Article

OBJECTIVE : To document the temporal development and evolution of upper limb
spasticity, and to establish clinical correlates and predictors of upper limb
spasticity in a cohort of stroke patients. DESIGN: Prospective cohort study.
SETTING: A rehabilitation unit. PARTICIPANTS: Patients (N=163) with a first-ever
ischemic stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Ashworth
Scale for measuring upper limb spasticity, Motor Assessment Scale for upper limb
activity, Motricity Index for upper limb strength, and Modified Barthel Index for
self-care. Upper limb spasticity was defined as an Ashworth Scale score of 1 or
greater. RESULTS: Upper limb spasticity occurred in 54 patients (33%) at 3 months
after stroke. Development of spasticity at later stages of the stroke was
infrequent, occurring in only 28 patients (17%). In patients with mild spasticity
(Ashworth Scale score 1) at 3 months after stroke, worsening of spasticity
occurred in only 1 patient. On the other hand, almost half of the patients with
moderate spasticity (Ashworth Scale score 2) at 3 months progressed to severe
spasticity (Ashworth Scale score 3). Poor upper limb activity was the most
important correlate of "moderate to severe spasticity" (Ashworth Scale score
>/=2) (P<.001), and poor upper limb strength on admission to rehabilitation, the
most important predictor of "moderate to severe spasticity" (P<.001).
CONCLUSIONS: Upper limb spasticity was relatively infrequent in this study,
occurring in 33% of patients at 3 months after stroke. Selective monitoring to
detect severe spasticity is recommended for patients with an Ashworth Scale score
of 2 or greater at 3 months after stroke, and in patients with severe upper limb
weakness on admission to rehabilitation.
CI - Copyright (c) 2012 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS