Medicine and Health Sciences Commons^™

Switching Adult Patients With Spasticity From Onabotulinumtoxina To Abobotulinumtoxina: A Real-World Data Analysis Across Three Us-Based Treatment Centers, Nate Way, Edward Dabrowski, Mitchell Paulin, Martin Taylor, John Madden, Amandeep Mann, Jonathan Bouchard

Conference Presentation Abstracts

Introduction: The therapeutic impact of botulinum toxin type A (BoNT-A) as first-line treatment for adult focal spasticity is well established across numerous therapeutic guidelines. However, relatively little real-world evidence exists to inform clinician decision-making when considering switching patients between BoNT-A products. This 5-year retrospective study aims to illustrate the safe transitioning of patients from onabotulinumtoxinA (ONA) to abobotulinumtoxinA (ABO) therapy in US centers that have considerable experience with BoNT-A usage in adults with spasticity.

Methods: Chart data from patients with upper limb spasticity (ULS), lower limb spasticity (LLS), or upper and lower limb spasticity (ULS+LLS) aged >18 years were collected …

Effect Of Botox And Therapy On Spasticity In Cerebral Palsy: A Critically Appraised Topic, Rachel Bray Mot/S, Tatum Cabot Mot/S, Peyton Clark Mot/S, Cameron Goodman Mot/S, Tarason Moore Mot/S, Claire Napier Mot/S

Master of Occupational Therapy Student Critically Appraised Topics

Children diagnosed with Cerebral Palsy often experience upper limb spasticity. Research has shown Botox injections in combination with occupational therapy can reduce the effects of spasticity in the upper limb. This literature review aims to determine how long is the appropriate duration of occupational therapy to administer after Botox injections to see decreased spasticity in the upper limbs.

Improvements In Lower Limb Spasticity-Related Pain In Children/Adolescents With Cerebral Palsy After Incobotulinumtoxina Injections, Florian Heinen, Michaela Bonfert, Petr Kanovsky, A Sebastian Schroeder, Henry Chambers, Edward Dabrowski, Thorin Geister, Angelika Hanschmann, Michael Althaus, Marta Banach, Deborah Gaebler-Spira

Conference Presentation Abstracts

Introduction: The effects of incobotulinumtoxinA on lower limb (LL) spasticity-related pain (SRP) over multiple treatment cycles (ICs) in children/adolescents (C/As) with cerebral palsy (CP) were analyzed using pooled data from three prospective phase 3 trials.

Patients and methods: C/As aged 2–17 years with CP-associated LL spasticity received incobotulinumtoxinA for 4 ICs. SRP was assessed with the Questionnaire on Pain caused by Spasticity (QPS) using C/A- (direct or via interviewer) and parent/caregiver (P/C)-completed LL modules. The pain population included all C/As with a key QPS item score >0 at baseline; post-baseline scores of 0 indicated complete pain relief.

Results: Data from …

Improvements In Upper Limb Spasticity-Related Pain In Children/Adolescents With Cerebral Palsy After Incobotulinumtoxina Injections, Florian Heinen, Michaela Bonfert, Petr Kanovsky, A Sebastian Schroeder, Henry Chambers, Edward Dabrowski, Thorin Geister, Angelika Hanschmann, Michael Althaus, Marta Banach, Deborah Gaebler-Spira

Conference Presentation Abstracts

Introduction: The effects of incobotulinumtoxinA on upper limb (UL) spasticity-related pain (SRP) over multiple treatment cycles (ICs) in children/adolescents (C/As) with cerebral palsy (CP) were analyzed using pooled data from two prospective phase 3 trials.

Patients and methods: C/As aged 2–17 years with CP-associated UL spasticity received incobotulinumtoxinA for 4 ICs. SRP was assessed with the Questionnaire on Pain caused by Spasticity (QPS) using C/A- (direct or via interviewer) and parent/caregiver (P/C)-completed UL modules. The pain population included all C/As with a key QPS item score >0 at baseline; post-baseline scores of 0 indicated complete pain relief.

Results: Data from …

Prevalence Of Spasticity-Related Pain In Children/Adolescents With Cerebral Palsy, Florian Heinen, Michaela Bonfert, Petr Kanovsky, A Sebastian Schroeder, Henry Chambers, Edward Dabrowski, Thorin Geister, Angelika Hanschmann, Michael Althaus, Marta Banach, Deborah Gaebler-Spira

Conference Presentation Abstracts

Introduction: This analysis determined the prevalence and intensity of spasticity-related pain (SRP) in children/adolescents (C/As) with cerebral palsy (CP).

Patients and methods: Baseline data from the prospective incobotulinumtoxinA trials TIM, TIMO and XARA were pooled. In all three studies, SRP was assessed in C/As aged 2–17 years with lower limb (LL) and/or upper limb (UL) spasticity using the Questionnaire on Pain caused by Spasticity (QPS); both self-reports (direct or via interviewer) and parent/caregiver (P/C) observer reports were included. A C/A was considered to have SRP if any QPS key item score was rated >0 at baseline. Individual QPS modules were …

Absence Of Neutralizing Antibody Formation During Incobotulinumtoxina Treatement Of Spasticity In Botulinum Toxin-Naive Children With Cerebral Palsy: Pooled Analysis Of Three Phase 3 Studies, Henry Chambers, Petr Kanovsky, A Sebastian Schroeder, Edward Dabrowski, Thorin Geister, Angelika Hanschmann, Irena Pulte, Michael Althaus, Marta Banach, Deborah Gaebler-Spira, Florian Heinen

Conference Presentation Abstracts

Introduction: The development of neutralizing antibodies (NAbs) has been linked to secondary non-response to botulinum neurotoxin type A (BoNT-A) injections. This may be of special concern when treating conditions like pediatric spasticity. We investigated NAb formation in three large Phase 3 studies with incobotulinumtoxinA, a BoNT-A lacking complexing proteins, in children/adolescents with cerebral palsy (CP).

Patients and methods: Patients with lower-limb (LL), upper-limb (UL), or combined LL/UL spasticity (2–17 years; uni- or bilateral CP; Ashworth Scale score ≥2 in clinical patterns for treatment) received total body weight incobotulinumtoxinA ≤16–20 U/kg (max. 400–500 U) depending on the study (TIM: NCT01893411; TIMO: …

Safety Of Incobotulinumtoxina In Multipattern Treatment Of Upper And Lower Limb Spasticity In Children/Adolescents With Cerebral Palsy: Pooled Analysis Of 3 Large Phase 3 Studies, Marta Banach, Petr Kanovsky, A Sebastian Schroeder, Henry G. Chambers, Edward Dabrowski, Thorin L. Geister, Hanna Dersch, Michael Althaus, Deborah Gaebler-Spriag, Florian Heinen

Conference Presentation Abstracts

Introduction: This analysis assessed the safety and tolerability of repeated incobotulinumtoxinA treatment for lower-limb (LL), upper-limb (UL), or combined LL/UL spasticity in ambulant and non-ambulant children/adolescents with cerebral palsy (CP) using pooled data from 3 large Phase 3 studies.

Methods: Pediatric patients with spasticity (2–17 years of age; uni- or bilateral CP; Gross Motor Function Classification System [GMFCS] level I-V; Ashworth Scale [AS] score ≥2 in clinical patterns for treatment; clinical need for treatment) were enrolled. Patients received total body incobotulinumtoxinA doses of 16 U/kg body weight (BW, ≤400 U) for LL spasticity in 2 injection cycles (ICs) in TIM …

Improvement Of Spasticity-Related Pain With Incobotulinumtoxina Treatment In Children/Adolescents With Cerebral Palsy: Pooled Analysis Of 3 Phase 3 Studies, Florian Heinen, Petr Kanovsky, A Sebastian Schroeder, Henry G. Chambers, Edward Dabrowski, Thorin L. Geister, Hanna Dersch, Irena Pulte, Michael Althaus, Marta Banach, Deborah Gaebler-Spirag

Conference Presentation Abstracts

Introduction: Spasticity-related pain (SRP) in children and adolescents with cerebral palsy (CP) is common, often neglected, and impacts daily quality of life. We assessed the effect of incobotulinumtoxinA on SRP using pooled data from 3 large Phase 3 pediatric studies.

Methods: Ambulant and non-ambulant patients (2–17 years of age; uni- or bilateral CP; Ashworth Scale score ≥2 in clinical patterns for treatment) were enrolled. Patients received total body incobotulinumtoxinA doses of ≤16 U/kg (≤400 U) for lower-limb (LL) treatment in 2 injection cycles (ICs) in TIM (NCT01893411). In TIMO (NCT01905683), TIM completers and new recruits received 4 ICs with 16–20 …

Pooled Efficacy Analysis Of Incobotulinumtoxina In The Multipattern Treatment Of Upper- And Lower-Limb Spasticity In Children And Adolescents With Cerebral Palsy, Florian Heinen, Petr Kanovsky, A Sebastitan Schroeder, Henry G. Chambers, Edward Dabrowski, Thorin L. Geister, Hanna Dersch, Irena Pulte, Michael Althaus, Marta Banach, Deborah Gaebler-Spirag

Conference Presentation Abstracts

Introduction: This pooled analysis assessed the efficacy of incobotulinumtoxinA for lower-limb (LL) and upper-limb (UL) spasticity in children and adolescents with cerebral palsy (CP) using data from the first controlled injection cycle of 2 large Phase 3 studies, TIM (NCT01893411) and XARA (NCT02002884).

Methods: Ambulant and non-ambulant pediatric patients with spasticity due to CP (2–17 years of age; uni- or bilateral CP; Ashworth Scale [AS] score ≥2 in clinical patterns for treatment) were enrolled. Patients were randomized (2:1:1) to 3 incobotulinumtoxinA dose groups: 8, 6, 2 U/kg body weight (BW), maximum 200, 150, 50 U per LL clinical pattern in …

Neuromuscular Response To A Single Session Of Whole-Body Vibration In Children With Cerebral Palsy: A Pilot Study, Huaqing (Virginia) Liang, Gena Henderson, Jianhua Wu

Physical Therapy Faculty Research

Background Whole-body vibration (WBV) is a relative new intervention paradigm that could reduce spasticity and improve motor function in children with cerebral palsy (CP). We investigated neuromuscular response to a single session of side-alternating WBV with different amplitudes in children with CP.

Methods Ten children with spastic CP aged 7–17 years at GMFCS level I-III participated in this pilot study. Participants received two sessions of side-alternating WBV with the same frequency (20 Hz) but different amplitudes (low-amplitude: 1 mm and high-amplitude: 2 mm). Each session included six sets of 90 s of WBV and 90 s of rest. Before and …

Effect Of Motor Imagery On Children With Developmental Disabilities, J. Bonner, Ots, L. Finnegan, Ots, V. Leonard, Ots, M. Scuderi, Ots, A. Shacklett, Ots, J. Thiel, Ots, M.-C. Potvin, Phd, Otr/L

Student Papers, Posters & Projects

This systematic review provides a comprehensive summary of current research evidence with the intent to help OTs working in pediatric settings understand the potential outcomes of using MI with children with DD.

The Temporal Relationship Between Stress And Spasticity, A Comparison Between Subjects With And Without Intact Thyroid Function, Dr. Roger Allen, Benjamin L. Hannula, Benjamin T. Gilksion, Caitlin A. Turner

Physical Therapy Research Symposium

Purpose/Hypothesis: Stress has been studied as a credible trigger of spasticity, but evidence is limited concerning temporal relationships. Case studies of complex regional pain syndrome (CRPS) and fibromyalgia (FM) have established a ten-day delay between psychogenic stress and episodic pain flares. This is explained by a stress induced release of thyroxine (T4) from the thyroid gland via the hypothalamus-pituitary-thyroid (HPT) axis, which reaches its peak effect by day 10. Models suggest that T4 may increase peripheral nerve excitability, which could increase sensitivity in 1A fibers from muscle spindles, leading to hyper-excitability in motor neuron pools. The purpose of our study …

Pedaling Alters The Excitability And Modulation Of Vastus Medialis H-Reflexes After Stroke, Dana P. Fuchs, Namita Sanghvi, Jon A. Wieser, Sheila Schindler-Ivens

Physical Therapy Faculty Research and Publications

Objective

Individuals post-stroke display abnormal Group Ia reflex excitability. Pedaling has been shown to reduce Group Ia reflexes and to normalize the relationship between EMG and reflex amplitude in the paretic soleus (SO). The purpose of this study was to determine whether these changes extend to the paretic quadriceps.

Methods

H-reflexes were used to examine Group Ia reflex excitability of the vastus medialis (VM). H-reflexes were elicited in paretic (n = 13) and neurologically intact (n = 13) individuals at 11 positions in the pedaling cycle and during static knee extension at comparable limb positions and levels of …

Correlation Between Impairment And Motor Performance During Reaching Tasks In Subjects With Spastic Hemiparesis, Charles Leonard, Kelsey A. Gardipee, Jennifer R. Koontz, John-Henry Anderson, Scott A. Wilkins

Physical Therapy and Rehabilitation Science Faculty Publications

Objective: The main purposes of this study were to examine, in subjects with chronic hemiparesis following a stroke: (i) the correlations between tests of muscle tone, stiffness, spasticity, paresis and co-contraction, and (ii) the correlations of these tests and measurements of impairment to upper extremity motor performance.

Design: Prospective, cross-sectional, correlation matrix using sample of convenience.

Subjects: Thirteen subjects with chronic hemiparesis secondary to a cerebrovascular accident (stroke) were tested.

Methods: Subjects were assessed using the Fugl-Meyer Upper Extremity Motor Assessment, modified Ashworth scale, deep tendon reflexes, and muscle characteristics that included quantification of muscle stiffness, paresis and co-contraction during …