S314 PRESENTATIONS

care which may decrease risk of mortality from subsequent strokes,decrease post-stroke morbidity, and also maximize functional gainsduring their post-acute inpatient rehabilitation stay. Furtherexpanded research is warranted and in process.

Poster 367Early Physical Medicine and RehabilitationConsultation Leads to Decreased Length of Stay forPatients Admitted with a Stroke.Andrew J. Chrisman, MD (William Beaumont Hospital,Royal Oak, MI, United States); Myron Laban, MD;Ronald S. Taylor, MD; Justin Riutta, MD.

Disclosures: A. J. Chrisman, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Objective: To determine if the timing of consults placed toPhysical Medicine and Rehabilitation (PM&R) for patients admittedwith a stroke in an acute medical center affects acute hospitalizationLength of Stay (LOS).Design: Restrospective cohort study.Setting: Tertiary Care Hospital.Participants: All patients age 18-99 admitted from 2/2009-12/2013 with one of the following ICD-9 codes listed as their primarydiagnosis: 430, 431, 432.1, 432.9, 433.01, 433.11, 433.21, 433.31,433.81, 433.91, 434.01, 434.11, and 434.91.Interventions: Not applicable.Main Outcome Measures: Acute hospitalization Length ofStay (LOS).Results or Clinical Course: The hospital’s database was queriedto illicit all patients admitted with the above ICD-9 codes andseparated into two groups: those who received a PM&R consult andthose who did not. Patients were excluded if the ICD-9 codediagnosis was not the primary reason for admission. Acute hospi-talization LOS was compared between the two groups and the datawas further analyzed to determine if LOS differed based on timingof the consult. LOS was significantly shorter in patients with earlyPM&R consults.Conclusions: This is the first documented study using Elec-tronic Medical Records to investigate how the timing of PM&Rconsultation affects acute hospitalization length of stay forpatients with strokes that has been reported in the literature todate. Our data indicate that early consultation of PM&R inpatients admitted with acute strokes reduces acute hospitalizationLOS. Given that Physical Medicine and Rehabilitation focuses onfunction we are uniquely qualified to both determine and facili-tate appropriate disposition plans for patients admitted withstrokes.

Poster 368Excessive Eructation in Post Mild Traumatic BrainInjury: A Case Report of a 76-year-old Man withConcussion after Motor Vehicle Collision PostConcussive Symptoms.Yevgeny Zadov, DO (Penn State Hershey MedicalCenter, Hershey, PA, United States).

Disclosures: Y. Zadov, No Disclosures: I Have No RelevantFinancial Relationships to Disclose.Case Description: Patient was involved in a motor vehiclecollision, resulting in mild traumatic brain injury. He was treated

at an emergency department and released home. He subsequentlydeveloped post concussive symptoms including balance dys-function, cognitive dysfunction, headaches, and nausea. Inaddition, he developed excessive and uncontrolled eructation(belching). He finds relief when in a recumbent position. Patientreports severe eructation any time he is not supine or recumbentfor more than 2-3 minutes. He is symptomatic several times per2-5 minutes. He denies any associated symptoms. He has seengastroenterology and has had upper and lower endoscopieswhich were negative. He was trialed on medications for boweldiscomfort such as simethicone. He was been trialed on oralbaclofen but this also failed. Review of records from primary careand gastroenterology found no further treatment or diagnosticmodalities being investigated. Our belief at this point is that thepatient has aerophagia, a type of eructation where excess gasdoes not enter the stomach but instead is released almost assoon as it enters the vocal cords.Assessment: This patient will undergo speech and behavioralcognitive therapy targeting his excessive eructation, in this casethought to be aerophagia. At the conclusion of therapies we willevaluate for relief given that excessive eructation is known to haveboth physiological and psychological components.Setting: Outpatient concussion clinic.Results or Clinical Course: This patient will undergo speechand behavioral cognitive therapy targeting his excessive eructa-tion, in this case thought to be aerophagia. At the conclusionof therapies we will evaluate for relief given that excessive eruc-tation is known to have both physiological and psychologicalcomponents.Discussion: This patient displays unusual symptoms within thepost concussive realm. There is no prior literature discussingtreatment of such a case and therefore we are exploring a noveltreatment for his specific complaint.Conclusions: The diagnoses of post concussive syndrome isbased on common symptoms that appear after a mild traumaticbrain injury. Neuropsychological changes are common and in thiscase the unusual eructation may have a neuropsychological causerather than a physiological cause.

Poster 369Development of a Picture Guide to Identify CommonPostures of Spasticity.Ib Odderson (University of Washington, Seattle, WA,United States); Todd Bentley, MD, MS; Jörg Wissel;Khashayar Dashtipour, MD, PhD; Nathan Johnson, MPh;Christopher Evans, PhD; Patrick J. Gillard, PharmD, MS;Richard D. Zorowitz, MD.

Disclosures: I. Odderson, Allergan Inc. and SawbonesInc.,Consulting fees or other remuneration (payment)Objective: To develop an illustrative picture guide to identifycommon postures of upper and lower limb spasticity for use byclinicians and patients.Design: Five specialists in spasticity management providedguidance on the most common postures observed in patients withspasticity. A photo-shoot with patients was held to capture photosof these spasticity postures across four etiologies (stroke, traumaticbrain injury, multiple sclerosis, and cerebral palsy).Setting: Physician office