Early prediction of long-term upper limb spasticity after stroke

Abstract

Objective:To identify predictors and the optimal time point for the early prediction of the presence and severity of spasticity in the upper limb 12 months poststroke.Methods:In total, 117 patients in the Gothenburg area who had experienced a stroke for the first time and with documented arm paresis day 3 poststroke were consecutively included. Assessments were made at admission and at 3 and 10 days, 4 weeks, and 12 months poststroke. Upper limb spasticity in elbow flexion/extension and wrist flexion/extension was assessed with the modified Ashworth Scale (MAS). Any spasticity was regarded as MAS ≥1, and severe spasticity was regarded as MAS ≥2 in any of the muscles. Sensorimotor function, sensation, pain, and joint range of motion in the upper limb were assessed with the Fugl-Meyer assessment scale, and, together with demographic and diagnostic information, were included in both univariate and multivariate logistic regression analysis models. Seventy-six patients were included in the logistic regression analysis.Results:Sensorimotor function was the most important predictor both for any and severe spasticity 12 months poststroke. In addition, spasticity 4 weeks poststroke was a significant predictor for severe spasticity. The best prediction model for any spasticity was observed 10 days poststroke (85% sensitivity, 90% specificity). The best prediction model for severe spasticity was observed 4 weeks poststroke (91% sensitivity, 92% specificity).Conclusions:Reduced sensorimotor function was the most important predictor both for any and severe spasticity, and spasticity could be predicted with high sensitivity and specificity 10 days poststroke.

A method of hand motor control assessment in patients with post-stroke spasticity

“…Oceny dokonywano w 3 i 10 dniu oraz 4 tygodnie i 12 miesięcy po udarze. Wykazano, że wysoki poziom zaburzeń czuciowo-ruchowych kończyny górnej mierzony w 10. dniu oraz po 4 tygodniach jest predyktorem utrzymywania się spastyczności do 12 miesięcy po udarze [36]. W badaniach Yang i wsp.…”

“…wykazano, że 3 miesiące po udarze spastyczność występuje u 33% pacjentów [6]. Do oceny poziomu spastyczności najczęściej wykorzystuje się zmodyfikowaną skalę Ashworth i skalę Tardieu [7][8][9][10][11][12][13][14][15]. Zmodyfikowana skala Ashworth (Modified Ashworth Scale, MAS) stanowi subiektywną Abstract Introduction: In order to assess hand spasticity in post-stroke patients, it is necessary to apply an objective and sensitive method which allows for characterising motor control.…”

“…Do oceny kontroli motorycznej, a tym samym poziomu funkcji ręki przydatne są skale Fugl -Meyer (Fugl -Meyer Assessment, FMA) i Brunnström [3,11,14,15,17,23,24]. Skale te mają charakter skal subiektywnych.…”

“…Fugl-Meyer Assessment and Brunnström Approach are useful scales in assessing hand motor control and function [3,11,14,15,17,23,24]. These scales are of subjective character.…”

“…In their research, Keng et al revealed that 3 months post stroke, spasticity occurred in 33% of the patients [6]. The level of spasticity is usually assessed with Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) [7][8][9][10][11][12][13][14][15]. …”