Time-course and determinants of spasticity during the first six months following first-ever stroke.

OBJECTIVE To explore the occurrence of, and risk factors for, spasticity until 6 months after first-ever stroke. METHODS Forty-nine patients were examined at day 2-10, at 1 month, and at 6 months. The modified Ashworth Scale was used to assess resistance to passive movements. A comprehensive clinical examination was performed to identify other positive signs of upper motor neurone syndrome, in accordance with a broader definition of spasticity, and to evaluate whether spasticity was disabling. Neurological impairments were determined by use of the National Institutes of Health Stroke Scale and global disability by use of the modified Rankin Scale. RESULTS Spasticity was present in 2 patients (4%) at day 2-10, in 13 patients (27%) at 1 month, and in 11 patients (23%) at 6 months. Severe paresis of the arm at day 2-10 was associated with a higher risk for spasticity at 1 month (odds ratio = 10, 95% confidence interval 2.1-48.4). Disabling spasticity was present in one patient at 1 month and in 6 patients (13%) at 6 months. CONCLUSION Spasticity according to the modified Ashworth Scale usually occurs within 1 month and disabling spasticity later in a subgroup. Severe paresis of the arm is a risk factor for spasticity.

[1]  AD Pandyan,et al.  Spasticity, an impairment that is poorly defined and poorly measured , 2009, Clinical rehabilitation.

[2]  P. Neilson,et al.  Spasticity and muscle contracture following stroke. , 1996, Brain : a journal of neurology.

[3]  M. Kaste,et al.  Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) , 1998, The Lancet.

[4]  M. Leathley,et al.  Prevalence of spasticity post stroke , 2002, Clinical rehabilitation.

[5]  M. Leathley,et al.  Development and Inter-rater Reliability of an Assessment Tool for Measuring Muscle Tone in People with Hemiplegia after a Stroke , 1999 .

[6]  G. Sheean,et al.  Upper Motor Neurone Syndrome and Spasticity: Neurophysiology of spasticity , 2008 .

[7]  A. Thilmann,et al.  The limitations of the tendon jerk as a marker of pathological stretch reflex activity in human spasticity. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[8]  K. Aho,et al.  Cerebrovascular disease in the community: results of a WHO collaborative study. , 1980, Bulletin of the World Health Organization.

[9]  T. Brott,et al.  Improved Reliability of the NIH Stroke Scale Using Video Training , 1994, Stroke.

[10]  J. Marler,et al.  Measurements of acute cerebral infarction: a clinical examination scale. , 1989, Stroke.

[11]  M. Sabbahi,et al.  Correlation of spasticity with hyperactive stretch reflexes and motor dysfunction in hemiplegia. , 1999, Archives of physical medicine and rehabilitation.

[12]  A. Thilmann,et al.  The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. , 1991, Brain : a journal of neurology.

[13]  DE Wood,et al.  Theoretical and methodological considerations in the measurement of spasticity , 2005, Disability and rehabilitation.

[14]  H Rodgers,et al.  A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity , 1999, Clinical rehabilitation.

[15]  G. Francisco,et al.  Consensus Panel Guidelines for the Use of Intrathecal Baclofen Therapy in Poststroke Spastic Hypertonia , 2006, Topics in stroke rehabilitation.

[16]  J. Borg,et al.  Prevalence of disabling spasticity 1 year after first‐ever stroke , 2008, European journal of neurology.

[17]  P Trouillas,et al.  Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. , 1998, Lancet.

[18]  K H Mauritz,et al.  Chronic transformation of muscle in spasticity: a peripheral contribution to increased tone. , 1985, Journal of neurology, neurosurgery, and psychiatry.

[19]  AD Pandyan,et al.  Spasticity: Clinical perceptions, neurological realities and meaningful measurement , 2005, Disability and rehabilitation.

[20]  L. Widén Holmqvist,et al.  Spasticity and Its Association with Functioning and Health-Related Quality of Life 18 Months after Stroke , 2006, Cerebrovascular Diseases.

[21]  D Burke,et al.  Spasticity as an adaptation to pyramidal tract injury. , 1988, Advances in neurology.

[22]  M. Leathley,et al.  Predicting spasticity after stroke in those surviving to 12 months , 2004, Clinical rehabilitation.

[23]  W Z Rymer,et al.  Objective quantification of spastic hypertonia: correlation with clinical findings. , 1992, Archives of physical medicine and rehabilitation.

[24]  Lin Fumei,et al.  Correlation of Spasticity With Hyperactive Stretch Reflexes and Motor Dysfunction in Hemiplegia , 1999 .

[25]  M. Leathley,et al.  Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity. , 1999, Archives of physical medicine and rehabilitation.

[26]  Garth R. Johnson,et al.  Upper Motor Neurone Syndrome and Spasticity: Clinical Management and Neurophysiology , 2008 .

[27]  M. V. von Arbin,et al.  Spasticity After Stroke: Its Occurrence and Association With Motor Impairments and Activity Limitations , 2003, Stroke.

[28]  W R Clarke,et al.  Baseline NIH Stroke Scale score strongly predicts outcome after stroke , 1999, Neurology.

[29]  James W. Lance,et al.  The control of muscle tone, reflexes, and movement , 1980, Neurology.

[30]  A. Ward,et al.  Spasticity treatment with botulinum toxins , 2008, Journal of Neural Transmission.

[31]  A. Geurts,et al.  Are clinical characteristics associated with upper-extremity hypertonia in severe ischaemic supratentorial stroke? , 2007, Journal of rehabilitation medicine.

[32]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.