FD in Rehabilitation patients has not been reported in thePM&R literature.Keywords: Rehabilitation, Gait, Drop foot, Walking.

Poster 210

Functional Anesthetic Diskography to ConfirmDiskogenic Back Pain in a Patient withEquivocal Results on Provocation DiskographyTesting: A Case Report.Shivani Shah, D.O (Emory University, Atlanta, GA);Michael K. Schaufele, MD.

Disclosures: S. Shah, None.Patients or Programs: A 45-year-old woman withchronic low back pain and well controlled depression.Program Description: Academic spine center.Setting: Emory Orthopedics and Spine Center, Emory Uni-versity, Atlanta Georgia.Results: The patient presents with a 6-year history of pro-gressive low back pain that is exacerbated by axial loadingand improved with lying supine which has not significantlyimproved with conservative therapy. Her physical examina-tion shows moderate pain on extension and decreased flex-ion. Her recent MRI revealed moderate-severe lumbar degen-erative disk disease at L4-L5, a possible L5-S1 annular tear,and normal at the levels above. To determine if the patientmay be a candidate for surgical intervention, she underwentprovocation diskography (PD) which showed a normal con-trol of L5-S1. PD of L4-5 revealed severe degenerative disko-gram pattern with severe 9/10 non-concordant pain. PDinjection of L3-4 showed a small annular tear with moderate6/10 non-concordant pain at high pressure only. The resultswere felt to be inconclusive and it was recommended that thepatient undergo functional anesthetic diskography (FAD)L4-5. On a separate day, an intradiskal catheter was insertedinto the L4-5 disk. The patient was brought to the recoveryarea and asked to perform functional activities with VASscoring of each activity. Next, with the patient blinded, thedisk was injected with 0.7cc of 4% lidocaine and after 20minutes the patient performed the same activities. Afterinjection of the local anesthetic, she experienced more than80% pain relief of her usually painful activities. Therefore,the study was felt to be consistent with diskogenic pain atL4-5.Discussion: There is no definitive test to prove diskogenicback pain. Currently PD, the controversial standard, hasmany inherent limitations. An agreement between PD andAD would be ideal however this may be difficult to achieve.In patients with inconclusive PD testing and no other struc-tural abnormalities except annular tears, confirmation by ADmay be considered when one is planning surgical treatment.Conclusions: Currently FAD could be used as an addi-tional test to PD in indeterminate cases, pending furtherresearch on FAD.Keywords: Diskogenic, Functional anesthetic diskogra-phy, Provocative diskography.

Poster 211

General Practitioners’ Understanding ofRehabilitation Physician Skills and Relation toReferrals in the Australian Capital Territoryand Surrounding New South Wales Area.Keith K. Chan, MB, BCh (The Canberra Hospital,Woden, ACT, Australia).

Disclosures: K. K. Chan, None.Objective: To study what general practitioners (GPs)/fam-ily physicians in the Australian Capital Territory (ACT) andsurrounding New South Wales (NSW) area understandabout rehabilitation physician skills and the relationshipbetween their understanding and other factors on referrals torehabilitation physicians.Design: Survey questionnaire.Setting: Regional survey, Australia.Participants: 470 general practitioners in the ACT Divisionof General Practice database, with 170 (36%) respondents.Interventions: Not applicable.Main Outcome Measures: Respondents were given 11referral scenarios (8 appropriate and 3 inappropriate refer-rals) and asked to indicate how likely they were to make thesereferrals to rehabilitation physicians. They were also assessedon their understanding of 6 skills of rehabilitation physicians.Demographic and professional data were requested.Results: Respondents’ average age was 49 years (� 10years). 54% were women. 77% were graduates of Australian/New Zealand medical schools. Most respondents workedmore than 6 sessions a week and had been in practice for least5 years. 35% of respondents had exposure to rehabilitationmedicine in medical school and 25% had previously workedin a rehabilitation medicine setting. 86% of respondents hadpreviously referred patients to rehabilitation medicine phy-sicians. On average, 7 out of 11 referral scenarios werecorrectly selected. There was a significant relationship be-tween selection of appropriate referrals and understanding ofrehabilitation physician skills (P�.05), but not with GPdemographics and professional characteristics.Conclusions: This survey suggests that appropriate GPreferrals to rehabilitation physicians in the ACT/surroundingNSW area is significantly correlated with their understandingof rehabilitation physician skills. Improving GPs’ knowledgeof rehabilitation physician skills may increase the number ofappropriate referrals to the specialty.Keywords: Rehabilitation, Physicians, Family, Referraland consultation, Australia.

Poster 212

Guillain-Barre Syndrome—One-Year Follow-upin Neurological Rehabilitation Unit: FunctionalRecovery and Residual Deficits.Anupam Gupta, MD (National Institute of MentalHealth & Neuro Sciences, Bangalore, India);Thyloth Murali, MD (Psychiatry); AbhishekSrivastava, MD (PM&R); Arun Taly, DM (Neurology).

S195PM&R Vol. 1, Iss. 9S, 2009

Disclosures: A. Gupta, None.Objective: To analyze long-term functional recovery andresidual deficits in patients with Guillain-Barre Syndrome(GBS).Design: Prospective longitudinal follow-up study.Setting: Neurological rehabilitation unit of tertiary carehospital.Participants: Forty-one out of 330 patients (12.42%) ad-mitted in the institute were transferred to the neurologicalrehabilitation unit for inpatient rehabilitation. Twenty-sixpatients (M:F,14:12) reporting at 1 year follow-up (63.41%)were included in the study (between Sept. 2005-Arpil 2008).Their functional recovery and residual deficits were recordedand analyzed.Interventions: Not applicable.Main Outcome Measures: Modified Barthel Indexscores, Modified Rankin Scale and Hughes Disability Scalewere used to assess functional disabilities at admission, dis-charge and follow-up.Results: Age ranged from 4-65 years (29.69 � 17.19). Atadmission, 21 patients had typical GBS and 5 had AMANvariant. Eight patients had bulbar weakness, 3 had auto-nomic dysfunction and 17 had facial palsy (uni/ bilateral).Nineteen patients (73.07%) had neuropathic pain needingmedication with 6 requiring more than one drug. Five pa-tients (19.2%) were prescribed wrist cock-up splint (WCS)for wrist drop and 15 patients (57.6%) prescribed ankle-footorthoses-AFO (13 bilateral AFO) for foot drop. Twenty pa-tients (77%) needed assistive devices also for locomotion atdischarge. At 1 year follow-up, wrist drop and foot drop werestill present in 1 and 4 patients, respectively, using orthoses.Modified Barthel Index scores, Modified Rankin Scale andHughes Disability Scale were used to assess functional dis-abilities. Significant recovery was observed at the time ofdischarge and after 1 year when compared with dischargescores (P�.001 each).Conclusions: GBS patients continue to show significantfunctional recovery for a long period. They have disability inthe form of motor weakness even after 1 year and need to befollowed up for longer duration.Keywords: Functional recovery, Guillain Barre syndrome,Inpatient rehabilitation, Residual deficits.

Poster 213

Health and Function Data From an AdultCerebral Palsy Clinic: Initial Report.Heidi J. Haapala, MD (University of Michigan, AnnArbor, MI); Margy A. Fox, MS; Edward A.Hurvitz, MD.

Disclosures: H. J. Haapala, None.Objective: To describe health and functional status ofadults and older adolescents with cerebral palsy enrolled in aspecialty clinic.Design: Cross sectional.Setting: Tertiary care center.

Participants: 22 individuals (ages 17-53) with cerebralpalsy, GMFCS I-V, 16 female.Interventions: Survey, height and weight measures.Main Outcome Measures: BMI, pain (0-10 pointscale) and constipation rating scale scores, survey results,vitamin D levels.Results: BMI: 40.9% of the participants were overweight orobese, while 31.8% were underweight. Pain: Best, worst, andaverage pain over the past 3 months was scored. Worst painwas rated as �7/10 in 9/12 (75%). Average pain was 0-3/10in 5 (42%), 4-6/10 in 6 (50%), and �7/10 in 1 subject.Constipation: for 16 subjects, with 5 (31%) participantsscoring �5. Living situation: 12 lived with their parents, 3 ingroup homes, 1 with an aide, and 5 with roommates or bythemselves. Eight of the subjects attended school, 4 worked(including individuals in sheltered living situations), and 10neither worked nor attended school. Bone Health: As part ofan initial screen, vitamin D levels were checked on 10 sub-jects, with below normal vitamin D levels noted in 8/10(80%). Mobility: 9 used manual wheelchairs, 4 used powermobility, 1 used both. GMFCS levels: 4 subjects were level 1or 2, 10 subjects were level 3 and 8 subjects were level 4 or 5.This group was weighted toward GMFCS 3-5, accounting forthe higher prevalence of wheelchair use.Conclusions: Vitamin D levels were low in most of thesubjects, indicating a need for bone health assessment. Over-weight, pain, constipation, depression, nutrition and com-munity involvement should be monitored and addressed toincrease function along with tone, mobility and other morecommonly described issues in individuals with cerebralpalsy.Keywords: Cerebral palsy, Rehabilitation, Adult.

Poster 214

Heroin-induced Femoral Neuropathy andRehabilitation: A Case Report.Sooyeon Kim, (Montefiore Medical Center, Bronx,NY); Andrzej C. Kroszczynski, MD; MargaritaManahan.

Disclosures: S. Kim, None.Patients or Programs: A 43-year-old male heroin abuser.Program Description: We present a 43-year-old other-wise healthy male who developed worsening bilateral lowerextremities weakness and numbness for 4 months whichstarted soon after intravenous heroin injection. Physical ex-amination revealed marked atrophy of bilateral quadriceps,1/5 strength of knee extensor with absent patellar reflexes,normal strength of hip flexor and adductor, along with thepattern of bilateral anteromedial thigh and medial lower legsensory deficit consistent with bilateral femoral neuropathyor L3-4 nerve root pathology. EMG demonstrated severebilateral femoral neuropathies with sensory and motor ax-onal loss. The lesions were distal to the branch supplying theiliopsoas, as this muscle was not affected. There was noevidence of lumbosacral root dysfunction. Laboratory exam-inations include CPK, autoimmune diseases and infectious

S196 POSTER PRESENTATIONS