dent to modified independent for all activities of daily living. Thepatient was ambulating with crutches for short distances and usinga manual wheelchair for longer distances. Since discharge, thepatient was seen in the outpatient clinic for prosthetic evaluation.Current plans are for fitting for an ischial containment suctionsocket with hydraulic knee and dynamic response foot as well as anacute inpatient rehabilitation stay for prosthetic training.Discussion: Knee dislocation is an uncommon injury but one thatcan have devastating results. Up to a third of patients with a kneedislocation can have a popliteal injury, including those cases inwhich the dislocation spontaneously resolves. Delays in diagnosingvascular injury can increase the chances of an amputation.Conclusions: Vascular evaluation and monitoring is necessaryafter a knee dislocation to decrease chances of an amputation. Ifamputation becomes necessary, then acute inpatient rehabilitationis key to preparing the patient for prosthetic fitting as well as forprosthetic training.

Poster 391How 2 Tube-dependent Babies Learned to Eat: AnInterdisciplinary Rehabilitation Approach, A CaseSeries.Poonam Manasa, MD (University of Miami, Miami, FL,United States); Andrew L. Sherman, MD.

Disclosures: P. Manasa, none.Patients or Programs: Patient A: a 12-month-old Asian girl;patient B: a 19-month-old Asian girl.Program Description: Patient A presented with failure to thriveand dehydration, secondary to feeding aversion at 3 months old. Athorough workup revealed acid reflux, which was medically treated.Patient B presented with failure to thrive, secondary to feedingaversion at 6 months old. A thorough workup revealed pylorichypertrophy, which was surgically treated. Despite adequate med-ical treatment, both patients continued having severe feeding aver-sion and became gastric (G) feeding-tube dependent. Weeklyspeech therapy produced no improvement. Treatment: led by adevelopmental psychologist and an occupational therapist, an ag-gressive home-based tube wean was instituted. It reduced tube feedvolumes gradually until finally all tube feeds were discontinued.Exposure to varied food without pressure to eat was provided in aplay picnic format.Setting: Large academic medical center department of rehabilita-tion.Results: Results and Assessments: patient A responded to reversepsychology and learned to drink from a straw and an open cup.Because patient B preferred a lower stress environment, she was thusexposed to food at a slower pace and learned to avoid pocketingfood in buccal compartments. No major complications occurredduring treatment. Both patients initially lost weight, but regained itand maintained hydration without G-tube supplementation.Discussion: Although many medical conditions require NG- orG-tube placement in children, knowledge on how to effectively tubewean them when the underlying medical problem is resolved islacking. Hospital-based or outpatient tube-weaning rehabilitationprograms are scarce, scattered across the world, and rarely reim-bursed by insurance. Weekly outpatient speech therapy is insuffi-cient in many cases.Conclusions: A home-based, hunger-motivated interdisciplin-ary rehabilitation program with multiple therapies and an emphasis

on understanding a child’s individual motivating factors, can resultin a rapid, successful wean from G-tube dependency.

Poster 392Temporal Encephalocele and CholesteatomaComplicating Severe Pediatric Traumatic BrainInjury: A Case Report and Review of the Literature.Kimberly Hartman, MD (Cincinnati Children’s HospitalMedical Center and University of Cincinnati UniversityHospital, Cincinnati, OH, United States); Francesco T.Mangano, DO, Linda J. Michaud, MD, Ravi Samy, MD.

Disclosures: K. Hartman, none.Patients or Programs: A 17-year-old boy with severe traumaticbrain injury (TBI).Program Description: The patient presented 7 years after se-vere TBI and comminuted right temporal bone fracture that in-volved the squamosal and mastoid portions, the roof and floor of theexternal auditory canal, and tegmen tympani with disruption of theincudostapedial joint. He had persistent, recurrent episodes of otitismedia, with green, malodorous discharge that did not resolve withrepeated courses of antibiotics. He also had hearing loss in his rightear, which had been present since the time of injury, and hadlate-onset progressive worsening of cognitive function. The patienthad not undergone surgical intervention after injury and was lost tofollow-up for many years.Setting: Tertiary care pediatric hospital.Results: On examination, the right tympanic membrane could notbe visualized due to copious discharge. Magnetic resonance imagingrevealed significant a chronic fracture defect of the medial tegmentympani with herniation of temporal lobe parenchyma into thedefect and cholesteatoma. Two areas of encephalomalacia that ex-tended into the temporal bone fracture were resected, and duralrepair was performed by neurosurgery. To address the cholestea-toma, he concurrently underwent right middle cranial fossa floorrepair, with temporalis fascia and cranial bone grafting by otolaryn-gology and neurosurgery. After these repairs, he developed recur-rent cholesteatoma, managed with external auditory canal repairrevision, tympanomastoidectomy, and prosthetic cartilage grafting,and placement of a partial ossicular reconstruction prosthesis torestore hearing.Discussion: Herniation of brain parenchyma through dural andosseous defects in the temporal bone is a rare late complication oftemporal bone fracture and, to our knowledge, this is the firstreported case in the pediatric TBI population.Conclusions: Temporal bone fractures are rare in pediatric TBI,however, significant late sequelae, such as encephalocele and cho-lesteatoma, are possible. Otorrhea after temporal bone fracturerequires close monitoring and evaluation because preventable com-plications may contribute to significant secondary disability.

Poster 393Comparison of Lower Extremity Joint Motion ofChildren With Different Diagnoses of Inborn Errors ofMetabolism.Mark Kasmer (MCW, Wauwatosa, WI, United States);Fred T. Klingbeil, MD, Xuecheng Liu, MD, PhD.

Disclosures: M. Kasmer, none.Objective: The neurologic symptoms of inborn errors of metab-olism can closely parallel features of cerebral palsy and even be

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