What is the incidence of spasticity?
The ongoing preoccupation with spasticity is surprising when the incidence of spasticity after stroke is actually quite low. The incidence of spasticity (depending on how it is defined and measured) seems to be somewhere between 17% (Lundstrom 2008) to 38% (Watkins 2002) (see Sommerfield 2012 for a review). However, it must be acknowledged that for some individual stroke survivors, the consequences of spasticity can have profoundly adverse consequences for their activities of daily living such as being unable to open their hand to be able to clean it.
Is there a relationship between spasticity and function?
Even more surprising, the research that has measured the relationship between spasticity and function has found that spasticity is not correlated with loss of functional ability (Dietz et al 1981, Ada et al Upper Limb 2006, Ada et al Lower Limb 1998, Williams et al Lower Limb – in traumatic brain injury – 2015, Fayazi 2014, Shaw et al 2011). So even if spasticity is present, it does not appear to be the main problem limiting stroke survivors’ ability to move. Weakness, on the other hand, is very strongly correlated with loss of function. (Look for future blogs to discuss the relationship between weakness and poor function in blogs on the StrokeEd website over the coming months.)
This is the first in a series of blogs about spasticity in an attempt to try to make sense of what continues to be a very fraught issue – despite the strong evidence that spasticity is not the main problem preventing stroke survivors from moving. These blogs will present some of the problems with the prevailing beliefs about spasticity and importantly, provide some evidence based strategies clinicians may use to assist stroke survivors learn to move even in the presence of spasticity.
Your comments, both from clinicians, researchers and stroke survivors, are very welcome. This blog is intended to help, not hinder, clinical decision making. So if you want to comment please keep the contributions about spasticity open and informative to progress the discussion for the benefit of all. Comments will be moderated to ensure a civil conversation!