Early development of spasticity following stroke: a prospective, observational trial

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.

Fig. 1

Study population

Fig. 2

Development of muscle hypertonia during follow-up. Number of patients with muscular hypertonia at different time points after stroke (blue fraction of the bar: patients with initial muscle hypertonia; red fraction of the bar: patients with initial hypertonia, but not at follow-up; yellow fraction of the bar: additional patients with muscle hypertonia)

Fig. 3

Localisation of spasticity in stroke patients at second follow-up. Numbers indicate percent of patients with spasticity at the respective joint

Fig. 4

Frequency and distribution of pain in patients with and without spasticity at second follow-up. Dotted bars mean patients without spasticity (MAS = 0), hatched bars show percent of patients with MAS 1–4