on pain reduction was not only maintained (upper bound �-0.45) during the extension phase but a further significantpain reduction (within-group) was observed. Significantwithin-group improvements in QOL, RDQ, CGI-S, and BPIseverity and interference ratings were also observed for pa-tients entering the extension phase. Duloxetine was welltolerated with safety findings being similar to those fromearlier duloxetine trials.Conclusions: In this study, the analgesic effect of duloxetinein patients with CLBP was maintained for at least 41 weeks.Keywords: Low back pain, Duloxetine.

Poster 56

Outcomes of Spinal Injections for Low BackPain: Results of a Cohort Study.Amitabh Goel, MD, FRCS (Wichita Clinic, Wichita,KS);

Disclosures: A. Goel, None.Objective: The primary purpose was to determine the effec-tiveness of spinal injections in treatment of low back pain.Design: An observational cohort study of prospectivelycollected outcomes.Setting: An interventional pain clinic affiliated with an ac-ademic center.Participants: Patients with low back pain referred to thepain clinic over a given period of time; who were offeredspinal injections. All participants had failed a trial of medica-tions and exercise therapy.Interventions: Spinal injections for treatment of low backpain.Main Outcome Measures: Pain relief using the VisualAnalog Scale and Functional Asessment using the RolandMorris Scale.Results: The study enrolled patients over 16 months. Therewere 112 participants in the study. Median length of timebetween initial visit and follow up after the spinal injectionswas 12 weeks. 64(57.1%) patients had improvement in bothpain and function, 16(14.3%) had improvement in pain and17(15.2%) had improvement in function only, 15(13.4%)had no improvement in pain or function. 11(9.8%) patientselected to have surgery.Discussion: There is considerable controversy in the liter-ature regarding the benefits of spinal injections for back pain.Most recent studies have looked at outcomes of surgery incomparison with medications or therapy; not spinal injec-tions. The few studies on spinal injections have focused on aspecific diagnosis or procedure rather than the utility ofspinal injections in a broader framework. This study assessedthe results of spinal injections for low back pain in general,with or without radicular symptoms, in terms of pain reliefand functional improvement over a period of time to assesswhether spinal injections are a viable intervention for lowback pain.Conclusions: Spinal injections for low back pain help toimprove pain and function. They should be considered be-fore surgery as part of the conservative treatment protocol.

Keywords: Rehabilitation, Back pain, Spinal injections,Outcome research.

Poster 57

Patient Registry of Outcomes in Spasticity(PROS) Care.Albert Esquenazi, MD (MossRehab, Elkins Park,PA); Stella Kim, MPA; Nathaniel H. Mayer, MD.

Disclosures: A. Esquenazi, Allergan, Research grants.Objective: To compile data characterizing clinical andpatient-reported outcomes associated with the diagnosis andtreatment of spasticity with chemodenervation in stroke andtraumatic brain injury (TBI) patients.Design: Prospective, multicenter, observational study.Setting: Multicenter.Participants: 363 patients to date.Interventions: Botulinum toxin Type A (BoNT-A) andphenol injections.Main Outcome Measures: Demographics, patient his-tory, pain score (VAS 0-10), patient goals, Ashworth, treat-ment, satisfaction (from -2 for “very dissatisfied” to 2 for “verysatisfied”), goal attainment (from -2 for “lost a lot of groundtowards goal” to 2 for “complete achievement of goal”).Results: Data analysis is based on 246 patients. Data com-prised of 74.0% stroke and 26.8% TBI patients. The flexedelbow was the most frequently presenting problem (26.2%)for the upper limb and the equinovarus foot (62.5%) for thelower limb. The most frequently injected muscle for theflexed elbow was the biceps (42.2%) and the medial/lateralgastrocnemius (23.6%) for the equinovarus foot. Averagedose of BoNT-A injections for the upper limb (n � 941) was61.4 � 37.3 units per muscle (range, 5.0 - 250.0 units) andfor the lower limb (n � 364) was 100.5 � 63.3 units permuscle (range, 10.0 - 400.0 units). Average phenol treatmentfor the upper limb (n � 8) was 3.7 � 0.7cc of 7% and theaverage for the lower limb (n � 15) was 4.0 � 1.3 cc of 6%and 7%. Mean Ashworth score (n � 96) improved -1.1 �1.0. On average, the foot (n � 12) presented the largestreduction in pain score -4.4 � 2.9. Patients reported “verysatisfied” (33.1%) and “somewhat satisfied” (45.5%) withtheir treatment. No related adverse effects were reported.Conclusions: This is the first, multicenter, descriptive,observational study providing insight into spasticity manage-ment relating to etiology, degree of spasticity, interventiontypes, muscle selection, delivery methods, patient goals andadverse effects.Keywords: Rehabilitation, Botulinum toxin type A, Musclespasticity.

Poster 58

Patient with Angioedema with PersistentMacroglossia: A Case Report.Catherine I. Dalton, MD (Sinai Hospital of Balti-more, Baltimore, MD).

Disclosures: C. I. Dalton, None.

S128 POSTER PRESENTATIONS

Objective: Angioedema is typically a self-resolving issue.Persistent macroglossia is an uncommon occurrence requir-ing further investigation and treatment.Patients or Programs: A 69-year-old African Americanwoman with systemic lupus erythematosus was admitted to achronic care hospital after a stroke and episode of angio-edema with persistent macroglossia.Setting: Chronic care hospital.Interventions: The patient was given a tracheostomy, gas-trostomy and botulinum toxin A to right temporalis musclesfor spasticity without relief. I was consulted for further treat-ment. Upon evaluation, the patient was found to have mac-roglossia with a rubbery tongue, lacerations on both surfacesof her tongue from her teeth, very spastic right pterygoids,and thrush. She was treated with clonazepam, tizanidine,baclofen, and nystatin oral solution. Wound care was alsoconsulted.Main Outcome Measures: Resolution of macroglossiaResults: After extensive wound care, elevation of tongueand further protection from the teeth, and antispasticitymedications, her tongue has almost returned to normal size.Her tracheostomy has been capped and she is able to pro-trude and retract her tongue so only a small amount isprotruding on the left side. Additionally, she is able to speakfairly clearly.Discussion: Angioedema may be caused by an allergic reac-tion, but often the cause is never found. Angioedema usuallyresolves on its own. In this case, the tongue continued to remainenlarged secondary to the lacerations and subsequent infectionand necrosis that developed. This may have blocked the lym-phatics and prevented drainage. The patient’s spasticity requiredfurther treatment by the addition of baclofen, tizanidine, andclonazepam. Nystatin oral care was started to treat the thrush.Bite blocks were initiated on the upper and lower teeth toprevent further lacerations. Further necrosis developed, so thebite block type was changed. A bite block that only interferedwith teeth closure was initiated, and nursing built up a sling withgauze to prevent the tongue from resting on her teeth. Goodmouth hygiene continued. As the tongue wounds healed, themacroglossia resolved.Conclusions: Consideration of secondary and tertiarycauses of persistent macroglossia in the setting of unresolvingangioedema should be considered.Keywords: Muscle spasticity, Angioedema, Macroglossia,Wounds and injuries.

Poster 59

Presence of Ventricular Assist Device (VAD)Does Not Impact Inpatient Rehabilitation Unit(ARU) Outcomes.Farha S. Ikramuddin, MD MBBS (University of Min-nesota, Minneapolis, MN); Michael Finch RNC,NP; Dennis D. Dykstra, MD, PhD; Linda E.Krach, MD.

Disclosures: F. S. Ikramuddin, None.Objective: Does the presence of a ventricular assist device

(VAD) predict worse performance in an acute rehabilitationunit?Design: Retrospective study of LVAD patients admitted toan acute rehabilitation unit (ARU).Setting: ARU.Participants: Patients admitted to ARU after LVAD place-ment.Interventions: Inpatient rehabilitation.Main Outcome Measures: After IRB approval, chartsof consecutive patients admitted to ARU between 7/1/2007and present who underwent LVAD placement were re-viewed. Demographic, medical history, length of stay (LOS),functional independence measure (FIM) scores and interven-tions were recorded.Results: During the 19-month period 973 patients wereadmitted to ARU, mean age 61.4 years and 53% female. LOSwas 10.27 � 0.21 days. Admission FIM was 75.59 � 0.56and discharge FIM was 94.57� 0.66, with FIM change of18.98 � 0.46. 18 patients s/p LVAD were admitted. Sixpatients were excluded due to removal of the device (1) andheart transplant (5). Of the 12 patients, 11 were males (P �.004). Mean age 61.15 years. Most common indication wasischemic cardiomyopathy. Etiology of heart failure waspost-MI (9), valvular impairment (2), sarcoidosis (1). Meanadmit FIM was 70.85 � 3.41(P � NS) and discharge FIMwas 94.31 � 2.93(P � NS), with a mean gain of 23.46 �3.49(P � NS). 76.80% of the LVAD patients had diabetes.LOS was 11.61 � 2.44(P � NS) days in VAD group. Pumpspeed and flow rate of LVAD was monitored during rehab. Allpatients underwent teaching regarding LVAD management.All were discharged home.Conclusions: LVAD patients admitted to ARU carry sig-nificant co-morbid burden; however, they show similar FIMgains on discharge and have no worse outcome than a typicalARU patient.Keywords: Rehabilitation, Recovery of function, Rehabili-tation centers, Ventricle-assist device.

Poster 60

Impact of the Ankle-Foot Orthoses on 3DAnkle Joint Rotation in Children with SpasticCP.Frederick T. Klingbeil, MD (Medical College ofWisconsin, Milwaukee, WI); Xue-Cheng Liu, MD;Elizabeth Moberg-Wolff, MD.

Disclosures: E. Moberg-Wolff, Healthier Wisconsin Part-ner Project, Research grants.Objective: Compare and identify gait and kinematic vari-ations of the lower extremity movement of children walkingwith and without AFO(s).Design: Prospective.Setting: Children’s Hospital of Wisconsin.Participants: Eleven children, (5 girls and 6 boys), withspastic CP were examined (ages ranged from 5-14.2 years,average age 10 years, 1 quadriplegic, 2 hemiplegic, and 8diplegic).

S129PM&R Vol. 1, Iss. 9S, 2009