Poster 90: Safety and Efficacy of Repeated Abobotulinumtoxin A Injections for Dynamic Equinus Foot in Children Less Than 6 Years of Age: A Subgroup Analysis

Abstracts / PM R 9 (2017) S131-S290 Main Outcome Measures: Post-intervention caliper measurements of the dye spread were taken after each technique. A descriptive analysis of the dye diffusion before and after technique application was presented. A two-way ANOVA for repeated measurements was applied. In function of the ANOVA, a post LSD Fisher test was applied (p
.05). Results: After the first mobilization, the mean experimental posttest, longitudinal dye spread measurement (7.516.63mm) was significantly greater (p¼.024) compared to the resting position. There was a significant diffusion effect with either tensioning (p¼.018) or sliding (p¼.016), with no statistically significant difference between both techniques (p¼.976, TT: 7.55.5mm SLT: 7.58.1mm). The order in which TT and SLT were administered did not influence diffusion in a significant way. Conclusions: Passive neurodynamic techniques in the form of 5-minute therapy of tensioning or sliding induced significant fluid dispersion in the median nerve at the level of the carpal tunnel of human cadavers. The close nerve relationship with the ligament could have had an increased effect as this has been previously suspected. These data provide an explanation regarding a potential mechanism of NDM in reducing intraneural edema. Level of Evidence: Level IV Poster 90: Safety and Efficacy of Repeated Abobotulinumtoxin A Injections for Dynamic Equinus Foot in Children Less Than 6 Years of Age: A Subgroup Analysis Ann Tilton (LSUHSC & Children’s Hospital New Orleans, New Orleans, LA, USA), Mark Gormley, MD, Edward Dabrowski, MD, Dennis J. Matthews, MD, Luisa Rodriguez Pose, MD, Anne-Sophie AS. Grandoulier, MD, Philippe Picaut, Pharm D, PhD, Mauricio R. Delgado, MD Disclosures: Ann Tilton: Research Grants - Ipsen, Consulting fees or other remuneration (payment) - Ipsen Objective: The safety and efficacy of single injections of abobotulinumtoxinA for pediatric dynamic equinus have recently been established in a Phase 3 trial. Treatment often begins in early childhood; we describe the effect of repeat injections from the open-label extension study, focusing on the subgroup of children aged <6 years. Design: Open-label extension study of repeat (up to 4 cycles) abobotulinumtoxinA injections into the gastrocnemius-soleus complex. Doses could be individually adjusted (minimum 5U/kg, maximum 30U/ kg) and other limb muscles were injected as required. Data were analyzed for the total safety population (TP; N¼216) and the younger patient subgroup aged <6 years (YP; N¼127). Setting: 23 sites across 6 countries. Participants: Ambulatory children (aged 2e17 y) with dynamic equinus due to cerebral palsy. Interventions: Repeated lower limb abobotulinumtoxinA injections. Main Outcome Measures: Mean change in Modified Ashworth Scale (MAS) and Physician’s Global Assessment (PGA) scores, and adverse events (AEs). Results: MeanSD age was 5.93.3y in the TP and 3.71.0y in the YP (both groups 60% male). Compared to the TP, more children were botulinum toxin treatment naı¨ve in the YP (53.2 vs. 63.8%). Treatmentemergent adverse events (TEAEs) were reported in 73.5% of the TP and 75.2% of the YP, the most common being upper respiratory infection in both groups. 1 patient (YP) withdrew from the study due to a TEAE in Cycle 1 (unrelated to treatment). Rates of serious AEs were also similar (TP:3.4%, YP: 5.0%). The magnitude of efficacy across open-label treatment cycles 1e3 was similar; mean change from baseline to Week-4 in MAS scores ranged from -1.0 to -1.1 in the TP and from -0.95 to -1.1 in the YP; mean Week-4 PGA scores were 1.4e1.5 in both groups. Conclusions: The efficacy and safety of abobotulinumtoxinA injections appear to be similar in the sub-population of younger children aged <6 years as compared to the total safety population. Level of Evidence: Level I

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Poster 92: Evaluation of Clinical Institute Withdrawal Assessment for Alcohol (CIWA) in Patients with Traumatic Brain Injury Jessica L. Hupe, MD (Virginia Commonwealth Univ Hlth Sys, Richmond, VA, United States), William E. Carter, MD, James Newman, MD, Adam Sima, PhD Disclosures: Jessica Hupe: I Have No Relevant Financial Relationships To Disclose Objective: Clinical Institute Withdrawal Assessment (CIWA) information regarding TBI severity outcomes and the role and impact of the Clinical Institute Withdrawal Assessment (CIWA) protocol on patient care is unclear. The purpose of this study is to evaluate the use and outcomes of those with TBI who received the CIWA protocol with primary hypothesis that severity of TBI will be positively correlated with elevated CIWA scores. Design: Retrospective cohort study. Setting: Single level one trauma center. Participants: 375 subjects identified from a single level 1 trauma center’s trauma registry positive for alcohol and/or who had suffered a brain injury from January 2009- July 2015. Inclusion criteria included CIWA protocol being implemented, age greater than 16, length of stay of at least 5 days. Interventions: Not Applicable. Main Outcome Measures: Frequency of elevated CIWA score, seizure incidence, medication administration incidence based on TBI severity. Results: When TBI specific outcomes are examined, no significant difference is found in the length of CIWA protocol utilization in days based on TBI severity. Patients with no TBI were on CIWA protocol for an average of 3.4 days, mild TBI 3.7 days, moderate TBI 4.2 days and severe TBI 4.0 days. Patients with no TBI were treated in the acute care hospital for an average of 7.0 days, mild TBI 9.0 days, moderate TBI 10.0 days and severe TBI 18.5 days. For subjects with no diagnosis of TBI the percentage of subjects receiving a CIWA score greater than eight was 4.5%, for mild TBI 12.5%, for moderate TBI 27.1% and for severe TBI the percentage of subjects receiving a CIWA score greater than eight was 50.0%. Conclusions: Subjects with TBI were assigned higher CIWA scores then their non-TBI counterparts. This highlights the importance of differentiating between acute ETOH withdrawal and TBI sequela when implementing CIWA protocol during acute care hospitalization. Level of Evidence: Level III Poster 93: Characterization of Upper Extremity Motion in Grasping and Reaching using Inertial Sensor Based Motion Capture System Hyung Seok Nam (Seoul National University College of Medicine), Han Gil Seo, MD, Sungwan Kim, PhD Disclosures: Hyung Seok Nam: I Have No Relevant Financial Relationships To Disclose Objective: To characterize upper extremity joint movements while performing grasping and reaching tasks in order to apply to the design of simplified rehabilitation robots. Design: Observational measurement study. Setting: University biomedical engineering and rehabilitation department. Participants: Five healthy volunteers without any upper limb impairments. Interventions: A whole body motion capture system based on 9-axis inertial measurement unit sensors were put on the volunteers and the upper extremity movements were recorded while performing the Action Research Arm Test (ARAT) tasks. Main Outcome Measures: Grasping (6 trials for each subject), pinching (6), and reaching (12) movements of the dominant arm during