Stroke is a major cause of long-term disability. Post-stroke spasticity (PSS) has been described as a velocity-dependent increase in muscle tone with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex and presenting as intermittent/sustained involuntary muscle activation. In clinical practice, accurate quantitative measures of spasticity can be difficult to obtain in a single examination: indeed, PSS can be modified in different conditions, e.g. static conditions as opposed to dynamic situations, such as walking. In addition, the impact of PSS on subjective sensations and activities of daily living (ADL) can be hard to describe. Furthermore, in order to optimize treatment procedures in patients with PSS, assessment of patient-reported outcomes and perceptions should be reported, given that sensorimotor alterations due to PSS may influence “interoception”, i.e. the sense of the physiological condition of the entire body. In order to improve understanding of these components of PSS, we studied 116 adults affected by first-ever unilateral stroke (more than 3 months from onset) with spasticity (less than 3 months from the last botulinum toxin treatment) in the affected arm (41 right hemiparesis and 75 left hemiparesis), graded ≥1 on the Modified Ashworth Scale (MAS). In conclusion, our patients with PSS described different patterns of sensations even without showing significant differences in their MAS and MI scores. We suggest that PSS might be considered not only as a modification of muscle tone, but also as a clinical condition that is specific to the single patient, and has a significant impact on his/her sensations and self-estimated autonomy in ADL.

Post-stroke spasticity as a condition: a new perspective on patient evaluation

PICELLI, Alessandro;
2016-01-01

Abstract

Stroke is a major cause of long-term disability. Post-stroke spasticity (PSS) has been described as a velocity-dependent increase in muscle tone with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex and presenting as intermittent/sustained involuntary muscle activation. In clinical practice, accurate quantitative measures of spasticity can be difficult to obtain in a single examination: indeed, PSS can be modified in different conditions, e.g. static conditions as opposed to dynamic situations, such as walking. In addition, the impact of PSS on subjective sensations and activities of daily living (ADL) can be hard to describe. Furthermore, in order to optimize treatment procedures in patients with PSS, assessment of patient-reported outcomes and perceptions should be reported, given that sensorimotor alterations due to PSS may influence “interoception”, i.e. the sense of the physiological condition of the entire body. In order to improve understanding of these components of PSS, we studied 116 adults affected by first-ever unilateral stroke (more than 3 months from onset) with spasticity (less than 3 months from the last botulinum toxin treatment) in the affected arm (41 right hemiparesis and 75 left hemiparesis), graded ≥1 on the Modified Ashworth Scale (MAS). In conclusion, our patients with PSS described different patterns of sensations even without showing significant differences in their MAS and MI scores. We suggest that PSS might be considered not only as a modification of muscle tone, but also as a clinical condition that is specific to the single patient, and has a significant impact on his/her sensations and self-estimated autonomy in ADL.
2016
Spasticity, stroke, rehabilitation
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/953454
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