Occurrence and Temporal Evolution of Upper Limb Spasticity in Stroke Patients Admitted to a Rehabilitation Unit

Kong KH, Lee J, Chua KS. Occurrence and temporal evolution of upper limb spasticity in stroke patients admitted to a rehabilitation unit.ObjectivesTo document the temporal development and evolution of upper limb spasticity, and to establish clinical correlates and predictors of upper limb spasticity in a cohort of stroke patients.DesignProspective cohort study.SettingA rehabilitation unit.ParticipantsPatients (N=163) with a first-ever ischemic stroke.InterventionsNot applicable.Main Outcome MeasuresAshworth Scale for measuring upper limb spasticity, Motor Assessment Scale for upper limb activity, Motricity Index for upper limb strength, and Modified Barthel Index for self-care. Upper limb spasticity was defined as an Ashworth Scale score of 1 or greater.ResultsUpper limb spasticity occurred in 54 patients (33%) at 3 months after stroke. Development of spasticity at later stages of the stroke was infrequent, occurring in only 28 patients (17%). In patients with mild spasticity (Ashworth Scale score 1) at 3 months after stroke, worsening of spasticity occurred in only 1 patient. On the other hand, almost half of the patients with moderate spasticity (Ashworth Scale score 2) at 3 months progressed to severe spasticity (Ashworth Scale score 3). Poor upper limb activity was the most important correlate of “moderate to severe spasticity” (Ashworth Scale score ≥2) (P<.001), and poor upper limb strength on admission to rehabilitation, the most important predictor of “moderate to severe spasticity” (P<.001).ConclusionsUpper limb spasticity was relatively infrequent in this study, occurring in 33% of patients at 3 months after stroke. Selective monitoring to detect severe spasticity is recommended for patients with an Ashworth Scale score of 2 or greater at 3 months after stroke, and in patients with severe upper limb weakness on admission to rehabilitation.