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


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.
Sommerfeld
Disa K
DK
Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden. disa_sommerfeld@hotmail.com
Eek
Elsy U-B
EU
Svensson
Anna-Karin
AK
Holmqvist
Lotta Widén
LW
von Arbin
Magnus H
MH
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000175:diagnosis / Q000453:epidemiology*; D009128:Muscle Spasticity / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D010291:Paresis / Q000453:epidemiology; D015995:Prevalence; D020127:Recovery of Function; D020521:Stroke / Q000453:epidemiology* / Q000503:physiopathology; D013548:Sweden / Q000453:epidemiology; D013995:Time