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Post-Stroke Spasticity

Upper Motor Neuron Spasticity After Cerebrovascular Accident

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Nöroloji department. Book Appointment →

What is Post-Stroke Spasticity?

Post-stroke spasticity (PSS) is a velocity-dependent increase in tonic stretch reflex with exaggerated tendon jerks, resulting from upper motor neuron syndrome.

Develops in 20-40% of stroke survivors, typically presenting weeks to months after stroke (peak 3-6 months).

Pathophysiology: loss of inhibitory control from descending pathways, leading to hyperexcitability of stretch reflexes; gradual development of secondary changes in muscle (fibrosis, contracture, viscoelastic changes).

Spastic patterns: upper limb (flexor synergy with shoulder adduction, elbow flexion, wrist/finger flexion), lower limb (extensor synergy with hip extension/adduction, knee extension, ankle plantarflexion/inversion).

Clinical scales: Modified Ashworth Scale (MAS, grades 0-4), Tardieu Scale, Spasm Frequency Scale.

Disability impact: pain, contractures, hygiene difficulties, gait dysfunction, fall risk, reduced quality of life.

Symptoms

Increased muscle tone with velocity-dependent resistance to passive stretching.
Exaggerated deep tendon reflexes (hyperreflexia).
Clonus (rhythmic involuntary contractions, especially ankle).
Abnormal posturing: flexor pattern in upper limb, extensor pattern in lower limb.
Stiffness, particularly in morning and after periods of inactivity.
Painful muscle spasms.
Difficulty with active and passive movement.
Functional limitations: dressing, hygiene, transfers, walking.
Joint contractures (later complication).
Skin breakdown in flexed positions (hand, axilla, palm).

Risk Factors

Severity of initial stroke (larger lesions, motor cortex involvement).
Initial paresis severity.
Cortical and subcortical strokes (especially internal capsule).
Younger age (more chronicity).
Female sex (higher prevalence in some studies).
Hemorrhagic stroke (vs. ischemic, mixed evidence).
Comorbid spasticity disorders (multiple sclerosis, prior stroke).
Failed early rehabilitation.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Post-stroke increased muscle tone or stiffness.
  • Difficulty with hygiene, dressing, or transfers due to limb posturing.
  • Painful muscle spasms.
  • Joint stiffness or developing contractures.
  • Falls related to gait abnormalities.
  • Failure to progress in rehabilitation due to spasticity.
  • Skin maceration or breakdown in flexed positions.

Treatment Methods

01
Multidisciplinary assessment: physiatry, neurology, physical/occupational therapy, orthotics.
02
Goal-setting: pain reduction, hygiene improvement, function enhancement, contracture prevention.
03
Standardized assessment: MAS, Tardieu Scale, Goal Attainment Scaling, range of motion, gait analysis.
04
Conservative therapy first-line:
05
Physical and occupational therapy: stretching, range of motion, strengthening of antagonist muscles, functional training.
06
Orthoses: AFOs, hand splints, resting splints to prevent contractures.
07
Cryotherapy, electrical stimulation, vibration therapy (adjuncts).
08
Pharmacotherapy:
09
Oral antispastics: baclofen (5-80 mg/day), tizanidine (2-36 mg/day), dantrolene, gabapentinoids; limited by sedation and weakness.
10
Botulinum toxin injection (BoNT-A or BoNT-B): first-line for focal spasticity; targeted muscle injection guided by EMG/ultrasound.
11
Phenol or alcohol nerve blocks: lower cost, longer duration, but technical complexity.
12
Intrathecal baclofen pump: for severe diffuse spasticity (especially lower limb), refractory to oral medications.
13
Surgical options for refractory cases:
14
Selective dorsal rhizotomy (rare in adult stroke).
15
Tendon lengthening, transfers, releases for fixed contractures.
16
Long-term management: ongoing rehabilitation, BoNT injections every 3-4 months, oral medication titration, lifestyle modifications.
17
Patient and family education: spasticity recognition, home exercise, positioning, contracture prevention.
18
Outcomes: BoNT improves MAS, pain, function in 60-80%; durable benefit with sustained therapy.

Which Department to Visit?

You can visit our Nöroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.