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Spasticity After Stroke

An Overview of Prevalence, Test Instruments, and Treatments

Sommerfeld, Disa K., PT, PhD; Gripenstedt, Ullabritt, MD, PhD; Welmer, Anna-Karin, PT, PhD

American Journal of Physical Medicine & Rehabilitation: September 2012 - Volume 91 - Issue 9 - p 814–820
doi: 10.1097/PHM.0b013e31825f13a3
Literature Review

ABSTRACT The objective of this study was to present an overview of the prevalence of spasticity after stroke as well as of test instruments and treatments. Recent studies show that spasticity occurs in 20%–30% of all stroke victims and in less than half of those with pareses. Although spasticity may occur in paretic patients after stroke, muscle weakness is more likely to be the reason for the pareses. Spasticity after stroke is more common in the upper than the lower limbs, and it seems to be more common among younger than older people. To determine the nature of passive stretch, electromyographic equipment is needed. However, the Modified Ashworth Scale, which measures the sum of the biomechanical and neural components in passive stretch, is the most common instrument used to grade spasticity after stroke. Treatment of spasticity with physiotherapy is recommended, although its beneficial effect is uncertain. The treatment of spasticity with botulinum toxin in combination with physiotherapy is suggested to improve functioning in patients with severe spasticity. A task-specific approach rather than a neurodevelopmental approach in assessing and treating a patient with spasticity after stroke seems to be preferred.

From the Department of Geriatric Medicine, Danderyd Hospital, Danderyd, and Division of Physiotherapy, Department of Neurobiology Care Sciences and Society, Karolinska Institutet Huddinge, Stockholm (DKS); Department of Rehabilitation Medicine and Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm (UG); and Department of Neurobiology, Care Sciences, and Society, Aging Research Center (ARC), Karolinska Institutet and Stockholm University, and Karolinska University Hospital, Stockholm, Sweden (AKW).

All correspondence and requests for reprints should be addressed to: Disa K Sommerfeld, PT, PhD, Department of Geriatric Medicine, Danderyd Hospital, SE-182 87 Danderyd, Sweden.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Dr Sommerfeld has been engaged in two international congresses (in Madrid, October 2010, and in Tallin, September 2011) to talk about the epidemiology of post-stroke spasticity.

© 2012 by Lippincott Williams & Wilkins