Poststroke spasticity

Abstract

Among the estimated 20% to 40% of stroke survivors who develop spasticity, the burden of this condition on patients, caregivers, and society is substantial. Stroke survivors with spasticity may experience reductions in their ability to perform activities of daily living and in their health-related quality of life. The occurrence of spasticity in stroke survivors may also result in an increased burden on their caregivers, who exhibit poorer physical and emotional health as compared with the general population. The responsibilities that caregivers have to the stroke survivor--in terms of providing medical care, protecting from falls, and assisting with feeding and hygiene, among other tasks of daily living--must be balanced with their responsibilities to other family members and to themselves. Caregivers of stroke survivors often report a feeling of confinement with little opportunity for relief, and although social support can be helpful, it is frequently limited in its availability. In terms of the socioeconomic burden of spasticity after stroke, recent data point to a 4-fold increase in health care costs associated with stroke survivors with spasticity compared with stroke survivors without spasticity. Thus, it is important to reduce the burden of spasticity after stroke. Consequently, effective spasticity treatment that reduces spasticity and the level of disability experienced by stroke survivors will likely increase their functioning and their health-related quality of life and will also result in a diminished burden on their caregivers.

Systematic review of the influence of spasticity on quality of life in adults with chronic neurological conditions

“…[1] Eighty percent of MS patients, 75% of patients with severe traumatic brain injury and 40% of stroke survivors report symptoms of spasticity. [2][3][4] High prevalence and limited effectiveness of current treatment options makes spasticity a significant health problem in neurological rehabilitation. [5,6] Several systematic reviews which evaluated the effects of spasticity on physical functioning concluded that spasticity has a serious impact on disability, affecting almost every aspect of patients' daily lives.…”

“…[5,6] Several systematic reviews which evaluated the effects of spasticity on physical functioning concluded that spasticity has a serious impact on disability, affecting almost every aspect of patients' daily lives. [4,7,8] Spasticity was found to mediate its effects on disability via reduced range of motion, loss of dexterity, pain and problems with hygiene and transfers. As a result of these spasticity-related impairments, spasticity carries a significant economic burden.…”

Cortical activity modulation by botulinum toxin type A in patients with post-stroke arm spasticity: Real and imagined hand movement

“…It is generally recognized that poststroke spasticity (PSS) may interfere with voluntary movement [31]. Disability associated with PSS may undoubtedly affect patient's quality of life, increase caregiver and socioeconomic burden [57]. Current multidisciplinary approach to relieve focal spasticity combines physiotherapy with botulinum toxin A (BoNT-A) application.…”

Management of spasticity with onabotulinumtoxinA: practical guidance based on the italian real-life post-stroke spasticity survey

“…Furthermore, the impaired ability of patients with poststroke spasticity to perform activities of daily living places a considerable burden on caregivers, leading, among other things, to depression, anxiety and low health-related quality of life (Zorowitz et al, 2013). In addition, the indirect costs to caregivers of patients with post-stroke spasticity, in terms of impaired productivity (as measured by absenteeism, presenteeism, work productivity, and activity limitation), have been found be high (monetization of the costs associated with lost productivity was reported to be >$10,000/year for each employed caregiver) (Ganapathy et al, 2015).…”

“…Spasticity can lead to chronic disability with a negative impact on the quality of life of patients and caregivers (Zorowitz et al, 2013;Gillard et al, 2015). Botulinum toxin has been found to significantly decrease carer burden in long-term care stroke patients with spasticity, mainly owing to its effects in terms of reducing limb spasticity and improving the joint range of movement of the affected limbs (Lam et al, 2012).…”