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Poster 15
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Corrections The following 3 abstracts were marked as “Canceled” and not included in the online edition of the October 2006 issue: Poster 11 The Acute Impact of Stroke on Functioning. Lois E. Finch, MSc (McGill University, Montreal, QC, Canada) J.M. Higgins, N.E. Mayo. Disclosure: None declared. Objective: To develop a measure of the acute impact of stroke on functioning by combining items from self-report and observational indices. Design: Observational. Setting: A large urban acute care hospital stroke unit. Participants: Consecutive subjects (N⫽235) admitted within 3 days of a stroke, either ischemic or hemorrhagic. Subjects were predominately male (age ⫾ SD, 71.6⫾12.5y), with ischemic stroke. Interventions: Not applicable. Main Outcome Measures: Functional assessments were made at 3 days poststroke, using 11 indices and tests commonly used to evaluate stroke survivors (total items, 171). Information on potentially important variables was also collected. Rasch analysis assisted in constructing the calibrated linear measure. Results: The 171 items reduced to a 38-item unidimensional measure, the acute impact of stroke on functioning, containing items on upper- and lower-extremity movement, balance, mobility, and activities of daily living. All Rasch model assumptions were met. Both person and item reliability (.97) indicated a stable hierarchy. Precision of the items and persons were .37 and 1.3 logits, respectively. Conclusions A single index quantifying the acute impact of stroke on functioning was developed. This measure may assist in matching patients to therapeutic options earlier. Key Words: Recovery of function; Rehabilitation. Poster 15 Safety and Efficacy of Repeated Botulinum Toxin Type A Treatments for Focal Upper-Limb Poststroke Spasticity: Results of a 12-Month Multicenter, Open-Label Trial. E. Elovic (Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ), A. Brashear, D. Kaelin, R. McIntosh, J. Liu, C. Turkel. Disclosure: Supported by Allergan. Elovic, Brashear, and Kaelin have received grant support from Allergan and have been or are on Allergan’s speakers bureau; Liu and Turkel are employees of Allergan. Objective: To evaluate long-term safety and efficacy of repeated botulinum toxin type A (BTX-A) (Botox) injections in the treatment of focal upper-limb poststroke spasticity. Design: Multicenter, open-label study. Setting: 35 North American study centers. Participants: 279 upper-limb poststroke spasticity patients. Interventions: Up to 5 BTX-A treatments (200 – 400U each) administered to the wrist, finger, and elbow flexors. Main Outcome Measures: Safety and efficacy were assessed by reported
adverse events (AEs), the Ashworth Scale, and the Disability Assessment Scale. One disability domain was selected and measured as the principal therapeutic intervention target. Results: 6.5% of patients reported AEs judged to be treatment-related, none of which was serious. Muscle tone in the wrist, fingers, and elbow improved considerably by week 6 and functional disability also improved with at least 50% of patients achieving a minimum 1-point improvement in principal therapeutic intervention target. Conclusions: Repeated BTX-A treatment safely improves upper-limb spasticity in poststroke patients. The low incidence of AEs represents an advantage over oral antispasticity medications associated with systemic side effects. Key Words: Botulinum toxin type A; Muscle spasticity; Rehabilitation. Poster 78 Objective Assessment of Changes in Gait Using Pedobarography, While Walking and Running After Botulinum Toxin Injections in the Management of Equinovarus Deformity: A Case Study. Gary N. Galang (Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ), Karen J. Nolan, Elie P. Elovic.
Disclosure: None declared. Objective: To objectively demonstrate changes in gait at different velocities after chemoneurolytic intervention for spastic equinovarus deformity. Design: Case study pre- and postintervention design. Setting: Outpatient rehabilitation center. Participants: Single patient diagnosed with spastic equinovarus gait secondary to traumatic brain injury treated in an open-label fashion. Intervention: Botulinum toxin injections to the right gastrocnemius muscles. Main Outcome Measures: Wireless pedobarography variables included regional analysis of contact time, contact area, peak pressure, percentage of single support, and percentage of stance. Results During running there was a significant decrease in lateral contact area (P⫽.027) that only approached significance during walking. During walking, an increase in medial contact area and peak pressure on the medial region was noted but only approached significance. For both walking and running, there was a trend to an increase in heel contact time during footstrike. In addition, percentage of stance and single support on the affected limb increased during both conditions but again only approached significance. Conclusions: Pedobarography was able to objectively demonstrate changes during gait after chemoneurolysis. The differences in spasticity effects at different velocities of gait was also demonstrated. Key Words: Gait; Muscle spasticity; Rehabilitation.
In the online edition of the October 2006 issue, the authors and order of authorship of poster 49 are: Strangman G, Buchbinder M, Goldstein R, Kelkar K, O’Neil-Pirozzi T, Rauch S, Savage C, Glenn M. Relationship between volume of cortical structures and scores on memory testing in people with traumatic brain injury. Arch Phys Med Rehabil 2006;87(10):E21.
In the online edition of the November 2006 issue, the authors of poster PR_259 are: Motycka PL, Piderman KM, Bida JP, Hanson AC, Mueller PS, Reeves RK. A pilot study of the interaction between spirituality and rehabilitation outcome in patients with spinal cord injury or disease. Arch Phys Med Rehabil 2006;87(11):E48.
Arch Phys Med Rehabil Vol 88, March 2007
Corrections The following 3 abstracts were marked as “Canceled” and not included in the online edition of the October 2006 issue: Poster 11 The Acute Impact of Stroke on Functioning. Lois E. Finch, MSc (McGill University, Montreal, QC, Canada) J.M. Higgins, N.E. Mayo. Disclosure: None declared. Objective: To develop a measure of the acute impact of stroke on functioning by combining items from self-report and observational indices. Design: Observational. Setting: A large urban acute care hospital stroke unit. Participants: Consecutive subjects (N⫽235) admitted within 3 days of a stroke, either ischemic or hemorrhagic. Subjects were predominately male (age ⫾ SD, 71.6⫾12.5y), with ischemic stroke. Interventions: Not applicable. Main Outcome Measures: Functional assessments were made at 3 days poststroke, using 11 indices and tests commonly used to evaluate stroke survivors (total items, 171). Information on potentially important variables was also collected. Rasch analysis assisted in constructing the calibrated linear measure. Results: The 171 items reduced to a 38-item unidimensional measure, the acute impact of stroke on functioning, containing items on upper- and lower-extremity movement, balance, mobility, and activities of daily living. All Rasch model assumptions were met. Both person and item reliability (.97) indicated a stable hierarchy. Precision of the items and persons were .37 and 1.3 logits, respectively. Conclusions A single index quantifying the acute impact of stroke on functioning was developed. This measure may assist in matching patients to therapeutic options earlier. Key Words: Recovery of function; Rehabilitation. Poster 15 Safety and Efficacy of Repeated Botulinum Toxin Type A Treatments for Focal Upper-Limb Poststroke Spasticity: Results of a 12-Month Multicenter, Open-Label Trial. E. Elovic (Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ), A. Brashear, D. Kaelin, R. McIntosh, J. Liu, C. Turkel. Disclosure: Supported by Allergan. Elovic, Brashear, and Kaelin have received grant support from Allergan and have been or are on Allergan’s speakers bureau; Liu and Turkel are employees of Allergan. Objective: To evaluate long-term safety and efficacy of repeated botulinum toxin type A (BTX-A) (Botox) injections in the treatment of focal upper-limb poststroke spasticity. Design: Multicenter, open-label study. Setting: 35 North American study centers. Participants: 279 upper-limb poststroke spasticity patients. Interventions: Up to 5 BTX-A treatments (200 – 400U each) administered to the wrist, finger, and elbow flexors. Main Outcome Measures: Safety and efficacy were assessed by reported
adverse events (AEs), the Ashworth Scale, and the Disability Assessment Scale. One disability domain was selected and measured as the principal therapeutic intervention target. Results: 6.5% of patients reported AEs judged to be treatment-related, none of which was serious. Muscle tone in the wrist, fingers, and elbow improved considerably by week 6 and functional disability also improved with at least 50% of patients achieving a minimum 1-point improvement in principal therapeutic intervention target. Conclusions: Repeated BTX-A treatment safely improves upper-limb spasticity in poststroke patients. The low incidence of AEs represents an advantage over oral antispasticity medications associated with systemic side effects. Key Words: Botulinum toxin type A; Muscle spasticity; Rehabilitation. Poster 78 Objective Assessment of Changes in Gait Using Pedobarography, While Walking and Running After Botulinum Toxin Injections in the Management of Equinovarus Deformity: A Case Study. Gary N. Galang (Kessler Medical Rehabilitation Research and Education Corp, West Orange, NJ), Karen J. Nolan, Elie P. Elovic.
Disclosure: None declared. Objective: To objectively demonstrate changes in gait at different velocities after chemoneurolytic intervention for spastic equinovarus deformity. Design: Case study pre- and postintervention design. Setting: Outpatient rehabilitation center. Participants: Single patient diagnosed with spastic equinovarus gait secondary to traumatic brain injury treated in an open-label fashion. Intervention: Botulinum toxin injections to the right gastrocnemius muscles. Main Outcome Measures: Wireless pedobarography variables included regional analysis of contact time, contact area, peak pressure, percentage of single support, and percentage of stance. Results During running there was a significant decrease in lateral contact area (P⫽.027) that only approached significance during walking. During walking, an increase in medial contact area and peak pressure on the medial region was noted but only approached significance. For both walking and running, there was a trend to an increase in heel contact time during footstrike. In addition, percentage of stance and single support on the affected limb increased during both conditions but again only approached significance. Conclusions: Pedobarography was able to objectively demonstrate changes during gait after chemoneurolysis. The differences in spasticity effects at different velocities of gait was also demonstrated. Key Words: Gait; Muscle spasticity; Rehabilitation.
In the online edition of the October 2006 issue, the authors and order of authorship of poster 49 are: Strangman G, Buchbinder M, Goldstein R, Kelkar K, O’Neil-Pirozzi T, Rauch S, Savage C, Glenn M. Relationship between volume of cortical structures and scores on memory testing in people with traumatic brain injury. Arch Phys Med Rehabil 2006;87(10):E21.
In the online edition of the November 2006 issue, the authors of poster PR_259 are: Motycka PL, Piderman KM, Bida JP, Hanson AC, Mueller PS, Reeves RK. A pilot study of the interaction between spirituality and rehabilitation outcome in patients with spinal cord injury or disease. Arch Phys Med Rehabil 2006;87(11):E48.
Arch Phys Med Rehabil Vol 88, March 2007