effect. There were no trends for changes in peak torque or WOMAC measures. Rate of drop outprior to completion of all study requirements was high (42%) and all patients admitted using otherpain medications during the trial. The desire for more pain control was implicated in dropping out.Conclusion: The efficacy of glucosamine for treating Canadians who have OA of the knee remainsunclear despite positive industry-linked trials. Key Words: Glucosamine; Osteoarthritis; Pain;Rehabilitation.

Poster 29Functional Outcomes of Liver Transplant Patients Treated in an Acute Rehabilitation Setting.Frederick S. Frost, MD (Cleveland Clinic Foundation, Cleveland, OH); Josef Endredi, MD;Vinod Sahgal, MD, e-mail: frostf@ccf.org.Disclosure: None.

Objective: To determine associations between categorical and continuous variables that char-acterize liver transplant patients and outcome variables measuring resource utilization and func-tional gains during inpatient rehabilitation. Design: Retrospective review. Setting: Inpatient acuterehabilitation unit and community follow-up. Participants: 13 liver transplant patients undergoinginitial acute rehabilitation. Interventions: �3h/d of acute multidisciplinary rehabilitation treatment.Main Outcome Measures: Rasch-converted FIM™ instrument scores, and categorical and con-tinuous clinical variables. Results: Patients of a mean age of 52�12.35 years were admitted at amean of 34.77�18.27 days after transplant. 9 of 13 patients were discharged to a residential setting,with mean rehabilitation length of stay (LOS) of 15.9�13.1 days. The median hospital charge was$21,500 (range, $7137–$107,568). These patients had a mean Model for End-Stage Liver Disease(MELD) score of 24.17�11.26 and serum ammonia averaged 104.46�73.08�mol/L. The Wilcoxonsigned-rank assessment of paired t tests for differences between time points (admission, discharge,follow-up) showed that motor scores (P�.001) improved for all timed comparisons, but cognitivescores did not improve (P�.99). Motor function at admission correlated with hypoalbuminemia(Spearman P�.01), while cognitive function correlated with low levels of total protein (SpearmanP�.014) and low globulin (Spearman P�.059). Despite this, these patients did not differ in thedegree of cognitive or motor gains across their stay. Subgroups characterized by other clinicalcharacteristics (eg, alcoholism, gender, cigarette use, diabetes) did not differ in rehabilitationoutcomes, although LOS varied by group. Conclusion: Patients with end-stage liver disease areamong the most medically complex and debilitated in the hospital. Despite this, we found that livertransplantation patients demonstrated significant reduction in motor disabilities when rehabilitationwas provided in an inpatient rehabilitation unit setting. Cognition did not improve during the studyperiod. Key Words: Liver transplantation; Outcomes research; Rehabilitation.

Poster 30Receipt of Depression Diagnoses in the Veteran Spinal Cord Injuries and Disorders Popula-tion. Bridget Smith, MPA (Department of Veterans Affairs, Hines, IL); Frances M. Weaver,PhD, e-mail: bsmith@research.hines.med.va.gov.Disclosure: None.

Objectives: To examine (1) the frequency of hospitalizations and outpatient visits for depressionin spinal cord injury (SCI) and disorders (SCD) and (2) the association between patient character-istics and the receipt of a depression diagnosis. Design: Retrospective study of administrative data.Setting: Department of Veterans Affairs (VA) facilities, October 1, 1998 to September 30, 2001(fiscal year 1999–2001). Participants: Subjects were selected from a cumulative VA registry basedon International Classification of Diseases, 9th Edition codes for SCI and SCD. All subjects in theregistry with any VA utilization during the study time period were included. Interventions: Notapplicable. Main Outcome Measures: Frequency of hospitalizations and visits with a depressiondiagnosis; and frequency of other diagnoses with depression. Results: Approximately 20%(n�4177) of the veterans with SCI and SCD had at least 1 encounter with a depression diagnosis;8% (n�1727) had at least 1 hospitalization; and 16% (n�3299) had at least 1 outpatient encounter.In the regression analysis, being younger (OR�1.98), female (OR�0.49), white (OR�1.36), havingchronic renal disease (OR�1.00), chronic pulmonary disease (OR�1.60), coronary artery disease(OR�1.57), diabetes (OR�1.40), or a hospitalization for a skin (OR�1.10) or kidney problem(OR�1.24), or drug use (OR�7.18) significantly increased the odds of having a depressiondiagnosis. Conclusions: Demographic characteristics, including age, gender, and race, and healthstatus characteristics such as the presence of chronic diseases, were associated with the likelihoodof receipt of a depression diagnosis. These findings could result from differences in depressionprevalence between groups and/or could occur because some groups are more likely to be screened.This study is the basis for additional work to examine outcomes of antidepressant use in the VApopulation with SCI and SCD. Key Words: Depression; Rehabilitation; Spinal cord injuries.

Poster 31Community-Acquired Pneumonia in Veterans With Spinal Cord Injury. Charlesnika T.Evans, MPH (Department of Veterans Affairs, Hines, IL); Frances M. Weaver, PhD;Heidi T. Chang, MPH; Raquel Hampton, MS; Stephen Burns, MD, e-mail:evans@research.hines.med.va.gov.Disclosure: None.

Objective: To describe the characteristics of community-acquired pneumonia (CAP) in personswith spinal cord injury (SCI) and how management is related to outcomes. Design: Cross-sectionalretrospective review of administrative and clinical data. Setting: Department of Veterans Affairs(VA) facilities, and for substudy, 3 VA SCI centers (October 1998–September 2000). Participants:Veterans with SCI: 260 inpatients with CAP; in the substudy, 41 inpatients and outpatients withCAP from 3 sites. Interventions: Not applicable. Main Outcome Measures: Percentage of patientswith an etiologic diagnosis, mortality rate, mean length of stay (LOS), and number and types ofprocedures and treatments. Results: Of the 260 inpatients with SCI identified from administrativedata with CAP, only 24% had an etiologic diagnosis. Etiologic diagnosis was not associated withmortality after adjusting for several factors (OR�1.38; CI, 0.45–4.20), however, it was associatedwith an increase in LOS (P�.024). For the substudy, almost 75% of the 41 patients werehospitalized (mean LOS�16.3d) and 3 patients died. Most received chest radiographs (85%), but up

to 54% did not receive other tests standard for management of CAP during the first day of care (eg,blood cultures, CHEM 7). Of the 16 patients with sputum cultures, an organism was identified in44% through microbiology testing. Over 90% received antibiotics within 24 hours of admission.Conclusions: Many patients do not receive the minimum recommended testing. Empiric treatmentappears to have been the predominant type of management used in this population. Further researchto assess the relationship between clinical characteristics and management with patient outcomes iswarranted. Key Words: Pneumonia; Rehabilitation; Spinal cord injuries; Treatment outcome.

Poster 32Rehabilitative Outcome After Simultaneous Bilateral Hip Replacement: A Case Report. JohnA. Walter, DO (Ohio State University Medical Center, Columbus, OH); Vivek Kadyan, MD,e-mail: jwdo@peoplepc.com.Disclosure: None.

Setting: Acute Midwestern medical center and university-based rehabilitation hospital. Patient:55-year-old postmenopausal woman with a medical history remarkable for L4-5 laminectomy. CaseDescription: Bilateral total hip arthroplasty (THA) was performed. Postoperative course wascomplicated by anemia and pain. The patient was admitted to acute rehabilitation 4 days aftersurgery. We report on the rehabilitation outcome after simultaneous bilateral THA. Assessment/Results: On admission, the patient ambulated 50ft using a standard walker at a maximum assistlevel and total assistance for stairs. She did quite well and had a rather short inpatient course. Onday 7 of rehabilitation admission, the patient was discharged and was ambulating 400ft using arolling walker with supervision and was climbing 6 stairs with maximum assistance. At 1-monthfollow-up, she was ambulating with a cane approximately 0.5 mile daily. At 6 months, she isambulating without a cane over 1 mile daily, swimming 1 mile daily, and participating in low-impactaerobics twice weekly. Discussion: Osteoarthritis is a major cause of pain and disability in theUnited States with hip involvement often leading to significant functional impairment. THA,undertaken after conservative management failure, involves invasive surgery followed by a long anddemanding rehabilitation program. THA is invariably performed unilaterally and sequentially if bothhips are involved. Orthopedic surgical literature reports cases of simultaneous bilateral THA, butprovides little information about rehabilitation outcome. Conclusions: This case illustrates thatsimultaneous THA can be performed with favorable surgical and functional outcome. Our patienthad an excellent outcome and this could be attributed, in part, to her age, limited comorbidities, andgood physical conditioning prior to surgery. Further prospective research needs to be performed tohelp determine exact patient criteria, surgical approach, and rehabilitative techniques when per-forming simultaneous bilateral THA. Key Words: Osteoarthritis; Rehabilitation; Total hip replace-ment.

Electrodiagnosis

Poster 33Isolated Laryngeal Myokymia Causing Voice Dysfunction: A Case Report. Michael C. Munin,MD (University of Pittsburgh, Pittsburgh, PA); Clark A. Rosen, MD; Colleen Powell, MD;George Small, MD, e-mail: muninmc@msx.upmc.edu.Disclosure: None.

Setting: Tertiary care outpatient voice center. Patient: A 48-year-old women with isolatedlaryngeal myokymia causing dysphonia. Case Description: The patient presented with a 2-yearhistory of increasing dysphonia and pain with vocalization. Physical examination, including cranialnerve testing, was normal. Assessment/Results: Indirect laryngoscopy, performed by a board-certified otolaryngologist, showed focal, nonfatigable, left vocal cord tremor with phonation and atrest. A board-certified electromyographer performed laryngeal electromyography, which demon-strated abundant myokymic potentials within the left thyroarytenoid muscle. Other muscles ofvocalization were normal on electromyographic testing, as was limb electromyography performedseparately. Magnetic resonance imaging (MRI) of the brain demonstrated a loop of the left vertebralartery compressing the left medulla. No demyelinating plaques were observed. An MRI from theposterior fossa to the upper chest excluded compression of the vagus tree as well as other neckpathology. The symptoms did not respond to the oral anticonvulsants carbamazepine (Tegretol) orphenytoin (Dilantin), which were then discontinued. Discussion: Laryngeal myokymia has beenpreviously described only in Isaacs’ syndrome. Isolated myokymia has been reported in facial andtrochlear nerve brainstem lesions. Medullary compression may be the cause of focal laryngealmyokymia in this patient. Conclusion: To our knowledge, this is the first report of isolated laryngealmyokymia. Isolated laryngeal myokymia should be considered in the differential diagnosis ofdysphonia. Key Words: Dysphonia; Electromyography; Larynx; Myokymia; Rehabilitation.

Poster 34Spinal Cord Injury Patient With Compressive Neuropathy From Normal Tourniquet Pres-sure: A Case Report. Andre C. Hobbs, MD (Temple University, Philadelphia, PA); MichaelWeinik, DO, e-mail: achobbs70@hotmail.com.Disclosure: None.

Setting: Tertiary care pediatric hospital. Patient: A 19-year-old man with an incomplete C5spinal cord injury (SCI). Case Description: This patient underwent a tendon-lengthening procedureof the right brachioradialis and biceps secondary to severe spasticity and the onset of contractures.Prior to surgery, he was able to extend his right wrist and fingers without assistance. A decline inhis functional status (inability to extend his wrist and fingers) was noted postoperatively. A radialneuropathy was suspected and an electrodiagnostic evaluation was performed. Assessment/Results:The electrodiagnostic evaluation was performed 4 weeks after surgery and revealed severe acuteaxonal loss (fibrilations, positive waves) in muscles that are innervated distal to deltoid, includingthe musculocutaneous, ulnar, median, and radial nerves. The axillary nerve was spared. Discussion:It was suspected that the patient suffered a compressive neuropathy from tourniquet pressure duringsurgery. After discussing this with the surgeon, he agreed but mentioned that the tourniquet time wasstandard. To our knowledge, this is the first reported case of a patient with SCI with a compressive

A11ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Arch Phys Med Rehabil Vol 84, September 2003