Are clinical characteristics associated with upper-extremity hypertonia in severe ischaemic supratentorial stroke?

OBJECTIVE The primary goal of this study was to identify clinical risk factors, in addition to muscle weakness, for upper-extremity hypertonia in patients with severe ischaemic supratentorial stroke. The secondary goal was to investigate the time course of upper-extremity hypertonia in these patients during the first 26 weeks post-stroke. DESIGN Inception cohort. PATIENTS Forty-three consecutive patients with an acute ischaemic supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. MAIN OUTCOME MEASURES PRIMARY OUTCOME hypertonia assessed by the Ashworth scale at week 26 post-stroke. Potential risks factors: motor functions assessed by the upper-extremity subscore of the Fugl-Meyer motor assessment, Barthel Index at week 1, consciousness, sensory disturbances, apraxia, neglect, and hyper-reflexia. Secondary outcome: time course of upper-extremity hypertonia by assessing its prevalence at 6 consecutive moments post-stroke during a follow-up period of 26 weeks. RESULTS Twenty-five patients (63%) developed hypertonia during the follow-up period of 26 weeks. During this period, the prevalence of hypertonia followed a rather dynamic course, with cases of early, transient and late hypertonia. Univariate analyses yielded none of the selected clinical characteristics as significantly associated with hypertonia. CONCLUSION Despite the high incidence of hypertonia (63%) observed, none of the selected clinical characteristics could be identified as a risk factor for hypertonia.