Page 47 - NNS 2014 Program & Abstract Book

dose groups improved an average of 16.4 – 17.3 points from baseline in
total motor score (TMS) and 12.2 – 10.5 points in upper extremity motor
score (UEMS) during the year after injury; participants in the best dose
group improved 27.3 –13.3 points in TMS and 15.7 – 5.5 points in
UEMS. These trends are promising, given the 9.6–13.2 point TMS re-
covery and 8.8 – 9.6 point UEMS recovery seen in historical individuals.
In addition, 31% of Cethrin-treated cervical participants converted two or
more AIS grades in the year after injury, and 44% converted two or more
motor levels. These trends also compare favorably with historical data:
only 17% of historical individuals convert two or more AIS grades in the
year following injury, and 24%–33% convert two or more motor levels.
BioAxone is presently planning a placebo-controlled, randomized Phase
IIb trial to further examine Cethrin in acute cervical spinal cord injury.
The primary endpoint in this trial will be UEMS. Secondary endpoints
will include established tests such as the Spinal Cord Independence
Measure (SCIM), and newer tests such as the Capabilities of Upper
Extremity Test (CUE-T) and the Graded Redefined Assessment of
Strength Sensibility and Prehension (GRAASP). In addition, BioAxone
is developing a questionnaire to assess the role of rehabilitation in the
recovery of treated and placebo groups.
Key words
cervical, paralysis, regeneration, Rho, SCI, spinal cord injury
OC5-03
MULTIPLE PRIOR CONCUSSIONS ARE ASSOCIATED
WITH SYMPTOMS IN HIGH SCHOOL ATHLETES
Mannix, MD, MPH, R.1, Iverson, PhD, G.L.2,3, Maxwell, PhD, B.4,
Atkins, PhD, J.5 , Berkner, D.O., P.6
1Division of Emergency Medicine, Boston Children’s Hospital, Bos-
ton, USA
2Harvard Medical School, Department of Physical Medicine and
Rehabilitation, Boston, USA
3Red Sox Foundation and Massachusetts General Hospital Home
Base Program, Boston, USA
4Department of Computer Science, Colby College, Waterville, Maine
5Department of Psychology, Colby College, Waterville, Maine
6Health Services, Colby College, Waterville, Maine
Several recent studies have reported conflicting results as to whether
or not multiple prior concussions are associated with differences in
baseline computerized neurocognitive testing and symptom scores.
The purpose of this study is to evaluate the association of prior con-
cussion on baseline computerized neurocognitive testing in a large
cohort of high school athletes.
This is a retrospective cohort study of student athletes from 49
Maine High Schools in 2010 who underwent baseline computerized
neurocognitive evaluation with Immediate Post-Concussion Assess-
ment and Cognitive Testing (ImPACT ). As part of the ImPACT ,
subjects reported a prior history of concussion as well as demographic
information and a symptoms score. Subjects reporting a concussion
within 26 weeks of baseline testing were excluded. We used linear
regression to evaluate the association of prior concussion with base-
line: 1) ImPACT composite scores; 2) Symptom scores.
Six thousand seventy five subjects were included in the study, of
whom 57% were male. The majority of athletes (85.3%) reported no
prior history of concussion while 4.6% reported having sustained 2 or
more prior concussions. On simple linear regression, increasing
number of concussions was related to worse performance in verbal
memory (p = 0.039) and higher symptoms scores (p < 0.001). On
multivariate modeling, controlling for demographic factors, only the
association with baseline symptom scale remained (p < 0.001).
In this large-scale, retrospective survey study, history of multiple
prior concussions was associated with higher symptom burden but not
baseline computerized neurocognitive testing.
Key words
baseline neurocognitive test, ImPact Test, multiple concussion, self
report, symptoms
OC6-01
REPORT OF LONGITUDINAL MRS AND DTI AFTER MOD-
ERATE/SEVERE PEDIATRIC TBI
Holshouser, B.A.1, Ghosh, N.2, Rundquist, M.2, Pivonka-Jones, J.2,
Tong, K.1, Ashwal, S.2
1Loma Linda University, Department of Radiology, Loma Linda, USA
2Loma Linda University, Department of Pediatrics, Loma Linda, USA
We present our findings on a prospective study of MRS and DTI
measures in pediatric TBI patients acutely and at 1-year after injury.
Pediatric patients, ages 4 to 18, were enrolled if they sustained a
moderate/severe TBI requiring admission to hospital, defined either as
having a GCS score < 13 OR if evidence of intracranial injury on initial
computed tomography scan. Patients underwent 3T MRI with DTI and
proton MRS in the acute period (6–17 days post TBI), and at 1 year
after injury. TBI and control regional DTI metrics (FA, ADC, AD, RD)
and MRS ratios (NAA/Cr, NAA/Cho, Cho/Cr) for the initial and one
year follow-up studies were compared and correlated to neurologic
(PCPCS) and neuropsychological outcomes at 12 months, specifically
general measures of memory utilizing the Children’s Memory Scale
(CMS: General Memory score), attention utilizing the Test of Everyday
Attention for Children (TEA-CH: Teach G score), and the Wechsler
Abbreviated Scale of Intelligence (WASI: Full Scale IQ).
We studied 58 children (43M/15F); mean age was 12.2 – 3.5 yrs (5.2–
17.9 yrs); initial GCS (Mild = 23; Moderate = 8; Severe = 27) and 54
control children; mean age 12.1 – 3.3 yrs (5.5–17.4 yrs). Initial studies
were done at 11.5 –3.4 days after injury and follow-up studies were
done at 12.2 –3.5 months for TBI patients and 12.1 – 3.3 months for
controls. Total and regional NAA/Cr ratios and total, corpus callosal,
parietal and temporal white matter mean FA and AD measures were 1)
significantly reduced initially compared to controls; 2) were significantly
correlated with neurologic outcomes, FSIQ and General Memory scores
and 3) did not recover in patients with initial severe injury at 1 year.
Metabolite and DTI measures that remain reduced at one year after
injury in patients with severe injury suggest that neuronal loss and
axonal injury contribute to long term intellectual and memory deficits.
Support from NIH/NINDS:R01-NS054001.
Key words
diffusion tensor imaging, magnetic resonance spectroscopy, pediatric,
traumatic brain injury
OC6-02
OPTIMIZING NEUROMODULATION FOR WALKING IN
HUMAN INCOMPLETE SPINAL CORD INJURY
Tansey, K.E.1,3, White, J.M.1,2, DeWeerth, S.P.1,2
1Emory University School of Medicine, Atlanta, USA
2Georgia Institute of Technology, Atlanta, USA
3Veterans Administration Medical Center, Atlanta, USA
Locomotor recovery occurs to some extent in humans with incomplete
spinal cord injury (SCI) and this recovery can be augmented with
A-15