title: Post-stroke spasticity: predictors of early development and considerations for therapeutic intervention.
abstract: OBJECTIVE
  The complexities of post-stroke spasticity (PSS), and the resultant difficulties in treating the disability, present a significant challenge to patients, stroke rehabilitation teams, and caregivers. Reducing the severity of spasticity and its long-term complications may be facilitated by early intervention, making identification of stroke patients at high risk for developing spasticity essential. Factors that predict which patients are at risk for the development of PSS are identified. TYPE: Systematic search and review
  
  
  METHODS
  A PubMed search of the following terms was conducted: predictors OR risk factors AND stroke AND spasticity. Studies discussing predictors of early PSS development and factors predictive of motor/functional outcomes and recovery were selected and reviewed in detail.
  
  
  RESULTS
  Several predictors of PSS have been proposed, based on studies conducted in patients within 6 months after stroke, including development of increased muscle tone, greater severity of paresis, hemihypesthesia, and low Barthel Index score. Predictors identified in later stages post-stroke (within 12 months) have also proved useful for clinicians, as has the consideration of predictors of motor and functional outcomes and recovery; yet there is a need for additional studies in this area. An understanding of these and other potential predictive factors--such as motor impairment, neurologic and sensory deficit, lesion volume and location, and associated diseases--has not progressed to the same extent and warrants further investigation.
  
  
  CONCLUSIONS
  The studies discussed in this review support the notion that early identification of factors predictive of PSS should significantly affect the course of intervention, help target individuals who would benefit most from specific types and intensities of therapy, and possibly provide better motor and functional outcomes.
authors.affiliation: Department of Neurology, Neurorehabilitation Unit, Vivantes Klinikum Spandau, Neue Bergstrasse 6, D-13585, Berlin, Germany(∗). Electronic address: joerg@schwarz-wissel.de.
authors.forename: Jörg
authors.initials: J
authors.lastname: Wissel
authors.affiliation: Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada(†).
authors.forename: Molly
authors.initials: M
authors.lastname: Verrier
authors.affiliation: Clinical Neurophysiology Laboratories, Department of Neurology, Mount Sinai Medical Center, New York, NY(‡).
authors.forename: David M
authors.initials: DM
authors.lastname: Simpson
authors.affiliation: Department of Neurology, Vanderbilt University Medical Center, Nashville, TN(§).
authors.forename: David
authors.initials: D
authors.lastname: Charles
authors.affiliation: Imprint Publication Science, New York, NY(‖).
authors.forename: Pia
authors.initials: P
authors.lastname: Guinto
authors.affiliation: Allergan, Inc., Irvine, CA, and University of Miami, Miller School of Medicine, Miami, FL(¶).
authors.forename: Spyros
authors.initials: S
authors.lastname: Papapetropoulos
authors.affiliation: Institute of Neuroscience and Physiology, Section for Clinical Neuroscience and Rehabilitation, Gothenburg University, Gothenburg, Sweden(#).
authors.forename: Katharina S
authors.initials: KS
authors.lastname: Sunnerhagen
mesh_terms: D006233:Persons with Disabilities / Q000534:rehabilitation*; D006801:Humans; D009128:Muscle Spasticity / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013997:Time Factors