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Poster 9 Relationships Between Ankle Spasticity and Strength, Walking Capacity and Self-Perceived Walking Limitations in Multiple Sclerosis
2012 ACRM–ASNR Annual Conference Abstracts
dose-escalation study in patients with GBS. Setting: University-based outpatient rehabilitation clinic. Interventions: A four-week duration of treatment with 30 milligrams per day of 4-AP in each sequence: 4-AP followed by placebo or placebo followed by 4-AP. Along with a one-week placebo washout between treatment periods. Participants: Nine patients enrolled. One patient withdrew before randomization. One patient withdrew due to relapse of chronic demyelinating polyneuropathy, not thought to be related to the medication. The remaining seven patients completed the study. Mean age was 57 years (range 27-73 years). Main Outcome Measures: Improvement in motor function and grip strength. Results: There were statistically significant improvements in motor function and grip strength with medication. Lower extremity strength score increased from 3.2 to 3.7 (p⫽0.0001), upper extremity strength score increased from 4.0 to 4.3 (p⫽0.0065), and bilateral grip strength increased from 8.2 to 12.2 pounds (p⫽0.0243). There was no significant improvement with placebo or change in the GBS Functional Assessment Index. Conclusions: Despite the small size of this study, the results indicated that 4-AP might improve motor function in GBS. Comparisons with placebo were likely not valid because of significant carryover effects with only a one-week washout in this crossover design. Most patients reported improved motor endurance while on 4-AP, including increased ambulation and repetitive hand movements. The medication was well tolerated. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Poster 9 Relationships Between Ankle Spasticity and Strength, Walking Capacity and Self-Perceived Walking Limitations in Multiple Sclerosis. Joanne M. Wagner (Saint Louis University, St. Louis, MO), Theodore R. Kremer. Disclosure: Joanne M. Wagner, Acorda Therapeutics, Speaker. Theodore R. Kremer has no disclosures. Objective: To determine the relationships between ankle spasticity, ankle strength, walking capacity and self-perceived walking limitations in ambulant persons with multiple sclerosis (pwMS). Design: Cross-sectional study. Setting: Research Laboratory. Participants: 42 pwMS (27 female, 15 male; age 42.9. ⫾ 10.1 years) with moderate clinical disability (EDSS 3.6 ⫾ 1.6). Interventions: Not applicable. Main Outcome Measures: Bilateral ankle plantarflexor (PF) spasticity was assessed using the Modified Ashworth Scale (MAS) and an isokinetic dynamometer. For the instrumented spasticity measure (ISM), the dynamometer measured the resistive torque of the PFs during passive ankle dorsiflexion (DF) at four different speeds. Data were processed to yield a single spasticity value for each ankle. Bilateral ankle DF and PF maximal voluntary isometric torque (MVIT) was assessed using an isokinetic dynamometer. Walking capacity was assessed by the Timed 25-Foot Walk Test (T25FWT) and the Six Minute Walk Test (6MWT). Self-perceived limitations in walking were documented by the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Results: Twenty-nine (69%) participants had PF spasticity (MAS ⱖ 1). PF spasticity was not related to PF strength (MAS ⫽ ⫺0.13; ISM ⫽ 0.02), but was weakly related to DF strength (MAS ⫽ ⫺0.36; ISM ⫽ 0.08) PF spasticity was weakly correlated with walking capacity (MAS || ⬍ 0.27; ISM || ⬍ 0.26) and self-perceived walking limitations (MAS || ⬍ 0.11; ISM || ⬍ 0.23). Ankle strength had a larger correlation with walking capacity (DF MVIT || ⬍ 0.45; PF MVIT || ⬍ 0.50) and self-perceived walking limitations (DF MVIT || ⬍ 0.35; PF MVIT || ⬍ 0.37). Conclusions: There is a limited relationship between ankle spasticity and ankle strength in ambulant pwMS. Ankle weakness may contribute to walking limitations in pwMS. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Poster 10 Assessment of Improvement of Functional Status of Chronic Guillain-Barré Syndrome with 4-Aminopyridine – Phase IIB
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Study. Jay Meythaler (Wayne State University, Detroit, MI, Oakwood Hospital, Dearborn, MI), Saurabha Bhatnagar. Disclosure: Jay Meythaler, Potential patent royalties to the University that may be shared discoverer, principle investigator, Patent filed by University in my name. Saurabha Bhatnagar discloses 4-Aminopyridine. Objective: To investigate whether orally administered 4-aminopyridine (4-AP) is effective in improving motor function in patients with Guillain-Barré syndrome (GBS). Design: Phase IIB double-blinded, randomized, placebo-controlled, crossover, dose-escalation trial in patients with GBS. Setting: University-based rehabilitation clinic. Interventions: An eight-week duration of treatment with a target dose of 30 milligrams per day of 4-AP in each sequence: 4-AP followed by placebo or placebo followed by 4-AP along with a three-week placebo washout between treatment periods. Participants: 19 subjects enrolled. Seven subjects withdrew prematurely: Three due to adverse events, two because of travel difficulties, one because of relocation, and one secondary to pretreatment laboratory abnormalities. The remaining 12 patients completed the study. Mean age was 59 years (range 23-77 years). Main Outcome Measures: Main outcome was the Functional Independence Measure (FIM) motor score. Secondary outcomes included motor strength, grip strength, six-minute walk test, and Medical Outcomes Study 12-Item Short Form. Results: There was a trend toward improvement in FIM motor scores (indicating greater functional independence) during 4-AP treatment (p⫽0.12). At baseline, the group, on average, had FIM scores near the upper limit, which produced a “ceiling effect,” i.e., reducing the amount of change that can be detected with the FIM. After removing three patients who entered the study with maximum FIM scores, the 4-AP treatment arm was superior to placebo (p⫽0.655). The three-week placebo washout may have been insufficient time. No statistically significant differences were found for the secondary measures. Conclusions: 4-AP may be beneficial for some patients with chronic weakness following GBS. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Poster 11 Characteristics of Hand Force Production for Lifting of an Object in Dementia Patients. Hiroshige Jinnouchi (Osaka University, Osaka, Japan). Disclosure: None disclosed. Objectives: Ability to produce lifting force appropriately tuned for weight of daily objects using visual information may decline with dementia. To investigate this, force generated during lifting of plastic bottles with/and without visual information of water volume was compared between elderly individuals with and without dementia. Design: Matched-pairs control group. Setting: Welfare institution for elderly people. Participants: Ten elderly patients with dementia (72-86 yrs., CDR ⱖ 1, MMSE ⱕ 20, FAB ⱕ 15), and 10 age-matched elderly controls (77-89 yrs., CDR ⱕ 0.5, MMSE ⱖ 27, FAB ⱖ 10). Interventions: Not applicable. Main Outcome Measures: The participants lifted small transparent or opaque (black) plastic tea bottles (230 mm height, 65 mm diameter) weighing 100 and 500 g repetitively from a force-transducer-equipped platform providing continuous lifting force information. Tests were performed under constant-weight and switching-weight conditions. Duration between lifting force increase and the bottle lift-off moment, average and peak lifting force rate, and their trial-to-trail variability were evaluated. Results: No dementia-control difference was found in any of the parameters examined for the constant-weight conditions. For the condition of switching weights with the transparent bottle, on the other hand, there was a significant group difference in the duration and force-rate parameters. The dementia participants were clearly less sufficient in production of predictive lifting force using a visual cue of object weight. Conclusions: Cognitive decline with dementia does not affect lifting force production in a steady weight condition. It, however, affects visual-volume cue based adjustment of lifting force production. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Arch Phys Med Rehabil Vol 93, October 2012
dose-escalation study in patients with GBS. Setting: University-based outpatient rehabilitation clinic. Interventions: A four-week duration of treatment with 30 milligrams per day of 4-AP in each sequence: 4-AP followed by placebo or placebo followed by 4-AP. Along with a one-week placebo washout between treatment periods. Participants: Nine patients enrolled. One patient withdrew before randomization. One patient withdrew due to relapse of chronic demyelinating polyneuropathy, not thought to be related to the medication. The remaining seven patients completed the study. Mean age was 57 years (range 27-73 years). Main Outcome Measures: Improvement in motor function and grip strength. Results: There were statistically significant improvements in motor function and grip strength with medication. Lower extremity strength score increased from 3.2 to 3.7 (p⫽0.0001), upper extremity strength score increased from 4.0 to 4.3 (p⫽0.0065), and bilateral grip strength increased from 8.2 to 12.2 pounds (p⫽0.0243). There was no significant improvement with placebo or change in the GBS Functional Assessment Index. Conclusions: Despite the small size of this study, the results indicated that 4-AP might improve motor function in GBS. Comparisons with placebo were likely not valid because of significant carryover effects with only a one-week washout in this crossover design. Most patients reported improved motor endurance while on 4-AP, including increased ambulation and repetitive hand movements. The medication was well tolerated. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Poster 9 Relationships Between Ankle Spasticity and Strength, Walking Capacity and Self-Perceived Walking Limitations in Multiple Sclerosis. Joanne M. Wagner (Saint Louis University, St. Louis, MO), Theodore R. Kremer. Disclosure: Joanne M. Wagner, Acorda Therapeutics, Speaker. Theodore R. Kremer has no disclosures. Objective: To determine the relationships between ankle spasticity, ankle strength, walking capacity and self-perceived walking limitations in ambulant persons with multiple sclerosis (pwMS). Design: Cross-sectional study. Setting: Research Laboratory. Participants: 42 pwMS (27 female, 15 male; age 42.9. ⫾ 10.1 years) with moderate clinical disability (EDSS 3.6 ⫾ 1.6). Interventions: Not applicable. Main Outcome Measures: Bilateral ankle plantarflexor (PF) spasticity was assessed using the Modified Ashworth Scale (MAS) and an isokinetic dynamometer. For the instrumented spasticity measure (ISM), the dynamometer measured the resistive torque of the PFs during passive ankle dorsiflexion (DF) at four different speeds. Data were processed to yield a single spasticity value for each ankle. Bilateral ankle DF and PF maximal voluntary isometric torque (MVIT) was assessed using an isokinetic dynamometer. Walking capacity was assessed by the Timed 25-Foot Walk Test (T25FWT) and the Six Minute Walk Test (6MWT). Self-perceived limitations in walking were documented by the 12-item Multiple Sclerosis Walking Scale (MSWS-12). Results: Twenty-nine (69%) participants had PF spasticity (MAS ⱖ 1). PF spasticity was not related to PF strength (MAS ⫽ ⫺0.13; ISM ⫽ 0.02), but was weakly related to DF strength (MAS ⫽ ⫺0.36; ISM ⫽ 0.08) PF spasticity was weakly correlated with walking capacity (MAS || ⬍ 0.27; ISM || ⬍ 0.26) and self-perceived walking limitations (MAS || ⬍ 0.11; ISM || ⬍ 0.23). Ankle strength had a larger correlation with walking capacity (DF MVIT || ⬍ 0.45; PF MVIT || ⬍ 0.50) and self-perceived walking limitations (DF MVIT || ⬍ 0.35; PF MVIT || ⬍ 0.37). Conclusions: There is a limited relationship between ankle spasticity and ankle strength in ambulant pwMS. Ankle weakness may contribute to walking limitations in pwMS. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Poster 10 Assessment of Improvement of Functional Status of Chronic Guillain-Barré Syndrome with 4-Aminopyridine – Phase IIB
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Study. Jay Meythaler (Wayne State University, Detroit, MI, Oakwood Hospital, Dearborn, MI), Saurabha Bhatnagar. Disclosure: Jay Meythaler, Potential patent royalties to the University that may be shared discoverer, principle investigator, Patent filed by University in my name. Saurabha Bhatnagar discloses 4-Aminopyridine. Objective: To investigate whether orally administered 4-aminopyridine (4-AP) is effective in improving motor function in patients with Guillain-Barré syndrome (GBS). Design: Phase IIB double-blinded, randomized, placebo-controlled, crossover, dose-escalation trial in patients with GBS. Setting: University-based rehabilitation clinic. Interventions: An eight-week duration of treatment with a target dose of 30 milligrams per day of 4-AP in each sequence: 4-AP followed by placebo or placebo followed by 4-AP along with a three-week placebo washout between treatment periods. Participants: 19 subjects enrolled. Seven subjects withdrew prematurely: Three due to adverse events, two because of travel difficulties, one because of relocation, and one secondary to pretreatment laboratory abnormalities. The remaining 12 patients completed the study. Mean age was 59 years (range 23-77 years). Main Outcome Measures: Main outcome was the Functional Independence Measure (FIM) motor score. Secondary outcomes included motor strength, grip strength, six-minute walk test, and Medical Outcomes Study 12-Item Short Form. Results: There was a trend toward improvement in FIM motor scores (indicating greater functional independence) during 4-AP treatment (p⫽0.12). At baseline, the group, on average, had FIM scores near the upper limit, which produced a “ceiling effect,” i.e., reducing the amount of change that can be detected with the FIM. After removing three patients who entered the study with maximum FIM scores, the 4-AP treatment arm was superior to placebo (p⫽0.655). The three-week placebo washout may have been insufficient time. No statistically significant differences were found for the secondary measures. Conclusions: 4-AP may be beneficial for some patients with chronic weakness following GBS. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Poster 11 Characteristics of Hand Force Production for Lifting of an Object in Dementia Patients. Hiroshige Jinnouchi (Osaka University, Osaka, Japan). Disclosure: None disclosed. Objectives: Ability to produce lifting force appropriately tuned for weight of daily objects using visual information may decline with dementia. To investigate this, force generated during lifting of plastic bottles with/and without visual information of water volume was compared between elderly individuals with and without dementia. Design: Matched-pairs control group. Setting: Welfare institution for elderly people. Participants: Ten elderly patients with dementia (72-86 yrs., CDR ⱖ 1, MMSE ⱕ 20, FAB ⱕ 15), and 10 age-matched elderly controls (77-89 yrs., CDR ⱕ 0.5, MMSE ⱖ 27, FAB ⱖ 10). Interventions: Not applicable. Main Outcome Measures: The participants lifted small transparent or opaque (black) plastic tea bottles (230 mm height, 65 mm diameter) weighing 100 and 500 g repetitively from a force-transducer-equipped platform providing continuous lifting force information. Tests were performed under constant-weight and switching-weight conditions. Duration between lifting force increase and the bottle lift-off moment, average and peak lifting force rate, and their trial-to-trail variability were evaluated. Results: No dementia-control difference was found in any of the parameters examined for the constant-weight conditions. For the condition of switching weights with the transparent bottle, on the other hand, there was a significant group difference in the duration and force-rate parameters. The dementia participants were clearly less sufficient in production of predictive lifting force using a visual cue of object weight. Conclusions: Cognitive decline with dementia does not affect lifting force production in a steady weight condition. It, however, affects visual-volume cue based adjustment of lifting force production. Key Words: Neurodegenerative disorder; Motor function; Neuroscience; Rehabilitation. Arch Phys Med Rehabil Vol 93, October 2012