intravenous methylprednisolone, and his symptoms resolvedwithin 24 hours.Setting: Inpatient rehabilitation facility.Results: He completed his course of prednisone taper fortransverse myelitis in acute rehabilitation unit, while under-going physical, occupational, recreational therapy, as well asneuropsychology. During each admission he successfullycompleted prosthetic limb ambulation training and returnedto previous level of function.Discussion: Transverse myelitis is a neurological disordercaused by an inflammatory process of the spinal cord and cancause demyelination. Demyelination arises idiopathically fol-lowing infections, vaccination, or multiple sclerosis. Acutely,the onset is sudden and progresses rapidly within hours todays. Symptoms depend upon the level and extent of thespinal cord involvement, and generally include limb weak-ness, numbness and sphincter deficits. Corticosteroids areused to decrease cord inflammation and swelling. Prognosisfor complete recovery is generally poor, however aggressiveand ongoing physical and occupational therapy helps de-crease long term disabilities and maximize physical function.Conclusions: Recognizing the degree of functional im-pairment that can be caused by transverse myelitis is impor-tant, particularly with recurrent episodes. Early rehabilita-tion is pertinent to improving quality of life, especially forlower extremity amputees who will require aggressive pros-thetic gait re-training. Successfully rehabilitated patients re-spond to further treatment after exacerbations of their con-ditions.Keywords: Rehabilitation, Amputation, Transverse myeli-tis.

Poster 358

Rehabilitation Outcomes Following Vascular-Related Spinal Cord Injury.Amit Sinha, MD (VCUHS, Richmond, VA);William McKinley, MD.

Disclosures: A. Sinha, None.Objective: Prior studies have noted similar outcomes be-tween vascular-related spinal cord injury (VR-SCI) and thosewith traumatic SCI (T-SCI), despite significantly differingdemographics and clinical presentation (age, level of injuryand degree of incompleteness). The objectives of this studywere to review demographics and clinical presentation ofVR-SCI and compare their outcomes with a similar groupwith T-SCI.Design: Review of 30 consecutive patients with VR-SCIadmitted to an SCI rehabilitation unit and comparison toT-SCI, matched for age, level of injury (LOI) and ASIAclassification.Setting: A level 1 tertiary university trauma center.Participants: Patients admitted to the inpatient SCI reha-bilitation unit.Interventions: None.Main Outcome Measures: Functional IndependenceMeasure (FIM) score changes from admission to discharge.

Secondary outcome measures included admission and dis-charge FIM scores, FIM efficiency, rehabilitation length ofstay (LOS), and disposition.Results: Individuals with VR-SCI were more likely to beolder (mean age 56.1 vs 37.2 years), have paraplegia (90% vs54%) and have incomplete injuries (73% vs 57%) than thosewith T-SCI. Common etiology for VR-SCI was postsurgicalcomplication (43%), arteriovenous malformation (17%), an-nular dissection (13%) and systemic hypotension (13%).Common region of injury and ASIA classification in VR-SCIwas thoracic (73%) and ASIA C (33%). Common SCI-relatedcomplications in VR-SCI included neurogenic bowel/bladder(93%), urinary tract infection (73%), pain (67%), pressureulcers (47%), and spasticity (20%). Matched-group outcomecomparisons did not reveal significant differences in FIMchange, FIM efficiency, LOS and disposition between VR-SCIand T-SCI.Conclusions: This study again notes differing demo-graphic and injury characteristics between VR-SCI and T-SCIgroups. Rehabilitation functional outcomes were similar,however, between patients matched for these differences.Keywords: Rehabilitation, Spinal cord injury, Vascular.

Poster 359

Safety and Efficacy of an AcceleratedTraining Program Preparing FES-assistedWalking in Complete SCI Patients.Paolo Di Benedetto, MD (Physical Medicine andRehabilitation, Udine, Italy); Emiliana Bizzarini,MD; Giuliana De Maio, PT; Cristina Malisan, PT;Chiara Pinzini, PT; Giulio Vezzio, PT; AgostinoZampa, MD.

Disclosures: P. Di Benedetto, None.Objective: To test the feasibility and the effectiveness of aspecific program preparing walking with functional electricalstimulation (FES) in complete spinal cord injury (SCI) pa-tients.Design: Cohort controlled study.Setting: Spinal Unit, Rehabilitation Institute.Participants: 6 thoracic level chronic SCI patients, age33.56 � 1.14 years, ASIA impairment scale A, AshworthScale 1-3, wheelchair locomotion.Interventions: PO22 Stimulator Fequa system andParastep system were used for walking. Training: 1) Pat-terned electrical stimulation (PES) assisted isometric exer-cises for the quadriceps muscles, 30 minutes, five sessions/week for 3 weeks; 2) FES cycling, 60 minutes 3 times a weekfor 3 weeks; 3)FES walking at body weight supported tread-mill (TR Spacetrainer) beginning with a cargo of 30% of bodyweight (BW) and reaching 70% of BW, 30 minutes 3 times aweek for 3 weeks; 4) over-ground FES walking training, 30minutes 3 times a week for 4 weeks.Main Outcome Measures: Training was monitored atevery step through: 1)plicometer to calculate the thigh musclearea; 2) isokinetic dynamometer to test quadriceps isometrictorque during PES; 3) respiratory gases analyzer (VO2000,

S260 POSTER PRESENTATIONS

medgraphics-USA) to measure O2 maximal consumptionand the energetic cost of gait.Results: At the end of the training we verified an increase ofthe thigh muscle area (from 114.21 to 120.33 cm2), anincrease of quadriceps thigh torque (from 0.360 to 0.502Nm/Kg), walking speed (from 0.17 to 0.20 m/s), and aerobicperformance, and a decrease of the energetic cost of gait(from 25.76 to 19.94 J/kg/m).Conclusions: We believe that the monitoring of muscle’sefficiency parameters and the energetic cost of gait couldpermit the definition of a specific training to prepare com-plete SCI patients walking with FES, even an acceleratedprogram could realize an advantageous gait.Keywords: Rehabilitation, Spinal cord injury, Gait, Func-tional electrical stimulation.

Poster 360

Severe Abdominal Pain and DiscomfortCaused by Methadone in Adolescents with anAcute Spinal Cord Injury.Mark E. Gormley, MD, (Gillette Childrens SpecialtyHealthcare, St Paul, MN); Supreet Deshpande, MD;Aakash Deshpande; Caroline Gormley; ErinKeefe.

Disclosures: M. Gormley, None.Objective: Children and adolescents with acute spinalcord injury (SCI) can have pain for many reasons, includingspinal injury, neuropathic pain, hypercalcemia, and gastro-paresis. Patients with SCI are often prescribed narcotic med-ications, to decrease postoperative pain. Oral methadone isoften used to help with the taper and discontinuation ofnarcotic medications. Although methadone is widely used toreduce pain, 2 patients at our center paradoxically experi-enced pain and discomfort during their treatment with meth-adone.Design: Retrospective cohort study.Setting: Pediatric rehabilitation hospital.Participants: Teenage patients 11-18 years old with SCI.Interventions: Not applicable.Main Outcome Measures: We reviewed the medicalrecords of all teenage patients with acute SCI who wereadmitted to the rehabilitation service between the years 1998to 2008. We collected information regarding level and sever-ity of injury, spinal surgeries, bowel management, narcoticmedication use and presence of hypercalcemia.Results: 32 male and 12 female patients with SCI weretreated on the inpatient rehabilitation unit between the years1998 and 2008. Three of these patients received methadone,12 patients including these 3 patients were treated with othernarcotic medications and 14 patients were treated with gaba-pentin for pain. The patients treated with methadone hadpersistent abdominal pain, nausea and vomiting, despiteaggressive pain and medical management. Typical reasonsfor pain were found negative in 2 patients, while the third hadimmobilization hypercalcemia. Symptoms eventually im-

proved when methadone was tapered off. No other narcoticshave demonstrated this problem.Conclusions: Previously unreported, methadone mayhave a tendency to provoke paradoxical abdominal pain insome patients with SCI. Only our patients who receivedmethadone experienced this intractable abdominal pain andtheir discomfort resolved with decreasing or discontinuingtheir methadoneKeywords: Rehabilitation, SCI, Abdominal pain, Metha-done.

Poster 361

Shoulder Pain in Chronic Spinal Cord Injury isNot Associated with Wheelchair Use.Nitin B. Jain, MD, MSPH (Spaulding RehabilitationHospital/Harvard Medical School, Boston, MA);Eric Garshick, MD.

Disclosures: N. B. Jain, None.Objective: Previous literature has described high preva-lence of shoulder pain in chronic spinal cord injury (SCI).Prior studies have focused on shoulder pain in manualwheelchair users due to overuse injury but have not de-scribed whether prevalence of shoulder pain is independentof manual wheelchair use. We assessed the prevalence ofshoulder pain and its association with the use of assistivedevices for mobility in SCI.Design: Cross-sectional analysis in a cohort study.Setting: SCI service in a hospital and the community.Participants: Between August 2005 and January 2008, 93participants with chronic spinal cord injury completed astandardized health questionnaire and pain questionnaire.Interventions: Not applicable.Main Outcome Measures: Shoulder pain.Results: Of the 93 participants, 65 (69.9%) reported pain atany site in the 6 months prior to testing. Of these 65 partic-ipants, 37 (56.9%) reported shoulder as one of the sites ofpain. When stratified by use of assistive devices for mobility,shoulder pain was reported by 75.0% of motorized wheel-chair users (n � 8), 58.6% of manual wheelchair users (n �29), 64.3% of participants using aids such as crutches or cane(n � 14), and 33.3% of participants walking without assis-tance (n � 6); (P � .4 for comparison of 4 groups, 3participants were missing data).Conclusions: Shoulder pain is highly prevalent in SCI.Previous studies have largely attributed shoulder pain in SCIto manual wheelchair use. However, our results provideevidence for similar or possibly a higher prevalence of shoul-der pain among motorized wheelchair uses and those usingcrutches or cane as compared to manual wheelchair users.This suggests that in addition to overuse injury from cyclicwheelchair propulsion, there are other factors that lead toshoulder pain in SCI. These factors are possibly related tobiomechanical imbalance in the shoulder that accelerates orleads to shoulder arthropathies, cuff tears, and subluxation.The investigation of cause of shoulder pain is an unmet need

S261PM&R Vol. 1, Iss. 9S, 2009