Spasticity After Stroke

Abstract

Background and Purpose-There is no consensus concerning the number of patients developing spasticity or the relationship between spasticity and disabilities after acute stroke. The aim of the present study was to describe the extent to which spasticity occurs and is associated with disabilities (motor impairments and activity limitations). Methods-Ninety-five patients with first-ever stroke were examined initially (mean, 5.4 days) and 3 months after stroke with the Modified Ashworth Scale for spasticity; self-reported muscle stiffness; tendon reflexes; Birgitta Lindmark motor performance; Nine Hole Peg Test for manual dexterity; Rivermead Mobility Index; Get-Up and Go test; and Barthel Index. Results-Of the 95 patients studied, 64 were hemiparetic, 18 were spastic, 6 reported muscle stiffness, and 18 had increased tendon reflexes 3 months after stroke. Patients who were nonspastic (nϭ77) had statistically significantly better motor and activity scores than spastic patients (nϭ18). However, the correlations between muscle tone and disability scores were low, and severe disabilities were seen in almost the same number of nonspastic as spastic patients. Conclusions-Although spasticity seems to contribute to disabilities after stroke, spasticity was present in only 19% of the patients investigated 3 months after stroke. Severe disabilities were seen in almost the same number of nonspastic as spastic patients. These findings indicate that the focus on spasticity in stroke rehabilitation is out of step with its clinical importance. Careful and continual evaluation to establish the cause of the patient's disabilities is essential before a decision is made on the most proper rehabilitation approach.

Botulinum toxin A modifies nociceptive withdrawal reflex in subacute stroke patients

“…Upper limb spasticity is a frequent complication of stroke that greatly interferes with hand function, motor relearning, recovery of voluntary movements, positioning, and hygiene; it can also cause pain, with activity limitation and loss of dexterity (Rosales et al., 2016; Sommerfeld, Eek, Svensson, Holmqvist, & von Arbin, 2003). For this reason, the pharmacological and rehabilitation treatment of spasticity is a primary objective in stroke patients (Bethoux, 2015).…”

The spasticity in the motor and functional disability in adults with post-stroke hemiparetic

“…It is currently believed that spasticity itself is one of the contributing factors for motor and functional loss after stroke (12), but it is not an isolated agent, since other primary conditions may be associated, such as muscle weakness (13). Conditions secondary to upper motor neuron injury, such as pain and muscle contracture, also impair the appearance and maintenance of voluntary movements (6) and they are, to a certain degree, associated with the acute and/or chronic rehabilitation process that the individuals underwent.…”

Predictive factors for spasticity among ischemic stroke patients

“…Of all the sequelae that persist for months, spasticity is the principal determining factor for functional loss, and it is considered to be a priority among therapeutic interventions 8 . The incidence of spasticity ranges from 19 to 39%, and it is not known exactly at what point it emerges following the stroke 9,10 . Independent of the type of intervention carried out, the prognosis for recovering from spasticity is poor and requires a multidisciplinary approach 8 .…”