TY - JOUR
T1 - Evaluation of upper-limb spasticity after stroke
T2 - A clinical and neurophysiologic study
AU - Pizzi, Assunta
AU - Carlucci, Giovanna
AU - Falsini, Catuscia
AU - Verdesca, Sonia
AU - Grippo, Antonello
PY - 2005/3
Y1 - 2005/3
N2 - 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.
AB - 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.
KW - Extremity
KW - H-reflex
KW - Muscle spasticity
KW - Rehabilitation
KW - Stroke
KW - Upper
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U2 - 10.1016/j.apmr.2004.10.022
DO - 10.1016/j.apmr.2004.10.022
M3 - Article
C2 - 15759220
AN - SCOPUS:14744271564
VL - 86
SP - 410
EP - 415
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
SN - 0003-9993
IS - 3
ER -