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Updated: May 26, 2026
Cognitive Function and Upper Limb Rehabilitation Training Post-Stroke Using a Digital Occupational Training System
Published on: December 29, 2023
Occurrence and temporal evolution of upper limb spasticity in stroke patients admitted to a rehabilitation unit
Keng H Kong1, Jeanette Lee, Karen S Chua
1Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore. kenghekong@gmail.com
Objectives:
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.
