Evaluation of upper-limb spasticity after stroke: A clinical and neurophysiologic study

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.