title: Evaluation of upper-limb spasticity after stroke: A clinical and neurophysiologic study.
abstract: OBJECTIVE
  To assess upper-limb spasticity after stroke by means of clinical and instrumental tools and to identify possible variables influencing the clinical pattern.
  
  
  METHODS
  Descriptive measurement study of a consecutive sample of patients with upper-limb spasticity after stroke.
  
  
  METHODS
  Neurorehabilitation hospital.
  
  
  METHODS
  Sixty-five poststroke hemiplegic patients.
  
  
  METHODS
  Not applicable. Main outcome measures Upper-limb spasticity, as assessed clinically (Modified Ashworth Scale [MAS], articular goniometry) and neurophysiologically (maximum H-reflex [Hmax], maximum M response [Mmax], Hmax/Mmax ratio).
  
  
  RESULTS
  Poorer MAS scores were associated with lower passive range of motion (PROM) values at the wrist ( P =.01) and elbow ( P =.002). The flexor carpi radialis Hmax/Mmax ratio correlated directly with MAS scores at the wrist ( P =.005) and correlated inversely with PROM. The presence of pain in the fingers, wrist, and elbow was significantly associated only with lower PROM values at the wrist.
  
  
  CONCLUSIONS
  Upper-limb spasticity is involved in the development of articular PROM limitation after a stroke. Pain appears to be related to PROM reduction as well, but the exact causal relationship between these 2 factors is still unclear. The MAS and the Hmax/Mmax ratio correlated when evaluating poststroke spasticity; they characterize 2 different aspects of spasticity, clinical and neurophysiologic, respectively, and they could be used as an integrated approach to study and follow poststroke patients.
authors.affiliation: Department of Neurorehabilitation, Fondazione Don C. Gnocchi Onlus IRCCS, Centro S. Maria agli Ulivi, Pozzolatico (Firenze), Italy. apizzi@dongnocchi.it
authors.forename: Assunta
authors.initials: A
authors.lastname: Pizzi
authors.forename: Giovanna
authors.initials: G
authors.lastname: Carlucci
authors.forename: Catuscia
authors.initials: C
authors.lastname: Falsini
authors.forename: Sonia
authors.initials: S
authors.lastname: Verdesca
authors.forename: Antonello
authors.initials: A
authors.lastname: Grippo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006181:H-Reflex / Q000502:physiology*; D006429:Hemiplegia / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000145:classification / Q000209:etiology; D010243:Paralysis / Q000145:classification / Q000209:etiology / Q000534:rehabilitation*; D016059:Range of Motion, Articular; D012047:Rehabilitation Centers; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications; D034941:Upper Extremity / Q000503:physiopathology*