Steven R. Edgley

Common Pain Syndromes in Stroke Patients: Review of Two Cases

Abstract Due to multiple neurological and musculoskeletal factors, stroke patients are at significant risk for the development of disabling pain syndromes. This article provides examples of two commonly encountered clinical situations, poststroke shoulder and poststroke hip pain. Appropriate use of imaging, medications, modalities, and injections are discussed for the purpose of enhancing management strategies that decrease pain and increase overall function.

Efficacy and Safety of AbobotulinumtoxinA (Dysport) for the Treatment of Hemiparesis in Adults With Upper Limb Spasticity Previously Treated With Botulinum Toxin: Subanalysis From a Phase 3 Randomized Controlled Trial

To assess the efficacy and safety of abobotulinumtoxinA in adults with upper limb spasticity previously treated with botulinum toxin A (BoNT‐A).

Rehabilitation Interventions in Parkinson Disease

This self‐directed learning module provides an evidence‐based update of exercise‐based rehabilitation interventions to treat Parkinson disease (PD). It is part of the study guide on stroke and neurodegenerative disorders in the Self‐Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This focused review emphasizes treatment of locomotion deficits, upper limb motor control deficits, and hypokinetic dysarthria. New dopaminergic agents and deep brain stimulation are facilitating longer periods of functional stability for patients with PD. Adjunctive exercise‐based treatments can therefore be applied over longer periods of time to optimize function before inevitable decline from this neurodegenerative disease. As function deteriorates in patients with PD, the role of caregivers becomes more critical, thus training caregivers is of paramount importance to help maintain a safe environment and limit caregiver anxiety and depression. The overall goal of this article is to enhance the learners existing practice techniques used to treat PD through exercise‐based intervention methods.

Stroke and Neurodegenerative Disorders: 3. Poststroke Rehabilitation

This self‐directed learning module highlights rehabilitation strategies in poststroke rehabilitation. It is part of the study guide on stroke and neurodegenerative disorders in the Self‐Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on typical clinical presentations, recovery patterns, and traditional and innovative therapeutic interventions in poststroke rehabilitation such as constraint‐induced movement therapy, treadmill training, functional electrical stimulation, robot‐aided therapy, virtual reality treatment, cortical stimulation, speech therapy for aphasia, and orthotic management. The goal of this article is to influence the learners knowledge on the delivery of poststroke rehabilitation treatment.

Poster 288 Efficacy and Safety of Repeated AbobotulinumtoxinA Injections in Adults with Lower Limb Spasticity

medical/neurological workup, a diagnosis of Cefepime Induced Encephalopathy was made. Cefepime dose was reduced to 1gm q24 hours. Within 2-3 days patient’s symptoms subsided and she returned to her neurologic baseline. Discussion: Cefepime is broad spectrum fourth generation cephalosporin introduced in 1990s. It covers broad spectrum of G+ and Gaerobic species. Major rare side effects that often are underdiagnosed are non-convulsive status epilepticus and encephalopathy. Most common signs of neurotoxicity are confusion, agitation, myoclonic jerks, epileptic seizures and coma. They may appear five days after therapy initiation. Cefepime inhibits GABA binding to GABAa receptors. EEG shows distinct wave and voltage activity. Symptoms disappear within 48-72 hours from Cefepime discontinuation. Conclusions: It is important to be aware of potential neurotoxic adverse effects by newly developed medications. This case was complicated by the onset of unexpected neurological findings. After significantly reducing Cefepime dosage, patient completely returned to her baseline. Level of Evidence: Level V

Poster 67: Recreational Readiness Classification Post Stroke

amino acids had odd ratio of 1.241 (P < .05), 0.817 (P < .05), 0.778 (P < .01) respectively, to predict functional outcome after adjustment for age. The receiver operating characteristic (ROC) curve analysis showed that combination of glutamate and arginine has high sensitivity and specificity to predict functional outcome (AUC1⁄40.959, 95% confidence interval 0.9041.000). Conclusions: This metabolomic study suggests that dysregulation of threonine, glutamate, arginine may impede stroke recovery. Further studies are warranted to identify more specific targets for therapeutic intervention. Level of Evidence: Level II

Poster 90: Assessing Stroke Patients' Steps using the Garmin Vivofit3: A Validity Study

Disclosures: Allison Capizzi: I Have No Relevant Financial Relationships To Disclose Objective: To determine whether a commercially available fitness tracker can offer valid and reliable step counts for ambulatory, hemiparetic stroke patients. Design: The commercial activity tracker, the Garmin Vivofit3, was chosen based on low price, ability to sync wirelessly with a smart phone and long battery life. Each participant wore 2 devices, one on each wrist, and was videotaped while ambulating at a self-selected pace for a total of 6 minutes. Steps tracked by each Garmin Vivofit3 was recorded. Two separate research investigators watched the videos independently and counted total steps, which is considered the gold standard. Step counts recorded by the Garmin Vivofit3 on the unaffected arm and the hemiparetic arm were compared to the video gold standard. Setting: An outpatient tertiary care center. Participants: Five stroke patients (2 males and 3 females; mean age 1⁄4 52.4 years) who were ambulatory with a minimum Functional Ambulation Classification (FAC) of 5. Interventions: Not applicable Main Outcome Measures: Total steps taken during a 6-minute walk test. Results: There were large-sized correlations between step counts measured by video and those measured by Vivofit for normal limbs (r 1⁄4 0.958). The intraclass correlation was 0.929 (95% confidence interval 1⁄4 0.562 to 0.992). For hemiside limbs, the correlation was also large (r 1⁄4 0.723), yet producing more variability in the step counts. Conclusions: Findings suggest the commercially available Garmin Vivofit3 may be a reasonable alternative to medical grade activity trackers in assessment of step counts in stroke survivors. This offers a more cost-effective approach to motivating and tracking physical activity compared to current research-grade devices (e.g. StepWatch) which are cost prohibitive and do not allow patients to interact with their activity data. We realize the limitations of this small sample size. We intend to use these results for a larger study evaluating commercial activity trackers in motivating ambulation in the post-stroke population. Level of Evidence: Level III

Poster 119 An Analysis of Early and Late Response to Foot Drop Stimulation in Persons with Stroke

by admission and discharge functional independence measure (FIM). Clinical characteristics including age, sex, race, marital status, stroke risk factors, stroke site, and discharge destination were recorded. The association between serum BDNF level and stroke functional outcomes was assessed using Pearson’s correlation analysis. Results or Clinical Course: The mean serum BDNF level was 22.60 9.87ng/ml (range, 5.22-44.83ng/ml). Pearson’s correlation analysis showed that the lower serum BDNF level was associated with less marital family support (r1⁄40.316, P1⁄4.047), lower FIM motor subscore on admission (r1⁄40.338, P1⁄4.033) and discharge (r1⁄40.355, P1⁄4.025) and lower total FIM score on discharge (r1⁄40.363, P1⁄4.021). Stroke patients with lower serum BDNF level were more likely to be discharged to skilled nursing facility (r1⁄4-0.407, P1⁄4.009). Conclusion: Serum BDNF level was associated with functional outcomes as measured by FIM and discharge destination within 2 month of the onset of stroke. BDNF may serve as a prognostic biomarker for functional recovery and may be used as a surrogate marker to evaluate the responsiveness to targeted neurorestorative therapies. Larger scale studies are warranted to confirm these results.

Poster 405: Safety of Aquatic Treadmill Therapy in Ambulatory Adult Stroke Patients: A Case Report

mobility, ambulating 250 feet without a device. She has advanced to Day-Rehabilitation therapies and continues to achieve her goals. Discussion: Choriocarcinoma is an aggressive tumor with a good prognosis if treated early. Metastatic choriocarcinoma to lung and brain is rare. Polychemotherapy is the principal treatment, along with surgery. There are few reported cases of hemorrhagic metastatic choriocarcinoma and no available literature on the functional outcome of brain metastasis affected patients. Conclusions: Comprehensive acute rehabilitation is beneficial, in conjunction with chemotherapy, for patients with neurological deficits from metastatic choriocarcinoma, providing them with cognitive and communicative training, opportunity to upgrade gait and motor control, focused strength and coordination exercises as well as family training.

Stroke and Neurodegenerative Disorders: 1. Stroke Management in the Acute Care Setting

This self‐directed learning module highlights management of stroke in the acute care setting. It is part of the study guide on stroke and neurodegenerative disorders in the Self‐Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Using a case vignette format, this article specifically focuses on initial assessment and management of acute ischemic and hemorrhagic stroke, descriptions of posterior circulation and lacunar stroke, and criteria for admission to acute inpatient rehabilitation after stroke and secondary stroke prevention. The goal of this article is to improve the learners ability to identify, treat and manage a patient with a stroke in the acute care setting.