| 제목 |
Natural history of spasticity for upper limb in patients with stroke |
| 소속 |
The Catholic University of Korea, Seoul St. Mary1, The Catholic University of Korea, St. Vincent’s Hospital, Department of Rehabilitation Medicine2, Inha University Medical School, Department of Rehabilitation Medicine3, Gachon University College of Medicine, Department of Rehabilitation Medicine4, Kyung Hee University College of Medicine, Department of Rehabilitation Medicine5, Korea University College of Medicine, Department of Rehabilitation Medicine 6, Cungbuk national university, , Department of Rehabilitation Medicine 7, Presbyterian Medical Center, Seonam University College of Medicine, Department of Rehabilitation Medicine 8, Busan Paik Hospital, College of Medicine, Inje University, Department of Rehabilitation Medicine 9, Jeju National University Hospital, Jeju National University School of Medicine, Department of Rehabilitation Medicine 10, Dong-A University College of Medicine, Department of Rehabilitation Medicine11 |
| 저자 |
Kyung Eun Nam1*, Seong Hoon Lim2†, Joon Sung Kim2, Bo Young Hong2, Han Young Jung3, Ju Kang Lee4, Seung Don Yoo5, Sung-Bom Pyun6, Kyoung Moo Lee7, Kwang Jae Lee8, Hyundong Kim9, Eun Young Han10, Keong Woo Lee11 |
Introduction
Spasticity is one of the major complications of stroke and commonly defined as a velocity-dependent increased in tonic stretch reflexes. Upper extremity spasticity has a significant contribution on functional impairment due to restrictions in range of motion and speed of limb movement. Severe spasticity can be deep distress, such as painful muscle spasm, to the stroke survivors. Therefore, post-stroke spasticity should always be looked for as their adequate treatment.
The prevalence of upper extremity spasticity had been reported to vary from 17% to 42% and increase with time. Different risk factors associated with the development of spasticity have been suggested in various studies, including lower BI scores, degree of paresis, stroke related pain, and sensory deficits. Although there are many studies to find early predictors of upper limb spasticity, it is not clear when spasticity occurs after stroke. Therefore, we investigate the time to develop upper extremity spasticity after stroke onset and topical distribution, with nation-wide multicenter studies in South Korea.
Methods
This was a large-scale, multi-center, cross-sectional, retrospective clinical study from December of 2011 to November of 2014. Eight hundred sixty one subjects with post-stroke spasticity of upper limb were recruited from the Department of Rehabilitation Medicine in nation-wide 10 Hospital. Inclusion criteria are as follows: 1) spasticity, defined as grade 1 or more by modified Ashworth scale(MAS), in upper limb; 2) diagnosed first-ever ischemic or hemorrhagic stroke and evaluated within 3 months after onset. Exclusion criteria were 1) previous recruitment for study of spasticity management such as botulinum toxin; 2) recurrent stroke. We obtained demographic data, co-morbidity and brain imaging studies (MRI or CT) undertaken within 30 days after onset. Spasticity in the upper extremity was assessed with MAS and followed up to 12 months if possible.
Result
The demographic characteristics of the patients are shown in table 1. The basal ganglia (42.04%), cortex (37.05%) and thalamus (8.48%) are common brain lesion mainly involved. The mean time to develop upper limb spasticity after stoke onset is 62.03 ± 118.21 days (Table2). Statistically, it shows great heterogeneity and about 16% of stroke survivors develop spasticity after 6 months from onset. At the time of diagnosis for spasticity, most patients show only a slight increase in muscle tone and severe spasticity (MAS ≥3) is observed in only 2.90%. Table 3 shows the distribution of the MAS at each of the joints. Spasticity presents in the order of elbow, wrist, finger, shoulder and slightly increases with time up to 12 months.
Conclusion
The time to occur spasticity of upper extremity after stroke is average 2 months and very diverse. Post-stroke spasticity can develop after 6 months from onset. Therefore, follow up examination for identification of spasticity is necessary even in the chronic state. |
|
Table 1. The demographic characteristics of the patients
Table 2. The time to develop upper extremity spasticity after stroke onset and its severity (Days)
Table 3. Topical distribution of the MAS at each of the joints
|
