gait. During the swing phase only a decrease in the magnitude ofankle plantar flexion was noted.Conclusions: Overall, our results are consistent with those re-ported by Steinbok et al, which demonstrated improvement inambulation distances; increased stride lengths; and improved hip,knee, and ankle motions after undergoing an SDR. Also, resultsfrom this retrospective study are consistent with a previous report,by Boscarino et al, of increase hip extension during stance. Ourstudy also reported a similar finding, by Boscarino et al, that anonstatistical significant increase in walking speed was found to bedue to a statistically significant increase in stride length. In our data,less ankle plantar flexion throughout the gait cycle and less hip andknee flexion during stance were reported. Lastly, our kinematic dataare inconsistent with Nivedita et al, who reported an increase in hipand knee flexion 1 year after undergoing a SDR.

Poster 383Urologic Adverse Effects of Intrathecal BaclofenTherapy in a Pediatric Population: Review of CaseSeries.Maura McManus, MD (Alfred I. duPont Hospital forChildren, Wilmington, DE, United States); Ahmad Bani-Hani, MD, Sharon Lyons, MSN, CRRN, FNP, Nicole Mar-cantuono, MD, Susan Myers, MSN, FNPC.

Disclosures: M. McManus, none.Objective: To review the urologic adverse effects commonly seenwith intrathecal baclofen (ITB) therapy in pediatric patients withcerebral palsy and acquired brain injury.Design: Retrospective review study.Setting: Tertiary care pediatric hospital.Participants: 295 pediatric patients with cerebral palsy or ac-quired brain injury who have ITB pumps for management of spas-ticity and/or dystonia.Interventions: Not applicable.Main Outcome Measures: Patients and caregivers were inter-viewed before ITB pump implantation and during clinical encoun-ters after pump implantation, as well as by follow-up telephonecalls. Information regarding voiding function was obtained. Positiveand negative urologic adverse effects were reported. In some cases,urologic consultation was done, urologic studies were performed,and data were reviewed.Results: Most patients had no significant change in voiding func-tion reported after ITB therapy. A few patients had beneficial effectsnoted, such as detrusor relaxation with improved bladder capacity.Negative urologic adverse effects were noted in nearly 10% of thesepatients, including urinary retention, urge incontinence, and hesi-tancy.Conclusions: While managing patients with ITB therapy, it isimportant to have a detailed voiding history and note any changesafter ITB therapy. It can be a challenge to determine which patientsare at the highest risk for negative adverse effects. Patients with aclinical history of voiding dysfunction should have baseline urologicscreening before pump implantation. Some patients with voidingdysfunction seem to tolerate smaller ITB dose adjustments overlonger periods of time. Having as much urologic information aspossible has helped to minimize these negative adverse effects andoptimize our treatment.

Poster 384Heterotopic Ossification Confused WithOsteomyelitis in a Child With Cerebral Palsy: ACase Report.Sathya Vadivelu, DO (University of Missouri-Columbia,Columbia, MO, United States); Jane A. Emerson, MD.

Disclosures: S. Vadivelu, none.Patients or Programs: An 11-year-old girl with quadriplegiccerebral palsy (CP).Program Description: The patient was routinely followed up inthe physical medicine and rehabilitation clinic for quadriplegic CPwith severe spastic dystonia. She was treated with oral medications(including baclofen, clonazepam, levodopa/carbidopa, and trihexy-phenidyl), physical therapy, onabotulinumtoxinA, and intrathecalbaclofen. She then developed left hip pain, with decreased painfulrange of motion and without a history of significant trauma, and hadno history of orthopedic surgery.Setting: Outpatient pediatric physical medicine and rehabilitationclinic.Results: Pelvic radiograph revealed a bone lesion, which, based onclinical findings, was suspected to be heterotopic ossification (HO).However, based on radiographic interpretation, concern was raisedfor osteomyelitis. As a result, magnetic resonance imaging wasordered, which revealed abnormal signal enhancement, which in-creased the concern for osteomyelitis. To confirm the diagnosiswithout subjecting the patient to a bone biopsy, a triple-phase bonescan and an indium-tagged white blood cell scan was obtained.These studies showed markedly increased activity around the lefttrochanteric region without corresponding white blood cell uptake,consistent with the diagnosis of HO. Treatment with indomethacinand omeprazole was implemented for 7 weeks, with improvementin pain and range of motion. After 1 year, radiographs continued toshow sclerotic thickening of the femoral cortex.Discussion: Despite minimal adverse outcomes in this case, thereis potential for significant morbidity or mortality based on misdiag-nosis. Due to clinical judgment, unnecessary hospitalization andsurgery was avoided.Conclusions: This case illustrates the importance of correlatingclinical and radiographic findings to ensure appropriate diagnosisand treatment of HO, and serves as a reminder that radiographicinterpretation without clinical support can lead to misdiagnosis anddelayed treatment of HO.

Poster 385Added Value of Neuropsychological Testing inReturn-to-Play Decision Making After PediatricConcussion: A Case Series.Phong Kieu, MD (Johns Hopkins University, Ellicott City,MD, United States); Jennifer Reesman, PhD, Stacy J.Suskauer, MD.

Disclosures: P. Kieu, none.Patients or Programs: Seven patients, ages 6-17 years old, withconcussion.Program Description: At initial evaluation (mean, 23 days afterinjury), history, and physical examinations were completed for allthe patients. All the patients also underwent abbreviated neuropsy-chological testing, including assessment of learning, memory, atten-tion, response speed, working memory, and organization by using

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standardized, norm-referenced instruments. When available, per-formance was compared with the child’s baseline test results.Setting: Multidisciplinary outpatient concussion clinic at an aca-demic pediatric rehabilitation hospital.Results: History did not reveal any clear cognitive symptoms, andphysical examinations were normal. Neuropsychological testingidentified impairments in verbal memory, information processingspeed, and/or speed of timed motor movements in all children.These data contributed to the assessment that recovery was ongoing,and children were not cleared to return to contact sports. At follow-up, performance on neuropsychological testing improved. Whencognitive performance returned to the child’s presumed or docu-mented preinjury baseline, and any other concussion-related symp-toms had resolved, clearance was given for progression through agraduated activity program, including return to contact sports.Discussion: These patients highlight a population of children forwhom neuropsychological testing plays a critical role in concussionmanagement. Subtle impairments in the often-affected domains ofmemory and processing speed may not be detected by history andphysical examination. Furthermore, time to full recovery of cogni-tive function is variable after a concussion, and children may not betruthful regarding symptomatology due to a desire for clearance toreturn to play. These factors further emphasize the importance ofstandardized neuropsychological testing, in addition to neurologicevaluation, in individual return to play decisions.Conclusions: Standardized cognitive assessment plays an impor-tant role in return-to-play decision making for student athletes. Thebenefit of serial cognitive assessment should be considered as guide-lines, and systems are developed for identifying and managingconcussion in children.

Poster 386Weight- and Image-related Barriers to Employmentin Myelomeningocele.David Berbrayer, MD (University of Toronto, Toronto,Ontario, Canada); , Bsc (MED), FRCPC, DABPMR.

Disclosures: D. Berbrayer, none.Objective: Relationship between obesity employment status andexperiences with weight discrimination and negative employmentfor persons with myelomeningocele.Design: Myelomeningocele database, university hospital. Survey,Valtonen ambulation, education, level, hydrocephalus, function,gender. Ambulatory, 4 categories - Hoffer. Self-reported FunctionalMeasure job and/or income satisfaction, and previous experiences,with weight-discrimination questions, Rothblum (NAAFA). Eightquestions, current employment, vanMechelen. Obesity, body massindex (BMI) addition, 2 questions, self-reported height and weight.Setting: University hospital.Participants: Myelomeningocele.Interventions: Demographics, Hoffer, Self-reported FunctionalMeasure, NAAFA, BMI.Main Outcome Measures: BMI, function, employment.Results: 15 myelomeningocele (31 years); 67% unemployed (10/15); employed or unemployed, similar age and/or BMI, significantdifferences in gender. High average BMI (27 unemployed, 32 em-ployed); women better employed, 80% women (4/5) and 10% menemployed (1/9) (P�.007). Obesity (BMI, �30), hydrocephalus,ambulation, function, education employment not statistically sig-nificant (P�.05). Poorer employment, nonambulatory 75% (6/8),

ambulatory unemployed 57% (4/7). Logistic regression, no interac-tion between obesity and employment. Obese (BMI�30) betteremployed nonobese (odds ratio [OR], 6.00 [95% confidence inter-val {CI}, 0.56-63.98]). Both overweight (BMI�25) and not over-weight with equal likelihood of employment (OR, 1.00 [95% CI,0.112-8.947]). Effect of gender did not change effect of BMI onemployment (OR, 1.00), widening 95% CI, 0.046-21.508. Personsoverweight felt less qualified for jobs (P�.346), more satisfied withboth job (P�.346) and salary (P�.518); 47% perceived overweight(7/15) versus 53% (8/15) felt average weight. Those perceivedoverweight were better employed than average weight (4/7 versus1/8; P�.067); 27% participants (4/15), weight discrimination atwork or weight interfered with personal self-confidence, but thosewho faced discrimination were better employed than those not(75% versus 18.2%; P�.039).Conclusions: Spina bifida, high rates of unemployment (67%)and weight-management issues (33% BMI, �30; 60% BMI, �25)lfemale positive predictor of employment; other studies, gender noadvantage; nonambulation, negative predictor of employment; BMI,not negatively affecting employment.

Poster 387Pediatric Botox Injections: Do Patients PreferConscious Sedation, and Does Conscious SedationImprove Patient Satisfaction?Thomas F. Chang, MD (Stanford University MedicalCenter, Redwood City, CA, United States); ChristineAguilar, Cherry Zamora.

Disclosures: T. F. Chang, none.Objective: To investigate whether patients prefer conscious se-dation for botulinum toxin (Botox) injection, and whether the use ofconscious sedation improves patient satisfaction.Design: Prospective cross-sectional survey.Setting: Pediatric rehabilitation outpatient Botox injection clinicin a community-based hospital.Participants: 101 patients, with an average (standard deviation[SD]) age of 9.81�5.65 years, with a majority (60) having lowerextremity spasticity, and others having upper, lower/upper, andneck spasticity.Interventions: Botox injection to spastic muscle groups.Main Outcome Measures: Patient questionnaire that indi-cated (1) patient’s choice for or against conscious sedation, (2)patient’s perception of satisfactory outcome with the injection at 2months, and (3) patient’s preference to repeat injections assessed at2 months.Results: 86 patients (85%) declined conscious sedation, whereas15 patients (15%) chose conscious sedation; 31 patients had mul-tiple return visits; 6 returning patients had at least 1 visit with usingconscious sedation, and only 1 returning patient chose conscioussedation for all visits; 8 patients had injections to the neck, and 7patients with neck injection chose conscious sedation. The average(SD) number of injections per visit was 3.7�1.7) without sedationand 3.7�2.5 with sedation. The percentage of injections thatyielded patient-perceived satisfactory outcome was 52% withoutsedation and 43% with sedation. The percentage of patients whowanted more injections in the future was 76% without sedation and72% with sedation.Conclusions: The majority of patients preferred not to haveconscious sedation with Botox injections, and performing Botox

S308 PRESENTATIONS