Occurrence and temporal evolution of upper limb spasticity in stroke patients admitted to a rehabilitation unit

Abstract

Objectives: To 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.

Design: Prospective cohort study.

Setting: A rehabilitation unit.

Participants: Patients (N=163) with a first-ever ischemic stroke.

Interventions: Not applicable.

Main outcome measures: Ashworth 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.

Results: Upper 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).

Conclusions: Upper 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.