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discharge, the patient displayed resolution of cognitive dysfunctionand significant improvement in LE weakness and mobility.Discussion: Neuro-Behcet’s syndrome is a rare, multisystem,relapsing, inflammatory disorder. The neurologic manifestations ofBehcet’s syndrome are only seen in 5-14% of patients and can haveserious neurologic consequences if untreated. As such, early diag-nosis and treatment is of the utmost importance to help preventdisease progression and promote timely recovery.Conclusions: Rehabilitation specialists play a crucial role in themanagement of patients with Neuro-Behcet’s by initiating earlycognitive re-training and therapy to address the myriad of physicalimpairments which may occur. Furthermore, it is essential forphysiatrists to recognize signs of multi-systemic involvement asBehcet’s can target the ocular, neurologic, musculoskeletal,gastrointestinal, and cardiopulmonary systems. This will allow forearly work-up and treatment to be initiated by the rehabilitationteam while coordinating care amongst other specialties.

Poster 124Ultrasound-Guided Chemodenervation withBotulinum Toxin in the Treatment of Spasticity:A Focused Review.Elizabeth Bagsby, MD (Indiana University School ofMedicine, Indianapolis, IN, United States);Shashank J. Dave, DO.

Disclosures: E. Bagsby, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Objective: To investigate current literature on the efficacy ofultrasound (US)-guided chemodenervation with botulinum toxintype A in the treatment of spasticity.Design: Literature search using Ovid� and PubMed� with thekey words “spasticity” “ultrasound” and “botulinum toxin.”Multiple opinion-based articles were found, but only clinical trialswere included in this study.Setting: Variety of both clinical and academic settings.Participants: Adults and children with spasticity secondary tostroke, cerebral palsy, multiple sclerosis and spinal cord injury wereincluded in this study.Interventions: Although study designs varied, US-guided che-modenervation was compared to manual needle placement (MNP)techniques and needle electrical stimulation guidance (EMG).Main Outcome Measures: Varied according to the study, butmost common outcomes were Modified Ashworth Score (MAS),accuracy of needle placement as seen by US, and the ModifiedTardieu Scale (MTS).Results or Clinical Course: 12 studies were found evaluatingthe efficacy of US-guided chemodenervation. 2 studies consideredUS as the gold standard when comparing other techniques such asMNP and EMG. 1 study compared EMG, MNP, and US. 2 studiescompared MNP and US. 1 study compared EMG and US. 5 studieslooked just at US and one study used EMG, US, and CT dependingon muscle location. All studies found US to be more efficaciousthan other methods evaluated. US lead to more accurate needleplacement than EMG and MNP leading to improved MAS and MTSand decreased complications from inadvertent neurovascularinjection.Conclusions: There is a growing body of evidence supportingUS as an adjunct for localization in patients with spasticity. US can

improve accuracy of toxin placement, leading to better toxin effects,and helping to avoid injection into neurovascular structures.

Poster 125Use of Musculoskeletal Ultrasound in the Evaluationof Residual Limb Pain in a Non-Traumatic Amputee:A Case Report.Tanya R. Chavez, MD (University of Washington, Seattle,WA, United States); Jeffrey Heckman, DO;Wayne Biggs, CPO; David C. Morgenroth, MD.

Disclosures: T. R. Chavez, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: The patient developed pain in his distalresidual limb shortly after his amputation in 2009. The pain wasinitially managed with prosthetic socket designs and analgesicmedication. As the pain worsened and developed a sharpshooting quality across the distal residual limb, there was clinicalconcern for a neuroma as the underlying etiology. The patient,who had been a regular community ambulatory, could no longerbear weight in his prosthesis secondary to pain, and was rele-gated to a wheelchair. Ultrasound examination of the residuallimb did not reveal any obvious neuroma, but did reveal a sharpbony fragment underlying the site of maximal tenderness. Staticradiograph with a radiopaque metal bead on the skin over thepoint of maximal tenderness confirmed a sharp bony spiculeconsistent with heterotopic ossification immediately deep to themetal bead.Program Description: A 67-year-old man with history ofunilateral transfemoral amputation secondary to failed total kneearthroplasty.Setting: VA Medical Center.Results or Clinical Course: The patient was referred toorthopedics and underwent surgical revision of his residual limb toremove the area of heterotopic ossification. Six weeks post-surgery,the patient was re-casted for a new prosthetic socket and hassubsequently been able to return to ambulating with minimal pain.Discussion: The development of heterotopic ossification is lesscommonly described in non-traumatic etiologies of amputation.This is the first reported case, to our knowledge, of the use ofmusculoskeletal ultrasound to help differentiate heterotopic ossifi-cation from neuroma as the underlying etiology of residual limbpain.Conclusions: Residual limb pain is common in the lowerextremity amputee population. Diagnostic ultrasound can bea helpful tool in the evaluation of residual limb pain that is notthought to be due to poor socket fit or prosthetic alignment.

Poster 126Preadmission Screening Checklist to Minimize AcuteDischarges from an Inpatient Rehabilitation Facility(IRF).Kirill Alekseyev, EMBA (Kingsbrook Jewish MedicalCenter, Brooklyn, NY, United States);Frances Atupulazi, MD; Adrian Cristian, MD, MHCM;Marc K. Ross, MD; Tatyana Stepanenko, MD;Raj Shah, BS.

Disclosures: K. Alekseyev, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.

S228 PRESENTATIONS

Objective: Describe the role of a Preadmission ScreeningChecklist (PSC) in minimizing acute discharges from IRF.Design: Retrospective review.Setting: IRF in an inner city hospital.Participants: Individuals referred for admission to IRF.Interventions: A PSC was designed and implemented as a part ofadmission record review prior to decision on whether or nota patient would be admitted to the IRF. The PSC included infor-mation relevant to the patient’s medical condition, rehabilitationpotential and potential risk for acute discharge. The PSC wascompleted by one reviewer (MKR) over a 4-month period.Main Outcome Measures: Pre-admission ScreeningChecklist.Results or Clinical Course: Acute discharge rate for IRFpatients for a 6-month period prior to implementation of thePSC was 15.7% which included 549 referrals and 86 patientsacutely discharged from IRF during their rehabilitation. The PSCwas used as part of record review for 324 referrals overa subsequent 4-month period. Of those that were reviewed usingthe PSC, 37 patients were acutely discharged from the IRFduring their rehabilitation (11.4%). The most common reasonsfor acute discharge were cardiac, sepsis and change in neuro-logical status.Conclusions: The PSC is a useful instrument that can be used toidentify patients at risk for acute discharge prior to admission to anIRF. The PSC can be a useful adjunct to efforts to minimize acutedischarges from an IRF.

Poster 127Two Patients with Patellar Tendon Rupture FollowingTotal Knee Arthroplasty: A Case Report.Michael Koniuch, MD (Schwab Rehab, Chicago, IL,United States); Joseph Rabi, MD; Theresa Lie-Nemeth.

Disclosures: M. Koniuch, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: Case 1: 41-year-old man with diabetesinitially presented to the hospital withswelling in his left kneewithout an inciting event. He was diagnosed with infected bursaand underwent incision and drainage. He had persistent pain andwas diagnosed with a tibia plateau fracture. External fixator wasplaced. He continued to have pain and was later diagnosed withnonunion. He underwent a TKA and was admitted to rehabilitation.While on a bike post-operative day 11, he heard a “pop” and couldnot extend his knee. MRI displayed patellar tendon rupture and hehad tendon repair. Case 2: 62-year-old woman with obesity anddiabetes presented for elective left TKA due to osteoarthritis. Onpost-operative day 6, she arose from a low reclining chair to herwalker and heard a “pop”. She had pain and could not extend herknee. MRI confirmed patellar tendon rupture. She underwenttendon repair.Setting: Inpatient Rehabilitation Hospital.Results or Clinical Course: Both patients had surgical repairand completed rehabilitation without complications.Discussion: Patellar tendon rupture is a rare complicationafter TKA with a prevalence of 0.1-2.5%. There are multiplerisk factors for patellar tendon rupture including: diabetes,renal disease, previous injury, obesity and corticosteroid injec-tion. Case 1 had diabetes and multiple surgeries on his leftknee prior to the rupture. Case 2 had history of steroid

injections, diabetes and obesity. Both injuries occurred with theknees flexed greater than 60 degrees. With more medicallycomplex patients undergoing TKAs, physiatrists should beaware of this rare complication. Special attention should begiven to patient’s risk factors.Conclusions: These two cases present a rare complication ofa patellar rupture following TKA. Physiatrists should be aware ofthe risk and possible prevention techniques as more medicallycomplex patients undergo TKAs.

Poster 128Rehabilitation of Dorsal Column Deficits afterIntradural, Intramedullary Neurosarcoid Biopsy andC3-C6 Laminectomy: A Case Report.David J. Cormier, DO, DPT (New York Presbyterian, NewYork, NY, United States); C. David Lin, MD.

Disclosures: D. J. Cormier, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: A 62-year-old African American man withhistory of hyperlipidemia, hypertension, and diabetes presentedwith progressive numbness of the extremities. Initially, numb-ness developed on the lateral aspect of his left thumb. EMGdemonstrated a bilateral sensory peripheral neuropathy. Symp-toms progressed to his lower extremities and gluteal region.Brain and total spine MRI showed enhancing cervical C6intramedullary lesion. He underwent a C3-6 laminectomy withbiopsy of intramedullary mass. Pathology showed granuloma-tous myelitis, with lymphocytes, and B-cells. Immunosuppres-sion work up was positive for quantiferon gold. Results oflumbar puncture were inconclusive. Acid Fast Bacilli stainingon pathology was negative. Chest CT scan was negative forevidence of sarcoid or malignancy.Program Description: New York Presbyterian Weill CornellMedical Center.Setting: Tertiary care hospital.Results or Clinical Course: After 3 weeks of acute inpatientrehabilitation, patient continued to deteriorate with diminishedsensation proprioception, vibratory sense, upgoing Babinski,hyperreflexia, and coordination deficits. Motor examination wassignificant for distal greater than proximal weakness. Functionallypatient could ambulate 75 feet with rolling walker requiringassistance by therapist for foot placement. Patient requiredindwelling catheter due to urine retention.Discussion: Intramedullary enhancing lesions are usually relatedto tumors arising from the spinal cord. Neurosarcoidosis of thespinal cord is rare but tends to occur with other signs and symp-toms of sarcoids. Although treatment for spinal tumors usuallyrequires surgical excision and chemotherapy, the recommendedtreatment for neurosarcoidosis is immunosuppressive therapy dueto the possible deterioration that can result from the surgery. Thispatient had no stigmata of sarcoidosis prior to surgery other thansensory neuropathy.Conclusions: Patients with intramedullary lesions related toneurosarcoids can worsen after surgical interventions such asa biopsy. Not all intramedullary lesions should undergo surgeryand a careful evaluation of possible differential diagnosis includingrheumatologic diseases should be considered. Sensory peripheralneuropathy may be the only initial sign of a rheumatologic processsuch as sarcoids.