S159 S290
Objective:
To test the hypothesis that cerebellar strokes may need an
increased length of stay for acute rehabilitation.
Design:
Retrospective case series.
Setting:
Acute Rehabilitation Unit at Tertiary care hospital.
Participants:
14 patients.
Interventions:
Not applicable.
Main Outcome Measures:
FIM efficiency and length of stay.
Results:
We completed a case review of 5 patients who had been
transferred to the CARU following cerebellar strokes. All patients had an
initial FIM score between 70-79, four of the five were discharged home
and onewas discharged to subacute rehab. The FIM efficiency, or change
in FIM score divided by the length of stay was calculated to compare
cerebellar strokes to our general stroke population. The FIM efficiency
for all stroke patients during the 2016 fiscal year was 2.33 in the Jef-
ferson University Hospital CARU whereas the national average was 2.26.
Between July 1 and Dec 15, 2016, patients who had an admission diag-
nosis of stroke with an initial FIM score between 70-79 who were dis-
charged home had an average FIM efficiency of 3.32 (n
¼
9). The FIM
efficiency for the 5 patients admitted with cerebellar strokes was 1.61.
Conclusions:
Posterior cerebral, specifically, PICA cerebellar stroke
may represent a subgroup population that have difficult to treat
symptoms that may have an impact on length of stay and acute
rehabilitation outcomes as seen by a longer length of stay required for
a similar progression of FIM efficiency.
Level of Evidence:
Level III
Poster 68:
Urinary Symptoms and Urinalysis do not Predict
Uropathogens on Pyrosequencing in Patients with
Spinal Cord Injury
Emma Nally, MD (MedStar Georgetown University Hospital,
Washington, District of Columbia, United States),
Suzanne L. Groah, MD
Disclosures:
Emma Nally: I Have No Relevant Financial Relationships
To Disclose
Objective:
To determine whether urine microbiome and inflammatory
marker changes are associated with the presence or absence of urinary
symptoms in patients with neurogenic bladder due to spinal cord injury
(SCI).
Design:
Observational within-subject pilot study.
Setting:
Outpatient Physiatry Clinic.
Participants:
Six adult patients with neurogenic bladder due to SCI
managed with intermittent catheterization contributed 25 urine
samples.
Interventions:
Urinalysis, cultivation, and bacterial DNA isolation was
performed on 25 urine samples stratified by the presence or absence of
urinary symptoms. Pyrosequencing was performed on 16 samples. Nine
samples were not sequenced due to low (
<
10 ng/
m
L) bacterial DNA
concentration.
Main Outcome Measures:
Standard urinalysis and culture performed
by Quest Diagnostics. Urine samples were sequenced using the Pacific
Biosciences sequencer (PacBio).
Results:
Of the 25 samples, 13 were from individuals not experi-
encing urinary symptoms and 12 were collected during urinary
symptoms. The most common symptoms reported were spasticity,
malodorous urine, cloudy urine, leakage and sweating. Leukocyte
esterase, nitrite, white blood cells, and growth of greater than
100,000 colony forming units of pathogenic bacteria on culture
was not associated with the presence of symptoms. Bacterial DNA
concentration was associated with the presence of symptoms. All
bacteria identified on culture were present on sequencing. Pyrose-
quencing identified bacteria not identified by cultivation and in one
subject; Burkholderia species were isolated in samples from both
symptomatic and asymptomatic state.
Conclusions:
These data show that the urine microbiome in patients
with SCI is composed largely of pathogenic bacteria in both
symptomatic and asymptomatic states. In addition, inflammatory
markers on urinalysis were not associated with presence of or absence
of symptoms. The lack of symptoms in these patients may be an
indication that these organisms are part of the natural urinary
microbiome in neurogenic bladder and do not require antibiotic
therapy. The presence of Burkholderia may indicate that in-
terrelationships amongst bacterial species are important to
pathogenicity.
Level of Evidence:
Level V
Poster 69:
Safety and Efficacy of High-Dose OnabotulinumtoxinA
for Post-Stroke Upper Limb Spasticity: Results of a
Double-Blind, Placebo-Controlled Trial
Atul T. Patel, MD, MHSA, FAAPMR (Kansas City Bone and Joint Clinic,
Overland Park, KS, United States), Carolyn Geis, MD,
Katharine E. Alter, MD, FAAPMR, Grace Pan, MS, Adele J. Thorpe, BSc,
Lynn M. James, MPH, Rozalina Dimitrova, MD, MPH
Disclosures:
Atul Patel: Research Grants - Allergan, Merz, Ipsen;
Speakers bureau - Allergan, Merz, Ipsen
Objective:
To evaluate the safety and efficacy of onabotulinumtoxinA
300U and 500U for post-stroke upper-limb spasticity (PSULS) in elbow
and shoulder sites not previously assessed.
Design:
Double-blind, randomized, placebo-controlled study.
Setting:
16 sites in the U.S. and Canada.
Participants:
Adults with PSULS (Modified Ashworth Scale [MAS] score
3).
Interventions:
Single treatment cycle of onabotulinumtoxinA 300U
(150U: elbow flexors; 150U: shoulder adductors) or 500U (250U; 250U)
vs placebo.
Main Outcome Measures:
Safety and efficacy were assessed at weeks
2, 4, 6, 8, and 12; P .05 was considered statistically significant. The
study was terminated early for administrative reasons.
Results:
All 53 enrolled subjects completed the study. Baseline
characteristics were similar between groups, except the onabotuli-
numtoxinA 500U group had more males. Most subjects were Caucasian
and had a history of cerebral ischemic stroke of moderate severity
(mean
¼
101.7 months before enrollment). Mean change from baseline
in elbow MAS for onabotulinumtoxinA 500U was significantly greater
than placebo at all time points (wks 2 and 4 for 300U). Significant tone
reductions were observed in the shoulder adductors with 500U (wks 2
and 4). The proportion of treatment responders ( 1-grade reduction in
elbow MAS) was numerically greater for onabotulinumtoxinA 500U and
300U than placebo at all time points (300U significant at wks 2, 4, and
8). CGI generally improved more with onabotulinumtoxinA than pla-
cebo (not significant). AEs were typically mild/moderate, unrelated to
treatment, and occurred in similar rates in onabotulinumtoxinA dose
groups but greater rates in the placebo group (300U, 27.8%; 500U,
29.4%; placebo, 50%).
Conclusions:
Preliminary results from this trial investigating the
safety and efficacy of higher-dose onabotulinumtoxinA for elbow and
shoulder spasticity indicate a dose-related benefit. At the higher total
dose of 500U onabotulinumtoxinA, no new safety signals were
observed; AEs did not appear to be dose-related.
Level of Evidence:
Level II
Poster 70:
IncobotulinumtoxinA Sustainably Improves Upper
Limb Spasticity
e
Pooled Analysis of Two Phase 3
Trials
Christina Marciniak (Rehabilitation Institute of Chicago, Chicago, IL,
USA), Petr Kanovsky´, MD, Michael C. Munin, MD, FAAPMR,
Michael Althaus, MD, Angelika Hanschmann, M Sc, Irena Pulte, MD,
MFPM, Reinhard Hiersemenzel, MD
S159
Abstracts / PM R 9 (2017) S131-S290