Stroke Diagnosis e33

spasticity post-stroke. It would be important to know if greater botu-

linum toxin dosages are required for managing spasticity in patients

with long standing spasticity post-stroke. The primary objective of this

study was to assess if time since stroke was associated with botu-

linum dosage.

Design: Retrospective study

Setting: Chart reviewParticipants: Patients post-strokeInterventions: NoneMain Outcome Measure(s): OnabotulinumtoxinA dose

Results: The average total dose of toxin injected in the arm muscles was

242 � 19 units (mean � standard error of mean; range 25 e 370) and in

leg muscles was 161 � 19 units (range 0 e 360). Average chronicity post-

stroke was 46� 17 (range 50 e 350 months). We found a mild to moderate

strength positive correlation between stroke chronicity and dosage in arms

(rZ0.35, pZ0.08) and legs (rZ0.43, pZ0.056).

Conclusions: Our results suggest that greater toxin dosage is injected in

patients with greater chronicity post-stroke. Clinical perception of higher

spasticity in patients with higher chronicity may be the underlying factor

explaining our results.

Key Words: Botulinum toxin, dose, stroke, spasticity, chronicity.

Disclosure: Chetan Phadke has the following disclosures: Allergan Inc.:

Study grant support.

Poster 62

Kinematic Symmetry Assessment of Lower Limb Motions inIndividuals with Stroke

Arvind Ramanujam (Kessler Foundation), Rakesh Pilkar,Kathleen Chervin, Karen J. Nolan

Objective: To assess the amplitude and phasic kinematic knee symmetry

during gait for individuals with stroke and healthy adults.

Design: A Prospective study

Setting: Rehabilitation Research Center

Participants: Three adults with right-sided foot drop post-stroke and five

healthy adults.

Interventions: Surface Functional Electrical Stimulation (FES) was

applied through a foot drop stimulator to the peroneal nerve for a period of

4-weeks during walking in the stroke group (SG) and no intervention was

provided for the healthy controls (HC).

Main Outcome Measure(s): Sagittal knee kinematics during walking at

a self-selected pace. The SG performed walking trials with FES at baseline

and 4-weeks. Data was collected for HCs only at baseline. Standard cross

correlation algorithm was applied on normalized bilateral sagittal knee

angles in a gait cycle to calculate the correlation coefficient r at each %

phase shift (PS). Perfect symmetry was hypothesized to occur at 50% PS

with rZ1.

Results: Bilateral sagittal knee kinematics mean peak correlation for: 1)

HCs (rZ0.99�0.01) occurred at 50.58�1.35% PS; 2) baseline SG with

FES (rZ0.87�0.06) occurred at 55.33�0.58% PS and 3) 4-weeks SG

with FES (rZ0.91�0.04) occurred at 53.67�1.53% PS, indicating

a 4.6% increase in symmetry in individuals with stroke after 4 weeks

of FES.

Conclusions: Symmetry indices form a suitable baseline to compare

kinematics across all joints and planes in pathological gait. Improve-

ments in amplitude and phasic kinematic symmetry for SG signify

improved flexion-extension range and timing of affected knee with

respect to its healthy counterpart, after 4 weeks of FES. Future refine-

ments could include techniques in frequency domain for gait symmetry

assessments.

Key Words: Stroke, rehabilitation, gait, symmetry.

Disclosure: Arvind Ramanujam has nothing to disclose.

www.archives-pmr.org

Poster 63

Paretic Upper Extremity Movement Gains are Retained 3 MonthsAfter Training with an Electrical Stimulation Neuroprosthesis

Stephen Page (The Ohio State University), Andre Persch,Colleen Murray

Objective: To determine retention of paretic upper extremity (UE) motor

changes 3 months after participation repetitive task specific training (RTP)

using an electrical stimulation neuroprosthesis (ESN).

Design: Prospective, blinded, cohort, pre-post studySetting: Outpatient rehabilitation hospital

Participants: 24 participants with chronic, stable, moderate UE hemi-

paresis from stroke (11 males; mean age Z 57.9 � 9.5 years; age range

39 � 75 years; mean time since strokeZ 36.7 months; range of onsetZ 7

- 162 months).

Interventions: As part of a larger trial, subjects had been randomly

assigned to receive an 8-week regimen comprised of repetitive task specific

practice (RTP) on valued activities using the ESN. This observational study

assessed this single group’s paretic UE motor levels after, and 3 months

after, the intervention.

Main Outcome Measure(s): The upper extremity section of the Fugl-

Meyer Assessment of Sensorimotor Impairment (FM), the Action

Research Arm Test (ARAT), the Arm Motor Ability Test (AMAT), and

Box and Block Test (BBT).

Results: None of the scores significantly changed from the period directly

after intervention to the test 3-months post intervention (FM: t Z 0.76;

ARAT: t Z 0.69; AMAT: t Z 0.89; 0.86; 0.80 for the functional ability,

quality of movement, and time scales, respectively; BBT: t Z 0.96).

Conclusions: While electrical stimulation has been used clinically for

decades, to our knowledge this is the first study showing that paretic UE

movement changes from RTP using ESN are retained 3 months after

conclusion of the intervention. Subjects with chronic, moderate UE hem-

iparesis can exhibit measurable, sustained benefit from interventions tar-

geting their paretic limbs

Key Words: Paresis, Rehabilitation, Stroke, Electric Stimulation, Occu-

pational Therapy.

Disclosure: Stephen Page has nothing to disclose.

Poster 64

Incorporating a Wearable Upper Extremity Robotics Device into DailyActivities at Home: A Case Series

Grace J. Kim (New York Presbyterian Hospital), Lisa Rivera, Joel Stein

Objective: Determine the feasibility of incorporating a wearable robotic

elbow device into a functional home program; provide descriptive data on

4 study subjects.

Design: Individual percent change scores on primary and secondary

outcome measures before and after the 6 week home program. The study

clinician provided device training and a personalized home program for

each subject. All clinical outcome measures were performed by different

member of the research team.

Setting: All Myomo training and outcome measures were conducted in the

outpatient clinic at NewYork Presbyterian Hospital. The 6 week home

program occurred in the individual subject’s home.

Participants: Four chronic stroke survivors with decreased elbow strength

and coordination. The mean age was 58�9.2 years and time from stroke

was 2.7� .79 years.

Interventions: Training independent use of the Myomo in the clinic for

2-3 weeks followed by 6 week personalized home program.

Main Outcome Measure(s): Primary: Fugl-Meyer-Upper Extremity Scale

(FMA-UE). Secondary: Motor Activity Log (MAL), Arm Motor Ability

Test (AMAT)