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Bavikatte G, Esquenazi A, Dimyan MA, Dashtipour K, Feng W, Mayadev A, Fanning K, Musacchio T, Zuzek A, Francisco GE. Safety and real-world dosing of onabotulinumtoxinA for the treatment of adult spasticity: post hoc analysis of the Adult Spasticity International Registry study. Am J Phys Med Rehabil 2024:00002060-990000000-00390. [PMID: 38206635 DOI: 10.1097/phm.0000000000002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate the safety of onabotulinumtoxinA treatment for spasticity across dose ranges in real-world practice. DESIGN Adult Spasticity International Registry (ASPIRE) was a multicenter, prospective, observational study (NCT01930786) of onabotulinumtoxinA treatment for adult spasticity over 2 years. Adverse events (AEs), serious AEs (SAEs), treatment-related AEs (TRAEs), and TRSAEs were sorted into 5 categories (≤200 U, 201-400 U, 401-600 U, 601-800 U, ≥801 U) based on cumulative dose per session. RESULTS In 3103 treatment sessions (T), 730 patients received ≥1 dose of onabotulinumtoxinA. Dose categories included: ≤200 U (n = 312; t = 811), 201-400 U (n = 446, t = 1366), 401-600 U (n = 244, t = 716), 601-800 U (n = 69, t = 149), ≥801 U (n = 29, t = 61). Of these patients, 261 reported 827 AEs, 94 reported 195 SAEs, 20 reported 23 TRAEs, and 2 patients treated with 201-400 U onabotulinumtoxinA reported 3 TRSAEs. TRAEs reported: ≤200 U (8 TRAEs/811, 0.9%); 201-400 U (7/1366, 0.5%); 401-600 U (6/716, 0.8%); 601-800 U (1/149, 0.7%); ≥801 U (1/61, 1.6%). CONCLUSIONS In this post hoc analysis, most treatment sessions were performed with 201-400 U onabotulinumtoxinA. Patients treated with 201-400 U onabotulinumtoxinA had an AE profile consistent with onabotulinumtoxinA package inserts globally (eg, United States, European Union, United Kingdom, Canada). No new safety signals were identified.
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Affiliation(s)
| | | | | | | | - Wuwei Feng
- Duke University School of Medicine, Durham, NC, USA
| | | | | | | | | | - Gerard E Francisco
- University of Texas McGovern Medical School and TIRR Memorial Hermann, Houston, TX, USA
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Esquenazi A, Bloudek L, Migliaccio-Walle K, Oliveri D, Tung A, Gillard P, Verduzco-Gutierrez M. Healthcare resource utilization and costs among patients with post-stroke spasticity before and after spasticity management including onabotulinumtoxina. J Rehabil Med 2023; 55:jrm11626. [PMID: 37902443 DOI: 10.2340/jrm.v55.11626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Real-world data regarding the impact of onabotulinumtoxinA on healthcare resource utilization and costs for post-stroke spasticity are scarce. OBJECTIVE To compare differences in 12-month healthcare resource utilization and costs before and after post-stroke spasticity management including onabotulinumtoxinA. METHODS This retrospective claims analysis of IBM MarketScan Commercial and Medicare Supplemental databases included adults with ≥ 1 onabotulinumtoxinA claim for post-stroke spasticity (1 January 2010 to 30 June 2018) and continuous enrolment for ≥ 12 months pre- and post-index (first onabotulinumtoxinA claim date). All-cause and spasticity-related healthcare resource utilization and costs were compared 12 months pre- and post-index (McNemar's χ2 test or paired t-test). A subgroup analysis assessed effect of stroke-to-index interval on costs. RESULTS Among 735 patients, mean (standard deviation) stroke-date-to-index-date interval was 284.5 (198.8) days. Decreases were observed post-index for mean all-cause outpatient (62.9 vs 60.5; p ≤ 0.05) and emergency department visits (1.1 vs 0.8; p ≤ 0.0001), and hospital admissions (1.5 vs 0.4; p ≤ 0.0001). Increase in prescription fills (43.0 vs 53.7) was seen post-index. Post-index decreases in all-cause (-66%) and spasticity-related (-51%) costs were driven by reduced inpatient care costs. Findings were consistent regardless of stroke-date-to-index-date interval. CONCLUSION Significant reductions in healthcare resource utilization and costs were observed after 1 year of post-stroke spasticity management including onabotulinumtoxinA. Long-term studies are needed to establish causality.
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Affiliation(s)
- Alberto Esquenazi
- MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA, USA.
| | | | | | | | - Amy Tung
- Allergan, an AbbVie Company, Chicago, IL, USA
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Esquenazi A, Zorowitz RD, Ashford S, Maisonobe P, Page S, Jacinto J. Clinical presentation of patients with lower limb spasticity undergoing routine treatment with botulinum toxin: baseline findings from an international observational study. J Rehabil Med 2023; 55:jrm4257. [PMID: 37794845 PMCID: PMC10562995 DOI: 10.2340/jrm.v55.4257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/11/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Describe how people with lower limb spasticity present for treatment in routine clinical practice. METHODS Prospective, observational study (Clinicaltrials.gov: NCT04050527) of ambulatory adult patients (≥ 18 years) with unilateral lower limb spasticity (able to take ≥ 5 steps with or without assistance) presenting for routine spasticity management, including treatment with abobotulinumtoxinA. RESULTS The study population included 430 adults with lower limb spasticity. Despite their relatively young age (mean ± standard deviation 53.7 ± 13.9 years), only 20% of patients were employed. Most patients had an acquired brain injury due to cerebrovascular disease; 84.1% reported having concomitant upper limb spasticity. Using the Leg Activity Measure, most patients reported no or only mild difficulties in performing hygiene/positioning tasks, while 80.7% had at least mild difficulty with indoor ambulation and 90.5% had at least mild difficulty with walking outdoors. Sensory, communication and/or cognitive impairments were also common. At the first treatment cycle, 50.7% of patients set active function primary goals, including locomotion transferring or standing. CONCLUSION These observations highlight the complexity of presentation that must be considered when setting treatment goals for lower limb spasticity and emphasize the types of impairment and activity (functional) limitations that treating teams may expect to encounter in their patients and should cover in their initial and follow-up assessments.
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Affiliation(s)
| | - Richard D Zorowitz
- MedStar National Rehabilitation Network and Georgetown University School of Medicine, Washington, DC, USA
| | - Stephen Ashford
- London Northwest University Healthcare NHS Trust, Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, UK; Department of Palliative Care, Policy, and Rehabilitation, King's College, London, UK
| | | | | | - Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de adultos 3, Estoril, Portugal
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Talaty M, Esquenazi A. Feasibility and outcomes of supplemental gait training by robotic and conventional means in acute stroke rehabilitation. J Neuroeng Rehabil 2023; 20:134. [PMID: 37794474 PMCID: PMC10552424 DOI: 10.1186/s12984-023-01243-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 09/07/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Practicality of implementation and dosing of supplemental gait training in an acute stroke inpatient rehabilitation setting are not well studied but can have positive impact on outcomes. OBJECTIVES To determine the feasibility of early, intense supplemental gait training in inpatient stroke rehabilitation, compare functional outcomes and the specific mode of delivery. DESIGN AND SETTING Assessor blinded, randomized controlled trial in a tertiary Inpatient Rehabilitation Facility. PARTICIPANTS Thirty acute post-stroke patients with unilateral hemiparesis (≥ 18 years of age with a lower limb MAS ≤ 3). INTERVENTION Lokomat® or conventional gait training (CGT) in addition to standard mandated therapy time. MAIN OUTCOME MEASURES Number of therapy sessions; adverse events; functional independence measure (FIM motor); functional ambulation category (FAC); passive range of motion (PROM); modified Ashworth scale (MAS); 5 times sit-to-stand (5x-STS); 10-m walk test (10MWT); 2-min walk test (2MWT) were assessed before (pre) and after training (post). RESULTS The desired supplemental therapy was implemented during normal care delivery hours and the patients generally tolerated the sessions well. Both groups improved markedly on several measures; the CGT group obtained nearly 45% more supplemental sessions (12.8) than the Lokomat® group (8.9). Both groups showed greater FIM improvement scores (discharge - admission) than those from a reference group receiving no supplemental therapy. An overarching statistical comparison between methods was skewed towards a differential benefit (but not significant) in the Lokomat® group with medium effect sizes. By observation, the robotic group completed a greater number of steps, on average. These results provide some evidence for Lokomat® being a more efficient tool for gait retraining by providing a more optimal therapy "dose". CONCLUSIONS With careful planning, supplemental therapy was possible with minimal intrusion to schedules and was well tolerated. Participants showed meaningful functional improvement with relatively little supplemental therapy over a relatively short time in study.
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Affiliation(s)
- Mukul Talaty
- Gait and Motion Analysis Laboratory, MossRehab, Elkins Park, PA, 19027, USA.
- Penn State University, 1600 Woodland Road, Abington, PA, 19001, USA.
| | - Alberto Esquenazi
- Gait and Motion Analysis Laboratory, MossRehab, Elkins Park, PA, 19027, USA
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Esquenazi A, Jost WH, Turkel CC, Wein T, Dimitrova R. Treatment of adult spasticity with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine (Baltimore) 2023; 102:e32376. [PMID: 37499086 PMCID: PMC10374184 DOI: 10.1097/md.0000000000032376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Upper and lower limb spasticity (ULS, LLS) often occur following a stroke or in patients with other neurological disorders, leading to difficulties in mobility and daily living and decreased quality of life. Prior to the use of onabotulinumtoxinA, antispastic medications had limited efficacy and often caused sedation. Phenol injections were difficult for physicians to perform, painful, and led to tissue destruction. The success of onabotulinumtoxinA in treating cervical dystonia led to its use in spasticity. However, many challenges characterized the development of onabotulinumtoxinA for adult spasticity. The wide variability in the presentation of spasticity among patients rendered it difficult to determine which muscles to inject and how to measure improvement. Another challenge was the initial refusal of the Food and Drug Administration to accept the Ashworth Scale as a primary endpoint. Additional scales were designed to incorporate a goal-oriented, patient-centered approach that also accounted for the variability of spasticity presentations. Several randomized, double-blind, placebo-controlled trials of post-stroke spasticity of the elbow, wrist, and/or fingers showed significantly greater improvements in the modified Ashworth Scale and patient treatment goals and led to the approval of onabotulinumtoxinA for the treatment of ULS in adult patients. Lessons learned from the successful ULS trials were applied to design an LLS trial that led to approval for the latter indication. Additional observational trials mimicking real-world treatment have shown continued effectiveness and patient satisfaction. The use of onabotulinumtoxinA for spasticity has ushered in a more patient-centered treatment approach that has vastly improved patients' quality of life.
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Affiliation(s)
| | - Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg, Germany, and Parkinson-Hospital Ortenau, Wolfach, Germany
| | | | - Theodore Wein
- Department of Neurology, McGill University, Montreal, QC, Canada
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Cao N, Barcikowski J, Womble F, Martinez B, Sergeyenko Y, Koffer JH, Kwasniewski M, Watanabe T, Xiao R, Esquenazi A. Efficacy of Early Inpatient Rehabilitation of Post-COVID-19 Survivors: Single-Center Retrospective Analysis. Am J Phys Med Rehabil 2023; 102:498-503. [PMID: 36282676 PMCID: PMC10184709 DOI: 10.1097/phm.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The aim of this study was to understand the demographic, clinical characteristics, and effectiveness of early inpatient rehabilitation of post-COVID survivors. DESIGN A single-center retrospective chart review analysis of 100 patients admitted to a newly created acute COVID rehabilitation unit (CORE+) from April to December 2020 was conducted. RESULTS The demographic and clinical characteristics and complications of 100 post-COVID patients were reviewed. Functional outcomes of GG Self-care and Mobility Activities Items (Section GG0130 and GG0170) of the Centers for Medicare & Medicaid Services of the Inpatient Rehabilitation Facility Patient Assessment Instrument (Version 3.0) at admission and discharge, prevalence of oxygen requirement, the need for cognitive and neuropsychology support by discharge, and dispositions after completion of inpatient rehabilitation facility stay were analyzed. The functional outcomes of 59 primary pulmonary manifestations of COVID patients were further analyzed based on the presence of intensive care unit stay before transfer to the COVID rehabilitation unit. Most patients demonstrated significant functional gains after completion of inpatient rehabilitation facility stay; however, a considerable number of patients continued to require cognitive support by discharge. CONCLUSION The data suggested the benefit of early rehabilitation for hospitalized post-COVID patients. Services need to be geared to include patients' cognitive deficits.
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Esquenazi A. Video enhanced visual analysis of hemiparetic gait muscle selection: A pilot study. Toxicon 2023; 228:107112. [PMID: 37060926 DOI: 10.1016/j.toxicon.2023.107112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/17/2023]
Abstract
This paper summarizes the use of video enhanced visual analysis (VEVA) as a muscle selection assistance method for abnormal foot postures in adults with upper motor neuron syndrome (UMNS) treated with botulinum neurotoxin (BoNT-A) in a real-world setting. This pilot study used a prospective treatment study design with persons in an outpatient, rehabilitation hospital. Participants had acquired brain injury (ABI) of >6-month duration who had a spastic ankle foot deformity amenable to treatment with botulinum toxin A and able to independently ambulate a minimum of 10 m. Participants were evaluated before abobotulinumtoxinA injection (500 U-1500 U) to the identified lower limb muscles and four to five weeks post injection. Main Outcome Measures: Temporal spatial data (self-selected and maximal walking velocities (SSWV/MWV); step length and stance time); Modified Ashworth Scale (MAS); Tardieu Scale (TS) and ankle Passive Range of Motion (PROM) change from baseline to follow-up (f/u). Data is presented on ten of the eleven consecutive participants enrolled in the study. One participant withdrew due to study unrelated opposite ankle pain before reassessment. Mean SSWV increased post treatment by 21% in the barefoot condition and 8% when walking with shoes. For the MWV condition, there was a 15% mean increase post treatment in the barefoot condition and 10% when walking with shoes. Participants showed improved symmetry in step length and stance time in both post-treatment walking conditions. Ankle MAS and TS improved with knee flexed or extended. Ankle PROM increased post treatment with knee flexed by 8° and knee extended by 11.7°. VEVA in addition to clinical evaluation appears to facilitate muscle identification and selection of ankle deformities for treatment with BoNT-A. Our findings show marked improvement in ankle MAS, TS and PROM as indicators of pharmacological activity and increase in SSWV as a marker of functional improvement.
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Edwards D, Kumar S, Brinkman L, Ferreira IC, Esquenazi A, Nguyen T, Su M, Stein S, May J, Hendrix A, Finley C, Howard E, Cramer SC. Telerehabilitation Initiated Early in Post-Stroke Recovery: A Feasibility Study. Neurorehabil Neural Repair 2023; 37:131-141. [PMID: 36876946 PMCID: PMC10080366 DOI: 10.1177/15459683231159660] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Enhanced neural plasticity early after stroke suggests the potential to improve outcomes with intensive rehabilitation therapy. Most patients do not get such therapy, however, due to limited access, changing rehabilitation therapy settings, low therapy doses, and poor compliance. OBJECTIVE To examine the feasibility, safety, and potential efficacy of an established telerehabilitation (TR) program after stroke initiated during admission to an inpatient rehabilitation facility (IRF) and completed in the patient's home. METHODS Participants with hemiparetic stroke admitted to an IRF received daily TR targeting arm motor function in addition to usual care. Treatment consisted of 36, 70-minute sessions (half supervised by a licensed therapist via videoconference), over a 6-week period, that included functional games, exercise videos, education, and daily assessments. RESULTS Sixteen participants of 19 allocated completed the intervention (age 61.3 ± 9.4 years; 6 female; baseline Upper Extremity Fugl-Meyer [UEFM] score 35.9 ± 6.4 points, mean ± SD; NIHSS score 4 (3.75, 5.25), median, IQR; intervention commenced 28.3 ± 13.0 days post-stroke). Compliance was 100%, retention 84%, and patient satisfaction 93%; 2 patients developed COVID-19 and continued TR. Post-intervention UEFM improvement was 18.1 ± 10.9 points (P < .0001); Box and Blocks, 22.4 ± 9.8 blocks (P = .0001). Digital motor assessments, acquired daily in the home, were concordant with these gains. The dose of rehabilitation therapy received as usual care during this 6-week interval was 33.9 ± 20.3 hours; adding TR more than doubled this to 73.6 ± 21.8 hours (P < .0001). Patients enrolled in Philadelphia could be treated remotely by therapists in Los Angeles. CONCLUSIONS These results support feasibility, safety, and potential efficacy of providing intense TR therapy early after stroke. CLINICAL TRIAL REGISTRATION clinicaltrials.gov; NCT04657770.
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Affiliation(s)
- Dylan Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Sapna Kumar
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Lorie Brinkman
- UCLA and California Rehabilitation Institute, Los Angeles, CA, USA
| | | | | | - Tiffany Nguyen
- UCLA and California Rehabilitation Institute, Los Angeles, CA, USA
| | - Michael Su
- UCLA and California Rehabilitation Institute, Los Angeles, CA, USA
| | | | | | | | | | | | - Steven C Cramer
- UCLA and California Rehabilitation Institute, Los Angeles, CA, USA
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Salga M, Gatin L, Deltombe T, Gustin T, Carda S, Marque P, Winston P, Reebye R, Wein T, Esquenazi A, Keenan MA, Molteni F, Zerbinati P, Picelli A, Coroian F, Coulet B, Sturbois-Nachef N, Fontaine C, Yelnik A, Parratte B, Henry P, Venkatakrishnan S, Rigoard P, David R, Denormandie P, Schnitzler A, Allart E, Genet F. International Recommendations to Manage Poststroke Equinovarus Foot Deformity Validated by a Panel of Experts Using Delphi. Arch Phys Med Rehabil 2023; 104:372-379. [PMID: 36030892 DOI: 10.1016/j.apmr.2022.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/27/2022] [Accepted: 07/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To establish international recommendations for the management of spastic equinovarus foot deformity. DESIGN Delphi method. SETTING International study. PARTICIPANTS A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). INTERVENTIONS Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. MAIN OUTCOME MEASURES A consensus was established when at least 80% of experts agreed on a statement RESULTS: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. CONCLUSION The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.
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Affiliation(s)
- Marjorie Salga
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France
| | - Laure Gatin
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Thierry Deltombe
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium; Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada
| | - Thierry Gustin
- Department of Neurosurgery, CHU UCL Namur site Godinne, Yvoir, Belgium
| | - Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Philippe Marque
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, France; Department of Neurological Rehabilitation, University Hospital of Toulouse, Hôpital de Rangueil, Toulouse, France
| | - Paul Winston
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Division of Physical Medicine and Rehabilitation, University of British Columbia, Victoria, British Columbia, Canada
| | - Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Theodore Wein
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Alberto Esquenazi
- MossRehab and Albert Einstein Medical Center, Elkins Park, Pennsylvania
| | - Mary-Ann Keenan
- Penn Neuro-Orthopaedics Service, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Italy
| | - Paolo Zerbinati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy; U.O. Neuroortopedia, Ospedale Santa Maria Multimedica Castellanza, Varese, Italy
| | - Alessandro Picelli
- Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Center, University of Verona, Verona, Italy
| | - Flavia Coroian
- Physical and Rehabilitation Medicine Department, Montpellier University Hospital, Montpellier, France; Euromov, Montpellier University, Montpellier, France
| | - Bertrand Coulet
- Hand and Upper Limb Surgery Department, CHRU Lapeyronie, Montpellier, France
| | - Nadine Sturbois-Nachef
- Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, Ontario, Canada; Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Christian Fontaine
- Department of Orthopedic Surgery, Lille University Medical Center, Lille, France
| | - Alain Yelnik
- Department of Physical and Rehabilitation Medicine, Université de Paris, AP-HP Hospital Fernand Widal, Paris, France
| | - Bernard Parratte
- Department of Physical and Rehabilitation Medicine, CHRU Jean Minjoz, Besançon-Franche-Comté University, Besançon, France
| | - Prakash Henry
- Department of Neurological Rehabilitation, Christian Medical College, Vellore, India
| | | | - Philippe Rigoard
- Institut Pprime CNRS - Université de Poitiers - ISAE-ENSMA, Poitiers, France; Spine and Neuromodulation Functional Unit, Department of Neurosurgery, CHU Poitiers, PRISMATICS Lab, Poitiers, France
| | - Romain David
- Department of Physical and Rehabilitation Medicine, University Hospital Center of Poitiers, PRISMATICS Lab, Poitiers, France
| | - Philippe Denormandie
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Department of Orthopaedic Surgery, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Alexis Schnitzler
- Department of Physical and Rehabilitation Medicine, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Etienne Allart
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, Neurorehabilitation Unit, Lille, France
| | - François Genet
- UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Physical and Rehabilitation Medicine Department, Raymond-Poincaré Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; Versailles Saint-Quentin-en-Yvelines University (UVSQ), UFR Simone Veil - Santé, Montigny-le-Bretonneux, France; Garches Neuro-Orthopaedics Research Group (GRENOG), Garches, France.
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Francisco G, Feng W, Munin MC, Ngo K, Schwartz M, Sadeghi M, Zuzek A, Esquenazi A. OnabotulinumtoxinA Treatment of Upper Limb Spasticity: Analysis of US Practice Patterns From the ASPIRE Study. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Ketchum EM, Downie SA, Esquenazi A, Francisco G, Verduzco-Gutierrez M, Ifantides K, Boroujerdi A, Buser A, Patel G, Ketchum N. A Virtual Reality Platform to Facilitate Training on Treatment of Lower Limb Spasticity With OnabotulinumtoxinA. Arch Phys Med Rehabil 2022. [DOI: 10.1016/j.apmr.2022.08.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Livolsi C, Conti R, Guanziroli E, Friðriksson Þ, Alexandersson Á, Kristjánsson K, Esquenazi A, Molino Lova R, Romo D, Giovacchini F, Crea S, Molteni F, Vitiello N. An impairment-specific hip exoskeleton assistance for gait training in subjects with acquired brain injury: a feasibility study. Sci Rep 2022; 12:19343. [PMID: 36369462 PMCID: PMC9652374 DOI: 10.1038/s41598-022-23283-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-moderate gait deficits, due to an ABI, were enrolled. Subjects presenting deficit in hip flexion and/or extension were included and divided into two groups based on the presence (group A, n = 6) or absence (group B, n = 8) of knee hyperextension during stance phase of walking. Two iHA-based profiles were developed for the groups. The protocol included two overground gait training sessions using APO, and two evaluation sessions, pre and post training. Primary outcomes were pre vs. post-training walking distance and steady-state speed in the 6-min walking test. Secondary outcomes were self-selected speed, joint kinematics and kinetics, gait symmetry and forward propulsion, assessed through 3D gait analysis. Following the training, study participants significantly increased the walked distance and average steady-state speed in the 6-min walking tests, both when walking with and without the APO. The increased walked distance surpassed the minimal clinically important difference for groups A and B, (respectively, 42 and 57 m > 34 m). In group A, five out of six subjects had decreased knee hyperextension at the post-training session (on average the peak of the knee extension angle was reduced by 36%). Knee flexion during swing phase increased, by 16% and 31%, for A and B groups respectively. Two-day gait training with APO providing iHA was effective and safe in improving walking performance and knee kinematics in ABI survivors. These preliminary findings suggest that this strategy may be viable for subject-specific post-ABI gait rehabilitation.
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Affiliation(s)
- Chiara Livolsi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy.
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy.
| | | | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | | | | | | | - Alberto Esquenazi
- Department of PM&R, MossRehab and Einstein Healthcare Network, Elkins Park, PA, USA
| | | | | | | | - Simona Crea
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Nicola Vitiello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant'Anna, Pisa, Italy
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Florence, Italy
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Esquenazi A, Elliott M, Lysandropoulos A. Corrections required for Dressler and Johnson 2022. J Neural Transm (Vienna) 2022; 129:1307-1308. [PMID: 36040626 PMCID: PMC9468082 DOI: 10.1007/s00702-022-02534-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/22/2022] [Indexed: 10/27/2022]
Affiliation(s)
- Alberto Esquenazi
- MossRehab & Albert Einstein Medical Center, 60 Township Line Rd., Elkins Park, PA, 19027, USA.
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Esquenazi A, Pons L, Calvi-Gries F, Otto J. Extensor Digitorum Brevis and DIRECTION: Two Studies in Progress Comparing the Duration of Response of AbobotulinumtoxinA With Other Native Botulinum Toxins. Toxicon 2022. [DOI: 10.1016/j.toxicon.2021.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Esquenazi A, Zorowitz RD, Ashford S, Calvi-Gries F, Maisonobe P, Page S, Jacinto J. Assessing the Effectiveness of AbobotulinumtoxinA Injections for Adult Lower Limb Spasticity in Routine Clinical Practice: Methodology and Baseline Data for the AboLiSh Study. Toxicon 2022. [DOI: 10.1016/j.toxicon.2021.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Esquenazi A, Ayyoub Z, Verduzco-Gutierrez M, Maisonobe P, Otto J, Patel AT. AbobotulinumtoxinA Versus OnabotulinumtoxinA in Adults with Upper Limb Spasticity: A Randomized, Double-Blind, Crossover Study Protocol. Adv Ther 2021; 38:5623-5633. [PMID: 34562231 PMCID: PMC8475311 DOI: 10.1007/s12325-021-01896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The safety and efficacy of both abobotulinumtoxinA and onabotulinumtoxinA for upper limb spasticity are well established, but head-to-head comparisons are lacking. METHODS DIRECTION is an international, randomized, double-blind, crossover study comparing the safety and efficacy of abobotulinumtoxinA with onabotulinumtoxinA in the management of upper limb spasticity at doses at or near maximum recommended in product labelling. Participants (18-75 years) will be randomized (1:1) to either one cycle of abobotulinumtoxinA (900U) followed by onabotulinumtoxinA (360U) or vice versa. To maintain blinding, a fixed volume (3.6 ml) will be injected into the target upper limb muscles (four wrist and finger flexors and biceps brachii). The second treatment cycle will begin at Week 12 if retreatment criteria are fulfilled, and if not, they will be reassessed every 4 weeks until they meet retreatment parameters. PLANNED OUTCOMES The primary hypothesis is that there is comparable safety between products; non-inferiority will be tested based on treatment-emergent adverse event (TEAE) rates from injection to Week 12. A secondary hypothesis is that abobotulinumtoxinA has longer duration of effect than onabotulinumtoxinA. This hypothesis will be tested with secondary efficacy endpoints, including injection cycle duration, Modified Ashworth Scale, Disability Assessment Scale and Physician Global Assessment. TRIAL REGISTRATION EudraCT ( http://eudract.ema.europa.eu ): 2021-000161-32 and Clinicaltrials.gov ( http://clinicaltrials.gov ): NCT04936542. Overview of the study protocol by the principal investigator (MP4 185265 KB).
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Affiliation(s)
- Alberto Esquenazi
- MossRehab & Albert Einstein Medical Center, Elkins Park, PA, 19027, USA.
| | - Ziyad Ayyoub
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
- Western University of Health Sciences, Pomona, CA, 91766, USA
| | - Monica Verduzco-Gutierrez
- Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | | | | | - Atul T Patel
- Kansas Institute of Research, Overland Park, KS, 66211, USA
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Bavikatte G, Francisco G, Esquenazi A, Dimyan M, Ngo K, Schwartz M, Zuzek A, Jost W. OnabotulinumtoxinA Treatment in Patients with Upper Limb and Lower Limb Spasticity from the ASPIRE Study. Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Cao N, Packel A, Marcy E, Sprik K, Harold E, Xiao R, Esquenazi A. Implementing Robotic-Assisted Gait Training in Acute Inpatient Stroke Rehabilitation: A Quality Improvement Initiative. J Int Soc Phys Rehabil Med 2021; 4:168-173. [PMID: 38283707 PMCID: PMC10821733 DOI: 10.4103/jisprm-000130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background The recovery of independent walking is one of the major goals of stroke rehabilitation; however, due to the current acute inpatient rehabilitation care paradigm, the intensity of walking practice provided has been far below that recommended for motor recovery to occur. A quality improvement initiative was implemented to encourage the physical therapist (PT) to incorporate various robotic gait training devices as part of the standard allotted PT sessions to improve the intensity of gait training. Materials and Methods After 6 months, a retrospective review was performed to assess the feasibility of the robotic-assisted gait training (RAGT) intervention in limited-ambulatory stroke patients and determine preliminary efficacy of the RAGT program by analyzing Functional Index Measure (FIM) motor gain and accelerometer-based daily step counts in patients who received the RAGT versus a group treated with conventional therapy. Results About 30% of limited-ambulatory patients admitted to the stroke rehabilitation unit received consistent integrated RAGT without safety concerns. Compared to those who received conventional treatment, these patients showed greater mean FIM motor gain (32.30 versus 17.88) at discharge (P < 0.005) and higher number of step counts in PT sessions (P < 0.005). Age, gender, or admission FIM motor were not associated with FIM motor gain. Conclusions Across a 6-month initial implementation period, RAGT was feasible and was associated with higher repetition of walking practice and also with improved FIM motor scores in limited-ambulatory individuals in an acute inpatient stroke rehabilitation program. However, the frequency of RAGT and the percentage of patients participating need to further improve. Some strategies to address these concerns were identified.
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Affiliation(s)
- Ning Cao
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Andrew Packel
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Elizabeth Marcy
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Kelly Sprik
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Erika Harold
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
| | - Rui Xiao
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, Pennsylvania, USA
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Esquenazi A, Feng W, Wittenberg G, Gallien P, Baricich A, Fanning K, Zuzek A, Francisco G, Bandari D. Consistent Dosing Over Time And Within Treatment Interval Groups With Onabotulinumtoxina: Analysis from the Adult Spasticity International Registry (ASPIRE). Arch Phys Med Rehabil 2021. [DOI: 10.1016/j.apmr.2021.07.605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Zafonte R, Borg-Stein J, Dillingham T, Esquenazi A, Francisco G, Kim C, Morgenroth D, Paganoni S, Rensing B. Research and Industry Partnerships in Physiatry. Am J Phys Med Rehabil 2021; 100:990-995. [PMID: 33782275 DOI: 10.1097/phm.0000000000001748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The Association of Academic Physiatrists, the home of academic physiatry, is interested in advancing industry partnerships in research among academic physiatrists. There are limited existing resources that outline opportunities for academic physiatrists in engaging the translational research continuum through industry partnerships and the skill sets that academic physiatrists need to successfully navigate these partnerships. In 2019, then President of the Association of Academic Physiatrists, John Chae, MD, ME, assembled a group of interested physician-scientists in physical medicine and rehabilitation to form the Research and Industry Partnerships Task Force to address this problem. The Task Force implemented a live educational session titled "Collaborating with industry" at Physiatry '19, the Annual Meeting of the Association of Academic Physiatrists held in Puerto Rico. To extend the reach of this valuable information, the Task Force is creating resources that can be easily distributed and accessed by all physiatrists. The goal of this white paper is to provide a roadmap to help academic physiatrists begin to navigate the field of academia-industry relationships with the ultimate goal of accelerating discovery for the benefit of physiatry and rehabilitation patients.
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Affiliation(s)
- Ross Zafonte
- From the Association of Academic Physiatrists Research and Industry Partnerships in Physiatry Task Force, Owings Mills, Maryland
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van Duijnhoven E, Waterval NF, Koopman FS, Esquenazi A, Tyson S, Nollet F, Brehm MA. Ankle-foot orthoses for improving walking in people with calf muscle weakness due to neuromuscular disorders. Hippokratia 2021. [DOI: 10.1002/14651858.cd014871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Elza van Duijnhoven
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Niels F Waterval
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Fieke Sophia Koopman
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Alberto Esquenazi
- Department of Rehabilitation Medicine; Jefferson University School of Medicine; Elkins Park PA USA
| | - Sarah Tyson
- Division of Nursing, Midwifery & Social Work; University of Manchester; Manchester UK
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC, University of Amsterdam; Department of Rehabilitation Medicine, Amsterdam Movement Sciences; Amsterdam Netherlands
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Esquenazi A, Francisco GE, Feng W, Baricich A, Gallien P, Fanning K, Zuzek A, Bandari DS, Wittenberg GF. Real-World Adherence to OnabotulinumtoxinA Treatment for Spasticity: Insights From the ASPIRE Study. Arch Phys Med Rehabil 2021; 102:2172-2184.e6. [PMID: 34245684 DOI: 10.1016/j.apmr.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To identify baseline characteristics and treatment-related variables that affect adherence to onabotulinumtoxinA treatment from the Adult Spasticity International Registry (ASPIRE) study. DESIGN Prospective, observational registry (NCT01930786). SETTING International clinical sites. PARTICIPANTS Adults with spasticity (N=730). INTERVENTIONS OnabotulinumtoxinA at clinician's discretion. MAIN OUTCOME MEASURES Clinically meaningful thresholds used for treatment adherent (≥3 treatment sessions during 2-year study) and nonadherent (≤2 sessions). Data analyzed using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs). Treatment-related variables assessed at sessions 1 and 2 only. RESULTS Of the total population, 523 patients (71.6%) were treatment adherent with 5.3±1.6 sessions and 207 (28.4%) were nonadherent with 1.5±0.5 sessions. In the final model (n=626/730), 522 patients (83.4%) were treatment adherent and 104 (16.6%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=1.84; CI, 1.06-3.21; P=.030) and use of orthotics (OR=1.88; CI, 1.15-3.08; P=.012). Baseline characteristics associated with nonadherence: history of diplopia (OR=0.28; CI, 0.09-0.89; P=.031) and use of assistive devices (OR=0.51; CI, 0.29-0.90; P=.021). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.43; CI, 0.26-0.72; P=.001) and clinician dissatisfaction with onabotulinumtoxinA to manage pain (OR=0.18; CI, 0.05-0.69; P=.012). Of the population with stroke (n=411), 288 patients (70.1%) were treatment adherent with 5.3±1.6 sessions and 123 (29.9%) were nonadherent with 1.5±0.5 session. In the final stroke model (n=346/411), 288 patients (83.2%) were treatment adherent and 58 (16.8%) were nonadherent. Baseline characteristics associated with adherence: treated in Europe (OR=2.99; CI, 1.39-6.44; P=.005) and use of orthotics (OR=3.18; CI, 1.57-6.45; P=.001). Treatment-related variables associated with nonadherence: treatment interval ≥15 weeks (OR=0.42; CI, 0.21-0.83; P=.013) and moderate/severe disability on upper limb Disability Assessment Scale pain subscale (OR=0.40; CI, 0.19-0.83; P=.015). CONCLUSIONS These ASPIRE analyses demonstrate real-world patient and clinical variables that affect adherence to onabotulinumtoxinA and provide insights to help optimize management strategies to improve patient care.
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Affiliation(s)
| | - Gerard E Francisco
- University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX
| | - Wuwei Feng
- Department of Neurology, Duke University School of Medicine, Durham, NC
| | - Alessio Baricich
- Physical and Rehabilitation Medicine, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Philippe Gallien
- Physical Medicine and Rehabilitation, Pôle MPR Saint Hélier, Rennes, France
| | | | - Aleksej Zuzek
- Medical Affairs, Spasticity and Movement Disorders/Urology, Allergan, an AbbVie Company, Irvine, CA
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Bardelli R, Harlaar J, Morone G, Tomba P, Esquenazi A, Benedetti MG. The Codivilla Spring: from then to now and beyond. Eur J Phys Rehabil Med 2021; 57:1012-1019. [PMID: 33861038 DOI: 10.23736/s1973-9087.21.06822-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ankle-foot-orthosis (AFO), originally called Codivilla Spring, is an orthotic device prescribed to the patients with foot drop due to neurological diseases in order to control the range of motion of the ankle joint, to compensate for the muscle weakness/spasticity thus optimizing the gait function. In this paper, a historical revision of the most known and used AFO worldwide from the origin of its name and the first applications at the Rizzoli Orthopedic Institute to the most advanced solutions in use today is covered. Through the critical analysis of historical documents available, the paper reports on the controversy about the true inventor of the Codivilla Spring during the first decades of the twentieth century. Main current adult and child AFOs, in terms of their design and indications are presented. Finally, possible approaches for the selection of the correct orthosis and the individual prescription are discussed in order to manage specific mechanical neuromuscular deficiencies of the subject's ankle-foot complex optimizing walking efficiency.
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Affiliation(s)
- Roberta Bardelli
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jaap Harlaar
- Clinical Technology & Technical Medicine, Delft University of Technology, Rotterdam Erasmus MC & Leiden UMC, Rotterdam, the Nederlands
| | | | - Patrizia Tomba
- Scientific Library, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Esquenazi
- Department of PM&R, MossRehab and Einstein Healthcare Network, Elkins Park, PA, USA
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy -
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Esquenazi A, Le S. Video and spatio-temporal parameter assessment of gait after abobotulinumtoxinA treatment: A pilot study. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Esquenazi A, Delgado MR, Hauser RA, Lysandropoulos A, Gracies JM. AbobotulinumtoxinA: Evidence for long duration of response from 5 patient populations. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Esquenazi A, Ferreira JJ, Jacinto J, Lysandropoulos A, Comella C. Management of symptom re-emergence in patients living with spasticity and cervical dystonia: Findings from 2 online patient surveys. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Esquenazi A, Jacinto J, Ferreira JJ, Lysandropoulos A, Comella C. Patient experiences of symptom re-emergence: Findings from 2 online patient surveys in spasticity and cervical dystonia. Toxicon 2021. [DOI: 10.1016/j.toxicon.2020.11.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Jacinto J, Varriale P, Pain E, Lysandropoulos A, Esquenazi A. Corrigendum: Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity. Front Neurol 2020; 11:629181. [PMID: 33391178 PMCID: PMC7774334 DOI: 10.3389/fneur.2020.629181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos 3, Alcabideche, Portugal
| | | | | | | | - Alberto Esquenazi
- MossRehab and Albert Einstein Medical Center, Elkins Park, PA, United States
- *Correspondence: Alberto Esquenazi
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Esquenazi A, Bavikatte G, Bandari DS, Jost WH, Munin MC, Tang SFT, Largent J, Adams AM, Zuzek A, Francisco GE. Long-Term Observational Results from the ASPIRE Study: OnabotulinumtoxinA Treatment for Adult Lower Limb Spasticity. PM R 2020; 13:1079-1093. [PMID: 33151636 PMCID: PMC8519010 DOI: 10.1002/pmrj.12517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 09/24/2020] [Accepted: 10/23/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION OnabotulinumtoxinA treatment for spasticity varies according to numerous factors and is individualized to meet treatment goals. OBJECTIVE To explore real-world onabotulinumtoxinA utilization and effectiveness in patients with lower limb spasticity from the Adult Spasticity International Registry (ASPIRE) study. DESIGN Two-year, multicenter, prospective, observational registry (NCT01930786). SETTING Fifty-four international clinical sites. PATIENTS Adults (naïve or non-naïve to botulinum toxin[s] treatment for spasticity, across multiple etiologies) with lower limb spasticity related to upper motor neuron syndrome. INTERVENTIONS OnabotulinumtoxinA administered at the clinician's discretion. MAIN OUTCOME MEASURES OnabotulinumtoxinA treatment utilization, clinician- and patient-reported satisfaction. RESULTS In ASPIRE, 530 patients received ≥1 onabotulinumtoxinA treatment for lower limb spasticity (mean age, 52 years; stroke, 49.4%; multiple sclerosis, 20.4%). Equinovarus foot was treated most often (80.9% of patients), followed by flexed knee (26.0%), stiff extended knee (22.5%), and flexed toes (22.3%). OnabotulinumtoxinA doses ranged between 10 and 1100 U across all presentations. Electromyography (EMG) was most commonly used for injection localization (≥41.1% of treatment sessions). Despite low patient response on the satisfaction questionnaire, clinicians (94.6% of treatment sessions) and patients (84.5%) reported satisfaction/extreme satisfaction that treatment helped manage spasticity, and clinicians (98.3%) and patients (91.6%) would probably/definitely continue onabotulinumtoxinA treatment. These data should be interpreted with care. Twenty-one adverse events (AEs) in 18 patients (3.4%) were considered treatment-related. Sixty-seven patients (12.6%) reported 138 serious AEs; 3 serious AEs in two patients (0.4%) were considered treatment-related. No new safety signals were identified. CONCLUSIONS ASPIRE provides long-term observational data on the treatment of lower limb spasticity with onabotulinumtoxinA. Real-world data from this primary analysis can help to guide the clinical use of onabotulinumtoxinA to improve spasticity management.
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Affiliation(s)
| | | | | | - Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany.,Parkinson-Klinik Ortenau, Wolfach, Germany
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Simon Fuk Tan Tang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Joan Largent
- IQVIA Real-World Evidence Solutions, Cambridge, MA, USA
| | | | | | - Gerard E Francisco
- University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX, USA
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Esquenazi A, Feng W, Wittenberg G, Gallien P, Baricich A, Fanning K, Zuzek A, Francisco G, Bandari D. Adherence to OnabotulinumtoxinA Treatment in Post-Stroke and Multiple Sclerosis Patients with Spasticity from the ASPIRE Study. Arch Phys Med Rehabil 2020. [DOI: 10.1016/j.apmr.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Carda S, Invernizzi M, Bavikatte G, Bensmaïl D, Bianchi F, Deltombe T, Draulans N, Esquenazi A, Francisco GE, Gross R, Jacinto LJ, Moraleda Pérez S, O'Dell MW, Reebye R, Verduzco-Gutierrez M, Wissel J, Molteni F. The role of physical and rehabilitation medicine in the COVID-19 pandemic: The clinician's view. Ann Phys Rehabil Med 2020; 63:554-556. [PMID: 32315802 PMCID: PMC7166018 DOI: 10.1016/j.rehab.2020.04.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
| | - Marco Invernizzi
- University of Eastern Piedmont, Department of Health Sciences, 28100 Novara, Italy
| | - Ganesh Bavikatte
- Neurorehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, L9 7LJ United Kingdom
| | - Djamel Bensmaïl
- Physical and Rehabilitation Medicine Department, R.-Pointcaré Hospital, AP-HP Université Paris-Saclay, Team INSERM 1179, UFR de Santé Simone-Veil, Université de Versailles Saint-Quentin, Paris, France
| | - Francesca Bianchi
- Neurophysiology Unit, IRCCS San Raffaele Scientific Institute Milan, Italy
| | - Thierry Deltombe
- Service de Médecine Physique & Réadaptation, CHU UCL Namur site Godinne, 5530 Yvoir, Belgium
| | | | - Alberto Esquenazi
- Department of Physical Medicine & Rehabilitation, MossRehab Gait and Motion Analysis Lab, Elkins Park, PA, USA
| | - Gerard E Francisco
- Department of Physical Medicine & Rehabilitation, UTHealth McGovern Medical School, and TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Raphaël Gross
- Service de MPR Neurologique, CHU de Nantes, Hôpital Saint-Jacques, 44093 Nantes cedex, France; EA 43334 laboratoire Motricité, Interactions, Performance-UFR STAPS Nantes, 44300 Nantes, France
| | - Luis Jorge Jacinto
- Serviço de Reabilitação de Adultos 3, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Susana Moraleda Pérez
- Physical Medicine & Rehabilitation Department, La Paz University Hopital, Madrid, Spain
| | - Michael W O'Dell
- New York Presbyterian Hospital, Weill-Cornell Medical Centre, New York, NY, USA
| | - Rajiv Reebye
- Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Joe-R.-and-Teresa-Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
| | - Jörg Wissel
- Neurological Rehabilitation & Physical Therapy, Department of Neurology with Stroke Unit, Vivantes Hospital Spandau, 13585 Berlin, Germany
| | - Franco Molteni
- Valduce Hospital, Villa Beretta Rehabilitation Centre, Costamasnaga (LC), Italy
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Esquenazi A, Delgado MR, Hauser RA, Picaut P, Foster K, Lysandropoulos A, Gracies JM. Duration of Symptom Relief Between Injections for AbobotulinumtoxinA (Dysport®) in Spastic Paresis and Cervical Dystonia: Comparison of Evidence From Clinical Studies. Front Neurol 2020; 11:576117. [PMID: 33101184 PMCID: PMC7546809 DOI: 10.3389/fneur.2020.576117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Botulinum toxin-A is a well-established treatment for adult and pediatric spastic paresis and cervical dystonia. While guidelines and approved labels indicate that treatment should not occur more frequently than every 12 weeks, studies and real-world evidence show that the timing of symptom recurrence between treatments may vary. Methods: We report retreatment criteria and response duration (retreatment intervals) from four pivotal, double-blind, placebo-controlled studies with open-label extensions involving patients treated with abobotulinumtoxinA (aboBoNTA) for upper limb (NCT01313299) or lower limb (NCT01249404) spastic paresis in adults, lower limb spastic paresis in children (NCT01249417), and cervical dystonia in adults (NCT00257660). We review results in light of recently available preclinical data. Results: In spastic paresis, 24.0-36.9% of upper limb patients treated with aboBoNTA and 20.1-32.0% of lower limb patients did not require retreatment before 16 weeks. Moreover, 72.8-93.8% of aboBoNTA-treated pediatric patients with lower limb spastic paresis did not require retreatment before 16 weeks (17.7-54.0% did not require retreatment before 28 weeks). In aboBoNTA-treated patients with cervical dystonia, 72.6-81.5% did not require retreatment before 16 weeks. Conclusion: AboBoNTA, when dosed as recommended, offers symptom relief beyond 12 weeks to many patients with spastic paresis and cervical dystonia. From recently available preclinical research, the amount of active neurotoxin administered with aboBoNTA might be a factor in explaining this long duration of response.
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Affiliation(s)
- Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA, United States
| | - Mauricio R Delgado
- Neurology and Neurotherapeutics Department, University of Texas Southwestern Medical Center and Scottish Rite Hospital for Children, Dallas, TX, United States
| | - Robert A Hauser
- University of South Florida Parkinson's Disease and Movement Disorders Center of Excellence, Tampa, FL, United States
| | | | | | | | - Jean-Michel Gracies
- UR 7377, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Albert Chenevier-Henri Mondor Hospital, Créteil, France
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Francisco GE, Bandari DS, Bavikatte G, Jost WH, McCusker E, Largent J, Zuzek A, Esquenazi A. High clinician- and patient-reported satisfaction with individualized onabotulinumtoxinA treatment for spasticity across several etiologies from the ASPIRE study. Toxicon X 2020; 7:100040. [PMID: 32875289 PMCID: PMC7452133 DOI: 10.1016/j.toxcx.2020.100040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 04/23/2020] [Accepted: 05/14/2020] [Indexed: 11/30/2022] Open
Abstract
Etiology-specific onabotulinumtoxinA utilization to manage spasticity is largely unknown. In this 1-year interim analysis, we evaluated real-world onabotulinumtoxinA utilization and effectiveness across several etiologies from the Adult Spasticity International Registry (ASPIRE) study. ASPIRE is a multicenter, prospective, observational registry (NCT01930786) examining stroke, multiple sclerosis [MS], cerebral palsy [CP], traumatic brain injury [TBI], and spinal cord injury [SCI] patients with spasticity treated with onabotulinumtoxinA at the clinician's discretion. Assessments included onabotulinumtoxinA utilization (each session), clinician (subsequent session)/patient (5±1 weeks post-treatment) satisfaction, and the Disability Assessment Scale (DAS; subsequent session). 730 patients received ≥1 onabotulinumtoxinA treatment, with 37% naïve to botulinum toxin(s) for spasticity. The most common etiology was stroke (n=411, 56%), followed by MS (N=119, 16%), CP (N=77, 11%), TBI (N=45, 6%), and SCI (N=42, 6%). The total body mean cumulative dose (±SD) of onabotulinumtoxinA per session ranged from 296 U (±145) in CP to 406 U (±152) in TBI. The most commonly treated upper limb presentations were clenched fist (stroke, MS, and SCI), flexed wrist (CP), and flexed elbow (TBI). Equinovarus foot was the most commonly treated lower limb presentation in all etiologies. Stroke patients showed improved DAS scores for nearly all subscales in both limbs, indicative of improved global function. All etiologies showed improved lower limb mobility DAS scores. Across all sessions, clinicians (range: 87.4% [SCI]-94.2% [CP]) and patients (range: 67.6% [TBI]-89.7% [SCI]) reported extreme satisfaction/satisfaction that onabotulinumtoxinA helped manage spasticity, and clinicians (range: 94.6% [TBI]-98.8% [CP]) and patients (range: 88.4% [stroke]-91.2% [TBI]) would definitely/probably continue treatment. Treatment-related adverse events (TRAEs) and treatment-related serious adverse events (TRSAEs) were reported as follows: stroke: 10 TRAEs (2.2% patients), 3 TRSAEs (0.5%); MS: 5 TRAEs (4.2%), 0 TRSAEs; CP: 0 TRAEs, 0 TRSAEs; TBI: 1 TRAEs (2.2%), 0 TRSAEs; SCI: 0 TRAEs, 0 TRSAEs. No new safety signals were identified. High clinician- and patient-reported satisfaction were observed following individualized onabotulinumtoxinA treatment, as well as improved global function. Interim results from ASPIRE demonstrate etiology-specific similarities and differences in clinical approaches to manage spasticity. ASPIRE found etiology-specific similarities and differences in real-world onabotulinumtoxinA utilization for spasticity. Across all etiologies, there was high clinician- and patient-reported satisfaction with onabotulinumtoxinA treatment. In DAS, all etiologies showed improved global function in lower limb mobility following onabotulinumtoxinA treatment. Adverse event data varied by etiology of spasticity; however, no new safety signals were identified. ASPIRE data may guide clinical strategies and educational programs to improve onabotulinumtoxinA spasticity management.
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Affiliation(s)
- Gerard E Francisco
- The University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX, USA
| | - Daniel S Bandari
- Multiple Sclerosis Center of California & Research Group, Newport Beach, CA, USA
| | | | - Wolfgang H Jost
- University of Freiburg, Department of Neurology, Freiburg im Breisgau, Germany.,Parkinson-Klinik Ortenau, Wolfach, Germany
| | | | - Joan Largent
- IQVIA Real-World Evidence Solutions, Cambridge, MA, USA
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Esquenazi A, Brashear A, Deltombe T, Rudzinska-Bar M, Krawczyk M, Skoromets A, O'Dell MW, Grandoulier AS, Vilain C, Picaut P, Gracies JM. The Effect of Repeated abobotulinumtoxinA (Dysport®) Injections on Walking Velocity in Persons with Spastic Hemiparesis Caused by Stroke or Traumatic Brain Injury. PM R 2020; 13:488-495. [PMID: 32741133 PMCID: PMC8246752 DOI: 10.1002/pmrj.12459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/29/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022]
Abstract
Background Botulinum toxin (BoNT) injections were shown to improve muscle tone of limbs in patients with spasticity. However, limited data are available regarding the effects of repeated BoNT injections on walking ability. Objective To assess changes in walking velocity (WV), step length, and cadence under different test conditions after repeated treatment with abobotulinumtoxinA (aboBoNT‐A; Dysport) in spastic lower limb muscles. Design Secondary analysis of an open‐label, multiple‐cycle extension (National Clinical Trials number NCT01251367) to a phase III, double‐blind, randomized, placebo‐controlled, single‐treatment cycle study, in adults with chronic hemiparesis (NCT01249404). Setting Fifty‐two centers across Australia, Belgium, the Czech Republic, France, Hungary, Italy, Poland, Portugal, Russia, Slovakia, and the United States. Patients 352 Ambulatory adults (18‐80 years) with spastic hemiparesis and gait dysfunction caused by stroke or traumatic brain injury, with a comfortable barefoot WV of 0.1 to 0.8 m/s. Interventions Up to four aboBoNT‐A treatment cycles, administered to spastic lower limb muscles. Main Outcome Measurements Changes from baseline in comfortable and maximal barefoot and with shoes WV (m/s), step length (m/step), and cadence (steps/minutes). Results At Week 12 after four injections, WV improved by 0.08 to 0.10 m/s, step length by 0.03 to 0.04 m/step, and cadence by 3.9 to 6.2 steps/minutes depending on test condition (all P < .0001 to .0003 vs baseline). More patients (7% to 17%) became unlimited community ambulators (WV ≥0.8 m/s) across test conditions compared with baseline, with 39% of 151 patients classified as unlimited community ambulators in at least one test condition and 17% in all four test conditions. Conclusions Clinically meaningful and statistically significant improvements in WV, step length, and cadence under all four test conditions were observed in patients with spastic hemiparesis after each aboBoNT‐A treatment cycle.
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Affiliation(s)
| | | | - Thierry Deltombe
- Service de Médecine Physique et Réadaptation, Centre Hospitalier Universitaire UCL, Yvoir, Belgium
| | - Monika Rudzinska-Bar
- Department of Neurology, Faculty of Medicine and Health Service, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | | | | | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Jean-Michel Gracies
- EA 7377 BIOTN, Université Paris-Est Créteil, Service de Rééducation Neurolocomotrice, Hôpitaux Universitaires Henri Mondor, Créteil, France
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Awad LN, Esquenazi A, Francisco GE, Nolan KJ, Jayaraman A. The ReWalk ReStore™ soft robotic exosuit: a multi-site clinical trial of the safety, reliability, and feasibility of exosuit-augmented post-stroke gait rehabilitation. J Neuroeng Rehabil 2020; 17:80. [PMID: 32552775 PMCID: PMC7301475 DOI: 10.1186/s12984-020-00702-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atypical walking in the months and years after stroke constrain community reintegration and reduce mobility, health, and quality of life. The ReWalk ReStore™ is a soft robotic exosuit designed to assist the propulsion and ground clearance subtasks of post-stroke walking by actively assisting paretic ankle plantarflexion and dorsiflexion. Previous proof-of-concept evaluations of the technology demonstrated improved gait mechanics and energetics and faster and farther walking in users with post-stroke hemiparesis. We sought to determine the safety, reliability, and feasibility of using the ReStore™ during post-stroke rehabilitation. METHODS A multi-site clinical trial (NCT03499210) was conducted in preparation for an application to the United States Food and Drug Administration (FDA). The study included 44 users with post-stroke hemiparesis who completed up to 5 days of training with the ReStore™ on the treadmill and over ground. In addition to primary and secondary endpoints of safety and device reliability across all training activities, an exploratory evaluation of the effect of multiple exposures to using the device on users' maximum walking speeds with and without the device was conducted prior to and following the five training visits. RESULTS All 44 study participants completed safety and reliability evaluations. Thirty-six study participants completed all five training days. No device-related falls or serious adverse events were reported. A low rate of device malfunctions was reported by clinician-operators. Regardless of their reliance on ancillary assistive devices, after only 5 days of walking practice with the device, study participants increased both their device-assisted (Δ: 0.10 ± 0.03 m/s) and unassisted (Δ: 0.07 ± 0.03 m/s) maximum walking speeds (P's < 0.05). CONCLUSIONS When used under the direction of a licensed physical therapist, the ReStore™ soft exosuit is safe and reliable for use during post-stroke gait rehabilitation to provide targeted assistance of both paretic ankle plantarflexion and dorsiflexion during treadmill and overground walking. TRIAL REGISTRATION NCT03499210. Prospectively registered on March 28, 2018.
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Affiliation(s)
- Louis N Awad
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA, USA.
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA, USA.
- Department of PM&R, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA.
| | - Alberto Esquenazi
- Department of PM&R, MossRehab and Einstein Healthcare Network, Elkins Park, PA, USA
| | - Gerard E Francisco
- Department of PM&R, University of Texas McGovern Medical School, TIRR Memorial Hermann, Houston, TX, USA
| | - Karen J Nolan
- Center for Mobility and Rehabilitation Engineering, Kessler Foundation, West Orange, NJ, USA
- Department of PM&R, Rutgers New Jersey Medical School, Kessler Rehabilitation, Newark, NJ, USA
| | - Arun Jayaraman
- Department of PM&R, Northwestern University, Chicago, IL, USA.
- Shirley Ryan AbilityLab, Chicago, IL, USA.
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Carda S, Invernizzi M, Bavikatte G, Bensmaïl D, Bianchi F, Deltombe T, Draulans N, Esquenazi A, Francisco GE, Gross R, Jacinto LJ, Moraleda Pérez S, O'dell MW, Reebye R, Verduzco-Gutierrez M, Wissel J, Molteni F. COVID-19 pandemic. What should Physical and Rehabilitation Medicine specialists do? A clinician's perspective. Eur J Phys Rehabil Med 2020; 56:515-524. [PMID: 32434314 DOI: 10.23736/s1973-9087.20.06317-0] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
COVID-19 pandemic is rapidly spreading all over the world, creating the risk for a healthcare collapse. While acute care and intensive care units are the main pillars of the early response to the disease, rehabilitative medicine should play an important part in allowing COVID-19 survivors to reduce disability and optimize the function of acute hospital setting. The aim of this study was to share the experience and the international perspective of different rehabilitation centers, treating COVID-19 survivors. A group of Physical Medicine and Rehabilitation specialists from eleven different countries in Europe and North America have shared their clinical experience in dealing with COVID-19 survivors and how they have managed the re-organization of rehabilitation services. In our experience the most important sequelae of severe and critical forms of COVID-19 are: 1) respiratory; 2) cognitive, central and peripheral nervous system; 3) deconditioning; 4) critical illness related myopathy and neuropathy; 5) dysphagia; 6) joint stiffness and pain; 7) psychiatric. We analyze all these consequences and propose some practical treatment options, based on current evidence and clinical experience, as well as several suggestions for management of rehabilitation services and patients with suspected or confirmed infection by SARS-CoV-2. COVID-19 survivors have some specific rehabilitation needs. Experience from other centers may help colleagues in organizing their services and providing better care to their patients.
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Affiliation(s)
- Stefano Carda
- Service of Neuropsychology and Neurorehabilitation, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland -
| | - Marco Invernizzi
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy
| | - Ganesh Bavikatte
- Neurorehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Djamel Bensmaïl
- Department of Physical and Rehabilitation Medicine, R. Pointcaré Hospital, AP-HP Université Paris-Saclay, Team INSERM 1179, UFR de Santé Simone Veil, Université de Versailles Saint-Quentin, Versailles, France
| | | | - Thierry Deltombe
- Service of Physical Medicine and Rehabilitation, CHU UCL Namur site Godinne, Yvoir, Belgium
| | | | - Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Lab, Elkins Park, PA, USA
| | - Gerard E Francisco
- Department of Physical Medicine and Rehabilitation, UTHealth McGovern Medical School, and TIRR Memorial Hermann Hospital, Houston, TX, USA
| | - Raphaël Gross
- Service de MPR Neurologique, CHU Nantes Hôpital Saint Jacques, Nantes cedex / EA 43334 laboratoire Motricité, Interactions, Performance - UFR STAPS Nantes, Nantes, France
| | - Luis J Jacinto
- Service of Rehabilitation for Adults 3, Centro de Medicina de Reabilitação de Alcoitão, Alcabideche, Portugal
| | - Susana Moraleda Pérez
- Department of Physical Medicine and Rehabilitation, La Paz University Hospital, Madrid, Spain
| | - Michael W O'dell
- New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
| | - Rajiv Reebye
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | | | - Jörg Wissel
- Unit of Neurological Rehabilitation and Physical Therapy, Department of Neurology with Stroke Unit, Vivantes Hospital Spandau, Berlin, Germany
| | - Franco Molteni
- Valduce Hospital, Villa Beretta Rehabilitation Center, Costamasnaga, Lecco, Italy
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Jacinto J, Varriale P, Pain E, Lysandropoulos A, Esquenazi A. Patient Perspectives on the Therapeutic Profile of Botulinum Neurotoxin Type A in Spasticity. Front Neurol 2020; 11:388. [PMID: 32477251 PMCID: PMC7233119 DOI: 10.3389/fneur.2020.00388] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Botulinum toxin-A (BoNT-A) injections are first-line treatment for adult spasticity. Prior patient surveys have reported that BoNT-A treatment improves quality of life but that symptoms usually recur before the next injection. We aimed to explore, in-depth, patient perceptions of the impact of spasticity and the waning of BoNT-A therapeutic effects. Methods: An internet-based survey was conducted through Carenity, an online patient community, from May to September 2019 in France, Germany, Italy, UK and USA. Eligible respondents were adult patients with spasticity due to stroke, traumatic brain injury (TBI) or spinal cord injury (SCI) who had ≥2 previous BoNT-A injections. Results: Two hundred and ten respondents (mean 47.2 years) met screening criteria and had their responses analyzed. Overall, 43% of respondents had spasticity due to stroke, 30% due to TBI and 27% due to SCI. The mean [95% CI] injection frequency for spasticity management was 3.6 [3.4-3.7] injections/year. Respondents described the time profile of their response to BoNT-A. The mean reported onset of therapeutic effect was 12.9 [12.1-13.7] days and the mean time to peak effect was 5.0 [4.7-5.4] weeks. Symptom re-emergence between injections was common (83%); the time from injection to symptom re-emergence was 89.4 [86.3-92.4] days. Muscle spasms usually re-emerge first (64%), followed by muscle stiffness or rigidity (40%), and limb pain (20%). Over half (52%) of respondents said they had lost their self-confidence, 46% experienced depression and 41% experienced a lack of sleep due to their spasticity symptoms in the past 12 months. Following a report of symptom re-emergence, the most common management approaches were to add adjunctive treatments (36%), increase the BoNT-A dose (28%), and wait for the next injection (26%). Seventy two percentage of respondents said they would like a longer lasting BoNT-A treatment. Conclusions: Patients with spasticity can expect a characteristic profile of BoNT-A effects, namely time lag to onset and peak effect followed by a gradual decline in the symptomatic benefits. Symptom re-emergence is common and has significant impact on quality of life. Greater patient/clinician awareness of this therapeutic profile should lead to better level of overall satisfaction with treatment, informed therapeutic discussions and treatment schedule planning.
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Affiliation(s)
- Jorge Jacinto
- Centro de Medicina de Reabilitaçãode Alcoitão, Serviço de Reabilitação de Adultos 3, Alcabideche, Portugal
| | | | | | | | - Alberto Esquenazi
- MossRehab and Albert Einstein Medical Center, Elkins Park, PA, United States
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Esquenazi A, Lee S, Watanabe T, Nastaskin A, McKee C, O'Neill J, Scheponik K, May J. A Comparison of the Armeo to Tabletop-assisted Therapy Exercises as Supplemental Interventions in Acute Stroke Rehabilitation: A Randomized Single Blind Study. PM R 2020; 13:30-37. [PMID: 32358874 DOI: 10.1002/pmrj.12397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To evaluate the feasibility of an additional therapeutic upper limb exercise (ULE) intervention in early phase post-stroke rehabilitation and to assess outcomes of therapy using the Armeo Spring (ARMEO) versus Therapist-assisted Table Top (TAT) interventions. DESIGN Randomized, single-blind trial. SETTING Stroke acute inpatient rehabilitation unit. PARTICIPANTS Forty-five participants early after first stroke, Fugl-Meyer Assessment (FMA) score >8, Modified Ashworth score (MAS) of <3. INTERVENTIONS Participants were randomized to TAT or ARMEO ULE in addition to the required 3 hours of 1:1 standard of care provided in an inpatient rehabilitation facility (IRF). MAIN OUTCOME MEASURES Completed number of treatments; withdrawals; serious/adverse events; Functional Independence Measure (FIM) motor; FIM efficiency; FMA; MAS; elbow active (A) and passive (P) range of motion (ROM); and therapist effort measured by the Modified Borg Rating of Perceived Exertion Scale (RPE). RESULTS Post-intervention FIM and FMA scores increased but did not demonstrate any statistically significant differences between the intervention groups (P = .585, .962, partial n2 = .001, .001, respectively). There were no statistically significant differences in post-intervention MAS elbow flexion and extension (P = .332, .252, partial n2 = .009, .007, respectively) and A/P ROM elbow extension between training groups (P = .841, .731, partial n2 = .001, .003, respectively). There was a statistically significant difference in post-intervention A/P ROM elbow flexion between groups (P = .031, .018, partial n2 = .123, .146). Post-intervention RPE did not show any statistically significant differences between the training groups (P = .128, partial n2 = .063). Total elbow range showed larger adjusted mean gains for the ARMEO. No serious adverse events were reported. CONCLUSIONS This study demonstrates that additional therapeutic ULE in the early phase of post-stroke inpatient rehabilitation is feasible and that both interventions showed positive changes in selected outcomes.
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Affiliation(s)
| | - Stella Lee
- Department of PM&R, MossRehab, Elkins Park, PA, USA
| | | | | | - Casey McKee
- Department of PM&R, MossRehab, Elkins Park, PA, USA
| | | | | | - Jaun May
- Department of PM&R, MossRehab, Elkins Park, PA, USA
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Esquenazi A, Stoquart G, Hedera P, Jacinto LJ, Dimanico U, Constant-Boyer F, Brashear A, Grandoulier AS, Vilain C, Picaut P, Gracies JM. Efficacy and Safety of AbobotulinumtoxinA for the Treatment of Hemiparesis in Adults with Lower Limb Spasticity Previously Treated With Other Botulinum Toxins: A Secondary Analysis of a Randomized Controlled Trial. PM R 2020; 12:853-860. [PMID: 32108436 PMCID: PMC7540573 DOI: 10.1002/pmrj.12348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/20/2020] [Indexed: 11/23/2022]
Abstract
Objective To examine the safety and efficacy of abobotulinumtoxinA in patients previously treated with botulinum toxin type A (BoNT‐A) products other than abobotulinumtoxinA. Design Secondary analysis from a phase 3, double‐blind, single‐cycle, randomized, placebo‐controlled study. Setting Fifty‐two centers (11 countries). Patients Adults with spastic hemiparesis were randomized (1:1:1) to receive abobotulinumtoxinA 1000 U, 1500 U, or placebo in their affected lower limb. Main Outcome Measurements Muscle tone (6‐point Modified Ashworth Scale [MAS], 0‐5) for the gastrocnemius‐soleus complex (GSC); proportion of MAS responders (≥1‐point improvement); angle of catch (XV3) and spasticity grade (Y) for the GSC and soleus. Assessments were at weeks 1, 4, and 12 post‐injection. Only descriptive statistics are presented. Results Of 388 patients, 84 received previous BoNT‐A treatment (abobotulinumtoxinA 1000 U: N = 30; abobotulinumtoxinA 1500 U: N = 28; placebo: N = 26). At week 4, mean (SD) changes in MAS score in the GSC were − 0.8 (1.1), −0.9 (1.0), and − 0.4 (0.7) for abobotulinumtoxinA 1000 U, 1500 U, and placebo, respectively. Greater MAS responder rates were observed for abobotulinumtoxinA versus placebo at all time points. Mean (SD) changes (week 4) for abobotulinumtoxinA 1000 U, 1500 U, and placebo for XV3 were: GSC, 8° (21), 6° (10) and 1° (7); soleus, 11° (21), 5° (9) and 0° (8), respectively; for Y: GSC, −0.4 (0.7), −0.6 (0.8) and − 0.0 (0.9); soleus, −0.5 (0.7), −0.5 (0.7) and − 0.1 (0.6), respectively. Safety data and adverse events were consistent with the overall known profile of abobotulinumtoxinA. Conclusions Patients previously treated with other BoNT‐As showed improved muscle tone and spasticity at week 4 following abobotulinumtoxinA injection versus placebo. These findings suggest that abobotulinumtoxinA, at the recommended doses, has a good safety and efficacy profile in adults with lower limb spasticity who were previously treated with other BoNT‐A products.
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Affiliation(s)
- Alberto Esquenazi
- Department of Physical Medicine and Rehabilitation, MossRehab Gait and Motion Analysis Laboratory, Elkins Park, PA, USA
| | - Gaëtan Stoquart
- Physical and Rehabilitation Medicine Department, Cliniques universitaires Saint-Luc, Catholic University of Louvain, Brussels, Belgium
| | - Peter Hedera
- Department of Neurology, Division of Movement Disorders, Vanderbilt University, Nashville, TN, USA
| | - Luis Jorge Jacinto
- Centro de Medicina de Reabilitação de Alcoitão, Estoril, Estoril, Portugal
| | - Ugo Dimanico
- Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Francois Constant-Boyer
- Unités de Médecine Physique et de Réadaptation, Hôpital Sébastopol, Université de Reims Champagne-Ardenne, Reims, France
| | - Allison Brashear
- School of Medicine, University of California, Davis, Sacramento, CA.,Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | | | - Jean-Michel Gracies
- Service de Rééducation Neurolocomotrice, EA 7377 BIOTN, Université Paris-Est, Hospital Albert Chenevier-Henri Mondor, Créteil, France
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Francisco GE, Jost WH, Bavikatte G, Bandari DS, Tang SFT, Munin MC, Largent J, Adams AM, Zuzek A, Esquenazi A. Individualized OnabotulinumtoxinA Treatment for Upper Limb Spasticity Resulted in High Clinician- and Patient-Reported Satisfaction: Long-Term Observational Results from the ASPIRE Study. PM R 2020; 12:1120-1133. [PMID: 31953896 PMCID: PMC7687094 DOI: 10.1002/pmrj.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/23/2019] [Indexed: 11/17/2022]
Abstract
Introduction OnabotulinumtoxinA treatment for spasticity is dependent on numerous factors and varies according to selected treatment goals. Objective To examine real‐world onabotulinumtoxinA treatment utilization and effectiveness in patients with upper limb spasticity over 2 years from the Adult Spasticity International Registry (ASPIRE) study. Design Multicenter, prospective, observational registry (NCT01930786). Setting Fifty‐four international clinical sites in North America, Europe, and Asia. Patients Adults (naïve or non‐naïve to botulinum toxins for spasticity) with upper limb focal spasticity related to upper motor neuron syndrome across multiple etiologies. Interventions OnabotulinumtoxinA administered at clinician's discretion. Main Outcome Measures OnabotulinumtoxinA utilization, clinician and patient satisfaction. Results Four hundred eighty‐four patients received ≥1 treatment of onabotulinumtoxinA for upper limb spasticity. Patients were on average 55.1 years old, 50.8% male, predominantly Caucasian (72.3%), and 38.6% were naïve to botulinum toxins. Stroke was the most frequently reported underlying etiology (74.0%). Most patients (81.2%) had moderate to severe spasticity at baseline. The most commonly treated upper limb clinical presentation was clenched fist (79.1% of patients). Across all presentations, onabotulinumtoxinA doses ranged between 5‐600U. Electromyography (EMG) was most often utilized to localize muscles (≥57.0% of treatment sessions). Clinicians (92.9% of treatment sessions) and patients (85.7%) reported being extremely satisfied/satisfied that treatment helped manage spasticity, and clinicians (98.6%) and patients (92.2%) would definitely/probably continue onabotulinumtoxinA treatment. One hundred seventy‐nine patients (37.0%) reported 563 adverse events (AEs); 15 AEs in 14 patients (2.9%) were considered treatment related. Sixty‐nine patients (14.3%) reported 137 serious AEs; 3 serious AEs in 2 patients (0.4%) were considered treatment related. No new safety signals were identified. Conclusions ASPIRE captured the real‐world individualized nature of onabotulinumtoxinA utilization for upper limb spasticity over 2 years, with consistently high clinician‐ and patient‐reported satisfaction. Data in this primary analysis will guide clinical use of onabotulinumtoxinA, as well as provide insights to improve educational programs on spasticity management.
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Affiliation(s)
- Gerard E Francisco
- The University of Texas Health Science Center McGovern Medical School and TIRR Memorial Hermann, Houston, TX
| | - Wolfgang H Jost
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | - Daniel S Bandari
- Multiple Sclerosis Center of California & Research Group, Newport Beach, CA
| | - Simon F T Tang
- Department of Physical Medicine and Rehabilitation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Joan Largent
- IQVIA Real-World Evidence Solutions, Cambridge, MA
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Wittenberg GF, Ngo K, Largent J, Zuzek A, Francisco G, Jost WH, Ellenbogen AL, Esquenazi A. OnabotulinumtoxinA Treatment in Adults with Spasticity Reduces Caregiver Burden: Results from the ASPIRE Study. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Esquenazi A, Fanning K, Zuzek A, Francisco G, Bandari D, Elmore M, Jensky N, Feng W(W, Wittenberg GF, Gallien P, Baricich A. Clinical Characteristics That Impact OnabotulinumtoxinA Treatment Adherence in Spasticity Patients From ASPIRE. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Roche N, Bonnyaud C, Reynaud V, Bensmail D, Pradon D, Esquenazi A. Motion analysis for the evaluation of muscle overactivity: A point of view. Ann Phys Rehabil Med 2019; 62:442-452. [PMID: 31276837 DOI: 10.1016/j.rehab.2019.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 11/15/2022]
Abstract
Muscle overactivity is a general term for pathological increases in muscle activity such as spasticity. It is caused by damage to the central nervous system at the cortical, subcortical or spinal levels, leading to an upper motor neuron syndrome. In routine clinical practice, muscle overactivity, which induces abnormal muscle tone, is usually evaluated by using the Modified Ashworth Scale or the Tardieu Scale. However, both of these scales involve testing in passive conditions that do not always reflect muscle activity during dynamic tasks such as gait or reaching. To determine appropriate treatment strategies, muscle overactivity should be evaluated by using objective measures in dynamic conditions. Instrumental motion analysis systems that include 3-D motion analysis and electromyography are very useful for this purpose. The method can be used to identify patterns of abnormal muscle activity that can be related to abnormal kinematic patterns. It allows for objective and accurate assessment of the effects of treatments to reduce muscle overactivity on the movement to be improved. The aim of this point-of-view article is to describe the utility of instrumental motion analysis and to outline both its numerous advantages in evaluating muscle overactivity and to present the current limitations for its use (e.g., cost, the need for an engineer, errors relating to marker placement and cross talk between electromyography sensors).
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Affiliation(s)
- N Roche
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France.
| | - C Bonnyaud
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - V Reynaud
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - D Bensmail
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - D Pradon
- U1179, service de physiologie et d'explorations fonctionnelles, Assistance publique des Hôpitaux de Paris, Raymond Poincaré Hospital, Garches, France
| | - A Esquenazi
- Gait and Motion Analysis Laboratory, Department of Physical Medicine and Rehabilitation, MossRehab, Elkins Park, PA, USA
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Abstract
Improving walking function is a desirable outcome in rehabilitation and of high importance for social and vocational reintegration for persons with neurologic-related gait impairment. Robots for lower limb gait rehabilitation are designed principally to help automate repetitive labor-intensive training during neurorehabilitation. These include tethered exoskeletons, end-effector devices, untethered exoskeletons, and patient-guided suspension systems. This article reviews the first 3 categories and briefly mentions the fourth. Research is needed to further define the therapeutic applications of these devices. Additional technical improvements are expected regarding device size, controls, and battery life for untethered devices.
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Affiliation(s)
- Alberto Esquenazi
- MossRehab Gait and Motion Analysis Laboratory, 60 Township Line, Elkins Park, PA 19027, USA.
| | - Mukul Talaty
- MossRehab Gait and Motion Analysis Laboratory, 60 Township Line, Elkins Park, PA 19027, USA
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Esquenazi A, Frontera W. 7.3 The organizations of physical and rehabilitation medicine in the world: Physical and rehabilitation medicine in the Americas. J Int Soc Phys Rehabil Med 2019. [DOI: 10.4103/jisprm.jisprm_32_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Esquenazi A, Moon D. A 10-year retrospective review of lower limb botulinum toxin injection for spasticity. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.11.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Esquenazi A, Gracies JM, Picaut P, Grandoulier AS, Delgado MR. AbobotulinumtoxinA (Dysport®) improves functional outcomes after single and repeat dosing in adults and children with spasticity. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.11.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stoquart G, Boyer FC, Hedera P, Brashear A, Esquenazi A, Grandoulier AS, Vilain C, Picaut P, Gracies JM. Efficacy of abobotulinumtoxinA for the treatment of hemiparetic adult patients with lower limb spasticity previously treated with botulinum toxins. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.11.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Francisco GE, Bandari DS, Bavikatte G, Jost WH, Largent J, Zuzek A, Esquenazi A. OnabotulinumtoxinA treatment utilization varies by etiology of spasticity, while maintaining high patient and clinician satisfaction: results from the aspire study. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.11.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Esquenazi A, Bavikatte G, Jost WH, Bandari DS, Munin MC, Tan Tang SF, Largent J, Zuzek A, Patel A, Francisco GE. Individualized onabotulinumtoxinA treatment for lower limb spasticity resulted in high patient and clinician satisfaction in the aspire study. Toxicon 2018. [DOI: 10.1016/j.toxicon.2018.11.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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