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were fall resulting in landing with head on the ground (4; two got
tackled by another player, one somersaulted for goal-celebration
and one collided with another player), heading the ball (2) and
direct head collision with another player (1). Thoracic SCI occurred
due to fall on upper back while stretching to intercept ball and SCI
symptoms only arose after 20 minutes of continuous play after the
impact. Lumbar SCI was due to fall on lower back after colliding
with another player. The player who performed goal-celebration
somersault died instantaneously. 8/9 sustained acute SCIs during
game time, whereas one had chronic cervical SCI due to repeated
heading of the ball. 7/8 acute cases got SCI symptoms immediately
after the impact. Less than a quarter of players could have
continued playing soccer after recovering from SCI. More details,
including management and outcomes of the SCIs suffered by most
soccer players could not be studied due to unavailability of related
records.
Conclusions:
Soccer players sustain SCI very rarely during a game or
training session. However, SCI has potential to cause career-ending
and catastrophic tragedy. Further studies need to be done for detailed
understanding on prevention, patterns, management and outcomes of
SCI in soccer players.
Level of Evidence:
Level IV
Poster 54:
Comprehensive Regenerative Therapies with Human
Amniotic Allograft Derived Cells, Platelet Rich Plasma
and Prolotherapy to Treat Joint Pain and
Osteoarthritis: Preliminary Findings of 128 Patients
Yibing Li (Center for Pain and Rehab, Peoria, IL, USA),
Katherine Cazilas, PA-C, MPAS, Leah Tabor, BS, Christina Luncsford,
MA, Jeffrey Xue, BS, student
Disclosures:
Yibing Li: I Have No Relevant Financial Relationships To
Disclose
Objective:
Ligament laxity, tendinopathy, cartilage degeneration,
and previous joint injuries/surgeries are the major root causes of joint
pain and osteoarthritis. Dextrose prolotherapy, platelet rich plasma
(PRP) and amniotic allograft injection into joints and surrounding
weakened ligaments and tendons are effective treatments for
reducing joint pain, improving functional status and correcting un-
derlying causes of osteoarthritis.
Design:
Among 128 patients with joint pain, majority were diagnosed
with moderate to severe degree of degenerative joint disease, liga-
ment laxity or tendinopathy from imaging studies and have failed
many traditional conservative treatments.
Setting:
Outpatient Pain Management and Rehabilitation Clinic.
Participants:
128 patients (aged 36-98, 63 male and 65 female)
with joint pain and limited function from various degrees of
osteoarthritis.
Interventions:
From September 2015 to January 2017, 90 knees, 18
hips, 15 shoulders and 5 ankle joints were injected with our
protocol.
Main Outcome Measures:
Outcomes were monitored using Visual
Analogue Scale (VAS), an 80-point functional extremity score, X- ray
and musculoskeletal ultrasound comparisons before and 2-4 months
after the initial treatments.
Results:
Data were collected from 105 out of 128 patients. Overall 36
patients (34%) reported 75-100% improvement, 28 (27%) patients re-
ported 50-75%, 25 patients (24%) reported 25-49%, and 16 patients
(15%) reported 0-24% improvement in pain scores after initial treat-
ments. Almost all patients showed varied degrees of soft tissue
regeneration from ultrasound comparison after treatment, some of
which showed X-ray changes. None experienced any adverse reactions
from these injections.
Conclusions:
Comprehensive regenerative therapies are very safe,
effective, non-surgical treatments for joint pain and functional limi-
tations from soft tissue degeneration and osteoarthritis. They can
potentially be considered as an alternative option to surgical inter-
vention. However, further clinical studies and follow ups are needed to
evaluate the long term outcomes and benefits.
Level of Evidence:
Level V
NEUROLOGICAL REHABILITATION POSTER HALL:
ORIGINAL RESEARCH
Poster 57:
Time to Retreatment with Botulinum Toxin A in
Upper Limb Spasticity Management: Initial Data from
the Upper Limb International Spasticity (ULIS)-III
Study
Lynne Turner-Stokes (King’s College London School of Medicine,
Palliative Care, Policy and Rehabilitation and Regional Rehabilitation
Unit, Northwick Park Hospital, London, United Kingdom),
Stephen Ashford, MD, Jorge Jacinto, MD, Klemens Fheodoroff, MD,
Pascal Maisonobe, MD, Jovita Balcaitiene, MD
Disclosures:
Lynne Turner-Stokes: Consulting fees or other remuner-
ation (payment) - Ipsen
Objective:
The ongoing ULIS-III study aims to describe real-life
clinical practice and assess patient centered goal attainment
with integrated upper limb spasticity (ULS) management that in-
cludes repeated botulinum toxin A (BoNT-A) injections. This interim
analysis evaluates BoNT-A reinjection rates within rehabilitation
management.
Design:
2-year longitudinal, prospective, observational, cohort study
(ClinicalTrials.gov: NCT02454803).
Setting:
Expected to involve 58 centers (14 countries). This analysis
involved 44 centers (13 countries).
Participants:
Expected to enroll
>
1000 adults with ULS receiving
BoNT-A. Data for 335 patients are presented here (reflective of ULIS-III
recruitment stage).
Interventions:
Repeated BoNT-A injections.
Main Outcome Measures:
Primary endpoint is goal attainment, using
Goal Attainment Scaling—Evaluation of Outcome for ULS tool to eval-
uate change following BoNT A treatments and concomitant treatment.
BoNT-A preparation type, total dose, number of injections, and in-
jection intervals will be recorded, as well as economic and quality-of-
life data.
Results:
Recruitment began January 2015. Patients with data for
2 injections (N
¼
335), had a mean (SD) time between first and
second injections of 154.9 (58.6), 137.8 (60.5), and 124.4 (41.0)
days for abobotulinumtoxinA (n
¼
203), onabotulinumtoxinA (n
¼
94),
and incobotulinumtoxinA (n
¼
38), respectively. Of these patients,
177 received 3 injections. Time between second and third injec-
tion was 146.4 (48.5), 131.8 (36.9), and 116.3 (32.3) days for abo-
botulinumtoxinA (n
¼
110), onabotulinumtoxinA (n
¼
48), and
incobotulinumtoxinA (n
¼
19), respectively. The mean (SD) change in
time between first and second injection intervals for these 177
patients was
e
5.8 (68.1), 2.3 (37.9), and 0.9 (23.3) days for abo-
botulinumtoxinA, onabotulinumtoxinA, and incobotulinumtoxinA,
respectively.
Conclusions:
Initial ULIS-III injection-interval data suggest differences
in time to retreatment with different BoNT-A preparations. Longer
injection intervals may reduce patient and carer burden. However, the
clinical significance and generalizability of the findings reported here
are as yet undetermined and other variables may influence
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Abstracts / PM R 9 (2017) S131-S290