Treatment of Post-Stroke Spasticity
Article first published online: 20 JUN 2014
© 2014 by the World Stroke Organization
World Stroke Academy
Special Issue: Treatment of Post-Stroke Spasticity
Volume 2, Issue 2, page 7, March 2014
How to Cite
Brainin, M. (2014), Treatment of Post-Stroke Spasticity. World Stroke Academy, 2: 7. doi: 10.1002/wsa2.20029
- Issue published online: 20 JUN 2014
- Article first published online: 20 JUN 2014
It is well-founded clinical knowledge that spasticity may either occur immediately after stroke or develop gradually within days or several weeks. Spasticity is often paired with sensorimotor paresis, hyperreflexia and a number of variable pathological reflexes. Spasticity in isolation is almost never found and therefore the definition of “pure'' spasticity is a laboratory artefact from animal experiments from previous times. Who is interested to test velocity-dependent passive resistance when flexing an extremity? What is the clinical value of a positive Babinski response? These findings are of very little value when reported in isolation. Clinicians today are interested in detecting, assessing and alleviating disability relating to spasticity. This implies that clinicians must be able to recognise the various phenomena of disabilities related to spasticity in stroke patients. Motor and non-motor consequences of spasticity include pain, dystonic postures and contractures, and tertiary changes to the muscle cells and tendon organs are frequently seen in chronic stroke patients. In previous years, such changes have been attributed to be the “normal'' appearance of post-stroke conditions. But today such changes are seen as being triggered and facilitated by spasticity and thus they represent largely preventable and treatable conditions1.
Professor Anthony Ward, from the North Staffordshire Rehabilitation Centre in Stoke on Trent, UK, is an expert in treatment of spasticity and has been practising and teaching the therapy of spasticity for many years. He has been the principal author of a treatment guideline for the Royal College of Physicians of London and for the British Society of Rehabilitation Medicine. In this module for the World Stroke Academy he explains the effects of spasticity on impairment, activity and participation and defines the multidisciplinary approaches. The range of available treatment includes physical therapy, nursing, home-based exercises as well as a variety of oral medications and injection of botulinum toxins. More rare possibilities include chemodenervation, intrathecal baclofen and surgery.