Brain, Vol. 119, No. 5, 1737-1749, 1996
© 1996 Guarantors of Brain
research-article |
Spasticity and muscle contracture following stroke
1School of Physiotherapy, Faculty of Health Sciences, The University of Sydney Sydney, Australia 2Cerebral Palsy Research Unit, Institute of Neurological Sciences, The Prince Henry Hospital and School of Electrical Engineering, University of New South Wales Sydney, Australia
Correspondence to:
N. J. O'Dwyer, School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, Sydney, NSW 2141, Australia
It has become increasingly recognized that the major functional deficits following brain damage are largely due to ‘negative’ features such as weakness and loss of dexterity rather than spasticity. A variety of studies suggest that spasticity is a distinct problem and separate from the loss of dexterity, but that it may be implicated in the formation of muscle contracture and even in the recovery of strength. In order to address these issues, we examined the relationship between spasticity, contracture, strength and dexterity in the affected upper limb following stroke. Spasticity was measured both as increased tonic stretch reflexes and increased resistance to passive stretch (hypertonia). Twenty-four patients were recruited non-selectively from three rehabilitation units within 13 months of their stroke. Few patients exhibited increased tonic reflexes but half were found to have muscle contracture, the earliest at 2 months following stroke. Hypertonia was associated with contracture but not with reflex hyperexcitability. Increased tonic stretch reflexes were observed only in a subgroup of those with contracture and where present could usually be elicited only at the end of muscle range. This finding suggests that instead of spasticity causing contracture, contracture may actually potentiate spasticity in some patients. However, the majority of patients with contracture did not have increased tonic stretch reflexes. In addition, we found no relationship between spasticity and either weakness or loss of dexterity. Therefore, while hypertonia remains an important problem following cerebral lesions, it would appear that the amount of attention directed to reflex hyperexcitability associated with spasticity is out of proportion with its effects. Consequently, hypertonia needs to be clearly distinguished from reflex hyperexcitability in patients with spasticity.
spasticity; muscle contracture; stroke; reflex hyperexcitability; hypertonia
Received December 8, 1995. Revised April 26, 1996. Accepted May 21, 1996.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  V. Dietz Studies on the Spastic Rat: An Adequate Model for Human Spastic Movement Disorder? J Neurophysiol, February 1, 2008; 99(2): 1039 - 1040. [Full Text] [PDF]
|
|
|
|
|
|
M. M. Mirbagheri, K. Settle, R. Harvey, and W. Z. Rymer Neuromuscular Abnormalities Associated With Spasticity of Upper Extremity Muscles in Hemiparetic Stroke J Neurophysiol, August 1, 2007; 98(2): 629 - 637. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. E Harris and J. J Eng Paretic Upper-Limb Strength Best Explains Arm Activity in People With Stroke Physical Therapy, January 1, 2007; 87(1): 88 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L D de Jong, A Nieuwboer, and G Aufdemkampe Contracture preventive positioning of the hemiplegic arm in subacute stroke patients: a pilot randomized controlled trial Clinical Rehabilitation, August 1, 2006; 20(8): 656 - 667. [Abstract] [PDF]
|
|
|
|
 |
|
 H. Morita, M. Shindo, H. Momoi, S. Yanagawa, S. Ikeda, and N. Yanagisawa Lack of modulation of Ib inhibition during antagonist contraction in spasticity. Neurology, July 11, 2006; 67(1): 52 - 56. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. S. Kumar, A. D. Pandyan, and A. K. Sharma Biomechanical measurement of post-stroke spasticity Age Ageing, July 1, 2006; 35(4): 371 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Patrick and L. Ada The Tardieu Scale differentiates contracture from spasticity whereas the Ashworth Scale is confounded by it Clinical Rehabilitation, February 1, 2006; 20(2): 173 - 182. [Abstract] [PDF]
|
|
|
|
|
|
A Cooper, I M Musa, R van Deursen, and C M Wiles Electromyography characterization of stretch responses in hemiparetic stroke patients and their relationship with the Modified Ashworth Scale Clinical Rehabilitation, July 1, 2005; 19(7): 760 - 766. [Abstract] [PDF]
|
|
|
|
|
|
A. J Turton and E. Britton A pilot randomized controlled trial of a daily muscle stretch regime to prevent contractures in the arm after stroke Clinical Rehabilitation, June 1, 2005; 19(6): 600 - 612. [Abstract] [PDF]
|
|
|
|
 |
|
 J A Burne, V L Carleton, and N J O'Dwyer The spasticity paradox: movement disorder or disorder of resting limbs? J. Neurol. Neurosurg. Psychiatry, January 1, 2005; 76(1): 47 - 54. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Mehrholz, Y. Major, D. Meissner, S. Sandi-Gahun, R. Koch, and M. Pohl The influence of contractures and variation in measurement stretching velocity on the reliability of the Modified Ashworth Scale in patients with severe brain injury Clinical Rehabilitation, January 1, 2005; 19(1): 63 - 72. [Abstract] [PDF]
|
|
|
|
 |
|
 J F Nielsen and T Sinkjaer Guided intrathecal baclofen administration by using soleus stretch reflex in moderate-severe spastic multiple sclerosis patients with implanted pump Multiple Sclerosis, October 1, 2004; 10(5): 521 - 525. [Abstract] [PDF]
|
|
|
|
 |
|
 W. M. Landau, D. K. Sommerfeld, E. Eek, A.-K. Svensson, L. W. Holmqvist, and M. H. von Arbin Spasticity After Stroke: Why Bother? * Response Stroke, August 1, 2004; 35(8): 1787 - 1788. [Full Text] [PDF]
|
|
|
|
 |
|
 M. H. Heitger, T. J. Anderson, R. D. Jones, J. C. Dalrymple-Alford, C. M. Frampton, and M. W. Ardagh Eye movement and visuomotor arm movement deficits following mild closed head injury Brain, March 1, 2004; 127(3): 575 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E Maupas, P Marque, C F Roques, and M Simonetta-Moreau Modulation of the transmission in group II heteronymous pathways by tizanidine in spastic hemiplegic patients J. Neurol. Neurosurg. Psychiatry, January 1, 2004; 75(1): 130 - 135. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Sommerfeld, E. U.-B. Eek, A.-K. Svensson, L. W. Holmqvist, and M. H. von Arbin Spasticity After Stroke: Its Occurrence and Association With Motor Impairments and Activity Limitations Stroke, January 1, 2004; 35(1): 134 - 139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A Mortenson and J. J Eng The Use of Casts in the Management of Joint Mobility and Hypertonia Following Brain Injury in Adults: A Systematic Review Physical Therapy, July 1, 2003; 83(7): 648 - 658. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V Dietz Spastic movement disorder: what is the impact of research on clinical practice? J. Neurol. Neurosurg. Psychiatry, June 1, 2003; 74(6): 820 - 821. [Full Text] [PDF]
|
|
|
|
|
|
M. Pohl, J. Mehrholz, and S. Ruckriem The influence of illness duration and level of consciousness on the treatment effect and complication rate of serial casting in patients with severe cerebral spasticity Clinical Rehabilitation, April 1, 2003; 17(4): 373 - 379. [Abstract] [PDF]
|
|
|
|
|
|
A. D Pandyan, C. I. Price, M. P Barnes, and G. R Johnson A biomechanical investigation into the validity of the modified Ashworth Scale as a measure of elbow spasticity Clinical Rehabilitation, March 1, 2003; 17(3): 290 - 294. [Abstract] [PDF]
|
|
|
|
|
|
A D Pandyan, M Cameron, J Powell, D J Stott, and M H Granat Contractures in the post-stroke wrist: a pilot study of its time course of development and its association with upper limb recovery Clinical Rehabilitation, January 1, 2003; 17(1): 88 - 95. [Abstract] [PDF]
|
|
|
|
 |
|
 T. D. Sanger Pathophysiology of Pediatric Movement Disorders J Child Neurol, January 1, 2003; 18(1_suppl): S9 - S24. [Abstract] [PDF]
|
|
|
|
 |
|
 T. D. Sanger, M. R. Delgado, D. Gaebler-Spira, M. Hallett, and J. W. Mink Classification and Definition of Disorders Causing Hypertonia in Childhood Pediatrics, January 1, 2003; 111(1): e89 - 97. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Blackburn, P. van Vliet, and S. P Mockett Reliability of Measurements Obtained With the Modified Ashworth Scale in the Lower Extremities of People With Stroke Physical Therapy, January 1, 2002; 82(1): 25 - 34. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Ada and N. O'Dwyer Do associated reactions in the upper limb after stroke contribute to contracture formation? Clinical Rehabilitation, February 1, 2001; 15(2): 186 - 194. [Abstract] [PDF]
|
|
|
|
|
|
P Marque, M Simonetta-Moreau, E Maupas, and C F Roques Facilitation of transmission in heteronymous group II pathways in spastic hemiplegic patients J. Neurol. Neurosurg. Psychiatry, January 1, 2001; 70(1): 36 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Richardson, G. Sheean, D. Werring, M. Desai, S. Edwards, R. Greenwood, and A. Thompson Evaluating the role of botulinum toxin in the management of focal hypertonia in adults J. Neurol. Neurosurg. Psychiatry, October 1, 2000; 69(4): 499 - 506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Vattanasilp, L. Ada, and J. Crosbie Contribution of thixotropy, spasticity, and contracture to ankle stiffness after stroke J. Neurol. Neurosurg. Psychiatry, July 1, 2000; 69(1): 34 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A D Pandyan, G R Johnson, C I M Price, R H Curless, M P Barnes, and H Rodgers A review of the properties and limitations of the Ashworth and modified Ashworth Scales as measures of spasticity Clinical Rehabilitation, May 1, 1999; 13(5): 373 - 383. [Abstract] [PDF]
|
|
|
|
|
|
M. Faist, M. Ertel, W. Berger, and V. Dietz Impaired modulation of quadriceps tendon jerk reflex during spastic gait: differences between spinal and cerebral lesions Brain, March 1, 1999; 122(3): 567 - 579. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Yelnik, T. Albert, I. Bonan, and I. Laffont A Clinical Guide to Assess the Role of Lower Limb Extensor Overactivity in Hemiplegic Gait Disorders Stroke, March 1, 1999; 30(3): 580 - 585. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R D Thijs, N C Notermans, J H J Wokke, Y van der Graaf, and J van Gijn Distribution of muscle weakness of central and peripheral origin J. Neurol. Neurosurg. Psychiatry, November 1, 1998; 65(5): 794 - 796. [Abstract] [Full Text]
|
|
|
|
|
|
L. Ada, W. Vattanasilp, N. J O'Dwyer, and J. Crosbie Does spasticity contribute to walking dysfunction after stroke? J. Neurol. Neurosurg. Psychiatry, May 1, 1998; 64(5): 628 - 635. [Abstract] [Full Text] [PDF]
|
|