The Relationship between Spasticity and Lower Extremity Strength with Functional Mobility Following Chronic Stroke

Abstract

Background: Spasticity and muscle weakness are the primary impairments that result in activity limitation after stroke. Functional mobility is the ability to transfer independently from one place to another that depends on the extent of impairments affecting body function. The knowledge of relationship between the physical consequences of stroke and functional limitation helps therapist to implement the most effective rehabilitation approach to improve mobility. Objective: The purpose of this study was to clinically assess the relationship between spasticity and lower extremity strength with functional mobility in hemi paretic stroke subjects. Methods: In this cross sectional analytical study using a convenience sampling, 30 (18 men, 12 women) participants with post stroke duration of 3-24 months participated. Spasticity of knee extensor and ankle plantar flexors was evaluated with Modified Tardieu scale. Lower extremity strength was measured with Motricity Index. Functional mobility was assessed by the Rivermead mobility index, Timed Up and Go test, 6 Min Walk Test and 10-Meter Walk Test. For analysis of data the Pearson correlation coefficient was used. Results: The results showed that there was no statistical significant relationship between the lower extremity spasticity and all functional mobility variables. The lower extremity strength and functional mobility variables were significantly correlated (p<0.05, r>0.70). Conclusion: It seemed that lower extremity spasticity was not correlated to functional mobility after stroke. The rehabilitation for decreasing lower extremity spasticity would not be functionally efficient. There should be increased focus on rehabilitation of lower extremity strength in order to enhance functional mobility.

Relationship between post-stroke spasticity and functional ambulation among Nigerian stroke survivors

“…Loss of motor units and decreased firing rate may reduce the efficiency of muscle contraction in stroke survivors with spasticity with consequent increased effort, fatigue and difficulty with voluntary force generation (Thibaut et al, 2013). Our finding is contrary to the findings of Fayazi et al (2014) and Patterson et al (2007). These authors found no significant correlation between spasticity and mobility.…”

“…In addition, spasticity has been associated with muscle paresis among stroke survivors (Bethoux, 2015). Though, muscle strength was not assessed in this study, lower limb muscle strength has been associated with functional mobility (Hsu et al, 2003;Fayazi et al, 2014;Watanabe et al, 2015). Loss of motor units and decreased firing rate may reduce the efficiency of muscle contraction in stroke survivors with spasticity with consequent increased effort, fatigue and difficulty with voluntary force generation (Thibaut et al, 2013).…”

“…Co-contraction of agonist and antagonist muscles of the knee may limit normal limb movement which in turn interferes with walking. In addition, participant in this study used assistive devices where necessary whereas earlier studies excluded stroke survivors who ambulated with assistive devices (Adegoke et al, 2012;Fayazi et al, 2014). According to the E-FAP protocol, appropriate factor attached to each assistive device must be used to multiply the time taken to complete the task for which the device was used.…”

“…Spasticity compounds motor impairments among stroke survivors, resulting in secondary complications (Francisco and Mcguire, 2012;Fayazi et al, 2014). Data on prevalence of PSS among stroke survivors in Nigeria are unavailable, reported prevalence from other region ranges between 19 and 47% (Urban et al, 2010;Thibaut et al, 2013;Zorowitz et al, 2013).…”

“…Data on the contribution of PSS to community ambulation is still emerging and there is no consensus on the actual relationship between spasticity and community or functional ambulation after stroke. For instance, Lundstrom et al (2008) and Doan et al (2012), reported higher disability in stroke survivors with spasticity than those without, while other researchers posited that PSS is a positive sign in the trajectory of stroke recovery (Thibaut et al, 2013;Fayazi et al, 2014;Li, 2017). To effectively manage spasticity for improved community ambulation, it is important to understand the actual relationship between post stroke spasticity and community ambulation.…”