Spasticity and contractures at the wrist after stroke: time course of development and their association with functional recovery of the upper limb

Abstract

Objective: To investigate the time course of development of spasticity and contractures at the wrist after stroke and to explore if these are associated with upper limb functional recovery. Design: Longitudinal observational study using secondary data from the control group of a randomized controlled trial. Setting: The Acute Stroke Unit at the University Hospital of North Staffordshire. Subjects: Patients without useful arm function (Action Research Arm Test — ARAT) score of 0 within 6 weeks of a first stroke. Main measures: Spasticity was measured by quantifying muscle activity during passively imposed stretches at two velocities. Contractures were measured by quantifying passive range of movement and stiffness. Upper limb functional movement was assessed using the ARAT. All assessments were conducted at baseline, and at 6, 12, 24 and 36 weeks after recruitment. Results: Thirty patients (43% male, median age 70 (range 52—90) years, median time since stroke onset 3 (range 1—5) weeks) were included. Twenty-eight (92%) demonstrated signs of spasticity throughout the study period. Participants who recovered arm function (n = 5) showed signs of spasticity at all assessment points but did not develop contractures. Patients who did not recover useful arm function (n = 25) had signs of spasticity and changes associated with contracture formation at all time points tested. Conclusion: In this group of patients who had no arm function within the first 6 weeks of stroke, spasticity was seen early, but did not necessarily hinder functional recovery. Contractures were more likely to develop in patients who did not recover arm function.