Poststroke spasticity management.

P oststroke spasticity (PSS) is a common complication associated with other signs and symptoms of the upper motor neuron syndrome, including agonist/antagonist co-contraction, weakness, and lack of coordination. Together, they result in impairments and functional problems that can predispose to costly complications. The goal of PSS management should take into consideration not only reduction of muscle hypertonia but also the impact of PSS on function and well-being. Therapeutic interventions focus on peripheral and central strategies, such as physical techniques to increase muscle length through stretching and pharmacological modulation. Although there are few comparative studies on the superiority of one method over another, it appears that optimal management of PSS involves a combined and coordinated compendium of therapies that encompass cost-effective pharmacological and surgical interventions, along with rehabilita-tive efforts. Spasticity, commonly defined as " a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitabil-ity of the stretch reflex, as one component of the upper motor neuron syndrome, " 1 is a common complication of stroke. It contributes to the impairments and disabilities that negatively impact functional recovery. Consequently, PSS, along with weakness and lack of coordination, result in gait abnormalities and problems with arm use. In addition to functional limitations , spasticity, when inappropriately treated, may lead to reduced quality of life, increased pain, and joint contractures. Three community-based studies that followed-up stroke survivors for 3 to 12 months reported an incidence of PSS between 17% and 43%. 2–4 Certain factors are recognized as predictors of PSS: stroke lesions in the brain stem; hemor-rhagic stroke and younger age; 5 and severe paresis and hemi-hypesthesia at stroke onset. To quantify the full impact of PSS, assessment should include a measure of passive stretch, volitional movement, and active/ passive function. The benefit of using multiple measures in the evaluation of PSS is to differentiate the various components of the upper motor neuron syndrome, such as spasticity, spastic co-contraction, spastic dystonia, synergistic limb patterns , weakness, soft tissue contractures, and the functional implications of these impairments. The most commonly used clinical measure of spasticity is the Ashworth Scale or its modified version. This ordinal scale is a simple clinical test of resistance to passive stretch and is limited 8–10 by poor inter-rater reliability. The Tardieu Scale 7,11 has advantages over the Ashworth Scale because it is an interval scale and takes into consideration the velocity-dependent …