The AKA revision was done in January 2010. His residual limb islong and is tender to palpation at the distal end. Acupuncture wasdone because he had ongoing pain in the residual distal stump.Program Description: He had tried other conservative modal-ities prior to acupuncture trial. Prior to initiation of acupuncturetreatments, patient reported pain at 8/10 on the Visual Analog PainScale (VAS). Biofeedback measures were done to assess heart rate(HR) variability, abdominal breathing, EMG muscle tension andskin conductance during rest, stressor and recovery. VAS was alsodocumented before and after treatment. Biofeedback measures weredone immediately before and after acupuncture treatment to assessfor objective improvement.Setting: Veterans administration outpatient PM&R clinic; acu-puncture has been utilized for pain control. In this case we haveused SP 9, GB 34, GB 33, ST 36 in the opposite limb, amputeelimb-GB 32, amputee distal stump points; side of amputation LI11,LI4 were also done.Results or Clinical Course: Patient demonstrated improve-ment after acupuncture. Improvement was seen in 1) HR variabilityrecovery after stressor, 2) skin conductance, 3) pain scores, and 4)decrease and regularity in respiratory rate with abdominal breath-ing, and 5) EMG muscle tension in quadriceps muscle showed 40%decrease in muscle tension was noted. Overall improvement inscores since beginning of acupuncture treatment is 50%.Discussion: In this case, there were significant improvements inall 5 measures. This case report shows potential for acupuncture fortreatment of chronic distal stump pain.Conclusions: Future studies with larger sample sizes are neededto find an objective tool to measure long-term effectiveness ofacupuncture for amputee stump pain.

Poster 329The Effect of Bilateral Above the Knee Amputationsin Becker Muscular Dystrophy: A Case Report.Keith Burchill, DC, MD (William Beaumont Hospital,Royal Oak, MI, United States); David Hass, ATP; RandiLong, MD.

Disclosures: K. Burchill, No Disclosures.Case Description: Patient is a 66-year-old man with Beckermuscular dystrophy (BMD) and bilateral above knee amputations(AKA). Patient required a left AKA for peripheral vascular disease(PVD) and femur fracture secondary to a fall. A right AKA had beenrequired several years earlier, also in the milieu of PVD. He lastwalked at the age of 47. Immediately prior to his second AKA, thepatient’s strength was such that he required 2 persons with maxi-mum assistance for transfers.Setting: Tertiary care hospital: inpatient rehabilitation.Results or Clinical Course: Therapies focused on bed mobility,transfers, sitting balance and the family was trained to performsliding board transfers. FIM scores improved from 39 at admissionto 47 at discharge. Most of the patient’s improvement was seen inwheelchair/locomotion (1 to 6) as well as eating (1 to 4). Ourmultidisciplinary team worked to identify barriers to his wheelchairuse. Prior to his second AKA his chair was 20” wide to accommodatehis hip abduction contractures. Bathroom access was hampered bywheelchair width. After the amputations, the spread of abductionwas reduced, allowing for scaling back to an 18” width. The loss ofhis lower limbs resulted in loss of counter balance. He would fallforward in his chair. His shoulders’ weakness and limited range

required him to bring his head forward while eating which furtheraltered his balance. Falling forward also occurred with mobility.These needs were met by moving the center of gravity rearward by6” with a 15-25 degree tilt while driving.Discussion: To the best of our knowledge there are no docu-mented cases of bilateral AKA in patients with BMD. As medicalmanagement of cardiac dysfunction improves, these men are livinglonger. New challenges in activities of daily living presented them-selves after the loss of his legs as a counter balance. Assistance withbed mobility was reduced due to not having to manage his weaklegs. He declined cosmetic prosthetic fitting.Conclusions: New considerations must be employed when pa-tients with severe myopathy undergo amputations of their limbs.Changes to wheelchair specifications may be needed. Mobility withprosthetic limbs is likely not possible due to severe weakness andcardiac demands.

Poster 330Rehabilitation of a Patient with Polymyositis-Dermatomyositis Complicated by Heart Failure: ACase Report.Kelly Baron, MD (Moss Rehab, Elkins Park, PA, UnitedStates); Heather R. Galgon, DO; Harry W. Schwartz, MD.

Disclosures: K. Baron, No Disclosures.Case Description: The patient is a 57-year-old man who wasadmitted to a tertiary care hospital with complaints of progressiveweakness in the upper and lower extremities. He was found to haveelevated creatinine phosphokinase (CPK) and a rash. MRI revealeddorsal paraspinal muscle signal abnormality compatible with myositis.Electromyography (EMG) results were consistent with inflammatorymyopathy. He was admitted for acute inpatient rehabilitation with adiagnosis of polymyositis-dermatomyositis (PM-DM). On hospital day9 he complained of shortness of breath requiring oxygen supplemen-tation. Clinical examination revealed crackles bilaterally, jugular ve-nous distension, and 3� pitting edema in bilateral lower extremities.Cardiology was consulted and further work-up was initiated. B-typenatriuretic peptide (BNP) was elevated at 1000 and the patient wasaggressively diuresed without significant improvement. Transthoracicechocardiogram revealed an ejection fraction (EF) of 45%, mild dia-stolic dysfunction, and volume overload. Unable to fully participate inacute rehabilitation, the patient was transferred to acute care for furtherwork-up and management of new onset heart failure.Setting: Acute inpatient rehabilitation hospital.Results or Clinical Course: The patient’s cardiopulmonarystatus was stabilized; however, he was unable to participate at therequired level for acute inpatient rehabilitation. Rheumatology con-cluded the patient had a poor prognosis given his cardiac involve-ment in the setting of PM-DM.Discussion: Although cardiac involvement in the setting ofPM-DM has been well described in the Cardiac literature, it has notbeen well documented in the Rehabilitation literature. Implicationsfor diagnosing and rehabilitating a patient with concomitant inflam-matory myopathy and heart failure will be discussed further.Conclusions: Serious cardiac complications are possible in thesetting of idiopathic inflammatory myopathies, including PM-DM.If present, cardiac conditions may adversely affect the course ofrehabilitation as well as provide insight to the patient’s long-termprognosis.

S302 PRESENTATIONS