Conclusions: Patients with poor initial FIM scores canmake significant improvements during inpatient rehabilita-tion.Keywords: Rehabilitation, Carotid artery dissection, Seatbelts.

Poster 415

Vertebral Artery Dissection After Diving intoShallow Waters: A Case Report.Jennifer Chung, (New York University, New York,NY); Alex Moroz, MD; Ira Rashbaum, MD;Neha Sahni.

Disclosures: J. Chung, None.Patients or Programs: A 24-year-old healthy man.Program Description: The patient dove in the water nearAthens, Greece. Before reaching the bottom, and withouttrauma, he experienced sudden left-sided neck pain. He thendeveloped left hemiplegia within several minutes. Brain mag-netic resonance imaging (MRI) demonstrated left medullaryinfarction involving the pyramid, extending posteriorly to-wards the floor of the 4th ventricle. Neck and brain magneticresonance angiography (MRA) showed dissection of the leftvertebral artery, tapering to total occlusion at the vertebro-basilar junction. Patient was started on enoxaparin, andsubsequently placed on warfarin. Physical examination re-vealed mild dysarthria, right eye nystagmus, normal cranialnerve function, normal sensation with mild proprioceptivedeficit in his fingers, hyperreflexia on the left, and significantleft-sided hemiplegia. Patient was admitted to inpatient reha-bilitation. He required assistance in all functional areas. Pa-tient made significant developments during the admission.Electrical stimulation to his left lower extremity helped tofacilitate function. He wore a hinged left ankle foot orthosis tocounteract foot drop and to improve ambulation. At dis-charge, the patient was able to ambulate without an assistivedevice. Further developments will be discussed.Setting: Urban tertiary rehabilitation center.Results: Patient developed left vertebral artery dissectionafter diving, leading to left medullary stroke with left hemi-plegia. The extensive dissection resulted in lateral medullarysyndrome, causing immediate onset of symptoms and result-ing in a long recovery period with residual weakness.Discussion: This is the first reported case, to our knowl-edge, of VAD immediately following a dive into shallowwaters. Possible causes are discussed with review of litera-ture. Radiological workup is presented.Conclusions: The differential diagnosis for neurologicalsymptoms consistent with stroke in young individualsshould include VAD after diving. Though not considereddirect trauma, cervical hyperextension from the impact of thehead with the water could cause extensive vertebral arterydissection.Keywords: Rehabilitation, Lateral medullary syndrome,Vertebral artery dissection.

Poster 416

Weight Supported Pre-Gait BalanceRehabilitation in Acute Stroke Patients: APreliminary Study.Noel Rao, MD (Marianjoy Rehabilitation Hospital,Wheaton, IL); Alexander Aruin, PhD; DonnaZielkie, MPT.

Disclosures: N. Rao, None.Objective: Individuals with a recent stroke frequentlydemonstrate problems with balance control including asym-metry of weight bearing. Moreover, since a large number ofthese individuals are unable to stand unassisted, they cannotparticipate in gait retraining. The goal of the study was toevaluate whether patients with acute stroke can participate inthe weight supported pre-gait balance rehabilitation.Design: This preliminary study involving two individualswith recent stroke who could not stand unassisted.Setting: Acute inpatient rehabilitation hospital stroke pro-gram.Participants: Two individuals who sustained a stroke lessthan a month earlier (85-year-old woman and 46-year-oldman) and who were unable to stand unassisted.Interventions: Assessment of their limits of stability andrhythmic weight shift was performed. The participants wereprovided with a harness system that allowed partial supportof their body weight and positioned on the Balance Masterplatform (NeuroCom International). Limits of stability andrhythmic weight shift were assessed before and after partici-pation in physical therapy focused on retraining of voluntarymotor control of balance with visual feedback.Main Outcome Measures: Limits of stability andrhythmic weight shift on the Balance Master platform (Neu-roCom International).Results: After participating in 3 physical therapy sessions,patients demonstrated improvement in both limits of stabil-ity and rhythmic weight shift.Conclusions: While provided with partial support of theirweight, patients were able to stand and participate in balanceretraining involving visual biofeedback. The preliminary re-sults provided support for utilization of the new weightsupported pre-gait balance therapy in rehabilitation of indi-viduals with recent stroke.Keywords: Rehabilitation, Stroke, Balance, Standing.

Poster 417

Increased Functional Recovery of AffectedUpper Extremity in an Adult 9 Years AfterCerebral Vascular Accident WithCombination Neuromuscular ElectronicStimulation and Somatosensory Stimulation: ACase Report.Curtis A. Merring, MOT (Brain & Spine RecoveryCenter University Medical Center Brackenridge,Austin, TX); Lauren Brandt, RN; Charlotte H.Smith, MD.

S285PM&R Vol. 1, Iss. 9S, 2009