Prevalence Of Spasticity Research Articles

Role of botulinum toxin in the management of hand ulceration due to post-stroke spasticity among aged care residents.

Individuals with significant post-stroke impairments often move to residential care. The prevalence of spasticity is high among these residents. Palmar ulceration is an under-recognised complication of unmitigated post-stroke hand spasticity. The ulcerations are painful, emit offensive smell and cause significant suffering for the individuals and the carers. The aim of this article is to discuss the healing of these ulcerations by reducing spasticity in the hand muscles with botulinum toxin A (BoNTA) injection followed by dressing, splinting and hand therapy. This article discusses the epidemiology, anatomy and clinical presentations of spastic hand ulcerations and mechanisms of action of BoNTA in alleviating the ulcers and related symptoms such as pain, sweating, offensive smell, and lessening the carer burden. The primary neuromuscular blocking action of BoNTA results in the opening of the hand, allowing dressing and ease of care. The toxin provides pain relief, inhibits excessive sweat production and causes vasodilatation, ultimately resulting in healing of the ulcerations.

Prevalence of spasticity in humans with spinal cord injury with different injury severity.

Spasticity is one of the most common symptoms manifested following spinal cord injury (SCI). The aim of this study was to assess spasticity in individuals with subacute and chronic SCI with different injury severity, standardizing the time and assessments of spasticity. We tested 110 individuals with SCI classified by the American Spinal Injury Association Impairment Scale (AIS) as either motor complete (AIS A and B; subacute, n = 25; chronic, n = 33) or motor incomplete (AIS C and D; subacute, n = 23; chronic, n = 29) at a similar time after injury (subacute, ∼1 mo after injury during inpatient rehabilitation and chronic, ≥1 yr after injury) using clinical (modified Ashworth scale) and kinematic (pendulum test) outcomes to assess spasticity in the quadriceps femoris muscle. Using both methodologies, we found that among individuals with subacute motor complete injuries, only a minority showed spasticity, whereas the majority exhibited no spasticity. This finding stands in contrast to individuals with subacute motor incomplete injury, where both methodologies revealed that a majority exhibited spasticity, whereas a minority exhibited no spasticity. In chronic injuries, most individuals showed spasticity regardless of injury severity. Notably, when spasticity was present, its magnitude was similar across injury severity in both subacute and chronic injuries. Our results suggest that the prevalence, not the magnitude, of spasticity differs between individuals with motor complete and incomplete SCI in the subacute and chronic stages of the injury. We thus argue that considering the "presence of spasticity" might help the stratification of participants with motor complete injuries for clinical trials.NEW & NOTEWORTHY The prevalence of spasticity in humans with SCI remains poorly understood. Using kinematic and clinical outcomes, we examined spasticity in individuals with subacute and chronic injuries of different severity. We found that spasticity in the quadriceps femoris muscle was more prevalent among individuals with subacute motor incomplete than in those with motor complete injuries. However, in a different group of individuals with chronic injuries, no differences were found in the prevalence of spasticity across injury severity.

A Pilot Study of the Government Pharmaceutical Organization (GPO) Cannabis Extract for Multiple Sclerosis (MS) Spasticity Treatment in Thailand

Background: The prevalence of spasticity in multiple sclerosis (MS) patients is nearly 90%. Most patients do not respond to current anti-spastic medications. Objective: To evaluate the efficacy and safety of Government Pharmaceutical Organization cannabis extract (GPOCE) in the treatment of spasticity in MS patients in Thailand. Materials and Methods: This prospective pilot study in patients diagnosed with MS whose spasticity was not relieved under current spasticity treatments, was performed between November 2019 and June 2020. The GPOCE formulation of THC:CBD 1:1 was administered to all patients. The treatment outcomes were determined at 12 weeks and compared with their baseline. Results: Seven patients participated in the present study. Among these, two patients withdrew after receiving only a small dose of GPOCE. Finally, five patients were included in the final analysis. The primary outcome was a reduction in the Modified Ashworth Score (MAS), which decreased among participants from a baseline of 15 (IQR 12 to 19) to 6 (IQR 1 to 12) (p=0.043). The key secondary outcome was a clinically relevant response (CRR), which was defined as a reduction of the spasticity Numeric Rating Scale (NRS) of more than thirty percent compared to baseline. Four patients (80%) achieved CRR. Moreover, the overall spasticity NRS decreased from a median of 6 (IQR5 to 7) to 2 (IQR2 to 3). A reduction of other NRS parameters, including fatigue, pain, tremor, sleep, spasm, anxiety, and depression, was also observed after treatment. Moreover, GPOCE was generally well tolerated. Conclusion: GPOCE is useful in treating spasticity in patients with MS. The safety profile is acceptable under the supervision of a health care provider. Keywords: Multiple sclerosis (MS), Cannabis extract, Spasticity

Prevalence of spasticity and spasticity-related pain among patients with Amyotrophic Lateral Sclerosis.

Although they are common symptoms of ALS, there is little information on the prevalence of spasticity and spasticity-related pain. Consecutive patients were prospectively recruited from an ALS referral center. Clinical assessment, functional scores, features of spasticity-related pains has been recorded. In a cohort of 150 patients, 36% presented with spasticity. Spastic patients were younger, with a longer duration of disease. Spasticity accelerates the functional decline of patients. Spasticity-related pain was reported in 42.5% of spastic patients with mild pain. However, 16.7% of spastic patients presented significant pain with numeric rating scale≥4. More clinical trials are needed to treat spasticity more effectively and to relieve ALS patients.

Prevalence of Spasticity in Nursing Home Residents

ObjectivesTo determine the prevalence, rate of underdiagnosis and undertreatment, and association with activities of daily living dependency of spasticity in a nursing home setting. DesignCross-sectional study. Setting and participantsThis study is an analysis of a deidentified data set generated by a prior quality improvement project at a 240-bed nursing home for residents receiving long-term care or skilled nursing care services. MethodsEach resident was examined by a movement disorders specialist neurologist to determine whether spasticity was present and, if so, the total number of spastic postures present in upper and lower limbs was recorded. Medical records, including the Minimum Data Set, were reviewed for neurologic diagnoses associated with spasticity, activities of daily living (ADL) dependency, and prior documentation of diagnosis and past or current treatments. Ordinary least squares linear regression models were used to evaluate the association between spasticity and ADL dependency. ResultsTwo hundred nine residents (154 women, 81.9 ± 10.9 years) were included in this analysis. Spasticity was present in 22% (45/209) of residents examined by the neurologist. Only 11% of residents (5/45) had a prior diagnosis of spasticity and were receiving treatment. Presence of spasticity was associated with greater ADL dependency (χ2 = 51.72, P < .001), which was driven by lower limb spasticity (χ2 = 14.56, P = .006). Conclusions and implicationsThese results suggest that spasticity (1) is common in nursing homes (1 of 5 residents), (2) is often not diagnosed or adequately treated, and (3) is associated with worse ADL dependency. Further research is needed to enhance the rates of diagnosis and treatment of spasticity in long-term care facilities.

Prevalence of Spasticity and Below-Level Neuropathic Pain Related to Spinal Cord Injury Level and Damage to the Lower Spinal Segments.

ObjectiveTo evaluate spasticity and below-level spinal cord injury neuropathic pain after spinal cord injury in patients with, or without, damage to the lumbar spinal cord and roots.Design/patientsChart review of 269 patients with spinal cord injury from segments C1 to T11.MethodsPatients were interviewed concerning leg spasticity and below-level spinal cord injury neuropathic pain in the lower trunk and legs. Damage to the lumbar spinal cord and roots was inferred where there was radiological evidence of a vertebral fracture, spinal stenosis or the narrowing of spinal foramina of a vertebra from thoracic 11 to lumbar 5, or; magnetic resonance imaging showing evidence of damage to the lumbar spinal cord and roots.ResultsAmong 161 patients without damage to the lumbar spinal cord and roots, 87% of those with cervical spinal cord injury experienced spasticity, compared with 85% with thoracic spinal cord injury. The corresponding figures for patients in whom damage to the lumbar spinal cord and roots was present were 57% and 52%, respectively. Below-level spinal cord injury neuropathic pain was not associated with damage to the lumbar spinal cord and roots. In those patients with no damage to the lumbar spinal cord and roots, regression showed that neither outcome was significantly associated with the level of spinal cord injury.ConclusionThe lack of segmental dependency for spinal cord injury and spasticity suggests mechanisms restricted mainly to the lumbar spinal cord. For below-level spinal cord injury neuropathic pain, additional mechanisms, other than lesions of the spino-thalamic tract, must be considered.LAY ABSTRACTFollowing a spinal cord injury, symptoms of increased nerve cell activity in the central nervous system appear, e.g. involuntary muscle activity (spasticity), below level neuropathic pain and urinary leakage. The distribution of overactive neurons is still unresolved. This chart review showed that leg spasticity was more frequent in patients with a cervical or thoracic spinal cord injury if the patients had no signs of damage to the lumbar spinal cord and roots. The occurrence of leg spasticity and below level spinal cord injury neuropathic pain was unrelated to each other or to the level of the spinal cord injury. This suggests that the mechanisms behind leg spasticity are mainly restricted to the lumbar spinal cord. For this pain, additional mechanisms other than lesions of the spino-thalamic tract must be considered

Budget impact of botulinum toxin treatment for spasticity after stroke \u2014 a German perspective

AimBotulinum toxin agents can improve the quality of life of patients with post-stroke upper limb spasticity (ULS) and are recommended by international and German guidelines. However, health-services research indicates an underuse of botulinum toxin agents in this patient group. The study aims to clarify the budget impact of treatment with botulinum toxin agents according to the guidelines for all eligible patients with ULS in Germany compared to usual care.MethodsThe budgetary impact for the statutory health insurance system was estimated by calculating a Markov cohort model with a timeframe of 5 years comparing three treatment options. Four health states were included. The base-case analysis compares standard doses of two botulinum toxin agents to usual care. The model accounts for direct medical costs. Sensitivity analyses vary doses of botulinum toxin agents and prevalence of spasticity after stroke.ResultsIn the base case, both botulinum toxin agents lead to increased costs compared to usual care. Treatment with Dysport® (cumulative costs for the 5-year period: €280,321,317) is less expensive than the treatment with Xeomin® (€377,511,529). Cumulative costs over 5 years in usual care are €61,306,062.ConclusionThe botulinum toxin therapy is associated with additional costs, but an increased use of botulinum toxin would be consistent with guideline-based therapy. In particular, it has to be considered that spasticity as a chronic condition is accompanied by a relevant loss of quality of life. Thus, considering only the therapy costs may not be sufficient for making final therapeutic decisions.

Early manifestation of spasticity after first stroke in the territory of the internal carotid artery: A prospective multicenter study.

The main aim of this study was to provide an estimate of the incidence and prevalence of spasticity following stroke in the internal carotid artery territory for Regional Stroke Centers in the Czech Republic. A secondary goal was to identify predictors for the development of spasticity. In a prospective cohort study, 256 consecutive patients with clinical signs of central paresis due to a first-ever stroke were examined in the acute stage. All patients had primary stroke of carotid origin and paresis of the upper and/or lower limb for longer than 7 days after stroke onset. All were examined between 7-10 days after the stroke. We evaluated the degree and pattern of paresis, spasticity using the Modified Ashworth scale and the Barthel Index, baseline characteristics and demographic data. Of 256 patients (157 males; mean age 69.9±12.4 years), 115 (44.9%) patients developed spasticity during the first 10 days after stroke onset. Eighty-three (32.5%) patients presented with mild neurological deficit (modified Rankin Scale 0 - 2) and 69 (27.0%) patients were bedridden. Spasticity was noted in 44.9% patients with neurological deficit due to first-ever stroke in the carotid territory in the first 10 days after stroke onset. Severe spasticity was rare.

The Onset and Frequency of Spasticity After First Ever Stroke

BackgroundSpasticity is one of the most important causes of disability after stroke. In spite of high incidence of spasticity, little is known about the relationship between the occurrence and the development of spasticity. This study aimed to determine risk-factors of post stroke spasticity. MethodsThis was an observational study of 149 persons with first ever stroke. The following parameters were assessed: Stroke severity, Spasticity, Disability and Joint contracture. ResultsPrevalence of spasticity was between 17–25% during the first 3 months after stroke. The onset of spasticity was 13.79% and 4.16% at 1 and 3 months after stroke respectively. The prevalence of spasticity in the upper extremity was significantly more than lower extremity at 1 month. Spasticity was significantly more severe in the upper extremity than lower extremity. In patients with hemorrhagic stroke Odds ratios of spasticity was 2.5 times more than persons with ischemic stroke (P = 0.0210. The Odds ratios of severe spasticity at 1 and 3 months were 1.66 and 1.75 times more than the first week (P = 0.024, P = 0.042 respectively). ConclusionsPost stroke spasticity is more common in persons with hemorrhagic stroke, severe paresis and lower functional abilities. The most incidence of spasticity happens in the first month after stroke.

Botulinum toxin in treatment of lower limb spasticity in patients with brain damage

To develop and test a method of examination of patients with lower limb spasticity, to describe lower limb spasticity patterns in patients with brain damage and to assess the efficacy of abobotulinumtoxin A (dysport) in the rehabilitation of patients with stroke. Spasticity rating scales (MAS and Tardieu), the Barthel index, the Rankin scale , the Rivermead Mobility Index, the Hauser Ambulation Index, a comfortable walking test were used. Treatment satisfaction was assessed with the Visual analogue scale. Abobotulinumtoxin A (dysport) was used for treatment of lower limb spasticity. Two most common patterns (dynamic and static) were identified in patients with post-stroke spasticity and the method of testing spasticity was developed. The prevalence of spasticity in individual muscles of the lower extremity was estimated as well. An analysis of the efficacy of dysport and a sensitive analysis of the scales used in the study were carried out.

Spasticity Management in Disorders of Consciousness.

Background: Spasticity is a motor disorder frequently encountered after a lesion involving the central nervous system. It is hypothesized to arise from an anarchic reorganization of the pyramidal and parapyramidal fibers and leads to hypertonia and hyperreflexia of the affected muscular groups. While this symptom and its management is well-known in patients suffering from stroke, multiple sclerosis or spinal cord lesion, little is known regarding its appropriate management in patients presenting disorders of consciousness after brain damage. Objectives: Our aim was to review the occurrence of spasticity in patients with disorders of consciousness and the therapeutic interventions used to treat it. Methods: We conducted a systematic review using the PubMed online database. It returned 157 articles. After applying our inclusion criteria (i.e., studies about patients in coma, unresponsive wakefulness syndrome or minimally conscious state, with spasticity objectively reported as a primary or secondary outcome), 18 studies were fully reviewed. Results: The prevalence of spasticity in patients with disorders of consciousness ranged from 59% to 89%. Current treatment options include intrathecal baclofen and soft splints. Several treatment options still need further investigation; including acupuncture, botulin toxin or cortical activation by thalamic stimulation. Conclusion: The small number of articles available in the current literature highlights that spasticity is poorly studied in patients with disorders of consciousness although it is one of the most common motor disorders. While treatments such as intrathecal baclofen and soft splints seem effective, large randomized controlled trials have to be done and new therapeutic options should be explored.

Prevalence of spasticity in patients suffering from ischemic stroke in the internal carotid artery territory – the results of interim analysis of the national registry SONAR (P4.313)

Prevalence of spasticity in patients suffering from ischemic stroke in the internal carotid artery territory – the results of interim analysis of the national registry SONAR (P4.313)

The Prevalence of Spasticity in Veterans Living in a Long-Term Care Facility

The Prevalence of Spasticity in Veterans Living in a Long-Term Care Facility

Prevalence and Effect of Problematic Spasticity After Traumatic Spinal Cord Injury

ObjectiveTo evaluate the prevalence and effect of spasticity after traumatic spinal cord injury (SCI). DesignProspective cohort study of the Rick Hansen Spinal Cord Injury Registry (RHSCIR) and retrospective review of inpatient medical charts. SettingQuaternary trauma center, rehabilitation center, and community settings. ParticipantsIndividuals (N=860) with a traumatic SCI between March 1, 2005, and March 31, 2014, prospectively enrolled in the Vancouver site RHSCIR were eligible for inclusion. InterventionsNot applicable. Main Outcome MeasuresQuestionnaires (Penn Spasm Frequency Scale, Spinal Cord Injury Health Questionnaire) and antispasticity medication use. ResultsIn 465 patients, the prevalence of spasticity at community discharge was 65%, and the prevalence of problematic spasticity (defined as discharged on antispasticity medication) was 35%. Problematic spasticity was associated with cervicothoracic neurologic level and injury severity (P<.001). In community follow-up, the prevalence of patients reporting any spasticity treatment (ie, problematic spasticity) was 35% at 1 year, 41% at 2 years, and 31% at 5 years postinjury. Interference with function caused by spasticity was reported by 27% of patients at 1 year, 25% at 2 years, and 20% at 5 years postinjury. Patients with American Spinal Injury Association Impairment Scale grade C injuries had the highest prevalence of ongoing spasticity treatment and functional limitation. ConclusionsSpasticity is a highly prevalent secondary consequence of SCI, particularly in patients with severe motor incomplete cervicothoracic injuries. It is problematic in one third of all patients with SCI up to 5 years postinjury. One in 5 patients will have ongoing functional limitations related to spasticity, highlighting the importance of close community follow-up and the need for further research into spasticity management strategies.

Prevalence, impact and treatment of spasticity in nursing home patients with central nervous system disorders: a cross-sectional study

Purpose To assess prevalence, impact and treatment of spasticity in nursing home patients with central nervous system (CNS) disorders. Methods The Modified Ashworth Scale was used as the main indicator of spasticity to assess muscle tone of the extremities. Further information was obtained on burden of care, level of independence, sleeping pattern, complaints, restrictions in functions/activities/participation and indication for treatment. Clinical assessments included coordination/sensibility parameters and various tests to assess motor performance. Results Fifty-six out of 77 participants (73%) with CNS disorders had spasticity, of whom 38 subjects also showed pathologically enhanced reflexes and 45 subjects had contractures in various joints. A high burden of care was observed in 71% and cramps/pain, cosmetic problems or other complaints due to spasticity were seen in 46, 20 and 26%, respectively. The vast majority of subjects were dependent for daily living activities and ambulation. Extra treatment of spasticity was indicated for 36% of the patients. Conclusion A high prevalence of spasticity was observed in nursing home residents with CNS disorders associated with substantial impact in terms of caregiving, complaints and compromised clinical outcome measures. To further optimize the treatment of spasticity in this vulnerable population, regional treatment plans should be developed.Implications for RehabilitationThe prevalence of spasticity in nursing home residents with central nervous system disorders is high (73%).The impact of spasticity is substantial in terms of increased dependency in activities of daily living, increased burden of care, sleeping problems and many complaints.Thirty-six percent of patients could be helped by extra specialized treatment, so the challenge for the multidisciplinary rehabilitation team is huge.Regional treatment plans should be developed to further optimize the treatment of spasticity in the vulnerable ageing population of nursing home residents.

Pharmacokinetics and pharmacodynamics of incobotulinumtoxinA influencing the clinical efficacy in post-stroke spasticity

ABSTRACTIntroduction: Post-stroke spasticity is a disabling neurological condition and may have a significant impact on quality of life. Ability to carry out activities of daily living is often compromised and painful contractures in the affected limbs may also develop. The prevalence of spasticity may be as high as 40% within the first year after the initial stroke event. Management of this condition focuses on improving muscle tone, function and pain. IncobotulinumtoxinA is effective in treating focal spasticity.Areas covered: This review will summarize outcomes from incobotulinumtoxin A phase III trials in upper limb spasticity. Pharmacodynamics and pharmacokinetics will also be discussed along with future studies and possible indications. Literature searches used for this review include; PubMed and www.clinicaltrials.gov searches. Congress abstracts and case reports are not included.Expert opinion: IncobotulinumtoxinA, is a 150 kiloDalton neurotoxin without complexing proteins and is well tolerated in patients with spasticity. There is an 80% improvement reported on spasticity and disability in several phase III studies. In the future, higher doses for upper and lower limb spasticity may be considered. Antibody formation does not seem to limit the administration of higher doses. Prospective studies are evaluating the efficacy of incobotulinumtoxin in children and adolescents with cerebral palsy. Furthermore, the clinical efficacy and immunogenic status of other botulinum neurotoxin A subtypes are currently under investigation.

Correlation of Modified Ashworth Scale and Dynamic Gait Index in Chronic Stroke Patients with Middle Cerebral Artery Infarct

Purpose of the study : Stroke is defined as the sudden loss of neurological function caused by an interruption of the blood flow to the brain. Almost 80% of the stroke patients have middle cerebral artery as the most commonly involved artery both due to hemorrhage as well as infarction. The prevalence of spasticity in the post stroke population is estimated at 38-60%of patients one year after stroke6. The Modified Ashworth Scale is the most frequently used and valid scale for measurement of both upper and lower limb spasticity. The Dynamic Gait Index is also a reliable and valid scale used for measuring gait outcome in chronic stroke patients. The aim of the study is to find whether there exists correlation these two measures in patients with MCA involvement thus helping us determine if a correlation exists between spasticity and gait. Objective : To correlate the MAS scores of upper l Balaji old age centre, Koparkhairne Navi Mumbai. Participants : patients with more than 3months of post stroke duration with involvement of MCA and able to walk atleast 10meters with or without support. Interventions : Not applicable. Main Outcome Measures : All subjects were evaluated for the MAS (Modified Ashworth scale) grading and DGI (Dynamic Gait Index) scores. Results : The MAS scores of the lower extremity correlates significantly with DGI scores (p 0.0043), also the subjects with left hemispherical involvement had good correlation with MAS scores (p U/L 0.0458 p L/L 0.0368). Staircase climbing is the most affected DGI component.(31.20%) Conclusions : The MAS scores of lower extremity in chronic MCA stroke patients show correlation with the DGI scores with Staircase climbing being the most affected component and correlation between MAS and DGI exists strongly in subjects with Left hemispherical involvement.

Phenol nerve block for the management of lower limb spasticity

Spasticity is defined as a motor disorder with failure to inhibit velocity-sensitive stretch reflexes leading to exaggerated muscle resistance. It is a cardinal feature of upper motor neuron lesions and can affect patients with congenital and acquired brain and spinal cord injuries of variable aetiologies (traumatic, vascular, neoplastic, and demyelination). The exact incidence and prevalence of spasticity are unknown. A consensus of experts in Britain believes it to be about 20% of stroke patients and 75% of patients with severe brain injury [1]. Spasticity varies in severity from muscle stiffness to severe, painful, and uncontrollable muscle spasms. Spasticity can be general, involving multiple limbs and trunk muscles, regional, affecting a group of muscles in one or more limbs, or focal, affecting a single muscle. Spasticity can affect the ability to feed and dress oneself, bladder and bowel control, hygiene, and mobility. It also predisposes to complications such as pressure sore formation due to poor seating / laying posture and contracture.

‘Causal relation between spasticity, strength, gross motor function, and functional outcome in children with cerebral palsy: a path analysis’

SIR–In their recent article 1 Kim and Park fail to deal with the entirety of Dr Lance’s classical definition of spasticity. 2 His carefully drafted statement documented the consensus of the 1979 symposium of 44 actively engaged neurological investigators (including me): ‘Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (‘muscle tone’) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one component of the upper motor neuron syndrome. This did not preclude discussion of other features of the upper motor neuron syndrome resulting from release of flexor reflexes, such as flexor spasms, or the negative symptoms such as the pattern of weakness and loss of dexterity caused by withdrawal of the influence of descending motor pathways.’ 2 Thus spasticity is not a subjective symptom like headache or diplopia. It is rather an objective observation of the professional examination, like a cardiac murmur or a dilated pupil. There is abundant evidence that the truly disabling negative symptoms, often more impaired dexterity than strength, are directly correlated with the degree of disconnection of the target motor neuron population from the complexly integrated control of forebrain and hindbrain nerve structures. This loss of fine control and force is neither augmented by antagonist muscle stretch reflexes 3 or improved by systemic medication, fusimotor blockade, 4 or dorsal rhizotomy. 5 Nor is the degree of clumsiness directly correlated with the prevalence of spasticity. 6 The Ashworth Scale has never been more than an amateur parascientific game, with personal impressions of stiffness and absent replicable physical parameters. Recently, Fleuren et al. 7 have gone to the trouble of proving that the Ashworth Scale is worthless. Occam’s razor requires cessation of the senseless and useless demonization of the spasticity epiphenomenon. Absent evidence-based potions, patients should be assisted to practice toward maximal autonomous function.

The Underutilization of Intrathecal Baclofen in Poststroke Spasticity

Stroke is one of the leading causes of adult disability in the United States, with a reported prevalence of 6.4 million people. Spasticity is one of the clinical features of the upper motor neuron syndrome seen after a stroke. The prevalence of spasticity after a stroke ranges from 17% to 42.6%, and an average of two-thirds of people with spasticity have upper and lower extremity involvement. Oral medications and botulinum neurotoxin injections are current treatments for problematic spasticity. However, these treatments are often limited by side effects or dose ceilings. Intrathecal baclofen (ITB) is a proven method for the management of disabling spasticity from multiple etiologies. Studies have demonstrated improved mobility, activities of daily living, and quality of life in spastic poststroke patients. Despite the benefits of ITB, fewer than 1% of stroke patients with severe disabling spasticity are being treated with ITB. This article will review the prevalence of severe poststroke spasticity and the rate of ITB use and will discuss reasons for its limited use in stroke survivors.