This document contains summaries of several poster presentations from an annual medical conference. It includes 3 posters on topics related to brain injury and rehabilitation: 1. A study examining factors that contribute to fatigue after traumatic brain injury, finding that depression, memory problems, pain, and abnormal hormone levels were significant predictors of fatigue. 2. A study validating a new pain assessment scale called the Scale of Pain Intensity for patients with cognitive and communication deficits after brain injury. It was found to accurately identify pain and track changes. 3. A study finding an increasing incidence of traumatic brain injury in the elderly using national hospitalization data, suggesting this may be an area for further research.

1. ACADEMY ANNUAL ASSEMBLY ABSTRACTS E13
Poster 11 tively). For the GFI, 3 variables were significant predictors: the pain
The Significance of Radiographs in Hip Pain. Dexter Wong, MD VAS (P .001), BDI-II (P .001), and NFI memory subscale
(Stanford University, Palo Alto, CA); Darren Don, MD; Esther (P .013). None of the other variables significantly contributed to
Kim, MD; Navjeet Boporai, MD; David Ben-Aviv, MD; Raj Mitra, prediction of FSS or GFI scores. Conclusions: Fatigue after TBI is a
MD. widespread problem. Depression and memory problems both contrib-
Disclosure: D. Wong, None; D. Don, None; E. Kim, None; N. Bopo- uted significantly to the prediction of FSS and GFI scores. A third
rai, None; D. Ben-Aviv, None; R. Mitra, None. variable, pain, was found to significantly predict GFI scores; this
Objectives: To determine if there is a correlation between the suggests that the 2 fatigue scales may be sensitive to different aspects
severity of hip arthritis and response to fluoroscopically guided steroid of fatigue. Pain, depression, sleep disorders, and hypothyroidism are
injections to the hip; and to investigate whether there is significant the most readily treatable conditions associated with fatigue. Compen-
improvement from injections in those with severe hip pain. Design: sation for memory difficulties probably contributes to fatigue. Key
Fluoroscopically guided intra-articular steroid injections were per- Words: Brain injuries; Depression; Endocrine diseases; Fatigue; Re-
formed on 10 patients. The data were retrospectively reviewed. Set- habilitation.
ting: Spine and pain clinic over a 2-year period. Participants: 10 of
130 men and women with hip pain. Interventions: Fluoroscopic
Poster 13
guidance was used to place a 25-gauge 3.5-in needle into the hip joint;
Screening for Pain Using the Scale of Pain Intensity: A Pain
placement was confirmed with Omnipaque 240 contrast dye, which
Assessment Tool Designed for Patients With Cognitive and Com-
revealed a hip arthrogram. All patients received an injection mixture of
munication Deficits Following Acquired Brain Injury. Lynne
80mg of triamcinolone and 4mL of 1% lidocaine. Their responses
Turner-Stokes, DM, FRCP (King’s College London, London,
were recorded by visual analog scale (VAS) for pain, obtained before
UK); Rebecca Disler, MSc; Heather Williams, MSc.
and 3 weeks after the procedure. Hip arthritis severity was measured
Disclosure: L. Turner-Stokes, None; R. Disler, None; H. Williams,
by the Kellgren-Lawrence grading scale. Main Outcome Measures:
None.
Change in VAS and patient’s severity of hip arthritis as described
Objective: To examine the validity, reliability, and utility of the
above. Results: Based on the Fisher exact test, there was no correla-
Scale of Pain Intensity (SPIN) as a screening tool for pain in patients
tion between hip arthritis and steroid injection (P .45). Also, people
with complex neurodisability. Design: A prospective cohort analysis.
with the most severe pain, based on a VAS score, did not seem to have
Setting: A tertiary inpatient neurorehabilitation service for severely
additional significant benefit from steroid injection (P .46). However,
disabled younger adults. Participants: 57 of 65 consecutive admis-
83.3% of injections resulted in significant improvement from the
sions with a median age of 50 years (IQR, 31–55) and male to female
intervention, while 0% injections resulted in worsening pain. Conclu-
ratio of 1:1. All had physical disability: 75% had communicative and
sions: The severity of hip osteoarthritis on radiographs is not a good
30% had cognitive deficits. Interventions: Screening according to a
predictor of clinically significant hip osteoarthritis, as determined by
standardized protocol, which includes inquiry for pain symptoms,
positive response to hip steroid and local anesthetic injections. Key
administration of the SPIN, and a Numbered Graphic Rating Scale
Words: Injections; Rehabilitation; Steroids; Visual analogue pain
(NGRS) for those (n 36) who were able. Repeat (blind) assessment of
scale.
the SPIN was undetected in 24 hours (n 23). Main Outcome Mea-
sures: The SPIN (possible score range, 0 –5) and converted NGRS
Brain Injury (normative range, 0 –10; divided by 2 to range, 0 –5). Results: 46 of 57
(80%) patients were able to use the SPIN screen (5 unable, 6 uncer-
tain). Of 32 (60%) patients who reported pain, the median SPIN score
Poster 12
was 2 (range, 1– 4), compared with 0 (range, 0 –2) in those reporting
Fatigue After Traumatic Brain Injury and Potential Contributing
no pain (Mann-Whitney z 5.9, P .001). There was a strong corre-
Factors. Jeffrey Englander, MD (Santa Clara Valley Medical Ctr,
lation between the SPIN and NGRS (Spearman .96, P .001).
San Jose, CA); Tamara Bushnik, PhD.
Weighted Cohen tests showed excellent agreement with the con-
Disclosure: J. Englander, NIDRR grant no. H133N020524 and Pfizer
verted NGRS score (.94). Of those who had a repeat assessment, 14
Inc; T. Bushnik, NIDRR grant no. H133N020524 and Pfizer Inc.
(60.9%) indicated that their level of pain had changed since the day
Objective: To examine the association between fatigue after trau-
before and 6 (26.1%) indicated the same level of pain. These changes
matic brain injury (TBI) and factors that have been suggested as
were reflected in their SPIN scores, with correspondingly reduced
contributing to fatigue. Design: Prospective, observational. Setting:
agreement ( .59) with the initial SPIN assessment. Conclusions:
Hospital research laboratory. Participants: 144 subjects with TBI of
The SPIN appears to provide a valid screening instrument for the
at least 1 year in duration completed questionnaires and underwent
presence of pain, which was also sensitive to change. It also seemed to
neuroendocrine testing. Interventions: Not applicable. Main Out-
be more accessible to more patients with cognitive and communicative
come Measures: Fatigue Severity Scale (FSS); Global Fatigue Inven-
deficits than conventional pain scales such as the NGRS. Further
tory (GFI); neuroendocrine levels, including peak growth hormone
testing is now warranted. Key Words: Pain assessment; Rehabilita-
(GH) levels after intramuscular glucagon stimulation; pain visual
tion.
analog scale (VAS); Beck Depression Inventory–II (BDI-II); Pitts-
burgh Sleep Quality Index; Neurobehavioral Functioning Inventory
(NFI) somatic, memory, and motor subscales. Results: 63% had Poster 14
abnormal peak GH levels (32%, 3ng/mL; 31%, 3–9.9ng/mL); 11% Increasing Incidence of Traumatic Brain Injury in the Elderly.
had central hypothyroidism; 11% of men had low testosterone; and Elliot B. Bodofsky, MD (UMDNJ-Cooper University Hospital,
60% presented with low basal cortisol ( 15 g/dL). Multiple regres- Camden, NJ); Frank Camaratta, MSPT.
sion analyses revealed that the independent variables predicted 45% of Disclosure: E.B. Bodofsky, None; F. Camaratta, None.
the FSS variance (F 13.467, P .001) and 59% of the GFI variance Objective: To determine changes in the incidence of brain injury in
(F 23.364, P .001). For the FSS, the BDI-II and NFI memory the elderly, as well as possible causes. Design: Review of data from
subscales were the 2 significant predictors (P .003, P .044, respec- the HealthCare Utilization Project. Setting: A stratified random survey
Arch Phys Med Rehabil Vol 88, September 2007