Prevalence of Spasticity and Postural Patterns in the Upper Extremity Post Stroke

Doussoulin, Arlette; Rivas, C.; Bacco, José Luis; Sepúlveda, Pablo; Carvallo, G.; Gajardo, C.; Soto, Álvaro; Rivas, Rodrigo

doi:10.1016/j.jstrokecerebrovasdis.2020.105253

Cited by 23 publications

(17 citation statements)

References 28 publications

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“…Spasticity is a positive symptom of UMNS and has been defined as “a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex” [ 2 ]. The prevalence of spasticity after first-ever stroke is 4–27% within the first 6 weeks, 19% at 3 months, 21.7–42.6% between 4 and 6 months, and 17–38% at 12 months from onset [ 3 , 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

Picelli

Santamato

Cosma

et al. 2021

Toxins

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Early management of spasticity may improve stroke outcome. Botulinum toxin type A (BoNT-A) is recommended treatment for post-stroke spasticity (PSS). However, it is usually administered in the chronic phase of stroke. Our aim was to determine whether the length of time between stroke onset and initial BoNT-A injection has an effect on outcomes after PSS treatment. This multicenter, longitudinal, cohort study included stroke patients (time since onset <12 months) with PSS who received BoNT-A for the first time according to routine practice. The main outcome was the modified Ashworth scale (MAS). Patients were evaluated before BoNT-A injection and then at 4, 12, and 24 weeks of follow-up. Eighty-three patients with PSS were enrolled. MAS showed a significant decrease in PSS at 4 and 12 weeks but not at 24 weeks after treatment. Among the patients with a time between stroke onset and BoNT-A injection >90 days, the MAS were higher at 4 and 12 weeks than at 24 weeks compared to those injected ≤90 days since stroke. Our findings suggest that BoNT-A treatment for PSS should be initiated within 3 months after stroke onset in order to obtain a greater reduction in muscle tone at 1 and 3 months afterwards.

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Section: Introductionmentioning

confidence: 99%

Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

Picelli

Santamato

Cosma

et al. 2021

Toxins

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“…Numerous studies have reported on muscles of the upper and lower extremities because they are easily explorable, they generate wide ranges of motion and they are anatomically accessible. The functional impact of spasticity on the extremities is high as it interferes with the performance of basic daily life activities, which in turn results in reduced social participation and quality of life (Urban et al 2010;Scrivener 2016;Doussoulin et al 2020). The bio-mechanical and physiologic modifications owing to spasticity can be evaluated by USE.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Elastography in the Assessment of the Stiffness of Spastic Muscles: A Systematic Review

Zúñiga

Gaviria-López

González

2021

Ultrasound in Medicine & Biology

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The incidence of muscle spasticity is high in patients with diseases of the central nervous system. This condition leads to significant limitations in movement and impaired functional capacities. Muscle spasticity manifests as changes in the mechanical properties of the muscles. This muscle disorder is generally assessed using qualitative methods, whose validity, reliability and sensitivity are questionable. In recent years, ultrasound elastography (USE) has been used as a non-invasive technique for characterizing the stress response and mechanical properties of individual muscles in the evaluation of spasticity. This article presents a systematic review of the USE techniques, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration guidelines, used for the evaluation of muscle stiffness caused by spasticity. The articles selected in this study were evaluated using the Quality Appraisal of Diagnostic Reliability (QAREL) tool. Mainly, studies on the assessment of spasticity involving the evaluation of muscle stiffness with USE techniques (i.e., shear-wave elastography [SWE] or compression elastography [CE]) were selected. Then, common topics related to the assessment of spastic muscles and the statistical results of these studies were classified. Of 21 articles, nine used only CE, 10 used only SWE and two used both techniques. In the studies, statistically significant differences were observed in the measurements of muscle stiffness between the paretic and non-paretic sides as well as between patients and healthy patients. The clinical measurements obtained, devices used and assessment and probe positions for both techniques were discussed. The most frequently studied muscles were the biceps (n = 7) and gastrocnemius (n = 11). On applying the QAREL tool, we found that only two studies showed compliance at 80%À90%, seven studies at 50%À70% and the remaining 12 at 10%À40%. The results showed that USE techniques have limitations in spasticity assessment, such as subjectivity because of the lack of standardized protocols. A deficit of studies on intra-operator and inter-operator measurements indicates that this technique is not yet mature for spasticity diagnosis, although it is a promising diagnostic tool for designing treatment plans and monitoring the effectiveness of therapeutic modalities.

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“…Regarding age, it is known that as age advances, the risk of Stroke increases. In a research carried out in 2019, 49.3% of the participants were aged 65 or older (8) . In the present study, all participants were aged over 65 years.…”

Section: Discussionmentioning

confidence: 99%

“…Its installation speed is related to the location and severity of the brain injury or the absence of a rehabilitation program. Previous research has confirmed that 40-60% of people after stroke develop spasticity (8,9) . After a long investment in this field, in 1979, Johnstone described the spastic pattern and hence become a world reference in the rehabilitation of the person after a stroke.…”

Section: Introductionmentioning

confidence: 87%

Anti-spastic pattern positioning

et al. 2022

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Objectives: Analyze whether the positioning is performed in an antispastic pattern in persons following a cerebrovascular accident (Stroke), which positions are most used and whether these decisions are influenced by the characteristics of patients or of the nurses. Methodology: Quantitative and cross-sectional study carried out in a hospital located in Northern of Portugal. The sample consists of the pattern positioning performed by nurses in persons following cerebrovascular accident, admitted to a neurology ward service. The sampling technique is a non-probability and was selected by convenience. Data collection took place between February and May 2019 using a form and observation of positions in an antispastic pattern.Results: Of the 376 positions, the most frequent was the supine (dorsal decubitus) position (n=152) and the least frequent the sitting position (n=28). The lateral decubitus position for the affected side obtained a higher average. The percentage of positioning with maximum classification, that is, with all body segments positioned in an antispastic pattern, was residual. Regarding the patients, the affected hemibody, spasticity and joint amplitude were significantly related to the classifications attributed to the positions. Regarding professional training, rehabilitation nurses positioned better in antispastic pattern in the supine position and in the lateral position to the unaffected side. Conclusion: During hospitalization, nurses do not systematically position persons following a stroke, in an anti-spastic pattern and the gaps identified in the positioning of various body segments require (re)thinking practices.

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Prevalence of Spasticity and Postural Patterns in the Upper Extremity Post Stroke

Cited by 23 publications

References 28 publications

Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

Early Botulinum Toxin Type A Injection for Post-Stroke Spasticity: A Longitudinal Cohort Study

Ultrasound Elastography in the Assessment of the Stiffness of Spastic Muscles: A Systematic Review

Anti-spastic pattern positioning

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