70% (n�9) in the marked to extreme coma range (CNC score, �2.9). Regardless of their initialscore, 46% (n�5) improved to a state of near to no coma (CNC score, �2). Of the 13 patientsreviewed, 23% (n�3) made no improvements at all. Conclusions: In this small cohort, level ofcoma on admission was not predictive of recovery from a comatose state. A high percentage (46%)of these children were discharged in a state of near to no coma, independent of admission comalevel. This does not suggest, however, that recovery from coma is predictive of long-term cognitiveand motor recovery. Assessment of long-term outcomes to further evaluate the capacity for recoveryfrom anoxic brain injury is indicated. Key Words: Anoxia; Coma; Pediatrics; Rehabilitation.

Poster 132Use of Alendronate to Treat Osteoporosis in Boys With Muscular Dystrophy: A Report of 3Cases. Susan D. Apkon, MD (Children’s Hospital and University of Colorado Health SciencesCenter, Denver, CO), e-mail: apkon.susan@tchden.org.Disclosure: None.

Setting: Tertiary care pediatric hospital. Patients: 2 boys with Duchenne’s muscular dystrophy(DMD), ages 11 and 12 years, and 1 boy with Becker’s muscular dystrophy (BMD), age 11 years.All boys are ambulatory for a portion of the day. Case Descriptions: Baseline bone mineral densityof the lumbar spine and femoral neck were assessed using dual-energy x-ray absorptiometry (DXA).Results revealed significant osteoporosis at the femoral neck, with a mean z score (SD using age-and sex-matched peers) of –3.73 (range, –3.16 to –4.42). Results at lumbar spine revealed mean zscore of –1.14 (range, –1.6 to 0.82). Because all subjects were having frequent falls, parents andphysicians felt aggressive treatment was necessary to prevent fractures. Oral alendronate wasinitiated at 45mg weekly for 6 months. Assessment/Results: All 3 subjects tolerated the medicationwithout side effects. There were no gastrointestinal complaints. Follow-up DXAs performed after 6months of treatment revealed improvements at the femoral neck in all 3 subjects, with a meanimprovement in z score of 0.94 (range, 0.3–1.33) representing an improvement of almost 1 SD.There was improvement at the lumbar spine, with a mean change of 0.28 (range, –0.45 to 1.11).Discussion: Osteoporosis is problematic in boys with DMD and becomes more severe as the diseaseprogresses. The high incidence of fractures in this group of boys is likely due to osteoporosis. Thisis the first known report on the use of alendronate in children with DMD or BMD in the treatmentof osteoporosis. Conclusion: In this small case series, weekly oral alendronate over 6 months waseffective in improving bone mineral density in boys with DMD and BMD. A prospective,randomized, double-blinded study is underway. Key Words: Alendronate; Duchenne dystrophy;Osteoporosis; Rehabilitation.

Poster 133Sciatic Nerve Injury in an Adolescent After Airbag Deployment: A Case Report. Douglas G.Kinnett, MD (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH), e-mail:rehab0@cchmc.org.Disclosure: None.

Setting: Tertiary care pediatric hospital. Patient: 13-year-old girl with no significant priormedical history. Case Description: The patient was a restrained front-seat passenger involved in amotor vehicle collision; her feet were positioned on the dashboard of the car at the time of airbagdeployment and her ankles were briefly forced to either side of her head. Radiographs for acutefractures were negative. She began to experience difficulty walking and required a walker andphysical therapy. Temperature change (cool), dusky discoloration, and pain complaints were notedin her distal lower extremities. Vascular studies and spinal magnetic resonance imaging werewithout significant findings. Improvement was seen after several months, but she remained with toewalking and foot pain. Assessment/Results: Significant findings at time of exam included bilateralplantarflexion deformities, early fatigue of ankle dorsiflexors, mottled dark red coloring at feet andankles, decreased ankle reflexes, and gait abnormality. Sensation was intact to touch and proprio-ception with subjective pain complaints over dorsal feet. Repeat Doppler studies were withoutsignificant findings, electromyography and nerve conduction studies demonstrated findings consis-tent with previous injury to the bilateral sciatic nerves. Discussion: Previous reports of nerve injuryafter airbag deployment have documented nerve injury in the shoulders, head, and neck areas. Thiscase is the first report of nerve injury in the lower extremity. Conclusion: There is a risk oflower-extremity nerve injury from airbag deployment in persons who place their feet on vehicledashboards. This behavior may be more prevalent among children and teenagers and thereforeparental and general education as to the potential danger of this behavior should be considered. KeyWords: Airbags; Pediatrics; Rehabilitation; Safety.

Poster 134Pathophysiologic and Impairment Outcomes in a Randomized Control Trial of BotulinumToxin Type A for Children With Spastic Diplegic Cerebral Palsy. Ross Hays, MD (Children’sHospital & Regional Medical Center, Seattle, WA); Kristie F. Bjornson, MS, PT; CathyGraubert, PT; Robert Price, MS; Francine Won, PT; John F. McLaughlin, MD, e-mail:kristie.bjornson@seattlechildrens.org.Disclosure: Hays, Relationship with Allergan; Bjornson, Relationship with Allergan; Graubert,Relationship with Allergan; Price, Relationship with Allergan; Won, Relationship with Allergan;McLaughlin, Relationship with Allergan.

Objectives: To document the impairment and pathophysiologic level effects (National Centerfor Medical Rehabilitation Research framework) of gastrocnemius botulinum toxin type A (BTX)injections in children with spastic diplegic cerebral palsy (CP). Design: Randomized, double-masked placebo-controlled trial. Setting: Tertiary care children’s hospital. Participants: 33 chil-dren with spastic diplegic CP, with a mean age of 5.5 years (range, 3.0–11.9y), of whom 19 wereboys (Gross Motor Function Classification Score: level I, 12; level II, 15; level III, 6). Interven-tions: All participants were randomized to receive either 12U/kg of BTX or placebo salineinjections. Main Outcome Measures: Collected at baseline, and at 3, 8, 12, and 24 weeks. Forpathophysiologic outcomes, electromyographic electric responses to maximal voluntary contraction(quantitative electromyographic kinesiology), which documented a significant effect (P�.05) of thetreatment versus placebo group at 3 weeks postinjection. For impairment level outcomes; an

electromechanical torque measure of spasticity (Spasticity Measurement System [SMS]), AshworthScale scores, Achilles’ deep tendon reflexes (DTRs), clonus, range of motion (ROM), and maximumtorque of the gastrocsoleus muscle. Results: SMS total and elastic path lengths were significantlylower for the treatment group at 8 weeks (P�.05). Ashworth scores did not differ significantly at anytime point. Achilles’ DTR (P�.03) and clonus (P�.05) decreased significantly in the treatmentgroup at 3 weeks. At 12 weeks, ankle dorsiflexion ROM was significantly greater for the treatmentgroup (P�.05). Maximum voluntary torque was significantly greater in the treatment group at 24weeks (P�.03). Conclusions: Significant decreases in electromyographic activity at 3 weeks areconsistent with the known pathophysiologic effect of the intervention. Significant differences inDTR and clonus at 3 weeks, SMS at 8 weeks, and subsequently the dorsiflexion ROM at 12 weeksmay be due to changes in the viscoelastic properties of the muscle. Change in maximum voluntarytorque at 24 weeks may be a response to improved ROM. Key Words: Botulinum toxin type A;Cerebral palsy; Rehabilitation.

Poster 135Use of Metabolic Measurement in Determining the Nutritional Needs in a Child in a PersistentVegetative State: A Case Report. Lisa J. Enders, MD (MCV/VCU, Richmond, VA); EugenioMonasterio, MD, e-mail: endersl@pol.net.Disclosure: None.

Setting: Pediatric extended-care facility. Patient: A 2-year-old ventilator-dependent girl in apersistent vegetative state (PVS). Case Description: The patient began gaining excessive weight at1 year of age on a nutritional regimen based on conventional formulas for predicting basal metabolicrate (BMR). Her caloric intake was decreased by approximately 10% per week in an attempt tostabilize her weight. Her weight finally began to stabilize when her calories were decreased to about50% of predicted caloric needs. Metabolic measurements were made at 21⁄2 years of age usingindirect calorimetry to measure oxygen consumption (V̇O2) and carbon dioxide production (V̇CO2)via expired gas. These measurements were used to calculate resting energy expenditure (REE) usingthe Weir equation: REE�(V̇O2[3.941]�V̇CO2[1.11])1440min/d. Assessment/Results: Nutritionalassessment based on metabolic measurements using indirect calorimetry showed that the childrequired significantly fewer calories than predicted by conventional formulas (152kcal/d vs 998kcal/d). The child continued on a nutritional regimen of 240kcal/d from formula and 75kcal/d fromProMod nutrition supplement. She remained adequately nourished and her weight stabilized.Discussion: The metabolic measurements using indirect calorimetry validated the low caloric needsin a child in PVS. Conclusion: Conventional formulas for predicting BMR may overestimate thecaloric needs in the patient in a PVS, which results in overfeeding. Metabolic measurements usingindirect calorimetry can be useful in determining nutritional needs and designing nutritionalregimens in the pediatric patient in a PVS. Key Words: Basal metabolism; Pediatrics; Persistentvegetative state; Rehabilitation.

Poster 136Home Internet and E-Mail Use by Parents Attending a Pediatric Rehabilitation Clinic. JoshuaAlexander, MD (University of North Carolina, Chapel Hill, NC); Alvin K. Antony, MD;Scottie Pate; Vicki Kolowitz, PhD, e-mail: antonya@med.unc.edu.Disclosure: None.

Objectives: To evaluate e-mail and Internet access currently available in the homes of parentswho have children with disabilities and to determine their use and satisfaction of online health careinformation related to their child’s condition. Design: Cohort study. Setting: University-basedpediatric rehabilitation practice. Participants: 157 consecutive parents attending a university-basedpediatric rehabilitation clinic. Intervention: Face-to-face interviews of parents and/or caretakersusing a standardized questionnaire. Main Outcome Measures: Parent demographics, presence,location, and speed of current Internet access, and ratings of usefulness of information found onlineas it pertained to their child’s condition. Results: 62% of the parents reported having e-mail accessat home. 66% of the parents reported having Internet access at home. 73% of online access at homewas achieved via dial-up modem. Younger parents were more likely to report having Internet access.Parents who reported attaining higher educational degrees were more likely to report having anInternet connection at home and using a faster connection. White parents and parents who reportedhigher household incomes were more likely to report having Internet access. Overall, 59% of parentsreported that they had used the Internet to get health care information related to their child’scondition. Of those who used the Internet, 94% found online health care information to be useful.Conclusions: Most parents bringing their children to a pediatric rehabilitation clinic have e-mail andInternet access at home. White parents, parents with higher socioeconomic status, and parents withhigher educational degrees were more likely to have e-mail and Internet access at home and to havefaster online connections. Almost 60% of all parents surveyed used the Internet to find health careinformation related to their child’s condition and an overwhelming number of them found onlineinformation to be useful. Key Words: Internet; Pediatrics; Rehabilitation.

Poster 137Weight Trends After Intrathecal Baclofen Therapy in Underweight Children With CerebralPalsy: A Case Series. Mary A. McMahon, MD (Cincinnati Children’s Hospital MedicalCenter, Cincinnati, OH); Doug G. Kinnett, MD; Amy Bailes, MSPT; Melanie Rak, MD; JudyBean, PhD.Disclosure: McMahon, Research grant from Medtronic; Kinnett, Research grant from Medtronic;Bailes, Research grant from Medtronic; Bean, Research grant from Medtronic; Rak, None.

Objective: To evaluate changes in weight during the first 12 months of intrathecal baclofen(ITB) therapy in underweight children with cerebral palsy (CP). Design: Retrospective case series.Setting: Children’s hospital tertiary care center. Participants: Subjects were considered under-weight if their weight was less than or equal to the fifth percentile for age on a standardized growthcurve. Data were available on 10 of 14 consecutive underweight children (mean age, 9.1y; range,4–14y) with CP treated with ITB. 50% of the children received all of their nutrition by gastrostomytube. Intervention: Continuous ITB for a minimum of 12 months. Main Outcome Measure: Theweight at pump implantation was recorded. Charts were reviewed for the closest recorded weights

A28 ACADEMY ANNUAL ASSEMBLY ABSTRACTS

Arch Phys Med Rehabil Vol 84, September 2003