Jeffrey Heckman

Mobile Health: Exploring Attitudes Among Physical Medicine and Rehabilitation Physicians Toward this Emerging Element of Health Delivery

Health care reform, coupled with recent technologic advances, is driving the rapid adoption of medical technology. Individual medical practitioners and integrated health care delivery systems have been forced to alter their approach to technology and to understand the potential applications within their practice. Among these technologic innovations is mobile health (mHealth), which is the practice of medical or public health supported by mobile electronic devices. mHealth enables the monitoring and delivery of health care and healthrelated information to a broad community in a real-time fashion. The power of mHealth stems from the ability to provide information, education, and resources to both health care providers and patients where and when they need it, thus extending traditional modes of information sharing and dissemination across the spectrum of health delivery. The dynamic nature of the devices and the accompanying software applications (apps) allows users to interact with each other and to access data in an unprecedented manner. For physicians and other members of a multidisciplinary care team, the result could be improved communication and alignment of services, clinical monitoring, multidisciplinary coordination of care, patient education, access to health records, and continuing medical education; for patients, mHealth could provide an additional point of contact with their providers that is interactive and that accompanies them throughout their day in their individual psychosocial milieu, allowing them to access information and become empowered at the point of need. Currently, our physical medicine and rehabilitation (PM&R) department is conducting a prospective study evaluating the impact of tablet computers, specifically the iPad (Apple Inc. Cupertino, CA), on patient care and resident education within a rehabilitation setting. Here we discuss attitudes among PM&R resident and attending physicians toward mHealth to better understand the current use and potential benefits within our field. The rapid movement of technology that is emerging outside of the traditional realm of hospital-driven information technology was initially dominated by personal digital assistant devices and by phones with advanced computer-like capabilities (smartphones) and has recently expanded to encompass tablet computers, including the iPad. There are currently more than 15,000 health-related apps available on iTunes, and at least 3 medical schools have already integrated iPads into the first-year curriculum [1,2]. Recent surveys suggest that 22% of physicians will own an iPad by the end of 2010 and more than 50% will have one by the end of 2011 [3,4]. The rapid adoption of mobile technology by health care practitioners has been matched by the use of mobile devices by patients. In fact, more than 80% of Medicaid patients text regularly, and groups who would otherwise have limited access to Internet services (eg, ethnic minorities) are leading adopters of Smartphones and tablets [5]. Not only can mHealth reach individuals whenever and wherever they carry their mobile device, it has the potential to accompany individuals over long periods of time and to involve underserved communities. Physicians indicate a willingness to have patients monitor their health remotely, with more than 85% of physicians stating they would prefer to have patients take more control of their own care in this way [5]. It is estimated that more than 14% of adult Americans are already using mobile devices to monitor their health [6], with some positive preliminary results reported [5-9].

Assessing Patient Expectations and Concerns in a Physical Medicine and Rehabilitation Unit: A Real-Time Snapshot

To evaluate patient expectations, concerns, and satisfaction during physical medicine and rehabilitation (PM&R) inpatient hospitalization. Patients were also asked to comment on what resources might benefit them during their stay.

Poster 178: Reduction of Residual Limb Pain with Botulinum Toxin Injection Following Small Finger Amputation: A Case Report

coronary artery disease initially presented for heart transplant evaluation, who developed a cardiogenic shock shortly requiring intraaortic balloon pump support (IABP). IABP placement was complicated by a left pontine ischemic stroke with right hemiparesis and a retroperitoneal hematoma compressing the lumbar plexus involving femoral and obturator nerves causing lumbar plexopathy adding to the right lower extremity weakness. The femoral IABP was replaced with axillary IABP to facilitate physical therapy. Physical therapy was started gradually 10 days after axillary IABP placement. Setting: Tertiary care adult inpatient coronary care unit (CCU). Results: The patient was able to tolerate out of bed to chair transfers, and stand from sitting, and therapeutic exercises. The physical therapy was done in the presence of the CCU nurse and the perfusionist with no untoward effects. The IABP was eventually weaned off and the patient was discharged to a subacute rehabilitation facility to optimize his condition to be eligible for heart transplant. Discussion: IABP maximizes coronary artery perfusion and increases cardiac output by reducing left ventricular afterload, thus increasing myocardial oxygen supply and decreasing myocardial oxygen demand, respectively. IABP was traditionally inserted via femoral artery, and patients were typically on bedrest until removal of the device. Axillary approach to IABP was developed to facilitate early ambulation which enables optimization of rehabilitation potential. Axillary IABP was also found to have increased subsequent heart transplant rate as compared to the femoral approach. Conclusions: The benefits of physical therapy for advanced heart failure have been understudied. This case was unique that the patient with IABP with multiple comorbidities in the CCU setting was able to tolerate a course of physical therapy without untoward effects. Level of Evidence: Level V

A Novel Augmented Reality Treatment Option for Phantom Limb Pain: A Case Report

Disclosures: M. Sohn, NoDisclosures: I Have Nothing To Disclose. Objective: To investigate the correlation between quantitative sonography and electrophysiologic study in patients with carpal tunnel syndrome (CTS) and to assess the clinical significance of quantitative sonography for the diagnosis of CTS. Setting: Forty hands with suggestive symptoms and signs of CTS and 40 hands from asymptomatic volunteers were prospectively evaluated by ultrasonography and electrodiagnostic studies. Electrodiagnostic study contained nerve conduction studies including median and ulnar nerves, and electromyography of abductor pollicis brevis (APB) and abductor digiti minimi (ADM). Ultrasonography was conducted in APB and ADM muscles. The muscle thickness, cross-sectional area (CSA) and echo intensity (EI) were determined in each muscle. The echo intensity was measured using computer-assisted grayscale analysis. Results or Clinical Course: There were significant differences in muscle thickness, CSA, EI of APB between the CTS and the control group (p<.05), whereas no significant differences in ADM. EI showed highly significant, positive correlation with electrophysiological severity, distal latency of median motor and sensory nerve. Muscle thickness and CSA showed significant, negative correlation with them. Conclusions: The quantitative muscle ultrasonography has clinical significance in the diagnosis of CTS.

Poster 431: Vascular Malformation in Spinal Cord Injury Rehabilitation: Preventing Thromboembolism Amidst Hemorrhage and Coagulation: A Case Report

Disclosures: M. C. Diamond, None. Patients or Programs: A 48-year-old man with KlippelTrenaunay-Weber syndrome, Kasabach-Merritt syndrome, and transfemoral amputation with new onset nontraumatic spinal cord injury (SCI). Program Description: The patient presented with weakness, sensory deficits, and urinary retention from spinal cord compression caused by a spinal hemangioma at T11. Before this injury, the patient had been independent in activities of daily living and a community ambulator with bilateral Lofstrand crutches. After tumor resection and evacuation of an associated spinal hematoma, the patient was admitted to inpatient rehabilitation with a complete SCI, essentially bedbound and requiring maximum assistance for most activities. The patient’s vascular tumors, which caused his amputation at age 30 as well as his recent SCI, also rendered him thrombocytopenic due to splenic sequestration from a splenic hemangioma. Setting: Inpatient rehabilitation unit. Results: Because current literature reveals an alarmingly high incidence of venous thromboembolism (VTE) after SCI, the issue of VTE prophylaxis was addressed on admission. Cases such as these are complex, however, because of the comorbid coagulopathy and history of bleeding. The decision was made to provide chemical VTE prophylaxis in the short term and a dedicated rehabilitation program focused on increasing the patient’s mobility in bed and maximizing function at a wheelchair level. The patient made slow and steady progress with no signs or symptoms of VTE over a 5-week course. At the time of discharge home, he had functionally improved to modified independence in many areas, including bed mobility, sliding board transfers to and from bed and wheelchair, and propelling a wheelchair. Discussion: Patients who are paralyzed and debilitated from vascular malformations with associated coagulation disorders offer unique challenges for rehabilitation. Conclusions: SCI patients with vascular tumors and thrombocytopenia can be safely rehabilitated and anticoagulated in an appropriate setting to prevent VTE and maximize function. STROKE

Poster 208: Evaluating the Efficacy of a Hospital-Based Multidisciplinary Amputee Support Group

that their subjective knowledge was not sufficient and most are interested in more end-of-life care training, indicating that there is likely an educational need in this area for providers who care for persons with MS. Providers appear more comfortable with procedural skills related to end-of-life care, such as making a hospice referral or completing a DNR form, than with interpersonal skills. Challenges with the design and analysis of this study reinforce the need for validated survey measures for these outcomes as well as additional surveys to measure provider attitudes, skills and knowledge related to end-of-life care both over time as well as before/after educational interventions.

Poster 49: Gender Differences Across Specialties: A Real-time Snapshot of Patient Expectations

discharge to home with her mother, the patient was at a supervision level for wheelchair propulsion of 75 feet. She required minimal assistance for upper extremity bathing and dressing, moderate assistance for lower extremity bathing and dressing, and moderate assistance for executive functioning tasks. Discussion: Dry beriberi and its neurological sequela of encephalopathy and peripheral neuropathy are typically associated with chronic alcohol use in the United States, but can occur in any thiamine deficient state such as in pregnancy. Neurological symptoms can be reversible if treated early with thiamine supplementation. No accurate statistics are available on the overall incidence of beriberi in the US, and there is no available literature on the functional outcome of such patients. Conclusions: Comprehensive acute rehabilitation is beneficial for patients with nutritional-related encephalopathy and neuropathy, providing them with family training, access to assistive devices, and an opportunity for upgrades in cognition, mobility, and self-care skills.