measure of pressure ulcer outcomes than measures taken at a single point in time (current), over a brief period of time (eg, 1y), or those relying on critical events occurring at any time since SCI onset (ie, surgeries to repair pressure ulcers). A general healthy lifestyle appears to be strongly associated with an absence of recurrent pressure ulcers, whereas the efficacy of specific prevention behaviors was not demonstrated.     

Presentation 4: Intensive medical intervention and pulmonary rehabilitation of patients with advanced restrictive lung disease

Objective: To examine the benefits of an inpatient pulmonary rehabilitation program on patients with advanced interstitial lung disease (ILD). Design: Prospective cohort study. Repeated measures with experimental interventions and control group over a 2-year period. Setting: In- and outpatient pulmonary rehabilitation program in a hospital-based academic center. Participants: A total of 80 patients with the diagnosis of advanced ILD—40 consecutive patients (mean age, 45.7y) admitted for inpatient pulmonary rehabilitation with the diagnosis of advanced ILD and 40 patients (mean age, 48.1y) with the diagnosis of advanced ILD who did not receive inpatient rehabilitation services. Intervention: Patients with advanced ILD were offered inpatient pulmonary rehabilitation. Patients admitted for inpatient pulmonary rehabilitation received services as defined by the American Association of Cardiovascular and Pulmonary Rehabilitation. Main Outcome Measures: Pulmonary vital capacity, diffusion capacity, FIM™ instrument, 6-minute walk, and St. George’s Questionnaire. All measures were collected at the time of eligibility for admission to rehabilitation. Subsequent measures were collected in the inpatient program (experimental group) on discharge. The same measures were collected from patients (control group) who were not admitted for rehabilitation at the same time interval. Results: Analysis of covariance was used to test for group differences in mean change after adjusting for initial status. Improvements in all outcome measures were found in patients with ILD who received inpatient pulmonary rehabilitation services. These patients had improved vital capacity (P≤.001), FIM score (P≤.001), St. George’s Questionnaire score (P≤.001), 6-minute walk score (P≤.001), and diffusion capacity (P=.009). Conclusion: Pulmonary rehabilitation of patients with advanced ILD results in statistically significant improvement in pulmonary physiology, physical functioning, and quality of life.     

Poster 4: Comparative efficacy of 3 in-hospital rehabilitation programs on knee flexion after total knee arthroplasty: a randomized controlled trial

Objective: To compare the efficacy of 3 in-hospital rehabilitation programs with and without continuous passive motion (CPM) on knee flexion after a primary total knee arthroplasty (TKA). Design: Randomized controlled trial. Setting: Acute care hospital. Patients: 81 patients who underwent a TKA for a diagnosis of osteoarthritis were randomly assigned to 3 groups immediately after TKA: group I: conventional rehabilitation (CONV) only (n=27); group II: CONV and CPM 35min/d (n=26); and group III: CONV and CPM 2h/d (n=28). Interventions: Rehabilitation programs began the day after TKA and continued once a day until discharge. All patients were evaluated twice: before TKA and 7 to 8 days after. Main Outcome Measure: The primary measure was active knee flexion as measured with a manual goniometer in seated position by a physical therapist blinded to the study. Results: Patients’ baseline characteristics were similar. No difference between groups was found for knee flexion after intervention (ANOVA, P=.33; 95% CI of group differences: groups I-II: −5.8° to 9.2°; groups I-III: −10.3° to 4.5°; groups II-III: −12.1° to 2.9°). Conclusion: Our results did not support the use of CPM, as applied in this study, during the acute phase of rehabilitation after TKA.     

Abstract 19: Cortical reorganization of hand motor function to primary sensory cortex in hemiparetic patients with a primary motor cortex infarct.

Objective: To demonstrate cortical reorganization in hemiparetic patients with a primary motor cortex (M1) infarct using functional magnetic resonance imaging (fMRI). Design: The hand motor function of 2 hemiparetic stroke patients and 20 control subjects was evaluated by fMRI. Setting: Academic medical center. Participants: 2 hemiparetic patients and 20 control subjects with no history of neurologic disease. Interventions: fMRI was performed using the blood oxygen level-dependent technique at 1.5T. For the motor task paradigm, hand grasp-release movements were performed at a frequency of 1Hz for stimulation, guided with a metronome, over a repeated cycle of 15 seconds of control and 15 seconds of stimulus. Each task paradigm of alternating control-stimulus (30s) was repeated 3 times. Main Outcome Measures: fMRI data were analyzed using SPM-99 software running under the Matlab environment. The images were then smoothed with an 8mm isotropic gaussian kernel. Statistical parametric maps were obtained and voxels were considered significant at P<.001, uncorrected, with the additional requirement of a cluster size of 5 voxels. Results: The contralateral primary sensorimotor cortex was activated by the hand movements of control subjects and of the unaffected side of the 2 patients. Only the contralateral (infarct side) primary sensory cortex (S1) was activated by the affected hand movements of the 2 patients, a result that was not observed in control subjects or the unaffected hand of stroke patients. Conclusions: We believe that the hand motor function of the infarcted M1 of these patients was reorganized into S1. It seems that cortical reorganization took place in patients with an M1 infarct.     

Poster 14: Cost savings of pulmonary vest therapy

Objectives: To determine cost savings from using pulmonary vest therapy to prevent hospitalizations related to pneumonia. Design: Quantitative research using before-during treatment data. Setting: 2 pediatric skilled nursing facilities for children with severe cerebral palsy (CP). Interventions: Not applicable. Main Outcome Measures: The average hospitalization for pneumonia was 5 days, 4 of which were in the intensive care unit (ICU). The daily hospitalization rates were obtained from the business offices of 3 regional hospitals with pediatric ICU units that serve our patients. Results: During our 1-year study, the number of hospitalizations was decreased by 10. The average hospitalization charge was $8225. Thus, the cost savings for 10 hospitalizations was $82,550. The cost of a vest therapy unit was $15,000 and a total of 3 units were used. The vest therapy units continue to be in use for the third year, without mechanical failure or maintenance requirements. Conclusion: In the first year alone, there was a very significant cost savings. It should be noted that these sums do not include hospital laboratory testing, pharmacy costs, or physician costs, and so significantly underestimate the actual savings.