S198 PRESENTATIONS

Interventions: None.Main Outcome Measures: Length of stay (LOS), admissionand discharge Functional Independence Measure (FIM) scores, FIMefficiency.Results or Clinical Course: The study included 28 male and 71female patients ages 26.7 to 86.9 years, mean of 65.3 years (stan-dard deviation [SD]10.8). Four patients had a diagnosis of rheu-matoid arthritis, 95 had osteoarthritis. Mean length of time betweensurgery and admission to AIR was 4.4 days (SD 3.2, range 1-33days). Mean LOS in rehabilitation was 11.5 days (SD 4.2, range 3-24 days). Mean admission and discharge FIM scores were 87.4 (SD11.5) and 111.0 (SD 16.7), respectively, with a mean FIM gain of25.9 (SD 10.3). The mean FIM efficiency was 2.37 (SD 0.96). Eightpatients required at least 1 transfer to an acute care hospital.Complications leading to transfer to acute care included sepsis,cardiac arrhythmias, knee dislocation and small bowel obstruction.Ninety-three patients were discharged home, 4 patients were dis-charged to skilled nursing facilities, and 2 patients were transferredto acute care and did not return to rehabilitation.Conclusions: This is the first study reporting functionaloutcomes of patients with simultaneous bilateral TKA in the acuteinpatient rehabilitation setting. Our data indicate that patients withbilateral TKAs demonstrate functional gains in AIR based on FIMgains and FIM efficiency scores. Only 8% of patients in our cohortrequired transfer to acute care due to complications during inpa-tient rehabilitation, and 94% of patients were discharged home.

Poster 47Gigantism of the Right Lower Extremity in a Patientwith Klippel-Trenaunay Syndrome: A Case Report.Yuriy Shepelyak, MD (JFK-Johnson RehabilitationInstitute, Edison, NJ, United States); Milan Patel, DO;Iqbal H. Jafri, MD; Sara J. Cuccurullo, MD.

Disclosures: Y. Shepelyak, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: A 29-year-old woman with history of Klip-pel-Trenaunay syndrome (KTS) and associated gigantism of rightlower extremity.Program Description: The patient had a prolonged hospitalcourse for cellulitis of the right thigh and hydrouretonephrosis,complications of KTS that required a right ureteral stent andresulted in severe weakness of the right lower leg (RLE). Onpresentation, a petite woman with narrow upper body frame wasfound to have a large right thigh and leg, accounting for more thantwenty five percent of her total body weight.Setting: Inpatient Rehabilitation Unit.Results or Clinical Course: A multi-treatment approach wasnecessary to improve the patient’s functional status. The patient hadchronic neuropathic pain in the RLE, 8 to 10 in intensity, andassociated with activity. On admission, she was on gabapentin andhydromorphone. A sphenopalatine block was performed, butprovided minor relief. Then cognitive-behavioral therapy wasapplied with moderate success; the patient was taught distractiontechniques and progressive relaxation exercises to decrease muscletension and reduce emotional distress. Her pain improved to fiveout of ten and required less oral analgesics. Furthermore, thepatient was seen by prosthetics and orthotics, with a specialdevelopment of a super depth width shoe for improved supportand stabilization of the RLE. During acute inpatient rehabilitation,

the patient improved from maximal assist in bed-mobility to beingable to ambulate 30 feet with a rolling walker.Discussion: KTS is a rare vascular congenital malformationdisorder, characterized by venous malformations (VMs), port-winestains, and hypertrophy of soft tissue and/or bone. Venous drainageis often abnormal, causing stasis and resulting in complicationssuch as infections, venous thromboembolisms, and limb pain.Although surgical interventions are possible, management ofpatients with KTS continues to be primarily nonoperative becauseof high risk for recurrence of VMs.Conclusions: In our patient with KTS, the complicated chronicpain and body mass distribution presented a unique challenge tothe rehabilitation team which required a comprehensive, multi-therapeutic approach to achieve optimal results.

Poster 48A Novel Device to Treat Severe Night Cramps ina Patient with Fibromyalgia: A Case Report.Lina M. Hurtado, MD (University of Miami, Miami, FL,United States); Tamar S. Ference, MD; Ricardo Grinbank;Physical Therapist; Deep Garg, MD.

Disclosures: L. M. Hurtado, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: A 63-year-old woman with generalized pain,difficulty sleeping, fatigue and severe night cramps worsening overone year. She presented with multiple severe episodes of leg crampsat night and she was unable to sleep. On physical examination shepresented with multiple tender points as per the fibromyalgia mapthroughout the trunk and extremities. There were no strength orsensory abnormalities. She was diagnosed with fibromyalgia andwas treated with different medications including Lyrica and Cym-balta. The medications provided better control of her generalizedpain but her leg cramps persisted despite her medications.She wasreferred to physical therapy. The therapist fabricated a foam-covered cylinder device. The patient was instructed to place both ofher heels on the cylinder while standing and holding her bodyagainst a fixed surface. She was instructed to hold the position for90 seconds and to repeat it multiple times during the day and oncemore before going to sleep. A photo of the device with instructionswill be provided in the Poster.Setting: Tertiary Care Hospital.Results or Clinical Course: The patient received 2 sessions perweek of physical therapy for a total of six sessions. She experiencedrelief of her night cramps after the first session and continued tohave relief throughout the treatment. She forgot to use the deviceone night with recurrence of cramps that remitted after resumingthe treatment. Patient experienced complete resolution of the legcramps after completion of the six treatment sessions.Discussion: Fibromyalgia is a syndrome characterized by chronicwidespread pain, multiple tender points, abnormal pain processing,sleep disturbances, fatigue and night cramps. Fibromyalgia can beextremely debilitating and interfere with basic daily activities. Theetiology is not well established. Conventional medical interventionis not always effective and alternative treatments play an importantrole in the treatment. Due to severe night cramps, fibromyalgiapatients develop poor sleep patterns and worsening fatigue andpain.Conclusions: An unconventional therapy modality can beeffective in the treatment of severe night cramps refractory to