independently. Post-hoc analysis demonstrated a statistically signif-icant correlation between greater age of participants and livingindependently. Secondary outcome from qualitative questions sug-gested many adults with spina bifida feel parents had been overpro-tective.Conclusions: Family counseling unlikely to incite an adult withspina bifida to transition to independence. Participants who con-tinue not to live independently are not necessarily discontentedwith their circumstances .The average age not living independentlywas 24.

Poster 430Complementary and Alternative Medicine Use inAdult Cerebral Palsy: Needs, Barriers and Impacton Quality of Life.David Berbrayer, MD, Bsc (MED), FRCPC, DABPMR (Uni-versity of Toronto, Toronto, Ontario, ON, Canada).

Disclosures: D. Berbrayer, No Disclosures.Objective: To determine whether the use of complementary andalternative medicine (CAM) is a significant determinant of health inadult cerebral palsy, identify motivations for seeking CAM therapiesand classify barriers to its use. The health outcome of most impor-tance was quality of life, as measured by the WHO DisabilityAssessment Score.Design: Structured survey administered at a tertiary academicinstitution. Survey was separated into three components: 1) demo-graphics 2) use of CAM modalities presented as options on surveywere: acupuncture, adeli suit, aquatic therapy, biofeedback, chiro-practic, equine therapy, functional electrical stimulation, herbal/vitamin supplements, homeopathy, hyperbaric oxygen, massagetherapy, naturopathy, prayer, relaxation therapy, stem cell therapy,traditional Chinese medicine; 3) health outcome: quality of life(adapted from WHO Disability Assessment Schedule). CAM use iscommon in adults with cerebral palsy (76%). Patient recruitment: inperson or by mail. All patients in the clinic’s patient registry wereinvited to participate; 169 approached, 19 consented, 17 completedthe survey, exclusion criteria: cognitive impairment.Setting: Tertiary academic hospital.Participants: 17 adults with cerebral palsy: 8 males, 9 females,average age: 43.7 (20-88), average years school: 14.8 (8-18) 81.25%living independently or with family.Interventions: Use of CAM modalities WHO Disability Assess-ment.Main Outcome Measures: Structured survey at clinic or on-line.Results: 76% used 1 CAM modality in last 12 months, and 12%were interested in using CAM massage and herbal supplements. Themost used barriers to CAM: too expensive and lack of information/providers. Subjective effects of CAM; improve function, reducepain, improve sleep and energy. WHO Disability assessment: aver-age disability score for CAM users, 28.8%. Average disability scorefor those who had not used CAM in the past 12 months was 53.0%.Conclusions: CAM use is common in adult cerebral palsy (76%).Barriers to CAM access are common - financial barriers, lack ofinformation and providers, and accessibility issues. Most users ofCAM perceive improvement in symptoms (most commonly citedbenefits - improved function and energy as well as reduced pain).Average disability differs by 24% between CAM users and non-users.

Poster 431Bilateral Foot and Ankle Paresis Following aGunshot Wound to the Head with a Bullet Lodgedin The Superior Sagittal Sinus: A Case Report.Desiree Roge, MD (Children’s Mercy Hospital, KansasCity, MO, United States).

Disclosures: D. Roge, No Disclosures.Case Description: A 15-year-old patient presented with bilat-eral foot and ankle paresis and numbness after suffering a gunshotwound to the apex of his skull. There was no loss of consciousness,trauma to his spine or to the lower extremities. He denied radicularpain in his legs, saddle anesthesia or bowel or bladder dysfunction.On physical examination he had no strength in ankle dorsiflexors,plantarflexors or foot muscles. Sensory deficits were present in anon peripheral nerve and non dermatomal distribution. Proximallower extremity and hip musculature was preserved. His patellarand Achilles reflexes were present. CT imaging of the head with andwithout contrast revealed “comminuted depressed skull fracture ofthe parietal bone at the midline of the vertex of the calvariumcausing mass effect focally narrowing the superior sagittal sinuswithout evidence of sagittal sinus occlusion, thrombosis, or extrav-asation.”Setting: Tertiary-care pediatric hospital.Results or Clinical Course: Differential diagnosis includedbilateral peripheral nerve injury to the sciatic nerve, spinal cordinjury or a focal midline lesion to the primary motor cortex. In thispatient, his deficits were best explained by a focal midline injury tothe motor cortex based on history, detailed physical examinationand neuroimaging studies available. Bullet was removed surgically.Sensory deficits improved but weakness remained. By discharge thepatient was able to ambulate independently with carbon fiber ankle-foot orthosis.Discussion: To our knowledge, this is the first reported case ofbilateral foot and ankle weakness following focal midline trauma tothe head irritating the primary motor cortex. This case also under-scores the importance of correlating clinical history and physicalexamination to imaging studies for functional neuro-anatomicallocalization of a lesion. Such a practice yields appropriate andcost-effective diagnostic and therapeutic interventions.Conclusions: Bilateral focal motor deficits are possible after pen-etrating head injury when the lesion is located midline in the motorstrip.

Poster 432An Unusual Cause of Peripheral Neuropathy in anAdolescent Patient in an Acute RehabilitationSetting. A Case Report.Diara Gross, DO (NYU Rusk Institute, New York, NY,United States); Renat R. Sukhov, MD.

Disclosures: D. Gross, No Disclosures.Case Description: The child was admitted to nearby tertiaryhospital with symptoms of fever and hemoptysis. Clinical coursewas complicated by development of multifocal pneumonia and leftalveolar hemorrhage. He consequently required advanced respira-tory support in an intensive care setting. Patient’s course was furthercomplicated by the development of pneumomediastinum, pneumo-pericardium, left apical pneumothorax, right pneumothorax and aright upper lobe cavitary lesion. As a part of the diagnostic work-up,

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