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treatment options for those with significant foot ulcers and/orperipheral vascular disease.Discussion: SVG has among the highest burdens of diabetes-related disability world-wide. Vincentian amputees have reducedquality of life and participation due to a difficult terrain and limitedaccess to prostheses, making prevention of diabetic amputationsparamount.Conclusions: Removing barriers to good glycemic control andimproving access to appropriate footwear and foot care are essentialto reduce disability among Vincentian diabetics.

Poster 132Ultrasound Guided Phenol Injection into ResidualLimb Neuroma: A Case Report.Matthew C. Martinez, MD (University of Missouri-Columbia, Columbia, MO, United States); Joseph E.Burris, MD.

Disclosures: M. C. Martinez, No Disclosures: I Have Nothing ToDisclose.Case Description: A 43-year-old male patient developeda painful nodule on the distal residual limb approximately 2years after original below the knee amputation following trauma.Ultrasound evaluation of the painful nodule was consistent witha neuroma. Doppler evaluation was performed to ensure thiswas not a vascular lesion. He then underwent a diagnostic/therapeutic injection of 1 cc of 40 mg/mL of kenalog mixedwith 2cc of 1% lidocaine without epinephrine. He did haveimprovement of pain after the original injection. He was seen inclinic for follow-up one week after the injection of kenalog andlidocaine. Subjectively the patient reported a 75% reduction inpain after the injection. The neuroma was reidentified usingultrasound guidance and Doppler evaluation. The area was theninjected with 0.75mL of phenol and he tolerated the procedurewell.Setting: Outpatient PM&R ClinicResults or Clinical Course: At 2 weeks post-injection, thepatient continued to report resolution of his pain.Discussion: To our knowledge, only a limited number of studieshave been reported in the medical literature of using ultrasoundguidance for visualization of and localization on residual limbneuroma injections.Conclusions: Ultrasound can be a useful tool on painful nodulesof the residual limb for both identification of neuromas and guid-ance of injections to ensure appropriate localization.

Poster 133Atypical Painless Presentation of MononeuritisMultiplex: A Case Report.Pooja Mundrati, DO (UMDNJ-NJMS, Newark, NJ, UnitedStates); Nigel Shenoy, MD.

Disclosures: P. Mundrati, No Disclosures: I Have Nothing ToDisclose.Case Description: A 67-year-old right-handed man with dia-betes and prior right Achilles tendon injury was referred forelectrodiagnostic (EDx) evaluation of left ulnar and right fibularneuropathies. In mid-December 2012, he fell onto his left sidewith subsequent elbow bruising and swelling. A week later, hereported left hand difficulty with grooming and dressing as well as

intermittent finger numbness, worsened by bending his elbow. Healso had difficulty moving his right ankle and picking up his footwhile walking. Neither region was painful. On 12/29/12, his sisterbrought him to the emergency department because he was drag-ging his right foot and not using his left hand well. On exam, hehad a mild right steppage gait and overall 4/5 left upper limbstrength. Of the tests ordered, all were within normal limits excepthis hemoglobin A1c which was elevated at 11.1. The last checkedresult was 8.0. On 2/6/13, the day of EDx testing, he hadpersistent left hand weakness with decreased light touch sensationon the dorsum of his hand, right steppage gait with decreasedankle range of motion, ankle weakness, and no pain. Nerveconduction studies revealed abnormalities in the following nerves:right-sided median motor, peroneal, tibial, and sural; bilateralulnar sensory; and left median (motor and sensory). Abnormalneedle findings were found in the following muscles: right-sidedabductor pollicis brevis, tibialis anterior, peroneus longus, andposterior tibialis.Setting: Outpatient electrodiagnosis visitResults or Clinical Course: EDx evidence was consistentwith mononeuritis multiplex given the asymmetric sensoryand motor peripheral neuropathy involving at least 2 differentnerves.Discussion: This is an atypical case of mononeuritis multi-plex that had incidental traumatic presentation and waspainless. It is most likely due to uncontrolled diabetes whichis common.Conclusions: Mononeuritis multiplex should be consideredeven when symptoms are painless and regardless ofpresentation.

Poster 134Delivering Consistent Results in Pediatric Patientswith Spinal Cord Injury: A Case Report.Nancy R. Behrndt, MS, MBA (Baylor University MedicalCenter, Our Childrens House, Dallas, TX, United States);Rajashree Srinivasan, MD.

Disclosures: N. R. Behrndt, No Disclosures: I Have Nothing ToDisclose.Case Description: Delayed discharges, poor patient satisfactionand poor Functional Independance Measure (FIM) scores promp-ted the development of templates to ensure effective care. Thesewere used as road maps to maintain and follow care through theinpatient stay.Program Description: The template breaks down all thedifferent areas of care with expected outcomes for each area of care,caregivers responsible for the care, and gives an expected length ofstay for each injury level. The template is not a plan of care, buta guide to make sure all disciplines are addressing the care needs ofthese complex patients so that they are ready for a safe discharge ina timely manner.Setting: Inpatient Rehabilitation in a Pediatric SpecialtyHospitalResults or Clinical Course: Prior to utilizing a treatmenttemplate, the average length of stay was 46 days with (FIM)gain being 28 points with an average of 1.63 gain per day. Afterimplementation of the templates, length of stay changed to 22days and FIM gain was 12.1 with average gain of 1.8 gain perday.

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Discussion: The purpose of developing the templates was toensure effective care while improving the outcomes. Thetemplates achieved their said objectives of improving FIM scoresand decreasing the length of stay. Overall length of stay signif-icantly decreased in the two years that the templates wereimplemented.Conclusions: Use of templates has improved the FunctionalIndependance Measures and decreased the length of stay whiledirecting complex care in an effective fashion.

Poster 135Electromyographic Pearl in Post-Polio Syndrome: ACase Report.Bradley F. Thompson, MD (Mayo Clinic, Rochester, MN,United States); Nathan Young, DO.

Disclosures: B. F. Thompson, No Disclosures: I Have Nothing ToDisclose.Case Description: A 69-year-old left-handed women withhistory of a prolonged, undiagnosed, viral illness in grade schooland mild gross motor delay presented with a three year historyof progressive right footdrop and fasciculations. She reportednon-progressive right calf asymmetry first noticed at age 13. Atage 66 the calf atrophy began to slowly progress and shedeveloped foot drop without associated pain, numbness, ortingling. By age 68 she required use of a right ankle-foot orthosisand extensive outpatient physical therapy. Physical examrevealed atrophy and weakness (MRC 3/5) of the distal greaterthan proximal right lower limb muscles and a steppage gaitpattern. The patellar reflex was reduced and the Achilles reflexwas absent.Setting: Tertiary Medical CenterResults or Clinical Course: Extensive laboratory testingrevealed mildly elevated creatine kinase. CSF analysis anda lumbar MRI were normal. Nerve conduction studies includingsural sensory were normal for age. Electromyographic exami-nation revealed a mixture of large stable triphasic, and complexunstable motor unit potentials with reduced recruit-ment and dense fibrillation potentials predominantly in distalmuscles.Discussion: Post-Polio syndrome (PPS) typically presents as new,otherwise unexplained, progressive weakness, functional decline,muscle atrophy, fatigue, and myalgias often 3-4 decades followingpoliomyelitis. Age-related motor neuron degeneration acceleratedby increased metabolic demands of the few remaining motorneurons is the postulated pathophysiology. Management is symp-tomatic and supportive; including non-fatiguing muscle strength-ening and energy conservation.Conclusions: Electromyographic findings of mixed large andsimple (old), as well as complex unstable (recent denervation) arecharacteristic of PPS.

Poster 136Bilateral Brachial Plexus Injury after a HangingSuicide Attempt: A Case Report.Ajai Sambasivan, MD (Baylor College of Medicine,Houston, TX, United States); Sindhu Pandit, MD, MBA.

Disclosures: A. Sambasivan, No Disclosures: I Have Nothing ToDisclose.

Case Description: We present a 21-year-old female whosuffered symmetric bilateral upper trunk brachial plexus injuriesafter a suicide attempt by hanging.Setting: Inpatient RehabilitationResults or Clinical Course: After resuscitation, the patient wasnoted to have an anoxic brain injury and an inability to flex andabduct her bilateral arms. MRI of the cervical spine did not showany acute lesions. EMG showed bilateral upper trunk lesionsaffecting only the motor nerves. With aggressive therapy, herstrength improved from no palpable biceps contraction to anti-gravity strength of bilateral biceps. She continued to havecognitive deficits at the time of discharge, and required 24 hoursupervision.Discussion: Hanging is one of the most common methods ofsuicide attempt. The success rate of suicide by hanging is high,but roughly 30% of attempts fail. Survivors are left with varyingdegrees of disability including cognitive and physical impair-ments. The etiologies of their injuries are clinically significant asdifferent injuries carry various prognoses and respond todifferent therapeutic interventions. Our case describes a raresymmetric injury to bilateral brachial plexus affecting only themotor nerves. This was an unlikely etiology of symmetric upperextremity weakness. A diagnostic EMG was pursued when MRIof her cervical spine did not reveal local cervical trauma,vertebral body fractures, or spinal cord injury that would morecommonly explain her weakness. Her strength improved duringher inpatient rehabilitation stay with aggressive occupationaltherapy and prognosis was good. We present this case toconsider bilateral brachial plexus injury as a rare complication ofa hanging suicide attempt.Conclusions: Our case suggests that one should consider bilat-eral brachial plexus injuries in the differential of a patient withbilateral muscle weakness following a cervical hanging or strangu-lation injuries.

Poster 137Deep Vein Thrombosis in Amputee Patients.Amarjit Arneja, MD, FRCPC (Health SciencesCentre, Winnipeg, MB, Canada); Hashem Alha-shemi, MD, FRCPC; Tracey Olafson, RN; Patrick Gross,BMR(PT).

Disclosures: A. Arneja, No Disclosures: I Have Nothing ToDisclose.Objective: To determine the prevalence of deep venous throm-bosis (DVT) in patients with lower extremity amputation.Design: Prospective studySetting: Two tertiary care hospitalsParticipants: 72 patients having recently undergone lowerextremity amputationsInterventions: Not applicableMain Outcome Measures: Doppler ultrasound screening postamputationResults or Clinical Course: Five patients were found to haveDVT. The prevalence of DVT in amputee patients who are on DVTprophylaxis up to one month post amputation is 7%.Conclusions: This result may necessitate keeping amputeepatients on DVT prophylaxis, even after discharge from hospital,until they have good mobility.