Peter Kossmehl

Poster 51: Efficacy of Intrathecal Baclofen Therapy Compared to Oral Medication on Pain and Quality of Life in Post-Stroke Spasticity: the SISTERS Study

Disclosures: Jeffrey Strakowski: I Have No Relevant Financial Relationships To Disclose Objective: The objective of this abstract is to describe clinically relevant sonographic features related to both positional changes and tissue torsion using high frequency ultrasound of the anterior shoulder as the shoulder transitions from neutral anatomic position to full external rotation (ER). Design: Sonographic images were obtained in a 53-year-old healthy woman. Conventional imaging locations typically used to assess musculoskeletal and peripheral nerve anatomy and to perform therapeutic injections were chosen. The transducer was centered over each region to obtain both short axis (SA) and long axis (LA) views in both anatomic neutral and full ER. Video recording was performed to track the movement of the muscles and nerves. Setting: Academic University Participants: Healthy human female Interventions: Ultrasonographic imaging Main Outcome Measures: N/A Results: The rotator interval including the intertubercular groove and biceps brachii long head moves far laterally when viewed in SA, becoming out of plane when viewed in LA. The subscapularis is poorly visualized in neutral but the tendon and more distal aspect of the muscle is well-visualized in ER. The pectoralis major tendon insertion is well-visualized in LA with the shoulder in both neutral and ER. Tension is placed on the pectoralis with ER and the rotation of the humerus and insertion point is seen. The pectoralis major muscle is seen in greater detail in ER. The medial, posterior and lateral cords of the brachial plexus are visualized at the infraclavicular portion of the shoulder relative to the axillary artery. Position of the cords is minimally altered with ER, however the overlying pectoralis minor is tightened. Conclusions: Movement into ER changes the sonographic appearance of the anatomic relationships of the anterior shoulder in predictable patterns. ER has a considerable effect on sonographic appearance of the anterior shoulder and knowledge of torsional changes can have diagnostic and therapeutic implications. Level of Evidence: Level IV

Poster 462: Efficacy of Intrathecal Baclofen Therapy Compared to Conventional Oral Treatment in Post-Stroke Spasticity: An International Multicenter Randomized Controlled Trial (SISTERS)

Disclosures: Ilana Etelzon: I Have No Relevant Financial Relationships To Disclose Objective: To analyze medication discrepancies in patients transferred from acute care hospital to inpatient rehabilitation facility. Design: This is a retrospective study. We gathered discharge summaries of patients admitted to inpatient rehabilitation facility from an acute care hospital from October 2016 to November 2016. We analyzed time the discharge summary was completed at the acute care hospital and recorded missing medications on the rehabilitation admission notes. Medications were categorized based on drug class. Setting: Inpatient rehabilitation facility at an inner-city hospital. Participants: Our study involved 57 cases, 24 males and 33 females. Interventions: Not applicable. Main Outcome Measures: We investigated the time of discharge summary documentation, type of medication missing, and the location the medication was initiated. Results: Fifty-one percent of the patients did not have any discrepancies in medications during patient hand-off. Of the 49% of patients with medication discrepancies, the three most common medications missing were anti-coagulants, diabetes medications, and anti-hypertensives. We also analyzed the location at which the missing medication was started and found that 41% of cases with missing medications were started in the acute care hospital and 59% of the medications were home medications. The majority of medication discrepancies were found on discharge summaries written at 5:00 pm. Conclusions: Medication discrepancies during patient hand-off is a serious mistake that leads to poor patient care. In this study, 49% of patients were found to have medication discrepancies. We hypothesize that the discrepancies can be attributed to the heavy workload of inpatient residents towards the end of the work day. Further investigation is needed to confirm this hypothesis. We would like to implement a patient checklist that is incorporated into discharge summary document on electronic medical record (EMR), as well as involving pharmacologist earlier in-patient management to further ease the transition of care. Level of Evidence: Level III

TOWER: Design of an Open-Label Incobotulinumtoxina Dose-Titration Study (≤800 U) In Lower- and Upper-Limb Spasticity

Disclosures: K. Alekseyev, No Disclosures: I Have Nothing To Disclose. Objective: To assess the incidence of intracranial injuries identified by head CT for patients who fell during acute inpatient rehabilitation. Design: Retrospective chart review Setting: Acute inpatient rehabilitation unit of an inner city hospital Participants: 118 patients (mean age 63) undergoing acute inpatient rehabilitation. Interventions: Retrospective chart review of head CT scans that were ordered as part of work-up for patients who fell during their stay on an inpatient rehabilitation unit over a twelve month period. Charts were reviewed for the following: a) physical examination findings at time of fall b) evidence of intracranial injury as a consequence of the fall (eg. hemorrhage) c) evidence of a prolonged hospitalization as a result of the fall associated intracranial pathology. Main Outcome Measures: Results of head CT scans. Results or Clinical Course: 30 head CT scans (25%) were obtained as part of workup in post-fall patients. Each patient analyzed had between one and three head CT scans performed as a result of a fall. Only 1 positive finding of all 30 head CT scans performed resulted positive for acute head injuries. The total cost of the head CT scans indicating negative findings for acute head injuries over the one-year period was

Intrathecal baclofen therapy versus conventional medical management for severe poststroke spasticity: results from a multicentre, randomised, controlled, open-label trial (SISTERS)

49,445 (each CT scan cost:

Effect of Intrathecal Baclofen on Pain and Quality of Life in Poststroke Spasticity

1705). Conclusions: There is a low diagnostic yield and high cost for head CT as part of post-fall evaluation in patients not exhibiting acute neurological changes. Physiatrists should use caution when ordering these imaging studies and limit their use to occasions when clinically indicated.