Abstract
BackgroundSystematic studies on increased muscle tone and spasticity late after ischemic stroke, without any selection, are limited. Therefore, we aimed to determine the prevalence of increased muscle tone, classical spasticity and contracture and predictors of increased muscle tone seven years after stroke.MethodsConsecutive patients with acute ischemic stroke <70 years of age (n = 411) were recruited to the Sahlgrenska Academy Study on Ischemic Stroke. Symptoms at index stroke were assessed using the Scandinavian Stroke Scale. Seven years after stroke, survivors (n = 358) were invited for follow‐up assessments, of whom 292 agreed to participate and 288 contributed data. Muscle tone according to the Modified Ashworth scale, classical spasticity, and contracture was assessed by a neurologist. The associations between increased muscle tone and characteristics at index stroke and recurrent strokes during follow‐up were investigated using logistic regression analysis.ResultsIncreased muscle tone was recognized in 99 participants (34%): 94 (33%) in the upper limbs, and 72 (25%) in the lower limbs. Classical spasticity was found in 51 participants (18%) and contracture in 26 (9%). Age (odds ratio [OR] 1.03 [95% confidence interval [CI] 1.00–1.06]), arm paresis (OR 1.76 [95% CI 1.40–2.2]), aphasia (OR 1.68 [95% CI 1.12–2.51]), and facial palsy (OR 2.12 [95% CI 1.10–4.07]) were independent predictors of increased muscle tone.ConclusionsOne‐third of patients with ischemic stroke before 70 years of age showed increased muscle tone at 7‐year follow‐up. Half of them also had classical spasticity. Age, arm paresis, aphasia, and facial palsy at index stroke were predictors of increased muscle tone poststroke.
Highlights
After stroke, increased muscle tone and spasticity may have a negative impact on health-related quality of life (Gillard et al, 2015), motor control recovery (Singer, Nishihara, & Mochizuki, 2016), muscle architecture (Dias et al, 2016), and daily activities (Duncan et al, 1997)
The present study aimed to investigate the long-term prevalence of increased muscle tone, classical spasticity, and contracture and to identify the predictors of increased muscle tone seven years after stroke
Seven-year National Institute of Health Stroke Scale (NIHSS) scores were converted into Scandinavian Stroke Scale scores using the 90-day algorithm: Scandinavian Stroke Scale = 56.68–2.20 × NIHSS (Gray, Ali, Lyden, & Bath, 2009)
Summary
After stroke, increased muscle tone and spasticity may have a negative impact on health-related quality of life (Gillard et al, 2015), motor control recovery (Singer, Nishihara, & Mochizuki, 2016), muscle architecture (Dias et al, 2016), and daily activities (Duncan et al, 1997). The prevalence of increased muscle tone during the first 12 months after stroke varies between 4% and 46% (Lundstrom, Smits, Borg, et al, 2010; Lundstrom, Terent, & Borg, 2008; Opheim, Danielsson, Alt Murphy, Persson, & Sunnerhagen, 2014; Shin et al, 2018; Sommerfeld, Eek, Svensson, Holmqvist, & von Arbin, 2004; Urban et al, 2010; Watkins et al, 2002), probably because of differences in the case-mix and study design. Systematic studies on increased muscle tone and spasticity late after ischemic stroke, without any selection, are limited. Muscle tone according to the Modified Ashworth scale, classical spasticity, and contracture was assessed by a neurologist. The associations between increased muscle tone and characteristics at index stroke and recurrent strokes during follow-up were investigated using logistic regression analysis. Age (odds ratio [OR] 1.03 [95% confidence interval [CI] 1.00–1.06]), arm paresis (OR 1.76 [95% CI 1.40–2.2]), aphasia (OR 1.68 [95% CI 1.12–2.51]), and facial palsy (OR 2.12 [95% CI 1.10–4.07]) were independent predictors of increased muscle tone
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