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What comes first, spasticity, reduced range of motion or pain in patients after stroke?

Conference contribution
Authors Arve Opheim
Margit Alt Murphy
Anna Danielsson
Hanna C Persson
Katharina S Sunnerhagen
Published in Journal of Rehabilitation Medicine. Presented at the 3rd Baltic and North Sea Conference on Physical & Rehabilitation Medicine, the 118th Congress of the German Society for Physical Medicine & Rehabilitation, and the annual Congress for the Austrian Society for Physical Medicine & Rehabilitation. September 2013, Hannover, Germany
Volume 45
Pages 960
ISSN 1650-1977
Publication year 2013
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation
Pages 960
Language en
Links dx.doi.org/10.2340/16501977-1223
Keywords Stroke, spasticity, pain, joint range of motion, sensorimotor function
Subject categories Neurology

Abstract

Introduction Pain, reduced range of motion (ROM) and reduced motor function has been found to be associated with spasticity in persons with stroke, but the developments of these impairments over time are less known. The aim of the study was to describe the development of spasticity, pain, ROM, sensibility and sensory motor function in persons with first stroke during the first year after stroke. Method 117 patients with first ever stroke was recruited for the study. No selections apart from reduced arm function on day 3 were made. The patients were assessed six times during the first year, at day 3, 10, week 4, month 3, 6 and 12. Upper limb spasticity was assessed with the modified Ashworth scale (MAS), and a MAS score ≥ 1 was regarded as presence of spasticity. Sensory motor function was assessed with the Fugl-Meyer Upper-Extremity scale (FM-UE). The presence of pain, reduced sensibility and range of motion (ROM) was regarded if lower than maximum scores on the non-motor domains of the FM-UE. Results The proportion of persons with spasticity increased from 0.25 at day 3 to 0.44 at week 4 and was stable up to 12 months. Sensory motor function improved from 28 (SD 25) at day 3 to 47 (SD 23) at 3 months and was stable up to 12 months. The proportion of persons with reduced ROM was 0.45 at day 3, was stable up to 3 months and increased at 6 and 12 months, 0.55 and 0.61, respectively. The proportion of patients with reduced sensibility decreased from 0.55 at day 3 to 0.36 at 12 months. Discussion Pain, spasticity and sensory motor function seemed to develop in about parallel the first 3 months. The proportion of persons with pain continued to increase during the first year. The proportion of patients with reduced ROM was unchanged during the first three months, but increased at 6 and 12 months. Based on this, reduced upper limb ROM seems secondary to pain and spasticity.

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