tably, she had heterotopic ossification in her hips. In addition, herknees lacked about 35° in extension, and her hands had flexioncontractures bilaterally. Her right shoulder did not flex beyond 90°passively, whereas her left shoulder flexed to 115°. Functionally,she was maximum dependent for ambulation and all activities ofdaily living. She subsequently was admitted to the acute inpatientrehabilitation.Setting: Tertiary carer rehabilitation center.Results: While in acute rehabilitation she received serial casting ofher right index and middle fingers, and, with this intervention,obtained a pincer technique to accomplish activities of daily livingwith her right hand. A right sciatic nerve block and serial casting toher knee were applied, and she gained 20° in knee extension andwas able to stand. Speech therapy advanced her to a soft diet, andher PEG was subsequently removed. She was able to maintain apulse oxygenation �92%, and her tracheostomy tube was removed.Pharmacologically, etidronate was administered for her heterotopicossification, which helped to improve her hip pain and bed mobil-ity. She progressed functionally to a minimum assistance withactivities of daily living and ambulatory level, and was dischargedhome.Discussion: Central pontine myelinolysis secondary to beer po-tomania is an uncommon cause of tetraplegia. This is the firstreported case, to our knowledge, of the rehabilitation course in thistype of a patient.Conclusions: A comprehensive rehabilitation approach can im-prove the functional status in individuals with tetraplegia aftercentral pontine myelinolysis due to beer potomania.

Poster 59Moyamoya Disease and Rehabilitation Outcomes:A Case Series.Mallikarjuna Nallegowda, MD, DNB, MNAMS (LomaLinda University Medical Center, Loma Linda, CA,United States); Ziyad Ayyoub, MD, Murray Brandstater,MD, Jared Myers, BA, Jiangnan Wang, MD, Xiao LingZhang, MD.

Disclosures: M. Nallegowda, none.Patients or Programs: Twelve patients identified with MoyaMoya disease (MMD) through retrospective chart review and com-parison of patients with stroke and those with non-traumatic braininjury.Program Description: Moyamoya disease (MMD) is a rarechronic progressive disorder of the cerebral arterial system, whichinvolves both extracranial and intracranial vessels, and causes isch-emic and hemorrhagic strokes. So far, no larger study has describedthe rehabilitation outcomes in this population. In this case series,patients with MMD were identified via hospital database of Interna-tional Classification of Diseases, Ninth Revision codes from 1994-2010, and their clinical characteristics and functional outcomeswere compared with same-case mix groups.Setting: A national rehabilitation hospital.Results: Of 12 patients with MMD, 2 were admitted twice due torepeated strokes. The average age was 33.5 years (range, 6-65years), 50% were female patients. Two patients attended only fordriving assessment. The stroke was ischemic in 8 patients, hemor-rhagic in 5, and bilateral in 6. Comorbidities were epilepsy (3),sickle cell disease (SCD) (2), Graves disease (1), hypothyroidism(2), diabetes mellitus (DM) (3), hypertension (HTN) (5), and dys-

lipidemia (7). One patient with SCD was discharged during inpa-tient rehabilitation due to pulmonary infarction. Two patients hadcranial vessel bypass-revascularization surgery. The average lengthof stay was 23 days for first admission. Only 8 patients had completeadmission and discharge Functional Independent Measure (FIM)scores. All the patients had lower FIM scores than other patients intheir national benchmark case-mix groups for the same dischargeyears, but 2 had high admission FIM scores.Discussion: Patients with MMD will have repeated admissions torehabilitation due to recurrent strokes and worsening neurologicdeficits, with comorbidities such as SCD, HTN, DM, and dyslipide-mia. The functional outcomes with these patients differ from that oftypical stroke patients due to significant motor, sensory, cognitive,and functional deficits, and associated comorbidities, and this wasevident in this series, with lower FIM scores compared with othercase-mix groups. Also, due to the repeated TIAs and strokes, thesepatients can develop cognitive decline at an early age.Conclusions: Larger prospective studies and a longer follow-upare required to look for late survival and long-term functionaloutcomes.

Poster 60A Rare Case of Transfusion-inducedThrombocytopenic Purpura at an InpatientRehabilitation Facility: A Case Report.George C. Christolias, MD (Hospital of the University ofPennsylvania, Philadelphia, PA, United States); GeorgeCyril, Kristin Gustafson, DO.

Disclosures: G. C. Christolias, none.Patients or Programs: A 62-year-old man presented to a uni-versity-based acute care hospital with complaints of a cold and amottled left foot, which was concerning for arterial thrombus.Program Description: The patient was taken to the operatingroom for emergent thrombectomy, left axillary-femoral and femo-ral-femoral bypass. A postoperative course was complicated byrhabdomyolysis, acute renal failure, and anemia, which requiredtransfusion of packed red blood cells. The patient was initiated on aheparin drip with a bridge to Coumadin. When the patient wasmedically stabilized, he was discharged to an inpatient rehabilita-tion facility.Setting: An acute rehabilitation facility at a university hospital.Results: Laboratory screening detected a decrease in his plateletcount to 146. Complete blood cell count was reevaluated the nextday, and a platelet count of 13 was returned. The patient wasemergently sent to an acute care hospital with a presumed diagnosisof heparin-induced thrombocytopenia, which was later excludedvia laboratory testing. The patient had low fibrinogen, an indicationfor diffuse intravascular coagulation. The patient was initiated onaminocaproic acid and prednisone, and received multiple transfu-sions with platelets and cryoprecipitate; however, the thrombocy-topenia remained refractory. Further testing revealed antibodies toglycoproteins Ia and IIa, and a diagnosis of transfusion-inducedthrombocytopenic purpura was given. The patient was maintainedon prednisone and given a course of intravenous immunoglobulinswith subsequent improvement in his platelet count.Discussion: Transfusion induced thrombocytopenic purpura is arare iatrogenic cause of thrombocytopenia that has not yet beendescribed in rehabilitation literature. The etiology was determinedto be transfusion of platelet-contaminated packed red blood cells.

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Acute onset thrombocytopenia of any degree warrants further eval-uation, even in patients who have not been treated with hepari-noids.Conclusions: Transfusion-induced thrombocytopenic purpurais an iatrogenic cause of thrombocytopenia that should not beoverlooked.

ELECTRODIAGNOSTIC MEDICINE

Poster 61Hanging Head: Idiopathic Isolated Neck ExtensorMyopathy: A Case Report.Nicole Marcantuono, MD (Thomas Jefferson UniversityHospital, Philadelphia, PA, United States); Niteesh Bha-rara, MD, John-Paul D. Hezel, MD, Channarayapatna R.Sridhara, MD.

Disclosures: N. Marcantuono, none.Patients or Programs: An 83-year-old man with chin-on-chestdeformity.Program Description: The patient presented, for electrodiag-nostic studies, with difficulty holding up his head for 3 months aftera fall. Clinical examination was notable for kyphosis of the cervicalspine, head drop, and significant limitation of neck range of motionin all planes except forward flexion. Antigravity strength of the neckextensors was decreased, whereas other muscles of the neck, back,and all 4 limbs were relatively spared. Magnetic resonance imagingof the neck was positive for bilateral multilevel foraminal stenosis.Setting: An outpatient electrodiagnostic laboratory in a tertiaryrehabilitation hospital.Results: There was increased spontaneous activity in the cervicaland upper thoracic paraspinal muscles. The cervical paraspinals hadmotor unit action potentials of small amplitude and narrow dura-tion, with increased recruitment. In a computerized interferencepattern analysis, the cervical paraspinal area revealed an increasedratio of turns per second to amplitude per turn, which suggested amyopathic process. Inflammatory myopathy workup was negative,which led to a diagnosis of idiopathic focal neck extensor myopathy.Discussion: Neck extensor weakness may be a sign of seriousmedical conditions, such as myasthenia gravis, anterior horn celldisease, Parkinson syndrome, and inflammatory myopathy. Whenthese disease processes are ruled out, a diagnosis of isolated neckextensor myopathy can be entertained. This condition is benign andnonprogressive, and may be treated with a soft cervical collar forcomfort and to improve head positioning and allow the patient toperform bimanual tasks.Conclusions: Neck extensor weakness can be a presenting symp-tom in many medical conditions. Once other more serious andprogressive neurologic conditions are ruled out, a patient may bediagnosed with idiopathic focal neck extensor myopathy andtreated with supportive measures.

Poster 62New Technique of Laryngeal Nerve ConductionStudy.Sang Jun Kim, MD, PhD (Johns Hopkins University,School of Medicine, Baltimore, MD, United States).

Disclosures: S. Kim, none.Objective: To develop a new nerve conduction technique of therecurrent laryngeal nerve and to supply the reference values of the

motor latency of recurrent laryngeal nerve in subjects without vocalcord palsy.Design: A prospective study.Setting: A tertiary university hospital.Participants: Fifty healthy volunteers without any voice prob-lem.Interventions: The recording was performed at the bilateral thy-roarytenoid muscles by using the monopolar needle. The electricalstimulation at the 2-finger breadth above the clavicle and just lateralto the trachea was done, and its intensity at the level of 15 mA. Fivetrials were done at each muscle.Main Outcome Measures: Averaged motor latencies.Results: The Cronbach � coefficient was .984 and the averagelatencies were 2.0�0.3 ms. Motor latencies showed normal distri-bution by the Kolmogorov-Sminov test (Z�.811, P�.527). Theseresults did not show the difference in both sides.Conclusions: Motor latencies of the recurrent laryngeal nerveshowed high internal consistency and normal distribution. Thisconduction study will be helpful to diagnose and estimate the vocalcord palsy state, such as demyelinating or conduction block, whichcannot be detected by the laryngeal needling study.

Poster 63Evaluation of Dysphagia After Cervical SurgeryWith the Aid of Laryngeal Electromyography.Ju Seok Ryu (CHA Bundang Medical Center, CHAUniversity, Seongnam-si, Korea, Republic of); Jin YoungKang, Min Young Kim, Ji Hyun Lee.

Disclosures: J. Ryu, none.Objective: To investigate the causes of dysphagia after cervicalsurgery with the aid of laryngeal electromyography (LEMG) and theeffect of laryngeal neuropathy on the severity of dysphagia.Design: A single-group longitudinal study.Setting: University rehabilitation center.Participants: Seventeen patients with dysphagia evident aftercervical surgery.Interventions: Not applicable.Main Outcome Measures: A videofluoroscopic swallowingstudy (VFSS) and LEMG were conducted between 3 weeks and 3months after cervical surgery. VFSS parameters evaluated includedthe volume of residue in the vallecular pouch (minimal [�10 %],small [10�50%], or large [�50%]), the Rosenbek penetrationaspiration scale (RPAS), and the swallowing function scoring system(SFSS). By VFSS findings, patients were divided into a mild dyspha-gia group (RPAS scores approximately 1-5 and SFSS scores approx-imately 5-6) or a severe dysphagia group (RPAS scores approxi-mately 6-8 or SFSS scores approximately 1-4). LEMG wasconducted on the thyroarytenoid and cricothyroid muscles.Results: Nine of 17 patients showed voice change. SFSS scoreswere 0 in 2 patients, 3 in 1 patient, 4 in 1 patient, 5 in 1 patient, and6 in 12 patients. RPAS scores were 1 in 8 patients, 2 in 5 patients, 7in 3 patients, and 8 in 1 patient. In terms of residue in the vallecularpouch, 2, 6, and 9 patients exhibited minimal, small, and largevolumes, respectively. Laryngeal neuropathy was evident in 7 pa-tients (41.2%). Of these, all the patients exhibited recurrent laryn-geal neuropathy, and 28.6% had superior laryngeal neuropathy.These patients also showed voice change (P�.001). When weevaluated LEMG findings with respect to the severity of dysphagia,the severe dysphagia group showed significant association with the

S198 PRESENTATIONS