Xeomin® and Gait Related Mobility After Stroke

Study Overview
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Brief Summary
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The aim of the present pilot study is to evaluate the association between change in gait related mobility in ambulatory male and female adult hemiparetic patients before and 4-6-weeks after Xeomin® injection into the upper limb, using two standardized tests of physical function in outpatient rehabilitation that are widely used; the 10-meter walk test and the timed 'up and go' test (TUG).

Detailed Description
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For this pilot study, the investigators hypothesize that there will be durational improvements in gait related mobility on the instrumented TUG and 10-meter walk tests 4-6-weeks post upper extremity Xeomin® injection. Physical function will be quantified as time to complete the instrumented TUG. A one-group pretest-post-test experimental design will be used. Participants will be tested on the primary and secondary outcome measures before upper extremity injection with Xeomin® and 4 to 6 weeks thereafter. Additionally, participants will be contacted for an end of study visit via telephone approximately 12-weeks post Xeomin® injection to obtain information regarding any adverse events and gain insight into the therapeutic duration of the Xeomin®. The proposed duration of the study is 2 years to allow adequate time for screening, recruitment and follow-up.

Official Title
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Upper Extremity Injection of Xeomin® and Changes in Gait Related Mobility in Adults After Stroke

Conditions
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Stroke

Intervention / Treatment
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* Drug: Xeomin®


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of hemiparesis and spasticity secondary to stroke with upper and lower limb spasticity and unilateral motor and/or sensory deficit No prior surgery to the lower limb Able to walk at least 10 meters without physical assistance from another person and without an assistive device Toe- ground clearance during swing phase without assistive device or orthoses No treatment with botulinum toxin within the past 4 months Exclusion Criteria: Passive range of motion at either the ankle, knee, or elbow joint less than 30 degrees Participants with uncorrected hearing impairment Weight bearing restrictions due to concurrent orthopedic injuries that would make ambulating with or without an assistive device unsafe Speech language expression deficit (e.g., aphasia) Absence of proprioception upon neurologic examination Presence of fixed contractures in the upper or lower extremities not correctable to neutral Other confounding neurological diagnoses or active acute illness (cancer, Parkinson's disease, multiple sclerosis)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 79 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: A one-group pretest-post-test experimental design will be used. Participants will be tested on the primary and secondary outcome measures before upper extremity injection with Xeomin® and 4 to 6 weeks thereafter.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Xeomin®<br>Participants will be injected via electromyographic guidance with a total of 200 units of Xeomin® into the pectoralis major, biceps brachii, brachioradialis, and latissimus dorsi muscles of the hemiparetic side using a standardized injection protocol (16). An additional 100 units of Xeomin® will be available at the discretion of the investigator for injection into additional affected upper extremity muscles | Drug: Xeomin®<br>* To discover whether injection into the upper extremity with Xeomin® triggers improvements in gait-related mobility and quality of life in adults with hemiparesis secondary to stroke.<br>* Other names: IncobotulinumtoxinA;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Instrumented Timed Up and Go test time | Subjects arise from a chair, walk at their normal speed, turn around right after passing the tape at the end of the pathway, return to the chair, turn around and sit down. Subjects will be fitted with a , single Attitude and heading reference system (AHRS) sensor fixed on the manubrium inferior to the interclavicular notch in a chest-mounted pack. The AHRS is a wireless-telemetry, 10-parameter unit which includes a tri-axial accelerometer, a tri-axial gyroscope, a tri-axial magnetometer and an onboard temperature sensor. | Baseline and 4-6 weeks after Xeomin injection | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Ten-meter walk test time | Subjects walk 10-meters at self-selected pace | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Mini-Mental State Examination score | Quantitative assessment of cognitive impairment. Scores range from 0-30, higher scores represent less cognitive impairment. | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Quality of Life in Neurological Disorders (Neuro-QoL) Depression - Short Form score | Eight-item assessment of loss and feelings of hopelessness, negative mood, decrease in positive affect, information-processing deficits, negative views of the self, and negative social cognition in patients with neurological disorders. Scores range from 8-40, higher scores represent greater depressive symptoms. | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Patient-Reported Outcomes Measurement Information System (PROMIS) General Life Satisfaction - Short Form 5a score | This form consists of 5-items and assesses the participant's cognitive evaluation of life experiences and whether that participant is content with their life. Scores range from 5-35, higher scores represent increased life satisfaction. | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Brief Pain Inventory (BPI) - Short Form score | The BPI is a self-report measure that assesses severity of pain, impact of pain on daily function, location of pain, pain medications and amount of pain relief in the past 24 hours. For the pain intensity portion of the assessment, scores range from 0-40, higher scores represent increased pain intensity. For the pain interference portion of the scale, scores range from 0-70, higher scores represent increased pain interference. | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Neuro-QoL Satisfaction with Social Roles and Activities - Short Form score | A reliable and valid 8-item measure of involvement in social roles, activities and responsibilities. Scores for the social roles portion of the assessment range from 4-20, higher scores represent increased satisfaction with social roles. Scores for the activities portion of the assessment range from 4-20, higher scores represent increased activity satisfaction. | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Modified Ashworth Scale (MAS) score | The MAS will be used as a measure of spasticity. Scores range from 0-4 for each muscle tested, higher scores represent increased spasticity. | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Berg Balance Scale (BBS) score | The BBS is a 14-item objective tool that assesses static balance and fall risk in adults' post-stroke. Scores range from 0-56, higher scores indicate increased functional balance. | Baseline and 4-6 weeks after Xeomin injection | 
| Change in Activities-Specific Balance (ABC) Scale score | The ABC scale is a 16-item self-report measure of balance confidence in performing various activities without losing balance or experiencing a sense of unsteadiness. Scores range from 0-100, higher scores indicate increased self-confidence with balance. | Baseline and 4-6 weeks after Xeomin injection |