Upper-Limb Spasticity During the First Year After Stroke

Opheim, Arve; Danielsson, Anna; Murphy, Margit Alt; Persson, Hanna; Sunnerhagen, Katharina Stibrant

doi:10.1097/phm.0000000000000157

Cited by 92 publications

(41 citation statements)

References 27 publications

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“…Approximately 85% of stroke survivors experience significant motor impairment in the contralesional (CL) arm (1), which can include a loss of independent joint control (2, 3), weakness (4), and spasticity (5). After stroke, precise, individuated control of single joints is often replaced by highly stereotyped patterns of multi-joint movement caused by abnormal muscle co-activation patterns (6).…”

Section: Introductionmentioning

confidence: 99%

Upper Extremity Motor Impairments and Microstructural Changes in Bulbospinal Pathways in Chronic Hemiparetic Stroke

2017

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Following hemiparetic stroke, precise, individuated control of single joints is often replaced by highly stereotyped patterns of multi-joint movement, or abnormal limb synergies, which can negatively impact functional use of the paretic arm. One hypothesis for the expression of these synergies is an increased dependence on bulbospinal pathways such as the rubrospinal (RubST) tract and especially the reticulospinal (RetST) tracts, which co-activate multiple muscles of the shoulder, elbow, wrist, and fingers. Despite indirect evidence supporting this hypothesis in humans poststroke, it still remains unclear whether it is correct. Therefore, we used high-resolution diffusion tensor imaging (DTI) to quantify white matter microstructure in relation to severity of arm synergy and hand-related motor impairments. DTI was performed on 19 moderately to severely impaired chronic stroke individuals and 15 healthy, age-matched controls. In stroke individuals, compared to controls, there was significantly decreased fractional anisotropy (FA) and significantly increased axial and radial diffusivity in bilateral corona radiata and body of the corpus callosum. Furthermore, poststroke, the contralesional (CL) RetST FA correlated significantly with both upper extremity (UE) synergy severity (r = −0.606, p = 0.003) and hand impairment (r = −0.609, p = 0.003). FA in the ipsilesional RubST significantly correlated with hand impairment severity (r = −0.590, p = 0.004). For the first time, we separately evaluate RetST and RubST microstructure in chronic stroke individuals with UE motor impairment. We demonstrate that individuals with the greatest UE synergy severity and hand impairments poststroke have the highest FA in the CL RetST a pattern consistent with increased myelination and suggestive of neuroplastic reorganization. Since the RetST pathway microstructure, in particular, is sensitive to abnormal joint coupling and hand-related motor impairment in chronic stroke, it could help test the effects of specific, and novel, anti-synergy neurorehabilitation interventions for recovery from hemiparesis.

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Section: Introductionmentioning

confidence: 99%

Upper Extremity Motor Impairments and Microstructural Changes in Bulbospinal Pathways in Chronic Hemiparetic Stroke

2017

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“…Stroke ranks fourth among all causes of death and is a leading cause of serious, long-term disability in the United States [ 2 ]. Spasticity, a sensorimotor disorder characterized by a velocity-dependent increase in muscle tone with exaggerated tendon jerks, has been estimated to occur in up to 46 % of patients 12 months after stroke [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

The negative impact of spasticity on the health-related quality of life of stroke survivors: a longitudinal cohort study

Gillard

Sucharew

Kleindorfer

et al. 2015

Health Qual Life Outcomes

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BackgroundSpasticity often leads to symptomatic and functional problems that can cause disability for stroke survivors. We studied whether spasticity has a negative impact on health-related quality of life (HRQoL).MethodsAs part of the Greater Cincinnati/Northern Kentucky Stroke Study (NCT00642213), 460 ischemic stroke patients were interviewed during hospitalization and then followed over time. HRQoL was measured by the Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form-12 (SF-12), EuroQol-5 dimension (EQ-5D), and Stroke-Specific Quality of Life (SSQOL) instruments, with lower scores indicating worse health. HRQoL differences between stroke survivors with and without spasticity were compared, adjusting for age, race, stroke severity, pre-stroke function, and comorbidities.ResultsOf the 460 ischemic stroke patients, 328 had spasticity data available 3 months after their stroke (mean age of 66 years, 49 % were female, and 26 % were black). Of these patients, 54 (16 %) reported having spasticity. Three months following their stroke, patients who reported spasticity had lower mean scores on the PCS (29.6 ± 1.4 vs 37.3 ± 0.6; P < .001), EQ-5D (0.59 ± 0.03 vs 0.71 ± 0.01; P < .001), and SSQOL (3.57 ± 0.08 versus 3.78 ± 0.03; P = .03) compared with patients who did not report spasticity. Lower HRQoL scores were also observed at the 1-year (PCS, EQ-5D, and SSQOL) and 2-year (EQ-5D and SSQOL) interviews in those with spasticity compared with those without spasticity.ConclusionsStatistically and clinically meaningful differences in HRQoL exist between stroke survivors with and without spasticity.

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“…Post-stroke spasticity is one of the most physically debilitating conditions that interfere with functional improvement ( 1 , 2 ). Prevalence estimates of spasticity are highly variable, ranging from 20 to 46% ( 3 – 6 ). Spasticity significantly affects their quality of life, thus causing a significant burden for survivors and caregivers ( 2 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Correlation of Resting Elbow Angle with Spasticity in Chronic Stroke Survivors

et al. 2015

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ObjectiveTo evaluate whether resting joint angle is indicative of severity of spasticity of the elbow flexors in chronic stroke survivors.MethodsSeventeen hemiparetic stroke subjects (male: n = 13; female: n = 4; age: 37–89 years; 11 right and 6 left hemiplegia; averaged 54.8 months after stroke, ranging 12–107 months) participated in the study. The number of subjects with modified Ashworth scale score (MAS) = 0, 1, 1+, 2, and 3 was 3, 3, 5, 3, and 3, respectively. In a single experimental session, resting elbow joint angle, MAS, and Tardieu scale score (Tardieu R1) were measured. A customized motorized stretching device was used to stretch elbow flexors at 5, 50, and 100°/s, respectively. Biomechanical responses (peak reflex torque and reflex stiffness) of elbow flexors were quantified. Correlation analyses between clinical and biomechanical assessments were performed.ResultsResting elbow joint angle showed a strong positive correlation with Tardieu R1 (r = 0.77, p < 0.01) and a very strong negative correlation with MAS (r = −0.89, p < 0.01). The resting angle also had strong correlations with biomechanical measures (r = −0.63 to −0.76, p < 0.01).ConclusionOur study provides experimental evidence for anecdotal observation that the resting elbow joint angle correlates with severity of spasticity in chronic stroke. Resting angle observation for spasticity assessment can and will be an easy, yet a valid way of spasticity estimation in clinical settings, particularly for small muscles or muscles which are not easily measurable by common clinical methods.

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Upper-Limb Spasticity During the First Year After Stroke

Cited by 92 publications

References 27 publications

Upper Extremity Motor Impairments and Microstructural Changes in Bulbospinal Pathways in Chronic Hemiparetic Stroke

Upper Extremity Motor Impairments and Microstructural Changes in Bulbospinal Pathways in Chronic Hemiparetic Stroke

The negative impact of spasticity on the health-related quality of life of stroke survivors: a longitudinal cohort study

Correlation of Resting Elbow Angle with Spasticity in Chronic Stroke Survivors

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