Spasticity and stroke: pathophysiology and management rules

Spasticity and stroke: pathophysiology and management rules 2 ARC Publishing in the rheological properties and in the contractile soft tissue and musculoskeletal system (intrinsic hypertonia) are often associated with chronic spasticity and, in turn have been associated with increased spasticity. Signs and symptoms of spasticity: Spasticity signs include muscle stiffness or spasm, muscle spasms, clonus, pain, difficulty performing voluntary movements or deformity of the limbs (cosmetic or functional concerns). Spasticity symptoms include the resistance to passive movement, twitching, co-contraction of agonist and antagonist muscles, spastic dystonia, decreased range of passive movement, abnormal posture and/or limb deformity. Spasticity pattern of cerebral origin: This pattern observed after a stroke differs from spinal-origin spasticity as found in spinal cord injury and in multiple sclerosis. Cerebral-origin spasticity is characterized by a postural stereotype involving antigravity muscles: the upper limb presents a flexor pattern: depression of the scapula, internal rotation and adduction of the shoulder, forearm pronation, elbow, wrist and fingers flexion; the lower limb presents an extensor pattern: extension, adduction and internal rotation of the thigh, knee extension, plantar flexion and foot inversion. Spasticity is often classified according to the distribution of the affected body areas as focal, multifocal, regional or general. It is important to identify the distribution of spasticity since it has definite implications for treatment. Rules of spasticity management: Spasticity does not always need to be treated. In fact, it may aid the patient to walk or perform other activities of daily living (ADL), maintain muscle mass and bone mineralization, and decreased oedema and the risk for deep vein thrombosis. However, it can interfere with mobility, exercise and range of motion, reducing the support and swing of gait and lead to contractures. It can also interfere with ADL and patient care, including hygiene. Moreover, pressure sores and sleep disturbance occur and can cause pain. In the treatment of spasticity, we may consider factors such as a chronical status, spasticity severity and distribution, location of the central lesion, patient comorbidities and caregiver availability. Treatment of spasticity should include three major classes of goals: technical (increasing the range of motion, reducing the tone or reducing spasm), functional (improving ADL, reducing pain, facilitating care, improving limb positioning and gait), and preventive (preventing contracture, skin maceration, and skin ulcers). Spasticity treatment should be performed by a multidisciplinary team that includes physiatrics, neurologists, nurses and caregivers, therapists, and should be always based on the person as a whole.