quadratus lumborum had markedly increased tissue density and was shortened. Assessment/Results: These findings were consistent with left anterior ilial rotation, out-flare, and up-slip.Intervention: To test the whether the pain was due to the pelvic dysfunction and not the prostheticfitting, prosthetic modifications were held and the pelvis was treated with manual medicinetechniques. Treatment included inferior mobilization with traction, muscle energy, strain andcounterstrain, and posterior mobilization. Results: The patient’s anterior groin pain resolved aftermanual medicine treatment. No further prosthetic modifications were needed. Discussion: To ourknowledge, this is the first published case of treatment of sacroiliac dysfunction after posttraumaticamputation. For this patient, proper prosthetic fitting was impaired because of pelvic dysfunction.We also noted some minor pelvic issues in other patients after traumatic amputations. Conclusion:A pelvic assessment should be done in all patients who have had traumatic amputations to optimizeprosthetic fit and function. Key Words: Amputation; Pelvic pain; Rehabilitation.

Poster 156Ambulation After Bilateral Below-Knee Amputations Secondary to Necrotizing Fasciitis: ACase Report. Krishna P. Bhat, MD (Rush-Presbyterian-St. Luke’s Medical Center, Chicago,IL); Christopher Reger, MD; Henry R. Caoili, MD, e-mail: Krishbhat@aol.com.Disclosure: None.

Setting: Tertiary care hospital. Patient: A 57-year-old woman with bilateral below-kneeamputations secondary to necrotizing fasciitis. Case Description: This patient was initially admittedwith respiratory distress, and she eventually developed bilateral lower-extremity open woundscaused by disseminated intravascular coagulation. Subsequently, she underwent bilateral below-knee amputations secondary to necrotizing fasciitis. Multiple skin grafts were done, with 100%grafting of both amputation stumps. She was informed that she would never be able to ambulateagain. At a later date, she had right elbow capsular release surgery for flexion contracture. Her rightindex to ring proximal interphalangeal joints had a 30° to 40° contracture, however, she was ableto make a partial fist. 10 months after her amputations, she commenced comprehensive inpatientprosthetic gait training and skin care education. A total-surface bearing hydrostatic socket prosthesiswith extra-thick silicone gel liners was issued for optimal shear force reduction and suspension. Asingle-axis dynamic foot with soft heel describes the foot component. Assessment/Results: 3 weeksafter admission, the patient was able to transfer and ambulate 50ft with supervision, and she requiredminimal to moderate assist for donning and doffing her prosthesis. Only 1 incident of skinbreakdown occurred since surgery. The patient followed up regularly in clinic and she continued toimprove. Currently, the patient is ambulating independently with a cane, and she manages herprosthesis with complete independence. Discussion: This is the first reported case, to our knowl-edge, of successful ambulation after bilateral below-knee amputations secondary to necrotizingfasciitis requiring complete skin grafting of residual limbs. Conclusions: This case illustrates thatmeticulous skin care in combination with an effective prosthetic device in skin grafted amputationstumps can lead to results that exceed expectation. Key Words: Fasciitis, necrotizing; Legprosthesis; Rehabilitation.

Poster 157The Validity and Reliability of the SENSERite System: A Preliminary Evaluation. Joshua H.You, PT, PhD (University of Virginia, Hampton, VA), e-mail: sung.you@hamptonu.edu.Disclosure: None.

Objectives: To establish the concurrent validity and reliability of the SENSERite computerizedankle proprioception analysis system and to determine and compare proprioceptive acuity (thresh-olds). Design: Within-groups, repeated-measures design with randomized sequence and controlgroup. Setting: A university research laboratory. Participants: 10 healthy younger adults; 41 olderadults (22 nonfallers, 14 fallers, 3 adults with stroke, 1 with peripheral neuropathy [PN], 1 withParkinson’s disease [PD]). Interventions: Instrument validity was determined by comparing thesystem’s performance with a validated goniometer measure. Instrument reliability was determinedby repeatedly measuring the established angles for the 5 different positions: neutral, inversion,eversion, plantarflexion, and dorsiflexion. In addition, proprioceptive acuities of the participantswere measured by the SENSERite system. Data were analyzed using descriptive statistics, intraclasscorrelation coefficients (ICCs), and independent t tests. Main Outcome Measures: Compositeproprioceptive acuity thresholds from the 5 position sense tests. Results: Excellent clinical goni-ometer and SENSERite correlation (ICC�.99, P�.0001) was found. The SENSERite system wasreliable (ICC�1.0, P�.0001). A significant difference in proprioceptive acuity threshold was foundbetween the younger adults and the older adults. No significant difference in proprioceptive acuitythreshold was observed between nonfallers and fallers. The nonfallers’ proprioceptive acuitythreshold was similar to that of stroke patients, whereas both the adult with PD and the adult withPN showed substantially increased thresholds. Conclusions: The SENSERite system is a valid andreliable instrument to measure ankle proprioception in the normal and pathologic populations.Persons with either a history of falls or neurologic impairments may or may not show diminishedankle proprioception. Key Words: Proprioception; Rehabilitation; Reproducibility of results.

Rehabilitation Topics

Poster 158Teaching Residents in Rehabilitation to Communicate Bad News to Their Patients. Thomas S.Kiser, MD, MPH (University of Arkansas for Medical Sciences, Little Rock, AR); Florian S.Keplinger, MD; Patricia O’Sullivan, PhD; Jeanne Heard, MD, e-mail:kiserthomass@uams.edu.Disclosure: None.

Objective: To determine if an educational program can improve a physical medicine andrehabilitation resident’s ability to deliver bad news to patients. Design: Preeducation and postedu-cation assessment of residents’ communication ability with a standardized patient. Setting: Clinicalskills center. Participants: 10 rehabilitation residents (PGY-2 to PGY-4). Intervention: Preedu-cation experience with a standardized patient with a simulated C6 complete spinal cord injury

followed by a 1-hour educational lecture using the American Medical Association’s (AMA)Education for Physicians on End-of-Life Care (EPEC) program on communicating bad news topatients. This was followed by a posteducation experience with the original standardized patient.The person monitoring the session then provided feedback to the resident before a novel standard-ized patient, who simulated a mother of a patient who had been in a persistent vegetative state forover a year. The monitor and the standardized patient used a standardized checklist to assess theresident’s performance. Main Outcome Measures: Monitor checklist of 8 items: score 1 if doneand 0 if not done (max�8, min�0). Standardized patient checklist of 7 items rated on a Likert scale:excellent, 5; very good, 4; good, 3; fair, 2; poor, 1 (max�35, min�7). Results: Monitor checklist:the preeducation mean was 2.9 (95% confidence interval [CI], 1.81–3.99); the posteducation meanwas 5.4 (95% CI, 4.377–6.423); and the novel case mean was 5.9 (95% CI, 5.044–6.756)(multivariate test [Hotelling trace], P�.002). Standardized patient checklist: the preeducation meanwas 31.4 (95% CI, 29.609–33.191); the posteducation mean was 34.2 (95% CI, 33.636–34.764);and the novel case mean was 27.9 (95% CI, 25.577–30.223) (multivariate test [Hotelling trace],P�.001). Resident survey (5-point scale): worthwhile educational experience was 4.9; I will usewhat I learned in the future was 4.7; and I would participate again if not compensated was 4.4.Conclusions: A 1-hour lecture on delivering bad news to patients using the AMA’s EPEC programproduced a significant change in resident behavior in interaction with a standardized patient.Residents felt that it was a worthwhile educational experience that would help them in their futurepractice. Key Words: Communication; Education; Rehabilitation.

Poster 159Contact Precautions in a Rehabilitation Hospital. Steven Lewis, MD (Marianjoy Rehabilita-tion Hospital, Wheaton, IL); Barbara Lewis, MS; Estelle Zanotti, RN; Jan Jensen, RN; CaraCoomer, RN; Nelson Escobar, MD, e-mail: ezanotti@marianjoy.org.Disclosure: None.

Objectives: To develop a modification of the US Centers for Disease Control and Prevention(CDC) contact precautions applicable to the rehabilitation environment and to determine its impacton implementation and nosocomial infection rates of specific pathogens. Design: Descriptiveepidemiologic study. Setting: 110-bed free-standing comprehensive inpatient rehabilitation teach-ing hospital. Participants: All hospital staff and inpatients. Interventions: An infection preventionprogram, based on CDC contact precautions directed at Clostridium difficile, methicillin-resistantStaphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE), was implemented.This program incorporated the following elements: new definitions for stop and start of precautions;establishment of criteria for private rooms and protective equipment utilization; institution ofprecautions within therapy departments; emphasis on housekeeping for prevention of environmentalcontamination; initiation of door-mounted isolation supplies; implementation of alcohol-basedwaterless hand hygiene; staff education; computer tracking of patients in isolation; surveillance ofisolation implementation and compliance; and selective use of eradication therapy. Main OutcomeMeasures: The ability of staff to comprehend, implement, and adhere to the prevention program;efficiency in isolation resource utilization; and nosocomial rates for Clostridium difficile, MRSA,and VRE. Results: Staff demonstrated better understanding of precaution implementation andimproved compliance with more reliable private room and protective equipment use. There was lessdisruption of the rehabilitation process. During the first year of program phase-in, the percentage ofnosocomial infections decreased as follows: Clostridium difficile, 48.7%; MRSA, 69.5%; and VRE,64.1%. Conclusion: We present a modification of the CDC contact precautions implementationspecific for the rehabilitation environment that is more easily understood, more consistently andeffectively implemented by staff, and that effectively prevents nosocomial transmission of epide-miologically important pathogens. Key Words: Epidemiology; Infection control; Nosocomialinfections; Rehabilitation.

Poster 160Dysphagia After West Nile Virus: A Report of 5 Cases. Nelson Escobar, MD (MarianjoyRehabilitation Hospital, Wheaton, IL); Norman Aliga, MD; Richard Krieger, MD; VasiliosStambolis, MD; Susan L. Brady, MS, e-mail: sbrady@marianjoy.org.Disclosure: None.

Setting: Free-standing rehabilitation hospital. Patients: 5 consecutive patients (3 men, 2women; mean age, 57.20y; range, 34–72y) who presented with dysphagia after West Nile virus(WNV) infection. Case Descriptions: All patients presented with their initial symptoms in Augustand September 2002. All diagnoses were confirmed by lumbar puncture. 3 patients were initially noteating by mouth and required nonoral nutritional support. 3 patients experienced pneumonia; 2patients required mechanical ventilation; and 1 patient required a tracheotomy tube. Assessment/Results: Swallowing therapy focused on compensatory swallowing safety strategies and swallowingrehabilitation and strengthening exercises. Videofluoroscopy was completed in 4 of the patients,with aspiration being present in 3 patients. Days from onset to discharge ranged from 24 to 183(mean � SD, 85.8�69.1d). The patient who required mechanical ventilation, a tracheotomy tube,and a gastrostomy tube had the longest length of stay. All patients were eventually able to return tooral feedings after swallowing therapy during their inpatient rehabilitation stay without requiringany supplemental tube feedings. All patients were weaned from the ventilators and tracheotomytube. 4 of the 5 patients were receiving a regular diet of thin liquids and bread at discharge.Discussion: Physicians should recognize that dysphagia is a potential complication after WNVinfection and should provide appropriate direction for the team management of dysphagia with thesepatients. Conclusion: Functional gains can be made for dysphagia after WNV infection. KeyWords: Dysphagia; Rehabilitation; West Nile virus.

Poster 161Axonal Neuropathy of the Extremities After West Nile Virus: A Case Report. VasiliosStambolis, MD (Marianjoy Rehabilitation Hospital, Wheaton, IL); Colleen Peterson, MPT;Deepthi Saxena, MD, e-mail: sbrady@marianjoy.org.Disclosure: None.

A32 ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Arch Phys Med Rehabil Vol 84, September 2003