Poster 366: Dose Response in Muscles Treated With Botulinum Neurotoxin Type A for Upper Limb Chronic Poststroke Spasticity: A Pooled-Data Analysis

Poster 366: Dose Response in Muscles Treated With Botulinum Neurotoxin Type A for Upper Limb Chronic Poststroke Spasticity: A Pooled-Data Analysis

E140 ACADEMY ANNUAL ASSEMBLY ABSTRACTS test, identify factors predictive of presentation with clinically relevant dysphagia. Design: Retrospective r...

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E140

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