PM&R Vol. 6, Iss. 8S2, 2014 S155

No. 315 Removal and Reimplantation of IntrathecalBaclofen System Provides Safer Treatment for InfectedCatheter in Meningitis. A Case Report.Tetsuya Enishi; Masanori Inatsugi; Nori Sato; Shinsuke Katoh.

Introduction And Aims: Baclofen is a centrally acting gamma-amino-butyric acid B agonist used to treat severe spasticity such as spinal cordinjuries (SCI). Intrathecal baclofen (ITB) therapy has become the treat-ment of choice for refractory spasticity. However the infection of thesystem and failure of implanted pump are subject to numerous compli-cations. Here we report the successful treatment for infected ITB systemand the usefulness of the system for spastic paraplegia. Material andMethods: A 35-year-old healthy woman presented with spastic para-plegia due to syringomyelia. After successful trial bolus injection ofbaclofen, ITB system was implanted. Nine months later she felt headacheand fever up in hospitalization. Intravenous antibiotic treatment wasstarted with ceftriaxone sodium hydrate in combination with gentacin.Results: Removal of ITB system was performed. The pump was notinfected but the catheter was surrounded by infected scar. Four monthsafter removal, ITB system reimplantation was perfomed to control severespasticity. Conclusion: Removal and reimplantation of intrathecalbaclofen system provides more safe treatment for infected catheter in thecase of meningitis.

No. 316 Bone Mineral Loss After Spinal Cord Injury.Belgin Erhan; Ebru Yilmaz Yalcinkaya; Berrin Gunduz;Hulya Aslan; Fatih Kahraman.

Introduction: Bone mineral loss is a common complication seen afterspinal cord injury (SCI) which leads to fractures that increase themortality and morbidity. The aim of this study was to investigate theincidence of bone mineral loss in our SCI patients and its relationshipbetween clinical and demographic features. Methods: A hundred SCIpatients with an injury duration longer than 2 months were enrolled inthis study. The patients under osteoporotic treatment or who hadheterotopic ossification in the areas evaluated were excluded. Demographicfeatures ASIA impairment scale (AIS), walking index for spinal cord injury(WISCI-II), dual-energy x ray absorptiometry (DXA), laboratory findingswere recorded from the patients’ files. Descriptive statistic, Pearson andSpearman correlation, independent t-test were used for analyzing data.Results: There were 57 male and 43 female patients with a mean age of45�15.4 years and median injury duration of 35 months (2-480). Fortyeight patients had motor incomplete injury and 67 were paraplegic. Fortypatients had a Z score lower than -2.5 at least in one region evaluated. Thelowest Z scores recorded among all sites were the leg and femur total Zscores, respectively. Leg and femur total Z scores were positively correlatedwith AIS and negatively correlated with injury duration. Male patients hadsignificantly higher Z scores in the lumbar region. Arm Z score wasnegatively correlated with AIS and positively correlated with injurylevel (C4-L4). In the bone mineral density values femur total waspositively correlated with WICSI-II and ambulation time, femur totaland neck values were negatively correlated with age. Con-clusion: Our results were similar to the literature; 40% of the patientshad bone mineral loss most prominent in the leg and femur. Bonemineral loss was correlated with the severity and duration of the injury,age, ambulation time, and WICSI-II scores. Among these factorsincreasing ambulation potential should be highlighted.

No. 318 Development of Automatic Clean Intermittent UrineCatheterization Device for Paraplegia Patients With SCI:Prototype.Sei Joo Kim; Joon Shik Yoon; Seung Nam Yang; Seok Kang.

Background: Because of the weakness in bilateral upper/lowerextremities, autonomic nervous system dysfunction, and uncontrolled

bladder/bowel system, it is difficult for patients with cervical spinal cordinjury to perform activities of daily living (ADLs). Especially aboutvoiding difficulty patients should insert a catheter (a tube to drain theurine) intermittently for emptying their bladder which is called cleanintermittent self-catheterization (CIC). However it is almost impossible forthe patients with high cervical cord injury to do CIC by themselves.Bladder control as one of the ADLs could be more related with quality oflife (QOL) than any other ADLs. If the patients perform CIC indepen-dently, it could much improve QOL of the patients as well as thecaregivers. The aim of this study was to develop the automatic device forperforming CIC in male patients with cervical spinal cord injury.Method: We decided to use motor system for inserting urethralcatheter to the bladder which has gel-sterilization system at catheterinsertion area. First patient should be ready for catheter by catheter-guideddevice inserted at the urethra. When patients push the start button forvoiding, catheter-guided device would dock with catheter by catheter rail.Then it would pass through sterilization step and be transferred incre-mentally to the bladder by stepper motor until pre-set length reached.After fully voiding, same process would be repeated in reverse. Finally,voided urine would be collected at a separate storage continuing withmain device. Results: We developed developmental prototype of theautonomic intermittent urine catheterization device with self-sterilizingmethod. It could help patients with spinal cord injury to perform cathe-terization by themselves and to improve their quality of life. Con-clusion: Further studies for clinical implementation are needed in patientswith cervical spinal cord injury who needed CIC for evaluating of safety andeffectiveness.

No. 320 Effects of Transvertebral Direct Current Stimulationin Healthy Humans: Early Results Froman Ongoing Randomized Cross Over Study.Radha Korupolu, MBBS MS; Elizabeth Salmon, MS;Lakshmi Reddy; Lumy Sawaki.

Objective: Non-invasive transcranial direct current stimulation hasbeen shown to modulate cortical excitability in various studies. Recentpreliminary studies suggest transvertebral direct current stimulation(TVDCS) may engender a similar modulation effect on spinal neurons.Promising adjuvant treatment options when paired with locomotortraining may therefore be possible for patients with neurological disor-ders. Our goal is to study the effects of TVDCS in healthy subjects in orderto establish a reliable reproducible TVDCS methodology to modulatespinal excitability in subjects with spinal cord injury (SCI). Long-termgoals include evaluating effects of TVDCS paired with locomotor train-ing for subjects with motor incomplete SCI. Design: Randomizedcrossover study. Setting: Acute inpatient rehabilitation hospital. Par-ticipants: Healthy subjects with no history of neurologic disorders.Intervention: We randomized subjects to receive 1 of 3 TVDCSconditions (ie anodal, cathodal, or sham) at an intensity of 2.0 mA for 20minutes to spinal level T10-T11. For sham, TVDCS intensity was ramped upthen ramped down over a thirty-second window in order to evoke a similarsensation as active TVDCS. Main Outcome Measures: Bilateraltriceps surae motor evoked potentials (MEP) elicited by transcranialmagnetic stimulation immediately before and after TVDCS. MEPs wererecorded at 100-130% of resting motor threshold. Level of Evidence: 2.Results: Preliminary results indicate a 13% to 70% increase in MEPamplitudes after cathodal stimulation. Sham and anodal stimulation led toa net decrease in MEP amplitudes. Conclusions: Initial results indicatethat cathodal TVDCS may increase MEP amplitudes. TVDCS appears to havegreat potential to modulate spinal excitability and optimize motor recovery inSCI patients in the future.