SYMPTOMATIC UPPER LIMB SPASTICITY IN PATIENTS WITH CHRONIC STROKE ATTENDING A REHABILITATION CLINIC: FREQUENCY, CLINICAL CORRELATES AND PREDICTORS

Objective: To document the frequency, clinical correlates and predictors of symptomatic upper limb spasticity in patients one year or more after stroke. Design: Cross-sectional study. Subjects: A total of 140 patients after stroke attending a rehabilitation clinic. Methods: Assessments of spasticity, upper limb function and self-care ability using the Ashworth Scale (AS), Motor Assessment Scale and Modified Barthel Index. We categorized spasticity as: spasticity in general (AS score >= 1), severe spasticity (AS score >= 23) and symptomatic spasticity (spasticity affecting upper limb function). Results: The mean age (standard deviation, SD) was 61.0 (SD 13.3) years and patients were evaluated at 41.7 (SD 35.1) months after stroke onset. The observed frequency of spasticity in general, severe spasticity and symptomatic spasticity was 78.6%, 38.6% and 30%, respectively. The total AS score was the most important correlate of symptomatic spasticity; patients with higher scores were likely to be symptomatic (p = 0.001). Severe spasticity was predicted by poor lower extremity power (p = 0.002), high National Institute of Health Stroke Scale score (p = 0.015) and presence of dysphasia (p = 0.046) on admission to rehabilitation. No predictors of symptomatic spasticity could be established. Conclusion: Symptomatic spasticity is relatively common in patients with chronic stroke and is significantly correlated with the severity of spasticity.