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E172012 ACRM–ASNR Annual Conference Abstracts

dose-escalation study in patients with GBS. Setting: University-basedoutpatient rehabilitation clinic. Interventions: A four-week duration oftreatment with 30 milligrams per day of 4-AP in each sequence: 4-APfollowed by placebo or placebo followed by 4-AP. Along with aone-week placebo washout between treatment periods. Participants:Nine patients enrolled. One patient withdrew before randomization.One patient withdrew due to relapse of chronic demyelinating poly-neuropathy, not thought to be related to the medication. The remainingseven patients completed the study. Mean age was 57 years (range27-73 years). Main Outcome Measures: Improvement in motor func-tion and grip strength. Results: There were statistically significantimprovements 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 orchange in the GBS Functional Assessment Index. Conclusions: De-spite the small size of this study, the results indicated that 4-AP mightimprove motor function in GBS. Comparisons with placebo werelikely not valid because of significant carryover effects with only aone-week washout in this crossover design. Most patients reportedimproved motor endurance while on 4-AP, including increased ambu-lation and repetitive hand movements. The medication was welltolerated. Key Words: Neurodegenerative disorder; Motor function;Neuroscience; Rehabilitation.

Poster 9Relationships Between Ankle Spasticity and Strength, WalkingCapacity and Self-Perceived Walking Limitations in MultipleSclerosis. Joanne M. Wagner (Saint Louis University, St. Louis,MO), Theodore R. Kremer.

Disclosure: Joanne M. Wagner, Acorda Therapeutics, Speaker. Theo-dore R. Kremer has no disclosures.

Objective: To determine the relationships between ankle spasticity,ankle strength, walking capacity and self-perceived walking limita-tions in ambulant persons with multiple sclerosis (pwMS). Design:Cross-sectional study. Setting: Research Laboratory. Participants: 42pwMS (27 female, 15 male; age 42.9. � 10.1 years) with moderateclinical disability (EDSS 3.6 � 1.6). Interventions: Not applicable.Main Outcome Measures: Bilateral ankle plantarflexor (PF) spastic-ity was assessed using the Modified Ashworth Scale (MAS) and anisokinetic dynamometer. For the instrumented spasticity measure(ISM), the dynamometer measured the resistive torque of the PFsduring passive ankle dorsiflexion (DF) at four different speeds. Datawere 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. Walkingcapacity was assessed by the Timed 25-Foot Walk Test (T25FWT) andthe Six Minute Walk Test (6MWT). Self-perceived limitations inwalking were documented by the 12-item Multiple Sclerosis WalkingScale (MSWS-12). Results: Twenty-nine (69%) participants had PFspasticity (MAS � 1). PF spasticity was not related to PF strength(MAS � � �0.13; ISM � � 0.02), but was weakly related to DFstrength (MAS � � �0.36; ISM � � 0.08) PF spasticity was weaklyorrelated with walking capacity (MAS |�| � 0.27; ISM |�| � 0.26)nd 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-perceivedwalking limitations (DF MVIT |�| � 0.35; PF MVIT |�| � 0.37).

onclusions: There is a limited relationship between ankle spasticitynd ankle strength in ambulant pwMS. Ankle weakness may contrib-te to walking limitations in pwMS. Key Words: Neurodegenerativeisorder; Motor function; Neuroscience; Rehabilitation.

oster 10ssessment of Improvement of Functional Status of Chronic Guil-

ain-Barré Syndrome with 4-Aminopyridine – Phase IIB

tudy. Jay Meythaler (Wayne State University, Detroit, MI, Oak-ood Hospital, Dearborn, MI), Saurabha Bhatnagar.

isclosure: Jay Meythaler, Potential patent royalties to the University thatay be shared discoverer, principle investigator, Patent filed by Univer-

ity in my name. Saurabha Bhatnagar discloses 4-Aminopyridine.Objective: To investigate whether orally administered 4-aminopyri-

dine (4-AP) is effective in improving motor function in patients withGuillain-Barré syndrome (GBS). Design: Phase IIB double-blinded, ran-domized, placebo-controlled, crossover, dose-escalation trial in patientswith GBS. Setting: University-based rehabilitation clinic. Interven-tions: An eight-week duration of treatment with a target dose of 30milligrams per day of 4-AP in each sequence: 4-AP followed by placeboor placebo followed by 4-AP along with a three-week placebo washoutbetween treatment periods. Participants: 19 subjects enrolled. Sevensubjects withdrew prematurely: Three due to adverse events, two becauseof travel difficulties, one because of relocation, and one secondary topretreatment laboratory abnormalities. The remaining 12 patients com-pleted the study. Mean age was 59 years (range 23-77 years). MainOutcome Measures: Main outcome was the Functional IndependenceMeasure (FIM) motor score. Secondary outcomes included motorstrength, grip strength, six-minute walk test, and Medical Outcomes Study12-Item Short Form. Results: There was a trend toward improvement inFIM motor scores (indicating greater functional independence) during4-AP treatment (p�0.12). At baseline, the group, on average, had FIMscores near the upper limit, which produced a “ceiling effect,” i.e.,reducing the amount of change that can be detected with the FIM. Afterremoving three patients who entered the study with maximum FIMscores, the 4-AP treatment arm was superior to placebo (p�0.655). Thethree-week placebo washout may have been insufficient time. No statis-tically significant differences were found for the secondary measures.Conclusions: 4-AP may be beneficial for some patients with chronicweakness following GBS. Key Words: Neurodegenerative disorder;Motor function; Neuroscience; Rehabilitation.

Poster 11Characteristics of Hand Force Production for Lifting of an Objectin 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 withdementia. To investigate this, force generated during lifting of plasticbottles with/and without visual information of water volume wascompared between elderly individuals with and without dementia.Design: Matched-pairs control group. Setting: Welfare institution forelderly people. Participants: Ten elderly patients with dementia(72-86 yrs., CDR � 1, MMSE � 20, FAB � 15), and 10 age-matchedelderly controls (77-89 yrs., CDR � 0.5, MMSE � 27, FAB � 10).Interventions: Not applicable. Main Outcome Measures: The par-ticipants lifted small transparent or opaque (black) plastic tea bottles(230 mm height, 65 mm diameter) weighing 100 and 500 g repetitivelyfrom a force-transducer-equipped platform providing continuous lift-ing force information. Tests were performed under constant-weightand switching-weight conditions. Duration between lifting force in-crease and the bottle lift-off moment, average and peak lifting forcerate, and their trial-to-trail variability were evaluated. Results: Nodementia-control difference was found in any of the parameters ex-amined for the constant-weight conditions. For the condition ofswitching weights with the transparent bottle, on the other hand, therewas a significant group difference in the duration and force-rateparameters. The dementia participants were clearly less sufficient inproduction of predictive lifting force using a visual cue of objectweight. Conclusions: Cognitive decline with dementia does not affectlifting force production in a steady weight condition. It, however,affects visual-volume cue based adjustment of lifting force

production. Key Words: Neurodegenerative disorder; Motor func-tion; Neuroscience; Rehabilitation.

Arch Phys Med Rehabil Vol 93, October 2012