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Poster 365: Does a 3-Sip Test Detect Dysphagia in Acute Stroke Rehabilitation Patients?
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
Stroke Poster 360 A Comparative Study of Stroke Rehabilitation in North and South America. Kanakadurga R. Poduri, MD (University of Rochester, Rochester, NY); Maria Isabel Buratto Gianini, MD. Disclosure: M. Buratto Gianini, none; K.R. Poduri, none. Objective: To compare the functional outcomes of stroke patients in Brazil and USA. Design: 2 physiatrists studied 25 stroke patients from each country. Patients in Brazil (group 1) were admitted to an inpatient rehabilitation ward and followed by the physiatrist from day 1 of the onset of stroke. Their functional status was monitored on the FIM on admission, weekly, and at discharge in the areas A through M. Similarly, the stroke patients in the U.S. (group 2) admitted to a hospital-based acute inpatient rehabilitation unit were monitored by the physiatrist in terms of their functional status on the FIM at admission, weekly, and at discharge. The patients were comparable in age, sex, and type of stroke (by computed tomography and magnetic resonance imaging). The admission and discharge FIM scores, length of stay (LOS) in days, and the FIM efficiency ratios were compared for the groups using a Student t test. Participants: Stroke patients admitted to the acute rehabilitation units in the U.S. and acute intensive care unit in Brazil. Interventions: Not applicable. Results: The average admission FIM score for group 1 was 33.8 compared with 43 for group 2. The discharge FIM score for group 1 was 67.3, with an average gain of 33.5 points, and 70 for group 2, with an average gain of 26 points. For group 1 and 2, the average LOS were 13 and 32 respectively, and the average efficiency ratios were 1.08 and 1.0 respectively. The difference in admission scores between the groups of 9.2 with an SE of 6.1 and t score of 1.52 (9.2/6.1) is not statistically significant. Similarly, a 2.7 difference in the discharge FIM scores between the groups, with an SE of 6.12 and t score of 0.44 is not significant. The difference in the efficiency ratios between the groups is 0.08, with SE of 0.43 and t score of 0.18 is also not statistically significant. However, LOS difference between the groups of 18.8 with SE of 2.34 with t score 8.04 is highly significant (P⬎.001). Conclusions: The comparison of outcomes of stroke patients in 2 different countries showed no differences in terms of their functional gains, however, patients (hemorrhagic strokes) are kept longer in the hospitals in the U.S. at the time (1994) the study was done. Key Words: Rehabilitation; Stroke. Poster 361 Acute Stroke Hospitalization Therapy Exposure: Primary Stroke Center Versus Rural Community Hospital. Keturah R. Faurot, PA, MPH (University of North Carolina at Chapel Hill, Chapel Hill, NC); Patricia Gregory, MD; Wesley Ibazebo, MD. Disclosure: K.R. Faurot, none; P. Gregory, none; W. Ibazebo, none. Objective: To test the hypothesis that geographic disparities exist in exposure to acute stroke hospitalization therapies that could adversely affect access to postacute rehabilitation. Design: Community survey. Setting: University-based tertiary care hospital (UTH) and a rural community hospital. Participants: 54 stroke patients. Interventions: None. Main Outcome Measures: Patient’s self-reported exposure at the 2 above-mentioned facilities to physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP). Results: A total of 48 patients were evaluated for PT exposure, 34 from a UTH and 14 from rural community hospital. There was a significant difference in exposure to OT, with only 4 of 14 patients at the rural community hospital reporting OT exposure versus 27 of 37 at the UTH (P⬍0.005). There was also a significant difference in exposure to SLP, with 6 of 14 patients reporting exposure at the rural community hospital and 27 of 39 at the UTH (P⬍0.05). Exposure to PT did not differ significantly between the 2 institutions (P⫽.075). Conclusions: Acute stroke hos-
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pital evaluations by PT, OT, and SLP help to identify postacute needs. Disparities in access to these services create a barrier to accessing post-acute rehabilitation. Key Words: Rehabilitation; Health services accessibility; Stroke. Poster 362: Cancelled. Poster 363: Cancelled. Poster 364 Consistent Efficacy of Botulinum Neurotoxin Type A: A MetaAnalysis From 7 Multicenter Studies of Upper Limb Spasticity in Post-Stroke Patients. Christina M. Marciniak, MD (McGaw Medical Center of Northwestern University, Northwestern Medical School/Rehabilitation Institute of Chicago, Chicago, IL); Susan Abu-Shakra, MD; Frederick Beddingfield, MD, PhD; Steven Hua, PhD; Tatiana Y. Khariton, PhD; Amanda Vandenburgh, PhD; Jonathan Wagg, MD, PhD. Disclosure: S. Abu-Shakra, Allergan Inc, employment; F. Beddingfield, Allergan Inc, employment, stock options or bond holdings; S. Hua, Allergan Inc, employment; T.Y. Khariton, Pharsight Corp, employment; C.M. Marciniak, Allergan Inc, research grants; A. Vandenburgh, Allergan Inc, employment; J. Wagg, Allergan Inc, consulting fees or other remuneration. Objective: To assess the consistency of spasticity reduction, as assessed by Ashworth Scores, across trials evaluating botulinum neurotoxin type A (BTX-A; BOTOX, Allergan, Irvine, CA) in the upper limb of poststroke patients. Design: Pooled analyses from 7 doubleblind, placebo-controlled trials injecting wrist flexors, and from 4 of these trials in which finger and elbow flexors were injected. Setting: Multicenter global clinical sites. Participants: Poststroke upper limb spasticity patients (N⫽576). Interventions: One treatment of BTX-A at doses of 360 U or less in the upper limb (including at least ⱕ200U administered into the wrist and/or finger flexor muscles). Results: Patients’ mean age was 59⫾13 years and 48% were women. Mean time since stroke was 4.2⫾5.1 years (7% wereⱕ6mo, 20% were ⬎6 –12mo, 20% were ⬎1–2y, and 50% were ⬎2y). At baseline, mean Ashworth scores were 2.85⫾0.77 for the wrist, 2.93⫾0.81 for the fingers and 2.39⫾0.93 for the elbow flexors. Across the 7 studies, there was a robust and reproducible reduction in flexor muscle tone. Improvement was observed as early as week 1 to 2 with wrist Ashworth scores ranging from 1.3 to 1.9 and persisting through approximately week 9. Significant reductions continued through week 12 in some studies. Similar effect onset was seen for the finger and elbow flexors. Pain in the extremity was the most frequently reported adverse event (6.6% BTX-A vs 4.4% placebo). Conclusions: BTX-A treatment in the upper limb consistently improved muscle tone within 2 weeks of treatment, and this effect persisted through approximately week 9, with continued reduction through week 12 in some studies. Key Words: Botulinum Toxin Type A; Rehabilitation; Stroke. Poster 365 Does a 3-Sip Test Detect Dysphagia in Acute Stroke Rehabilitation Patients? Stephanie A. Kopey, DO (Metrohealth Medical Center, Cleveland, OH); John Chae, MD; Mary M. Vargo, MD. Disclosure: J. Chae, Afferent Inc, consulting fees or other remuneration; S.A. Kopey, none; M.M. Vargo, none. Objectives: (1) Evaluate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a 3-sip test performed within 24 hours of acute stroke center admission as a screening tool for identifying those who will exhibit clinically relevant dysphagia during acute rehabilitation. (2) For those who pass the 3-sip Arch Phys Med Rehabil Vol 89, November 2008
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ACADEMY ANNUAL ASSEMBLY ABSTRACTS
test, identify factors predictive of presentation with clinically relevant dysphagia. Design: Retrospective review. Setting: Acute stroke rehabilitation center. Participants: 223 stroke patients admitted to acute rehabilitation between July 2004 and September 2007. Interventions: Not applicable. Main Outcome Measures: A positive 3-sip test was defined as a cough or wet voice after 3 sips of water via a straw. Clinically relevant dysphagia was defined as aspiration or laryngeal penetration on modified barium swallow and/or aspiration pneumonia. Other measures included patient demographics, stroke characteristics, and FIM data. Results: 17 patients (7.6%) failed the 3-sip test. Of the 206 patients who passed the 3-sip test, 57 (27.7%) manifested clinically relevant dysphagia. The sensitivity and specificity of the 3-sip test were 40.8% and 98.7%, respectively. The PPV and NPV were 88% and 72.3%, respectively. Among those who passed the 3-sip test, univariate analysis identified FIM-total, motor, cognition, and eating scores; acute care length of stay; sex; age; and level of stroke (cortical/ subcortical/brainstem) as possible factors predictive of clinically relevant dysphagia. However, logistic regression identified FIM total as the only independent predictor (B⫽⫺0.066, P⬍.001); 59% of those with FIM total less than 50 developed dysphagia, compared with 15 % for those with FIM total greater than 50. Conclusions: The sensitivity of the 3-sip test is poor for stroke rehabilitation patients. For those who passed the 3-sip test, a low FIM total score is predictive of presenting with clinically relevant dysphagia. A high degree of clinical suspicion for dysphagia should remain after passing a 3-sip screening test, especially for those with FIM total less than 50. Key Words: Deglutition disorders; Rehabilitation; Stroke. Poster 366 Dose Response in Muscles Treated With Botulinum Neurotoxin Type A for Upper Limb Chronic Poststroke Spasticity: A PooledData Analysis. Stuart A. Yablon, MD (Methodist Rehabilitation Center, Jackson, MS). Disclosure: S.A. Yablon, Allergan Inc, consulting fees or other remuneration, Medtronic Inc, research grants, Merz Inc, consulting fees or other remuneration. Objective: To characterize dose-by-muscle treatment response in chronic poststroke spasticity patients treated with botulinum toxin type A (BTX-A; BOTOX, Allergan, Irvine, CA). Design: Pooled analyses from 7 double-blind, placebo-controlled trials. Setting: Multicenter clinical sites. Participants: Patients (N⫽576, mean age 59⫾13y, 48% women) with poststroke upper-limb spasticity. Interventions: 1 treatment of BTX-A at doses of 360U or less in the distal upper limb (including 200U in the wrist), with 12 weeks of followup. Main Outcome Measures: Ashworth score, Ashworth score change from baseline. Results: Dose response curves (Ashworth score change from baseline) for wrist, finger, and elbow flexor muscles were plotted as a function of BTX-A dose per injected muscle group. This was determined using the mathematical formula of: Ashworth score change from baseline⫽Eo ⫹ Emax x Dose / (Dose ⫹ ED50); where Eo⫽week 6 placebo Ashworth response, Emax⫽week 6 maximal response and ED50⫽BTX-A dose estimated to elicit half-maximal week 6 Ashworth response. Mean (⫾ SEM) Ashworth scores at baseline were 2.88⫾0.77 for the flexors of the wrist, 2.92⫾0.81 for the fingers and 2.39⫾0.93 for the elbow. Ashworth score change from baseline increased as a function of dose and were well described by saturating Emax functions of dose. Doses of approximately 50U in each of the following muscles: flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) and 100U in the biceps brachii demonstrated significant improvement in Ashworth scores. Conclusions: The Ashworth scores improved as a function of dose and were well described by the dose response curves. Dose-response relationship curves indiArch Phys Med Rehabil Vol 89, November 2008
cate that doses of BTX-A of approximately 50U in the FCR, FCU, FDP, FDS muscles and 100U in the biceps brachii resulted in significant reductions in Ashworth scores with proportionately less additional benefit seen with higher doses. Key Words: Rehabilitation. Poster 367: Cancelled. Poster 368 Effect of Concentric Isokinetic Knee Strength Training on Gait, Balance and Quality of Life in Chronic Stroke Patients. Ho Lee (Eulji University College of Medicine, Daejeon, South Korea); Jong Moon Kim; Gil Bo Noh. Disclosure: J. Kim, none; H. Lee, none; G. Noh, none. Objective: To determine the effects of concentric isokinetic knee strength training on gait, balance, and health-related quality of life in chronic stroke patients. Design: 15 patients with chronic stroke participated in this study. All subjects were community ambulators and trained using Biodex System 3 isokinetic dynamometer 3 times a week for 6 weeks. The training program consisted of concentric isokinetic strengthening of both knee extensors and flexors. Peak torque of knee extensors and flexors, walking performance (temporospatial parameter of gait and stair climbing time), balance (overall balance index, anterior/posterior index, and medial/lateral index) and health-related quality of life measure (36-item Short Form Health Survey [SF-36]) were evaluated before and after training period. Interventions: Not applicable. Results: Muscle strength improved significantly after training. Walking speed, stride length, and stair climbing time improved significantly after training. Balance indices and SF-36 score also improved significantly after training. Conclusions: Gain in muscle strength appeared to be transferred to functional improvement. Therefore, an isokinetic resistance training program would be one of the effective rehabilitation programs for chronic stroke survivors. Further investigations are required for long-term effect and development of strength-specific resistance training program. Key Words: Concentric; Rehabilitation; Stroke. Poster 369: Paper presentation. Poster 370 Electrophysiological Characteristics of Autonomic Nervous System Function in Post-Stroke Patients. Ho Joong Jeong (Kosin University College of Medicine, Busan, South Korea); Sung Bock Choi; Po Sung Jun; Do Sung Kim; Ji Heoung Lee; Young Joo Sim. Disclosure: S. Choi, none; H. Jeong, none; P. Jun, none; D. Kim, none; J. Lee, none; Y. Sim, none. Objective: To evaluate the autonomic nervous function in poststroke patients. Design: Randomized, controlled study. Setting: A Cadwell Exel Plus (Cadwell Laboratories, Washington) electroneuromyographic device was used. The electrophysiologic tests were performed in a semi-darkened and silent room. The sympathetic skin response (SSR) and the R-R interval variation (RRIV) were tested. Participants: A total of 58 subjects, 34 poststroke patients (mean age, 61.35y) and 24 healthy subjects (mean age, 39.56y). Interventions: Not applicable. Main Outcome Measures: The SSR, the RRIV, and orthostatic hypotension (OH) were evaluated. Bilateral sympathetic skin responses were recorded on the palm and sole with stimulation of both median and tibial nerves. The obtained SSRs were divided into normal response and abnormal response, including no response. The RRIV were estimated during rest, deep breathing, and Valsalva maneuver, respectively. Results: In all healthy subjects, obtained SSRs were of normal response. Although the rate of abnormal SSR was 75.4% (205 of 272 waves) in stroke patients, the rate of abnormal SSR
Stroke Poster 360 A Comparative Study of Stroke Rehabilitation in North and South America. Kanakadurga R. Poduri, MD (University of Rochester, Rochester, NY); Maria Isabel Buratto Gianini, MD. Disclosure: M. Buratto Gianini, none; K.R. Poduri, none. Objective: To compare the functional outcomes of stroke patients in Brazil and USA. Design: 2 physiatrists studied 25 stroke patients from each country. Patients in Brazil (group 1) were admitted to an inpatient rehabilitation ward and followed by the physiatrist from day 1 of the onset of stroke. Their functional status was monitored on the FIM on admission, weekly, and at discharge in the areas A through M. Similarly, the stroke patients in the U.S. (group 2) admitted to a hospital-based acute inpatient rehabilitation unit were monitored by the physiatrist in terms of their functional status on the FIM at admission, weekly, and at discharge. The patients were comparable in age, sex, and type of stroke (by computed tomography and magnetic resonance imaging). The admission and discharge FIM scores, length of stay (LOS) in days, and the FIM efficiency ratios were compared for the groups using a Student t test. Participants: Stroke patients admitted to the acute rehabilitation units in the U.S. and acute intensive care unit in Brazil. Interventions: Not applicable. Results: The average admission FIM score for group 1 was 33.8 compared with 43 for group 2. The discharge FIM score for group 1 was 67.3, with an average gain of 33.5 points, and 70 for group 2, with an average gain of 26 points. For group 1 and 2, the average LOS were 13 and 32 respectively, and the average efficiency ratios were 1.08 and 1.0 respectively. The difference in admission scores between the groups of 9.2 with an SE of 6.1 and t score of 1.52 (9.2/6.1) is not statistically significant. Similarly, a 2.7 difference in the discharge FIM scores between the groups, with an SE of 6.12 and t score of 0.44 is not significant. The difference in the efficiency ratios between the groups is 0.08, with SE of 0.43 and t score of 0.18 is also not statistically significant. However, LOS difference between the groups of 18.8 with SE of 2.34 with t score 8.04 is highly significant (P⬎.001). Conclusions: The comparison of outcomes of stroke patients in 2 different countries showed no differences in terms of their functional gains, however, patients (hemorrhagic strokes) are kept longer in the hospitals in the U.S. at the time (1994) the study was done. Key Words: Rehabilitation; Stroke. Poster 361 Acute Stroke Hospitalization Therapy Exposure: Primary Stroke Center Versus Rural Community Hospital. Keturah R. Faurot, PA, MPH (University of North Carolina at Chapel Hill, Chapel Hill, NC); Patricia Gregory, MD; Wesley Ibazebo, MD. Disclosure: K.R. Faurot, none; P. Gregory, none; W. Ibazebo, none. Objective: To test the hypothesis that geographic disparities exist in exposure to acute stroke hospitalization therapies that could adversely affect access to postacute rehabilitation. Design: Community survey. Setting: University-based tertiary care hospital (UTH) and a rural community hospital. Participants: 54 stroke patients. Interventions: None. Main Outcome Measures: Patient’s self-reported exposure at the 2 above-mentioned facilities to physical therapy (PT), occupational therapy (OT), or speech-language pathology (SLP). Results: A total of 48 patients were evaluated for PT exposure, 34 from a UTH and 14 from rural community hospital. There was a significant difference in exposure to OT, with only 4 of 14 patients at the rural community hospital reporting OT exposure versus 27 of 37 at the UTH (P⬍0.005). There was also a significant difference in exposure to SLP, with 6 of 14 patients reporting exposure at the rural community hospital and 27 of 39 at the UTH (P⬍0.05). Exposure to PT did not differ significantly between the 2 institutions (P⫽.075). Conclusions: Acute stroke hos-
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pital evaluations by PT, OT, and SLP help to identify postacute needs. Disparities in access to these services create a barrier to accessing post-acute rehabilitation. Key Words: Rehabilitation; Health services accessibility; Stroke. Poster 362: Cancelled. Poster 363: Cancelled. Poster 364 Consistent Efficacy of Botulinum Neurotoxin Type A: A MetaAnalysis From 7 Multicenter Studies of Upper Limb Spasticity in Post-Stroke Patients. Christina M. Marciniak, MD (McGaw Medical Center of Northwestern University, Northwestern Medical School/Rehabilitation Institute of Chicago, Chicago, IL); Susan Abu-Shakra, MD; Frederick Beddingfield, MD, PhD; Steven Hua, PhD; Tatiana Y. Khariton, PhD; Amanda Vandenburgh, PhD; Jonathan Wagg, MD, PhD. Disclosure: S. Abu-Shakra, Allergan Inc, employment; F. Beddingfield, Allergan Inc, employment, stock options or bond holdings; S. Hua, Allergan Inc, employment; T.Y. Khariton, Pharsight Corp, employment; C.M. Marciniak, Allergan Inc, research grants; A. Vandenburgh, Allergan Inc, employment; J. Wagg, Allergan Inc, consulting fees or other remuneration. Objective: To assess the consistency of spasticity reduction, as assessed by Ashworth Scores, across trials evaluating botulinum neurotoxin type A (BTX-A; BOTOX, Allergan, Irvine, CA) in the upper limb of poststroke patients. Design: Pooled analyses from 7 doubleblind, placebo-controlled trials injecting wrist flexors, and from 4 of these trials in which finger and elbow flexors were injected. Setting: Multicenter global clinical sites. Participants: Poststroke upper limb spasticity patients (N⫽576). Interventions: One treatment of BTX-A at doses of 360 U or less in the upper limb (including at least ⱕ200U administered into the wrist and/or finger flexor muscles). Results: Patients’ mean age was 59⫾13 years and 48% were women. Mean time since stroke was 4.2⫾5.1 years (7% wereⱕ6mo, 20% were ⬎6 –12mo, 20% were ⬎1–2y, and 50% were ⬎2y). At baseline, mean Ashworth scores were 2.85⫾0.77 for the wrist, 2.93⫾0.81 for the fingers and 2.39⫾0.93 for the elbow flexors. Across the 7 studies, there was a robust and reproducible reduction in flexor muscle tone. Improvement was observed as early as week 1 to 2 with wrist Ashworth scores ranging from 1.3 to 1.9 and persisting through approximately week 9. Significant reductions continued through week 12 in some studies. Similar effect onset was seen for the finger and elbow flexors. Pain in the extremity was the most frequently reported adverse event (6.6% BTX-A vs 4.4% placebo). Conclusions: BTX-A treatment in the upper limb consistently improved muscle tone within 2 weeks of treatment, and this effect persisted through approximately week 9, with continued reduction through week 12 in some studies. Key Words: Botulinum Toxin Type A; Rehabilitation; Stroke. Poster 365 Does a 3-Sip Test Detect Dysphagia in Acute Stroke Rehabilitation Patients? Stephanie A. Kopey, DO (Metrohealth Medical Center, Cleveland, OH); John Chae, MD; Mary M. Vargo, MD. Disclosure: J. Chae, Afferent Inc, consulting fees or other remuneration; S.A. Kopey, none; M.M. Vargo, none. Objectives: (1) Evaluate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of a 3-sip test performed within 24 hours of acute stroke center admission as a screening tool for identifying those who will exhibit clinically relevant dysphagia during acute rehabilitation. (2) For those who pass the 3-sip Arch Phys Med Rehabil Vol 89, November 2008
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ACADEMY ANNUAL ASSEMBLY ABSTRACTS
test, identify factors predictive of presentation with clinically relevant dysphagia. Design: Retrospective review. Setting: Acute stroke rehabilitation center. Participants: 223 stroke patients admitted to acute rehabilitation between July 2004 and September 2007. Interventions: Not applicable. Main Outcome Measures: A positive 3-sip test was defined as a cough or wet voice after 3 sips of water via a straw. Clinically relevant dysphagia was defined as aspiration or laryngeal penetration on modified barium swallow and/or aspiration pneumonia. Other measures included patient demographics, stroke characteristics, and FIM data. Results: 17 patients (7.6%) failed the 3-sip test. Of the 206 patients who passed the 3-sip test, 57 (27.7%) manifested clinically relevant dysphagia. The sensitivity and specificity of the 3-sip test were 40.8% and 98.7%, respectively. The PPV and NPV were 88% and 72.3%, respectively. Among those who passed the 3-sip test, univariate analysis identified FIM-total, motor, cognition, and eating scores; acute care length of stay; sex; age; and level of stroke (cortical/ subcortical/brainstem) as possible factors predictive of clinically relevant dysphagia. However, logistic regression identified FIM total as the only independent predictor (B⫽⫺0.066, P⬍.001); 59% of those with FIM total less than 50 developed dysphagia, compared with 15 % for those with FIM total greater than 50. Conclusions: The sensitivity of the 3-sip test is poor for stroke rehabilitation patients. For those who passed the 3-sip test, a low FIM total score is predictive of presenting with clinically relevant dysphagia. A high degree of clinical suspicion for dysphagia should remain after passing a 3-sip screening test, especially for those with FIM total less than 50. Key Words: Deglutition disorders; Rehabilitation; Stroke. Poster 366 Dose Response in Muscles Treated With Botulinum Neurotoxin Type A for Upper Limb Chronic Poststroke Spasticity: A PooledData Analysis. Stuart A. Yablon, MD (Methodist Rehabilitation Center, Jackson, MS). Disclosure: S.A. Yablon, Allergan Inc, consulting fees or other remuneration, Medtronic Inc, research grants, Merz Inc, consulting fees or other remuneration. Objective: To characterize dose-by-muscle treatment response in chronic poststroke spasticity patients treated with botulinum toxin type A (BTX-A; BOTOX, Allergan, Irvine, CA). Design: Pooled analyses from 7 double-blind, placebo-controlled trials. Setting: Multicenter clinical sites. Participants: Patients (N⫽576, mean age 59⫾13y, 48% women) with poststroke upper-limb spasticity. Interventions: 1 treatment of BTX-A at doses of 360U or less in the distal upper limb (including 200U in the wrist), with 12 weeks of followup. Main Outcome Measures: Ashworth score, Ashworth score change from baseline. Results: Dose response curves (Ashworth score change from baseline) for wrist, finger, and elbow flexor muscles were plotted as a function of BTX-A dose per injected muscle group. This was determined using the mathematical formula of: Ashworth score change from baseline⫽Eo ⫹ Emax x Dose / (Dose ⫹ ED50); where Eo⫽week 6 placebo Ashworth response, Emax⫽week 6 maximal response and ED50⫽BTX-A dose estimated to elicit half-maximal week 6 Ashworth response. Mean (⫾ SEM) Ashworth scores at baseline were 2.88⫾0.77 for the flexors of the wrist, 2.92⫾0.81 for the fingers and 2.39⫾0.93 for the elbow. Ashworth score change from baseline increased as a function of dose and were well described by saturating Emax functions of dose. Doses of approximately 50U in each of the following muscles: flexor carpi radialis (FCR), flexor carpi ulnaris (FCU), flexor digitorum profundus (FDP), and flexor digitorum superficialis (FDS) and 100U in the biceps brachii demonstrated significant improvement in Ashworth scores. Conclusions: The Ashworth scores improved as a function of dose and were well described by the dose response curves. Dose-response relationship curves indiArch Phys Med Rehabil Vol 89, November 2008
cate that doses of BTX-A of approximately 50U in the FCR, FCU, FDP, FDS muscles and 100U in the biceps brachii resulted in significant reductions in Ashworth scores with proportionately less additional benefit seen with higher doses. Key Words: Rehabilitation. Poster 367: Cancelled. Poster 368 Effect of Concentric Isokinetic Knee Strength Training on Gait, Balance and Quality of Life in Chronic Stroke Patients. Ho Lee (Eulji University College of Medicine, Daejeon, South Korea); Jong Moon Kim; Gil Bo Noh. Disclosure: J. Kim, none; H. Lee, none; G. Noh, none. Objective: To determine the effects of concentric isokinetic knee strength training on gait, balance, and health-related quality of life in chronic stroke patients. Design: 15 patients with chronic stroke participated in this study. All subjects were community ambulators and trained using Biodex System 3 isokinetic dynamometer 3 times a week for 6 weeks. The training program consisted of concentric isokinetic strengthening of both knee extensors and flexors. Peak torque of knee extensors and flexors, walking performance (temporospatial parameter of gait and stair climbing time), balance (overall balance index, anterior/posterior index, and medial/lateral index) and health-related quality of life measure (36-item Short Form Health Survey [SF-36]) were evaluated before and after training period. Interventions: Not applicable. Results: Muscle strength improved significantly after training. Walking speed, stride length, and stair climbing time improved significantly after training. Balance indices and SF-36 score also improved significantly after training. Conclusions: Gain in muscle strength appeared to be transferred to functional improvement. Therefore, an isokinetic resistance training program would be one of the effective rehabilitation programs for chronic stroke survivors. Further investigations are required for long-term effect and development of strength-specific resistance training program. Key Words: Concentric; Rehabilitation; Stroke. Poster 369: Paper presentation. Poster 370 Electrophysiological Characteristics of Autonomic Nervous System Function in Post-Stroke Patients. Ho Joong Jeong (Kosin University College of Medicine, Busan, South Korea); Sung Bock Choi; Po Sung Jun; Do Sung Kim; Ji Heoung Lee; Young Joo Sim. Disclosure: S. Choi, none; H. Jeong, none; P. Jun, none; D. Kim, none; J. Lee, none; Y. Sim, none. Objective: To evaluate the autonomic nervous function in poststroke patients. Design: Randomized, controlled study. Setting: A Cadwell Exel Plus (Cadwell Laboratories, Washington) electroneuromyographic device was used. The electrophysiologic tests were performed in a semi-darkened and silent room. The sympathetic skin response (SSR) and the R-R interval variation (RRIV) were tested. Participants: A total of 58 subjects, 34 poststroke patients (mean age, 61.35y) and 24 healthy subjects (mean age, 39.56y). Interventions: Not applicable. Main Outcome Measures: The SSR, the RRIV, and orthostatic hypotension (OH) were evaluated. Bilateral sympathetic skin responses were recorded on the palm and sole with stimulation of both median and tibial nerves. The obtained SSRs were divided into normal response and abnormal response, including no response. The RRIV were estimated during rest, deep breathing, and Valsalva maneuver, respectively. Results: In all healthy subjects, obtained SSRs were of normal response. Although the rate of abnormal SSR was 75.4% (205 of 272 waves) in stroke patients, the rate of abnormal SSR