Quantitative Assessment of Hand Spasticity After Stroke: Imaging Correlates and Impact on Motor Recovery

Abstract

Objective: This longitudinal observational study investigated how neural stretch-resistance in wrist and finger flexors develops after stroke and relates to motor recovery, secondary complications, and lesion location. Methods: Sixty-one patients were assessed at 3 weeks (T1), three (T2), and 6 months (T3) after stroke using the NeuroFlexor method and clinical tests. Magnetic Resonance Imaging was used to calculate weighted corticospinal tract lesion load (wCST-LL) and to perform voxel-based lesion symptom mapping. Results: NeuroFlexor assessment demonstrated spasticity (neural component [NC] >3.4N normative cut-off) in 33% of patients at T1 and in 51% at T3. Four subgroups were identified: early Severe spasticity ( n = 10), early Moderate spasticity ( n = 10), Late developing spasticity ( n = 17) and No spasticity ( n = 24). All except the Severe spasticity group improved significantly in Fugl-Meyer Assessment (FMA-HAND) to T3. The Severe and Late spasticity groups did not improve in Box and Blocks Test. The Severe spasticity group showed a 25° reduction in passive range of movement and more frequent arm pain at T3. wCST-LL correlated positively with NC at T1 and T3, even after controlling for FMA-HAND and lesion volume. Voxel-based lesion symptom mapping showed that lesioned white matter below cortical hand knob correlated positively with NC. Conclusion: Severe hand spasticity early after stroke is negatively associated with hand motor recovery and positively associated with the development of secondary complications. Corticospinal tract damage predicts development of spasticity. Early quantitative hand spasticity measurement may have potential to predict motor recovery and could guide targeted rehabilitation interventions after stroke.

Feasibility and potential effects of using the electro-dress Mollii on spasticity and functioning in chronic stroke

“…The aim of this study was to explore if assessed and perceived functioning and disability was affected by using the Mollii® suit for treatment of spasticity in the home setting for 6 weeks. In line with previously reported results from the same study setting [38], approximately 2/3 of the screened eligible participants were found to have a clinically detectable neural component exceeding the cut off for spasticity according to the NeuroFlexor™. Thus, the participants included in this study may be considered representable for a slightly younger stroke population (mean age 58 years), living with hemiplegia and spasticity longterm after stroke.…”

“…In this study we used the standardized evaluated NeuroFlexor™ method to quantify and differentiate the neural, i.e. spasticity, elastic and viscosity components of an increased resistance to passive stretch [ 21 , 25 – 27 , 38 ]. The observation of stable baseline the NC values before the start of the intervention (A1-A3) lends strong support to the observed significant changes in the NC between the start (M1) and the end of the intervention (M2).…”

Evidence of Neuroplasticity: A Robotic Hand Exoskeleton Study for Post-Stroke Rehabilitation

“…The robotic-therapy was effective at releasing spasticity at the wrist-joint with ~ 26% (p = 0.03) improvement over ~ 14% in CG. The regaining normal muscle-tone is considered as a predictor of recovery or the rst-step in recovery (22) followed by an increase in muscle-strength and improvement in functional movements or ADL, nally leading to muscle-strength. In this study, AROM and Barthel-Index have been measured as the indicators of ADL (Table-2).…”

Soft Rehabilitation Actuator With Integrated Post-stroke Finger Spasticity Evaluation

“…In other words, this spasticity increases stiffness of the finger joints and furthermore leads to a decrease of their range-of-motion (ROM), creating severe reduction to hand function (Sadarangani et al, 2017). As spasticity and motor recovery are both related to neural plasticity after stroke, to lead targeted rehabilitation interventions, it is suggested that clinicians should decide the best treatment option for each patient based on their spasticity condition (Hong et al, 2018;Jeanette et al, 2019). In current clinical practice, primary measures (Bohannon and Smith, 1987;Copley and Kuipers, 1999;Gregson et al, 1999;Mackey et al, 2004) such as Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), Tone Assessment Scale, and King's Hypertonicity Scale are widely used to grade the resistance on the joints during passive soft tissue stretching (Thibaut et al, 2013).…”