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Published on: October 11, 2024
Evaluation of upper-limb spasticity after stroke: A clinical and neurophysiologic study
Assunta Pizzi1, Giovanna Carlucci, Catuscia Falsini
1Department of Neurorehabilitation, Fondazione Don C. Gnocchi Onlus IRCCS, Centro S. Maria agli Ulivi, Pozzolatico (Firenze), Italy. apizzi@dongnocchi.it
Objectives:
To assess upper-limb spasticity after stroke by means of clinical and instrumental tools and to identify possible variables influencing the clinical pattern.
Design:
Descriptive measurement study of a consecutive sample of patients with upper-limb spasticity after stroke.
Setting:
Neurorehabilitation hospital.
Participants:
Sixty-five poststroke hemiplegic patients.
Interventions:
Not applicable. Main outcome measures Upper-limb spasticity, as assessed clinically (Modified Ashworth Scale [MAS], articular goniometry) and neurophysiologically (maximum H-reflex [Hmax], maximum M response [Mmax], Hmax/Mmax ratio).
Results:
Poorer MAS scores were associated with lower passive range of motion (PROM) values at the wrist ( P =.01) and elbow ( P =.002). The flexor carpi radialis Hmax/Mmax ratio correlated directly with MAS scores at the wrist ( P =.005) and correlated inversely with PROM. The presence of pain in the fingers, wrist, and elbow was significantly associated only with lower PROM values at the wrist.
Conclusions:
Upper-limb spasticity is involved in the development of articular PROM limitation after a stroke. Pain appears to be related to PROM reduction as well, but the exact causal relationship between these 2 factors is still unclear. The MAS and the Hmax/Mmax ratio correlated when evaluating poststroke spasticity; they characterize 2 different aspects of spasticity, clinical and neurophysiologic, respectively, and they could be used as an integrated approach to study and follow poststroke patients.
