Post-stroke Spasticity

July 2015 Journal Club: Opheim A, Danielsson A, Alt Murphy M, Persson HC, Sunnerhagen, KS, (2014) Upper-Limb Spasticity During the First Year After Stroke: Stroke Arm Longitudinal Study at the University of Gothenburg. American Journal of Physical Medicine & Rehabilitation, 93(10), p 884–896. DOI: 10.1097/PHM.0000000000000157

Objective: The aims of this study were to describe the prevalence and the severity of upper-limb spasticity during the first year after stroke and to analyze sensorimotor function, pain, reduced range of motion, and sensibility in persons with and without spasticity.

Design: This is a longitudinal design with assessments at days 3 and 10; week 4; and months 3, 6, and 12. A total of 117 patients with first-ever stroke and arm paresis on day 3 were consecutively included. Sixty-five percent were assessed at 12 months. Upper-limb spasticity was assessed with the Modified Ashworth Scale, and a score of 1 or greater was considered spastic. Sensorimotor function, pain, sensibility, and joint range of motion were assessed with the Fugl-Meyer Assessment. Impairment was defined as a score of less than maximum on the motor and nonmotor domains of the Fugl-Meyer Assessment.

Results: Spasticity was present in 25% of the patients at day 3 and in 46% at 12 mos. In most patients with spasticity, the severity increased during the first year after stroke. Spasticity appeared first in the elbow flexors and later in the elbow extensors and the wrist flexors. The patients with spasticity had significantly worse sensorimotor function and more pain, reduced joint range of motion, and reduced sensibility.

Conclusions: Spasticity developed in almost half of the assessed patients, and the severity of spasticity increased over time. Because spasticity and impairments related to spasticity, such as pain and limitation in joint range of motion, influence upper extremity function negatively, early identification and treatment of spasticity may be warranted.

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