Poster 42Feasibility of Haptic Use for Patients with ChronicTraumatic Brain Injury.Naomi Lynn H. Gerber, MD (George Mason Univ, Fair-fax, VA, United States); Leighton Chan, MD, MPH; ZoranDuric, PhD; Sidney L. Johnson, OTA; Cody Narber, MS;Nalini Vishnoi.
Disclosures: N. H. Gerber, No Disclosures.Objective: Determine the utility of a force feedback robot andvirtual reality interface in assessed upper extremity activities insubjects with chronic traumatic brain injury (TBI).Design: Prospective cohort study.Setting: Biomedical research facility.Participants: 19 adults with TBI (7 mild, 3 moderate, 9 severe),11 male / 8 female, mean age 50.4 years (SD 7.1), mean years frominjury 10 year (SD 6.4). 3 were employed, 1 full time student; 9received inpatient neurorehabilitation. Seven injuries resulted fromMVA, 9 from falls, 2 from IED and 1 sports.Interventions: Stylus-driven haptic device navigating virtualscenes in 3D space. Subjects performed three repetitions of virtualtasks: 1. remove tools from a workbench (TOOL), 2. composethree-letter words (SPELL), 3. manipulate utensils to prepare asandwich (SAND).Main Outcome Measures: Self-report of engagement in theactivities (boredom), time to completion or number of words com-pleted, neuropsychological symptom inventory (NSI), Purdue PegMotor Test (PPT).Results: All 19 reported high engagement; 6 reported high level offrustration, but completed tasks with short breaks. Mean boredomscore: 108 (SD 17.7) (normal range 81-117); mean PPT 54 (SD 15),(normal range for assembly line workers � 67); mean NSI: 33 (SD26). Change in three trials: best improvement in TOOL time de-creased by (mean) 48 secs (SD 56.9); best improvement in SPELLwas (mean) 2.8 words (SD 2.6), and best improvement in SAND-prep time decreased by (mean) 19.7 sec(SD 32). PPT correlated withbaseline SAND (r-.61, P�.008) and SAND improvement time (r-.60, P�.02). NSI correlated with improvement in TOOL time(r-.45, P�.09).Conclusions: All subjects were highly engaged, despite somesubjects having difficulty with the task. Almost all subjects im-proved their performance suggesting significant practice effects thatwill require further study before this tool can be deployed as anassessment measure. The significant correlations between the PPT,NSI and haptic outcomes suggest a promising level of externalvalidity.
Poster 44Prescription Medications Received and Rates ofPhysical Medicine and Rehabilitation ClinicUtilization in Operation Enduring Freedom-Operation Iraqi Freedom-Operation New Dawn(OEF-OIF-OND) Veterans with Distinct ComorbidityClusters.Pamela Villalobos, MD (UT Health Science Center SanAntonio, San Antonio, TX, United States); Juan Cabrera,MD; Blessen Eapen, MD; Elizabeth J. Johnson, DO; MaryJo Pugh, PhD.
Disclosures: P. Villalobos, No Disclosures.Objective: The purpose of this study is to identify the most
commonly prescribed medications and rates of Physical Medicine &Rehabilitation Utilization for OEF-OIF-OND veterans from Afghan-istan and Iraq who have distinct clusters of comorbidities.Design: Retrospective cohort study.Setting: Department of Veterans Affairs, national outpatient data.Participants: OEF-OIF-OND veterans who received VA care inFiscal Year 2010.Interventions: N/A.Main Outcome Measures: The most commonly prescribedmedication for patients in comorbidity cluster groups and rates ofoutpatient PM&R clinic utilization for distinct comorbidity clustergroups in Fiscal Year 2010.Results: Among the 191,797 veterans evaluated, we found thatantidepressant medications were the most commonly prescribeddrug class for both the polytrauma clinical triad cluster (traumaticbrain injury, post-traumatic stress disorder, chronic pain;N�21,400) and the PTSD without depression cluster (N�31,787)prescribed at rates of 63.6% and 50.4% respectively. Non-steroidalanti-inflammatory medication was the most commonly prescribeddrug class in the low back pain � low depression � low substanceabuse cluster (N�24,282), prescribed to 36.8% of patients in thisgroup. Patients were seen in outpatient PM&R clinics at rates of29.5% in polytrauma triad cluster, 14.9% in the PTSD alone cluster,and 21.5% in the low back pain � low depression � low substanceabuse cluster.Conclusions: OEF-OIF-OND veterans are being seen in PM&Rclinic at high rates in all clusters studied. Recognition that patientsin the polytrauma triad cluster and PTSD cluster are being pre-scribed antidepressant medications at high rates will be useful forphysiatrists to recognize in order to improve holistic patient care.
Poster 45Postural Tachycardia Syndrome After Concussion:A Case Report.Priyan Perera, MD (Marianjoy Rehabilitation Hospital,Wheaton, IL, United States); Padma Srigiriraju, MD.
Disclosures: P. Perera, No Disclosures.Case Description: This is a 29-year-old woman with no signif-icant medical history who suffered a concussion after falling inFebruary 2011. Since then, she has experienced intermittent dizzi-ness, cognitive deficits, limb fatigue and imbalance. A full neuro-logic workup was inconclusive. Although her symptoms did notcompletely subside, they did decrease in frequency and intensity.The patient found ongoing speech therapy helpful for her cognitivedeficits. She had a relapse in February 2012 and started havingprogressive tachycardia when upright, fatigue with exertion, in-creased cognitive deficits, dizziness and episodes where her legswould give out, causing her to fall. After an extensive workup byendocrinology, cardiology, rheumatology and neurology, it wasultimately determined that the patient developed postural ortho-static tachycardia syndrome after her concussion.Setting: Free-standing rehabilitation hospital.Results or Clinical Course: The patient was advised to drinkfluids rich in electrolytes, increase salt intake and was put on a betablocker, fludrocortisone and vitamin B12. She was also admitted foracute inpatient rehabilitation. Physical and occupational therapyfocused on orthostatic tolerance and speech therapy worked on hercognitive deficits. This comprehensive treatment plan has helpedthe patient almost fully recover in just 2-3 weeks.
S204 PRESENTATIONS
