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      Early development of spasticity following stroke: a prospective, observational trial

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          Abstract

          This study followed a cohort of 103 patients at median 6 days, 6 and 16 weeks after stroke and recorded muscle tone, pain, paresis, Barthel Index and quality of life score (EQ-5D) to identify risk-factors for development of spasticity. 24.5% of stroke victims developed an increase of muscle tone within 2 weeks after stroke. Patients with spasticity had significantly higher incidences of pain and nursing home placement and lower Barthel and EQ-5D scores than patients with normal muscle tone. Early predictive factors for presence of severe spasticity [modified Ashworth scale score (MAS) ≥3] at final follow-up were moderate increase in muscle tone at baseline and/or first follow-up (MAS = 2), low Barthel Index at baseline, hemispasticity, involvement of more than two joints at first follow-up, and paresis at any assessment point. The study helps to identify patients at highest risk for permanent and severe spasticity, and advocates for early treatment in this group.

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          Spasticity after stroke: its occurrence and association with motor impairments and activity limitations.

          Disa K Sommerfeld, Elsy Eek, Anna-Karin Svensson … (2004)
          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). 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. 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 (n=77) had statistically significantly better motor and activity scores than spastic patients (n=18). 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. 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.
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            Spastic movement disorder: impaired reflex function and altered muscle mechanics.

            Volker Dietz, Thomas Sinkjaer (2007)
            In clinical practice, signs of exaggerated tendon tap reflexes associated with muscle hypertonia are generally thought to be responsible for spastic movement disorders. Most antispastic treatments are, therefore, directed at the reduction of reflex activity. In recent years, however, researchers have noticed a discrepancy between spasticity as measured in the clinic and functional spastic movement disorders, which is primarily due to the different roles of reflexes in passive and active states, respectively. We now know that central motor lesions are associated with loss of supraspinal drive and defective use of afferent input with impaired behaviour of short-latency and long-latency reflexes. These changes lead to paresis and maladaptation of the movement pattern. Secondary changes in mechanical muscle fibre, collagen tissue, and tendon properties (eg, loss of sarcomeres, subclinical contractures) result in spastic muscle tone, which in part compensates for paresis and allows functional movements on a simpler level of organisation. Antispastic drugs can accentuate paresis and therefore should be applied with caution in mobile patients.
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              Prevalence of spasticity post stroke.

              C Watkins, M Leathley, J M Gregson … (2002)
              To establish the prevalence of spasticity 12 months after stroke and examine its relationship with functional ability. A cohort study of prevalence of spasticity at 12 months post stroke. Initially hospitalized but subsequently community-dwelling stroke survivors in Liverpool, UK. One hundred and six consecutively presenting stroke patients surviving to 12 months. Muscle tone measured at the elbow using the Modified Ashworth Scale and at several joints, in the arms and legs, using the Tone Assessment Scale; functional ability using the modified Barthel Index. Increased muscle tone (spasticity) was present in 29 (27%) and 38 (36%) of the 106 patients when measured using the Modified Ashworth Scale and Tone Assessment Scale respectively. Combining the results from both scales produced a prevalence of 40 (38%). Those with spasticity had significantly lower Barthel scores at 12 months (p < 0.0001). When estimating the prevalence of spasticity it is essential to assess both arms and legs, using both scales. Despite measuring tone at several joints, spasticity was demonstrated in only 40 (38%) patients, lower than previous estimates.
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                Author and article information

                Contributors
                : +49-3320422310 , +49-3320422309 , wissel@rehaklinik-beelitz.de
                : +41-71-6862543 , +41-71-6862404 , ludwig.schelosky@stgag.ch
                : +49-331-2417102 , +49-331-2417100 , wchriste@klinikumevb.de
                : +49-337-6666336 , +49-337-6666141 , j.faiss@asklepios.com
                : +49-30-130132671 , +49-30-130132674 , Joerg.Mueller@vivantes.de
                Journal
                Journal ID (nlm-ta): J Neurol
                Title: Journal of Neurology
                Publisher: Springer-Verlag (Berlin/Heidelberg )
                ISSN (Print): 0340-5354
                ISSN (Electronic): 1432-1459
                Publication date (Electronic): 6 February 2010
                Publication date PMC-release: 6 February 2010
                Publication date (Print): July 2010
                Volume: 257
                Issue: 7
                Pages: 1067-1072
                Affiliations
                [1 ]Neurological Rehabilitation Hospital, Kliniken Beelitz GmbH, Paracelsusring 6a, 14547 Beelitz-Heilstätten, Germany
                [2 ]Kantonsspital Münsterlingen, 8596 Münsterlingen, Switzerland
                [3 ]Klinik für Neurologie, Ernst von Bergmann Hospital, Charlottenstrasse 72, 14467 Potsdam, Germany
                [4 ]Asklepios Fachkliniken Brandenburg GmbH, Buchholzer Str. 21, 15755 Teupitz, Germany
                [5 ]Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
                Article
                Publisher ID: 5463
                DOI: 10.1007/s00415-010-5463-1
                PMC ID: 2892615
                PubMed ID: 20140444
                SO-VID: 02a71d0a-0717-434a-a272-7a63acc0649c
                Copyright © © The Author(s) 2010
                History
                Date received : 16 October 2009
                Date revision received : 5 January 2010
                Date accepted : 11 January 2010
                Categories
                Subject: Original Communication
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2010

                ScienceOpen disciplines: Neurology
                Keywords: acute cerebral infarction,spasticity,spasticity related pain,barthel index,quality of life
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: acute cerebral infarction, spasticity, spasticity related pain, barthel index, quality of life

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