The following poster was a late addition and was presented at the 2013 ACRM | American Congress of Rehabilitation Medicine Annual Conference, Progress in Rehabilitation Research, 12-16 November, 2013, Orlando, Florida, USA.
Stroke Diagnosis
Poster 167
A Clinical Assessment and Neuro-Imaging based Grading Scale Predicts Severe Post-Stroke Limb Spasticity. Wayne Feng (Medical University of South Carolina, Charleston, SC), Andrew Gundran, Ali Tabesh, Lindsay Perry, Madhura Athreya, Michelle Woodbury, Steven Kautz, Robert Adams
Objective: The objective of this study is to identify a grading scale that can predict post-stroke limb spasticity from the acute phase.
Design: This is a prospective cohort study of 47 patients with first-ever acute ischemic strokes and various degrees of motor impairment. The first assessment was done between 2 to 5 days after stroke with Fugl-Meyer upper extremity (FM_UE) scale, NIH stroke scale and MRI of brain, the second assessment was completed at 3 months (+/- 2 weeks) with Modified Ashworth Spasticity Scale (MASS) at biceps, wrist and finger flexor. A highest value is used. Independent predictors of severe spasticity (MASS is ≥3) were identified by logistic regression. A risk stratification scale was developed with weighting of independent predictors based on strength of association.
Interventions: Observational study.
Main Outcome Measures: MASS.
Settings: Comprehensive stroke center.
Participants: Ischemic stroke patients.
Results: Factors independently associated with limb spasticity are motor function at baseline measured by FM_UE scale (P≤.0005), location of lesion (P=.002) and corticospinal tract (CST) lesion load (P<.03). The proposed grading scale is summation of individual points as followed: FM_UE Scale: >4(1 point), ≤4(0 point); Lesion location: subcortical or corti- cal (0 point), subcortical and cortical (1 point); CST lesion load: >7cc (1 point) ≤7cc (0 point). None of 22 patients (with score of 0) and all 7 patients (with score of 3) developed severe spasticity. The likelihood of developing severe spasticity in- creases steadily with grading scale score.
Conclusion: Our proposed grading scale can effectively predict severe post-stroke limb spasticity from the acute phase.
Disclosure: None disclosed.
Article info
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
