Objectives: To establish the prevalence of spasticity 12 months after stroke and examine its relationship with functional ability.
Design: A cohort study of prevalence of spasticity at 12 months post stroke. Setting: Initially hospitalized but subsequently community-dwelling stroke survivors in Liverpool, UK.
Subjects: One hundred and six consecutively presenting stroke patients surviving to 12 months.
Main outcome measures: Muscle tone measured at the elbow using the Modi”ed Ashworth Scale and at several joints, in the arms and legs, using the Tone Assessment Scale; functional ability using the modi”ed Barthel Index.
Results: Increased muscle tone (spasticity) was present in 29 (27%) and 38 (36%) of the 106 patients when measured using the Modi”ed Ashworth Scale and Tone Assessment Scale respectively. Combining the results from both scales produced a prevalence of 40 (38%). Those with spasticity had signi”cantly lower Barthel scores at 12 months (p < 0.0001).
Conclusion: When estimating the prevalence of spasticity it is essential to assess both arms and legs, using both scales. Despite measuring tone at several joints, spasticity was demonstrated in only 40 (38%) patients, lower than previous estimates.
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References
1.
Wade DT. Stroke rehabilitation and long term care. Lancet1992; 339:791–793.
2.
Bonita R, Beaglehole R, North JDK. Event, incidence and case fatality rates of cerebrovascular disease in Auckland, New Zealand. Am J Epidemiol1984; 120:236–243.
3.
Malmgren R, Bamford J, Warlow C, Sandercock P, Slattery J. Projecting the number of patients with ”rst ever strokes and patients newly handicapped by stroke in England and Wales. BMJ1989; 298:656–660.
4.
Bamford J, Sandercock P, Dennis M, Warlow C. A prospective study of acute cerebrovascular disease in the community:the Oxfordshire Community Stroke Project. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry1990; 53:16–22.
5.
Lance JW. Control of muscle tone, re‘exes and movement:Robert Wartenberg Lecture. Neurology1976; 30:1303–1313.
6.
Haas BM. Measuring spasticity:a survey of current practice among health-care professionals. Br J Ther Rehabil1994; 1:90–95.
7.
Wallesch C-W, Maes E, Lecomte P, Bartels C. Feasibility study on pharmacoeconomics of botulinum toxin A (Botox) in spasticity following stroke. 3rd European Botulinum Toxin Symposium Abstracts1997; 1:4-4.
8.
Gregson JM, Leathley MJ, Moore AP, Sharma AK, Smith TL, Watkins CL. Reliability of the Tone Assessment Scale and Modi”ed Ashworth Scale as clinical tools for assessing post-stroke spasticity. Arch Phys Med Rehabil1999; 80:1013–1016.
9.
Gregson JM, Leathley MJ, Moore AP, Sharma AK, Smith TL, Watkins CL. An assessment of the reliability of the Modi”ed Ashworth Scale for measuring muscle tone and the Medical Research Council scale for measuring muscle power in post-stroke patients. Age Ageing2000; 29:223–228.
10.
Barnes SA, Gregson JM, Leathley MJ, Sharma AK, Smith TL, Watkins CL. Development and inter-rater reliability of an assessment scale to measure abnormal tone in adult, hemiplegic stroke patients. Physiotherapy1999; 85:405–409.
11.
Wade DT. Measurement in neurological rehabilitation. New York:Oxford Medical Publications, 1992.
12.
Bohannon RW, Smith MB. Inter-rater reliability of a Modi”ed Ashworth Scale of muscle spasticity. Phys Ther1987; 67:206–207.
13.
Andrews K, Brocklehurst JC, Richards B, Laycock PJ. The recovery of the severely disabled stroke patient. Rheumatol Rehabil1982; 21:225–230.
14.
Wallesch C-W, Maes E, Lecomte P, Bartels C. Cost-effectiveness of botulinum toxin type A injection in patients with spasticity following stroke:a German perspective. Eur J Neurol1997; 4:S53–S57.
15.
Kotila M, Waltimo O, Niemi M-L, Laaksonen R, Lempinen M. The pro”le of recovery from stroke and factors in‘uencing outcome. Stroke1984; 15:1039–1044.
