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

Assunta Pizzi, Giovanna Carlucci, Catuscia Falsini, Sonia Verdesca, Antonello Grippo

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)410-415
Number of pages6
JournalArchives of Physical Medicine and Rehabilitation
Issue number3
Publication statusPublished - Mar 2005


  • Extremity
  • H-reflex
  • Muscle spasticity
  • Rehabilitation
  • Stroke
  • Upper

ASJC Scopus subject areas

  • Rehabilitation


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