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Krosschell KJ, Brown L, Hoffman K, Zumpf KB, Munson H, Bidwell J, Schulte DP, Schwaede AN, Buehner AN, DiDonato CJ, Kuntz NL, Rao VK. Longitudinal Assessment of Timed Function Tests Over Time in Ambulatory Individuals with SMA Treated with Nusinersen. J Neuromuscul Dis 2023; 10:337-348. [PMID: 36872785 DOI: 10.3233/jnd-221519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Ambulatory individuals with spinal muscular atrophy experience weakness and impairments of speed and endurance. This leads to decreased motor skill performance required for daily living including transitioning from floor to stand, climbing stairs, and traversing short and community distances. Motor function improvements have been reported in individuals receiving nusinersen, but changes in timed functional tests (TFTs) which assess shorter distance walking and transitions have not been well documented. OBJECTIVE To evaluate changes in TFT performance over the course of nusinersen treatment in ambulatory individuals with SMA and identify potential factors [age, SMN2 copy number, BMI, Hammersmith Functional Motor Scale expanded (HFMSE score), Peroneal Compound Motor Action Potential (CMAP) amplitude] associated with TFT performance. METHODS Nineteen ambulatory participants receiving nusinersen were followed from 2017 through 2019 (range: 0-900 days, mean 624.7 days, median 780 days); thirteen of 19 (mean age = 11.5 years) completed TFTs. The 10-meter walk/run test, time-to-rise from supine, time-to-rise from sitting, 4-stair climb, 6-minute walk test (6MWT), Hammersmith-Expanded and peroneal CMAP were assessed at each visit. Linear mixed-effects models were used to evaluate unadjusted and adjusted changes in these outcomes over time. RESULTS Apart from time to rise from sitting and from supine, all TFTs were found to improve over the course of treatment after adjusting for baseline age and BMI. CONCLUSIONS Improvement in TFTs over time in patients with SMA treated with nusinersen suggests that shorter TFTs may have value to assess individuals with SMA who have or later gain ambulatory function during treatment.
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Affiliation(s)
- Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA
| | - Laurey Brown
- Department of Rehabilitation Services, Ann and Robert H. Lurie Children's Hospital of Chicago, USA.,Division of Neurology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Katie Hoffman
- Department of Rehabilitation Services, Ann and Robert H. Lurie Children's Hospital of Chicago, USA.,Division of Neurology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Katelyn B Zumpf
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA- sponsor.,Statistical Consulting, OSF Healthcare, Chicago, IL, USA
| | - Hannah Munson
- Chicago College of Osteopathic Medicine, Midwestern University Downers Grove, IL, USA
| | - Jessa Bidwell
- Graduate Program of Genetic Engineering, Northwestern University, Chicago, IL, USA
| | - Duncan P Schulte
- Division of Neurology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Abigail N Schwaede
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA.,Division of Neurology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | | | - Christine J DiDonato
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA.,Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Nancy L Kuntz
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA.,Division of Neurology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
| | - Vamshi K Rao
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, USA.,Division of Neurology, Ann and Robert H. Lurie Children's Hospital of Chicago, USA.,Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, USA
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Alemdaroğlu-Gürbüz İ, İpek C, Bulut N, Karaduman A, Yılmaz Ö. The Impact of "Fear of Falling" on Physical Performance, Balance, and Ambulation in Duchenne Muscular Dystrophy. Neuropediatrics 2022; 53:330-337. [PMID: 36030791 DOI: 10.1055/s-0042-1750722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The aim of this study was to investigate falls and the fear of falling (FOF) in children with Duchenne muscular dystrophy (DMD) and to determine the relationships between the FOF and physical performance, balance, and ambulation. METHODS Thirty-eight ambulatory children with DMD were included in the study. The functional level, falling history, FOF, physical performance, balance, and ambulation were assessed by using Brooke Lower Extremity Functional Classification, History of Falls Questionnaire, Pediatric Fear of Falling Questionnaire (Ped-FOF), timed performance tests, Timed "Up and Go" (TUG) test, and North Star Ambulatory Assessment (NSAA), respectively. RESULTS Of the 38 children (mean age: 9.00 ± 2.03 years) 97.4% had a history of serious fall last year and 62.2% were injured due to this fall. The Ped-FOF score was 13.79 ± 7.20. Weak to moderate relations were determined between Ped-FOF and functional level (r = 0.33), frequency of falls (r = 0.41), duration of climbing 4-steps (r = 0.38), TUG (r = 0.36), and NSAA (r = -0.32) (p < 0.05). CONCLUSION Ambulatory children with better performance scores had lower levels of FOF despite their history of serious falls and injuries. FOF tends to increase as the symptoms of the disease progresses. Investigating the history of falls and FOF from the earliest period will guide to take precautions and make necessary interventions on time in treatment programs.
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Affiliation(s)
- İpek Alemdaroğlu-Gürbüz
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Canan İpek
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Numan Bulut
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayşe Karaduman
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
| | - Öznur Yılmaz
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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İpek C, Yilmaz Ö, Karaduman A, Alemdaroğlu-Gürbüz İ. Development of a questionnaire to assess fear of falling in children with neuromuscular diseases. J Pediatr Orthop B 2021; 30:494-499. [PMID: 32784329 DOI: 10.1097/bpb.0000000000000792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fear of falling (FOF) indicates loss of confidence in the ability to perform daily living activities without falling. Although specific questionnaires do exist to assess FOF in different patient populations, any of them targets the pediatric patients with neuromuscular diseases which falling is a frequent symptom. This study aims to present the development of a self-report FOF questionnaire for children with neuromuscular diseases, pilot application of the questionnaire, and its preliminary psychometric properties. An International Classification of Functioning, Disability and Health (ICF)-based 'Pediatric Fear of Falling Questionnaire' for neuromuscular diseases (Ped-FOF) was created by the study team following the steps of developing an instrument. The questionnaire included 34 items which were organized based on the 'Activities and Participation' component of ICF-children and youth. Thirty children with Duchenne muscular dystrophy (DMD) were recruited to obtain preliminary reliability and validity results of the questionnaire. The mean Ped-FOF score of study population was 15.30 ± 7.03. According to the preliminary results, intraclass correlation coefficient was 0.715 [confidence interval (CI) 95%], and moderate correlations between Ped-FOF and functional performance and quality of life were determined (P < 0.05). Ped-FOF promises a practical assessment of FOF in pediatrics with neuromuscular diseases with understandable items that allow self-report of children. Ped-FOF also allows clinicians and therapists to assess FOF efficiently in limited clinical time. Its preliminary reliability and validity results are also sufficient to be used in DMD that falling is a frequent condition, which indicates that the use of questionnaire is promising in many other pediatric neuromuscular disorders.
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Affiliation(s)
- Canan İpek
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindağ, Ankara, Turkey
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Trenkle J, Brugman J, Peterson A, Roback K, Krosschell KJ. Filling the gaps in knowledge translation: Physical therapy recommendations for individuals with spinal muscular atrophy compared to standard of care guidelines. Neuromuscul Disord 2021; 31:397-408. [PMID: 33741230 DOI: 10.1016/j.nmd.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/17/2021] [Accepted: 02/11/2021] [Indexed: 11/17/2022]
Abstract
This study describes the current landscape of physical therapy practice recommendations in the United States for children with spinal muscular atrophy (SMA) and their relationship to current SMA standard of care (SMA-SOC) guidelines. Pediatric physical therapists were surveyed to determine their knowledge of SMA-SOC guidelines, and the type, duration and frequency of intervention they recommend for children with SMA, as well as perceived barriers and facilitators to progress in physical therapy. Physical therapists recommend five key intervention areas for individuals with SMA; however discrepancies exist between the SOC recommended intervention parameters and respondents' reported frequency and duration of recommendations. After individuals with SMA initiated disease modifying pharmacotherapies, a majority of physical therapist respondents recommended increases in both frequency and duration of interventions. Nearly all respondents reported that familiarity with SOC guidelines was beneficial to their practice. The primary facilitator to progress was parent/caregiver support, while the primary barrier was limited access to resources. Variation in practice exists regarding care for those with SMA, particularly in the areas of frequency and duration of specific interventions. These findings can guide educational initiatives, identify future research needs and further inform SMA-SOC and best-practice rehabilitation management.
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Affiliation(s)
- Jessica Trenkle
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Jessica Trenkle, LLC, United States
| | - Jessica Brugman
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Anne Peterson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Katherine Roback
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
| | - Kristin J Krosschell
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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Van Geel F, Moumdjian L, Lamers I, Bielen H, Feys P. Measuring walking-related performance fatigability in clinical practice: a systematic review. Eur J Phys Rehabil Med 2020; 56:88-103. [DOI: 10.23736/s1973-9087.19.05878-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kennedy RA, Carroll K, Hepworth G, Paterson KL, Ryan MM, McGinley JL. Falls in paediatric Charcot-Marie-Tooth disease: a 6-month prospective cohort study. Arch Dis Child 2019; 104:535-540. [PMID: 30104392 DOI: 10.1136/archdischild-2018-314890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/07/2018] [Accepted: 07/16/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To prospectively study falls in children and adolescents with Charcot-Marie-Tooth disease (CMT). DESIGN Prospective cohort study. SETTING Neuromuscular outpatient clinic of a tertiary paediatric hospital. PATIENTS Sixty children and adolescents ('children') aged 4-18 years, 30 with CMT and 30 typically developing (TD). MAIN OUTCOME MEASURES Falls rate over 6 months and falls characteristics questionnaire. RESULTS Twenty-two children with CMT reported falling at least once in 6 months compared with eight TD children (CMT 2819 (0-1915), TD 31 (0-6) total falls (range)). Detailed falls characteristics were collected from 242 individual falls (CMT 216, TD 26). Injurious falls were reported by 19 children with CMT (74 falls) compared with 2 TD children (3 falls), with cuts, grazes and bruising most common. No fractures were sustained and no child required hospitalisation. However, 12 injuries from falls in children with CMT required management by a healthcare provider, versus none in TD children. Tripping was the most common mechanism of falls in both groups. Age was the strongest predictor of falls (ρ=-0.53, p=0.006) with all children (CMT and TD) aged <7 years falling. Balance was the strongest impairment-related predictor of falls (ρ=-0.47, p=0.02). The conservative estimate of risk of falls in children and adolescents with CMT was 33 times higher than their TD peers (incidence rate ratio=32.8, 95% CI 10.2 to 106.0). CONCLUSIONS Children and adolescents with CMT fall more often than TD peers and sustain more injuries when they fall.
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Affiliation(s)
- Rachel A Kennedy
- Neurology Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Kate Carroll
- Neurology Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Parkville, Victoria, Australia
| | - Kade L Paterson
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia
| | - Monique M Ryan
- Neurology Department, The Royal Children's Hospital, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jennifer L McGinley
- Physiotherapy Department, The University of Melbourne, Parkville, Victoria, Australia.,Murdoch Children's Research Institute, Parkville, Victoria, Australia
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Montes J, Zanotto D, Dunaway Young S, Salazar R, De Vivo DC, Agrawal S. Gait assessment with solesound instrumented footwear in spinal muscular atrophy. Muscle Nerve 2017; 56:230-236. [DOI: 10.1002/mus.25484] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/13/2016] [Accepted: 11/16/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Jacqueline Montes
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
- Department of Rehabilitation and Regenerative Medicine; Columbia University; New York New York USA
| | - Damiano Zanotto
- Department of Mechanical Engineering; Columbia University; New York New York USA
| | - Sally Dunaway Young
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
- Department of Rehabilitation and Regenerative Medicine; Columbia University; New York New York USA
| | - Rachel Salazar
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
| | - Darryl C. De Vivo
- SMA Clinical Research Center; Department of Neurology, Columbia University Medical Center; 180 Fort Washington Avenue, 5th Floor New York New York 10032 USA
| | - Sunil Agrawal
- Department of Rehabilitation and Regenerative Medicine; Columbia University; New York New York USA
- Department of Mechanical Engineering; Columbia University; New York New York USA
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Abstract
Spinal muscular atrophy (SMA) is a frequently fatal neuromuscular disorder and the most common inherited cause of infant mortality. SMA results from reduced levels of the survival of motor neuron (SMN) protein. Although the disease was first described more than a century ago, a precise understanding of its genetics was not obtained until the SMA genes were cloned in 1995. This was followed in rapid succession by experiments that assigned a role to the SMN protein in the proper splicing of genes, novel animal models of the disease, and the eventual use of the models in the pre clinical development of rational therapies for SMA. These successes have led the scientific and clinical communities to the cusp of what are expected to be the first truly promising treatments for the human disorder. Yet, important questions remain, not the least of which is how SMN paucity triggers a predominantly neuromuscular phenotype. Here we review how our understanding of the disease has evolved since the SMA genes were identified. We begin with a brief description of the genetics of SMA and the proposed roles of the SMN protein. We follow with an examination of how the genetics of the disease was exploited to develop genetically faithful animal models, and highlight the insights gained from their analysis. We end with a discussion of ongoing debates, future challenges, and the most promising treatments to have emerged from our current knowledge of the disease.
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Affiliation(s)
- Tomoyuki Awano
- />Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032 USA
- />Center for Motor Neuron Biology and Disease, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032 USA
| | - Jeong-Ki Kim
- />Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032 USA
- />Center for Motor Neuron Biology and Disease, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032 USA
| | - Umrao R. Monani
- />Department of Pathology and Cell Biology, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032 USA
- />Center for Motor Neuron Biology and Disease, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032 USA
- />Department of Neurology, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032 USA
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Dunaway S, Montes J, Garber CE, Carr B, Kramer SS, Kamil-Rosenberg S, Strauss N, Sproule D, De Vivo DC. Performance of the timed "up & go" test in spinal muscular atrophy. Muscle Nerve 2014; 50:273-7. [PMID: 24375426 DOI: 10.1002/mus.24153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The timed "up & go" (TUG) test is a quick measure of balance and mobility. TUG scores correlate with clinical, functional, and strength assessment and decline linearly over time. Reliability and validity have not been tested in spinal muscular atrophy (SMA). METHODS Fifteen ambulatory SMA participants performed TUG testing and strength, functional, and clinical assessments. Intraclass correlation coefficients quantified test-retest reliability. Convergent validity was determined using Pearson correlation coefficients. RESULTS Test-retest reliability was excellent for all participants. TUG was associated significantly with total leg and knee flexor strength, as well as the Hammersmith Functional Motor Scale Expanded, the 10-meter walk/run, and 6-minute walk tests. TUG findings were not associated with knee extensor strength, pulmonary function, or fatigue. CONCLUSIONS In SMA, the TUG test is easily administered, reliable, and correlates with established outcome measures. TUG testing is a potentially useful outcome measure for clinical trials and a measure of disability in ambulatory patients with SMA.
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Affiliation(s)
- Sally Dunaway
- Department of Neurology, Columbia University Medical Center, 180 Fort Washington Avenue, 5th Floor, New York, New York, 10032, USA
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Monani UR, De Vivo DC. Neurodegeneration in spinal muscular atrophy: from disease phenotype and animal models to therapeutic strategies and beyond. FUTURE NEUROLOGY 2014; 9:49-65. [PMID: 24648831 DOI: 10.2217/fnl.13.58] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Of the numerous inherited diseases known to afflict the pediatric population, spinal muscular atrophy (SMA) is among the most common. It has an incidence of approximately one in 10,000 newborns and a carrier frequency of one in 50. Despite its relatively high incidence, SMA remains somewhat obscure among the many neurodegenerative diseases that affect humans. Nevertheless, the last two decades have witnessed remarkable progress in our understanding of the pathology, underlying biology and especially the molecular genetics of SMA. This has led to a genuine expectation within the scientific community that a robust treatment will be available to patients before the end of the decade. The progress made in our understanding of SMA and, therefore, towards a viable therapy for affected individuals is in large measure a consequence of the simple yet fascinating genetics of the disease. Nevertheless, important questions remain. Addressing these questions promises not only to accelerate the march towards a cure for SMA, but also to uncover novel therapies for related neurodegenerative disorders. This review discusses our current understanding of SMA, considers the challenges ahead, describes existing treatment options and highlights state-of-the-art research being conducted as a means to a better, safer and more effective treatment for the disease.
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Affiliation(s)
- Umrao R Monani
- Department of Pathology & Cell Biology, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Department of Neurology, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Center for Motor Neuron Biology & Disease, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA
| | - Darryl C De Vivo
- Department of Neurology, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Center for Motor Neuron Biology & Disease, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA ; Department of Pediatrics, 630 West 168th Street, Columbia University Medical Center, New York, NY 10032, USA
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