#029 – Prevalence and Risk Factors for Spasticity After Stroke

#029 – Prevalence and Risk Factors for Spasticity After Stroke

ByAl-Jallad

Estimated reading time: 2 minutes, 53 seconds.*

⏮️Previously

  • Spasticity is a common sequela of stroke patients with an incidence of 4–42.6%.
    • Early stroke = 4–27%, post-acute stroke = 19–26.7%, and in chronic stroke = 17–42.6%

Previous definitions of spasticity:

Recent definition of spasticity:

Disabling spasticity:

  • Spasticity that have a clinically significant impact on movement function, activity performance, or participation in social life, accompanied by positive symptoms of UMN syndrome.
  • Spasticity that is considered by a spinal cord damage patients or caregiver to interfere with body function, activities and/or participation, as defined by ICF.

?Results

33 Article in the systematic review and 23 in meta-analysis.

Prevalence of spasticity:

  • 4 to 46% within 1 month, 4.16–48% in 1–3 months, 6.9–63% in 3–6 months, 7.6–49% beyond 6 months.

Disabling spasticity spasticity:

  • 2–2.6% of patients developed disabling or severe spasticity within 1 month, 5% in 1–3 months, 8–15.6% in 6 months and 12.5–18% beyond 6 months.

Risk Factors for Spasticity

  • Barthel Index, age, gender, hemisphere injury, smoking, hypertension, and diabetes could not predict post-stroke spasticity.
  • Paresis: Moderate to severe paresis was a risk factor for PSS.
  • Sensory disorder: 2/3 studies concluded that sensory disorder was not associated with an increased risk of PSS, while another third found an association. (755 participant)
    • In subgroup analysis, sensory disorder was found to predict post stroke spasticity in 3–6 months but not at other times.
  • Hemorrhagic Stroke: Pooled data suggested a significantly increased incidence of spasticity in patients with hemorrhagic stroke.
    • The risk of spasticity was significantly increased at 1, 6, and 12 months in hemorrhagic stroke, but not at 3 months.
  • Stroke Site: Combined results showed that posterior circulation injury was not the risk factor for spasticity.
    • the highest incidence of upper limb spasticity (63.3%) in basal ganglia and internal capsule infarction

?️In other words

  • Spasticity occurred in 25.3% of stroke patients and 39.5% of stroke patients with paresis.
  • 9.4% of stroke patients with paresis developed severe or disabling spasticity.
  • The incidence of severe spasticity (10.3%) in stroke patients with paralysis was slightly higher than that of disabling or severe spasticity, suggesting that not all severe spasticity develops into disabling spasticity.
  • 39.5% of stroke patients with paresis may have post stroke spasticity.
  • Spasticity following a moderate to severe stroke tends to stabilize within 30–90 days after stroke with poorer function over time.
  • At three months after stroke, patients with mild spasticity were less likely to deteriorate over time, while nearly half of those with moderate spasticity progressed to severe spasticity, and those with severe spasticity remained stable.
  • Basal ganglia injury increases involuntary muscle activation and cortical ridge marrow injury reduces voluntary muscle control, which may lead to involuntary muscle overactivity in central paralysis.
  • Damage to insula may result in disorders of the vestibulospinal system, which leads to post stroke spasticity.
  • The most common sites of injury in hemorrhagic stroke were putamen/globus pallidus (56%) and internal capsule (51%).

⏭️ Conclusion

The incidence of post stroke spasticity was 25.3%. 39.5% patients after first-ever stroke with paresis showed spasticity and 9.4% of which developed into severe or disabling spasticity.

?Reference

*Calculation is based on the average reading speed that around 200 words per minute (wpm).

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