Early development of spasticity following stroke: a prospective, observational trial
Jörg Wissel, Ludwig D Schelosky, Jeffrey Scott, Walter Christe, Jürgen H Faiss, Jörg Mueller, Jörg Wissel, Ludwig D Schelosky, Jeffrey Scott, Walter Christe, Jürgen H Faiss, Jörg Mueller
Abstract
This study followed a cohort of 103 patients at median 6 days, 6 and 16 weeks after stroke and recorded muscle tone, pain, paresis, Barthel Index and quality of life score (EQ-5D) to identify risk-factors for development of spasticity. 24.5% of stroke victims developed an increase of muscle tone within 2 weeks after stroke. Patients with spasticity had significantly higher incidences of pain and nursing home placement and lower Barthel and EQ-5D scores than patients with normal muscle tone. Early predictive factors for presence of severe spasticity [modified Ashworth scale score (MAS) >or=3] at final follow-up were moderate increase in muscle tone at baseline and/or first follow-up (MAS = 2), low Barthel Index at baseline, hemispasticity, involvement of more than two joints at first follow-up, and paresis at any assessment point. The study helps to identify patients at highest risk for permanent and severe spasticity, and advocates for early treatment in this group.
Figures
References
- Anonymous EuroQol––a new facility for the measurement of health-related quality of life. The EuroQol group. Health Policy. 1990;16:199–208. doi: 10.1016/0168-8510(90)90421-9.
- Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther. 1987;67:206–207.
- Crone C, Johnsen LL, Biering-Sorensen F, Nielsen JB. Appearance of reciprocal facilitation of ankle extensors from ankle flexors in patients with stroke or spinal cord injury. Brain. 2003;126:495–507. doi: 10.1093/brain/awg036.
- Dietz V. Spastic movement disorder: what is the impact of research on clinical practice? J Neurol Neurosurg Psychiatr. 2003;74:820–821. doi: 10.1136/jnnp.74.6.820-a.
- Dietz V, Sinkjaer T. Spastic movement disorder: impaired reflex function and altered muscle mechanics. Lancet Neurol. 2007;6:725–733. doi: 10.1016/S1474-4422(07)70193-X.
- Fellows SJ, Ross HF, Thilmann AF. The limitations of the tendon jerk as a marker of pathological stretch reflex activity in human spasticity. J Neurol Neurosurg Psychiatr. 1993;56:531–537. doi: 10.1136/jnnp.56.5.531.
- Hinz A, Klaiberg A, Brähler E, König HH. Der Lebensqualitätsfragebogen EQ-5D: Modelle und Normwerte für die Allgemeinbevölkerung. Psychother Psychol Med. 2006;56:42–48. doi: 10.1055/s-2005-867061.
- Hufschmidt A, Mauritz KH. Chronic transformation of muscle in spasticity: a peripheral contribution to increased tone. J Neurol Neurosurg Psychiatr. 1985;48:676–685. doi: 10.1136/jnnp.48.7.676.
- Ju MS, Chen JJ, Lee HM, Lin TS, Lin CC, Huang YZ. Time-course analysis of stretch reflexes in hemiparetic subjects using an on-line spasticity measurement system. J Electromyogr Kinesiol. 2000;10:1–14. doi: 10.1016/S1050-6411(99)00018-8.
- Lieber RL, Steinman S, Barash IA, Chambers H. Structural and functional changes in spastic skeletal muscle. Muscle Nerve. 2004;29:615–627. doi: 10.1002/mus.20059.
- Lundstrom E, Terent A, Borg J. Prevalence of disabling spasticity 1 year after first-ever stroke. Eur J Neurol. 2008;15:533–539. doi: 10.1111/j.1468-1331.2008.02114.x.
- Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Md State Med J. 1965;14:61–65.
- O’Dwyer NJ, Ada L, Neilson PD. Spasticity and muscle contracture following stroke. Brain. 1996;119:1737–1749. doi: 10.1093/brain/119.5.1737.
- Sommerfeld DK, Eek EU, Svensson AK, Holmqvist LW, von Arbin MH. Spasticity after stroke: its occurrence and association with motor impairments and activity limitations. Stroke. 2004;35:134–139. doi: 10.1161/01.STR.0000105386.05173.5E.
- Thilmann AF, Fellows SJ, Garms E. The mechanism of spastic muscle hypertonus. Variation in reflex gain over the time course of spasticity. Brain. 1991;114:233–244.
- Wade DT, Hewer RL. Functional abilities after stroke: measurement, natural history and prognosis. J Neurol Neurosurg Psychiatr. 1987;50:177–182. doi: 10.1136/jnnp.50.2.177.
- Watkins CL, Leathley MJ, Gregson JM, Moore AP, Smith TL, Sharma AK. Prevalence of spasticity post stroke. Clin Rehabil. 2002;16:515–522. doi: 10.1191/0269215502cr512oa.
- Welmer AK, von Arbin AM, Widen HL, Sommerfeld DK. Spasticity and its association with functioning and health-related quality of life 18 months after stroke. Cerebrovasc Dis. 2006;21:247–253. doi: 10.1159/000091222.
- Wissel J, Ward AB, Erztgaard P, Bensmail D, Hecht MJ, Lejeune TM, Schnider P, Altavista MC, Cavazza S, Deltombe T, Duarte E, Geurts AC, Gracies JM, Haboubi NH, Juan FJ, Kasch H, Katterer C, Kirazli Y, Manganotti P, Parman Y, Paternostro-Sluga T, Petropoulou K, Prempeh R, Rousseaux M, Slawek J, Tieranta N. European consensus table on the use of botulinum toxin type A in adult spasticity. J Rehabil Med. 2009;41:13–25. doi: 10.2340/16501977-0303.
- World Health Organization (2009) . Last access 19.11.2009
- Young RR. Spasticity: a review. Neurology. 1994;44:12–20.
Source: PubMed