Plantin J.1, Gaia P.1, Lindberg P.2
1Karolinska Institutet, Dept. of Clinical Sciences, Stockholm, Sweden, 2Karolinska Institutet and Université Paris Descartes, Dept of Clinical Sciences, KI, and INSERM, UPD, Paris, France
Background: The relation between early signs of spasticity, voluntary control of the hand and its recovery after stroke remains unclear.
Purpose: Our aim was to investigate the relation between longitudinal changes of hand spasticity and hand function after stroke.
Methods: 53 patients with stroke and with upper limb paresis, admitted to inpatient rehabilitation, were assessed at 2-6 weeks (T1), 3 months (T2) and 6 months (T3) after stroke. Measures included the Fugl-Meyer Assessment for upper extremity (FMA-UE), a visuomotor force tracking task to quantify grip force control, the NeuroFlexor method and normative (cut-off) values from a large sample of healthy controls to determine neural (NC) elastic (EC), and viscous (VC) contributions to the force resisting passive muscle stretch. Spasticity was defined as NC>3.4N. In addition, magnetic resonance imaging data was collected at T1 and T3 for lesion mapping and the estimation of corticospinal tract integrity (weighted CST lesion load).
Results: There was a wide range of initial voluntary hand function (FMA-UE 0-60) and a highly variable degree of motor recovery (FMA-UE change over time [T3-T1] = 0-35, mean= 10.8SD=11.4). At each time point, 28%, 49% and 53% had NC above cut-off. NC increased significantly over time (rmANOVA, p=0.001). NC did not relate significantly to degree of recovery of FMA-UE and grip force tracking measures. However, patients with high NC at T1 showed a reduction of passive ROM over time. EC change over time correlated with passive ROM change (rs=-0.57). Analysis of imaging data regarding lesion site and CST lesion involvement and its relation to the development of spasticity is ongoing.
Conclusion(s): Early spasticity did not impact on recovery of motor function measured either at the functional or the activity level according to the ICF. However, high initial spasticity was associated with decreasing range of motion and development of pain. Data regarding lesion mapping and the development of spasticity will be presented.
Implications: This study is important as it is unclear when the neural and mechanical contributions to spasticity develop and how they relate to lesion site/CST integrity and the recovery of hand function. A better understanding of these changes will enable a more specific targeting of treatments to the needs of the individual.
Funding acknowledgements: This study was supported by Stiftelsen Promobilia and Stroke-Riksförbundet.
Topic: Neurology: stroke
Ethics approval: Ethical approval (DNR: 2011/1510-31/3) was obtained from the local committee in Stockholm.
All authors, affiliations and abstracts have been published as submitted.
