PM&R Vol. 6, Iss. 9S, 2014 S245

Case Description: A 39-year old woman with secondaryprogressive multiple sclerosis (MS) and a history of tachycardiawas admitted to acute inpatient rehabilitation (AIR) after a stemcell transplant. Work-up for tachycardia in the acute carehospital was negative for thyroid abnormalities, deep venousthrombi, hypovolemia and infection. Echocardiography wasunremarkable and electrocardiography was notable for sinustachycardia. Orthostatic vitals demonstrated increased heart rateswith sitting and standing without change in blood pressure,consistent with postural orthostatic tachycardia syndrome(POTS). Several therapy sessions were missed secondary totachycardia greater than 80% of target maximal heart rate withminimal exertion. Given baseline hypotension, traditional medi-cations such as beta blockers were contraindicated. Modafiniland sertraline were started instead. A digital wearable trans-dermal sensor was placed on the patient to measure minuteinformation about heart rate, activity and position for three daysafter medication was started demonstrating improvements inbaseline and exertional heart rates.Setting: Acute inpatient rehabilitation (AIR) hospital.Results or Clinical Course: Mean baseline heart rate prior toinitiation of modafinil and sertraline was 114 bpm. Followingmedication therapy, the mean heart rates while lying down and notlying down were 73 and 98, respectively (P <.001), demonstratingsignificant improvement. A tendency for increased heart rates withupright activities was also noted, though significantly less thanprior to medication initiation. The patient was successfully able toresume therapies.Discussion: This case demonstrates the importance of recog-nizing POTS in patients with MS. The incidence of POTS in MS iscurrently unknown with only a few case reports in the literature.None of these reports fully document accurate measuring of heartrates with activity. This case also demonstrates successful treatmentwith serotonin reuptake inhibitors (sertraline) and dopaminereuptake inhibitors (modafinil).Conclusions: Recognition and accurate heart rate tracking in MSpatients with POTS improves management and maximizes therapybenefits in AIR.

Poster 172Focal Abdominal Dystonia in a Male with RepeatedAbdominal Trauma: A Case Report.Michael Ra, DO, MPT (JFK-Johnson RehabilitationInstitute, Edison, NJ, United States); Steven V. Escaldi, DO;Sara J. Cuccurullo, MD.

Disclosures: M. Ra, No Disclosures: I Have No Relevant FinancialRelationships to Disclose.Case Description: A 59-year-old male contractor with nosignificant medical history presented to outpatient spasticity clinicfor evaluation of his 6-year history of progressively worsening leftupper quadrant abdominal pain and spasms. Frequency of symp-toms increased from every 6 months to daily. Magnetic resonanceimaging revealed probable herniation at T8 and T9, and impinge-ment of the dural sac at T8, T9, T11 and T12 without cordimpingement. The patient had been treated by several painspecialists with oral medications, platelet rich plasma, and thoracicsteroid injections, but none of these provided any significantbenefit. Spinal cord and nerve root involvement were thereforeruled out. In addition, the patient was a martial artist of twenty

years and secondary to sparring routines sustained repeated blowsto the abdomen. Furthermore, he performed hundreds of abdom-inal crunches daily.Setting: Outpatient Spasticity Clinic.Results or Clinical Course: Given his previous unsuccessfultreatments, clinical presentation, and history, a diagnosis of focalabdominal dystonia was made. In treating the dystonia, the patientreceived several sets of botulinum toxin A injections under elec-tromyographic guidance. The first sets of injections were adminis-tered into the left rectus abdominis muscles. The patient at followup reported a 60% improvement in symptoms. A second set ofinjections 3 months later was performed. At follow up, the patientreported a near resolution to his pain and an increase in activitylevel.Discussion: Peripherally induced cervical and limb dystonia iswell recognized. However peripherally induced dystonias involvingthe abdomen are not well documented. This should be consideredwith a history of abdominal trauma in an otherwise healthyindividual.Conclusions: Focal abdominal dystonia should be consideredwith abdominal spasms and pain in the presence of a history ofrepeated abdominal trauma. Botulinum toxin A injections area viable treatment option.

Poster 173Continuous Quality Improvement (CQI): A TwoPhase Study on Bladder Management for PatientsAdmitted to an Inpatient Rehabilitation Unit.Jason Chen, DO (Baylor College of Medicine, Houston,TX, United States); Jess J. Arcure, MD;Avram Bram-Mostyn, DO; Meilani H. Mapa, MD.

Disclosures: J. Chen, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Objective: The first phase of our CQI project involved a stan-dardized bladder protocol that improved the post-void residual(PVR) documentation, at any time during the first day, at aninpatient rehabilitation unit. After standardizing the order placedfor bladder scans, the second phase of this quality improvementproject was to determine if scheduling bladder scans/post-voidresiduals (PVRs) would improve the PVR documentation in a timelymanner, during the first day, at an inpatient rehabilitation unit by30%.Design: Open label, controlled study.Setting: Inpatient rehabilitation unit.Participants: 20 consecutive subjects who were admittedbetween Feb 1, 2014, and March 15, 2014, to an inpatient reha-bilitation unit had bladder scans/PVRs scheduled on their first dayof admission.Interventions: Two “MD to nurse” orders were created. The firstorder read: “Have patient attempt to void during the hour at 0000-0600-1200-1800. If patient is able to void, perform a PVR Scan andrecord in EMR in appropriate location. If patient is unable to voidplease perform Scheduled Bladder Scan and record in EMR inappropriate location. If a patient has an incontinence episodewithin 1 hr prior to scheduled scan, please record PVR Scan at thattime and skip the scheduled attempt to urinate and associatedbladder scan. If bladder scan cannot be performed please notereason in EMR”. The second “MD to Nurse Order” read: If patient isretaining greater than 200cc on any bladder scan, please ask patient