Spasticity in post-stroke patients: incidence and therapeutical approach

Abstract

Stroke is a leading cause of serious long-term disability: about one third of patients developing spasticity of the affected limbs. Spasticity is characterized by a velocity-dependent increase in resistance to passive movement, and is one of the "positive signs" of upper motor neuron syndrome. Spasticity induces pain, ankylosis, tendon retraction, increasing motor deficit, which may limit the efficacy of rehabilitation methods . Spasticity is also correlated with activity limitations, and reduces quality of life of patients and caregivers. Assessment of post-stroke spasticity requires first clinical examination; scales as Ashworth Modifyed scale and Tardieu Modifyed scale are useful quantitative tools. Treatment of spasticity is often challenging for the rehabilitation team, requiring a multidisciplinary approach. Therapeutic interventions include physical therapy, occupational therapy, use of assistive devices, pharmacological treatment and injectable treatment. Botulinum toxin injections in spastic upper and lower limb muscles have significant effect in reducing muscle tone and improving passive function in affected limbs, and should also be considered for improvement of active function.

The effect of stretching exercises as part of the rehabilitation program for patients with spinal cord injury

“…Spasticity is defined as a velocity-dependent increase in the tonic stretch reflex resulting in hypertonia of the deficient muscles. Spasticity develops progressively over the months following an injury, after a period of spinal shock, characterized by loss of tendon reflexes below the level of the lesion, motor deficit (paralysis) and hypotonia (2,(5)(6)(7)(8)(9). Spasticity can be both beneficial and non-beneficial, and requires treatment when it causes significant impairments and complications.…”

“…Antispastic drugs (baclofen, benzodiazepine, tizanidine, clonidine, botulinum toxin, dantrolene sodium) modulate the neuronal component of spasticity, and physiotherapy reduces its biomechanical side effects. Electrotherapy comprises physiotherapy with exercises used to strengthen the deficient muscles, muscle stretching which helps in reducing muscle tone and in preserving joint mobility and range of motion, orthoses used to hold the limb in correct position, electrical stimulation which blocks the exaggerated motor activity (6,8,(12)(13)(14). Stretching, the process of elongation, is used by physiotherapists in the approach of spasticity.…”