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Spasticity and muscle contracture following stroke
Summary 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...
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Published in: | Brain (London, England : 1878) England : 1878), 1996-10, Vol.119 (5), p.1737-1749 |
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description | Summary 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. |
doi_str_mv | 10.1093/brain/119.5.1737 |
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J. ; Ada, L. ; Neilson, P. D.</creator><creatorcontrib>O'Dwyer, N. J. ; Ada, L. ; Neilson, P. D.</creatorcontrib><description>Summary 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.</description><identifier>ISSN: 0006-8950</identifier><identifier>EISSN: 1460-2156</identifier><identifier>DOI: 10.1093/brain/119.5.1737</identifier><identifier>PMID: 8931594</identifier><identifier>CODEN: BRAIAK</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cerebrovascular Disorders - physiopathology ; Elbow - physiopathology ; Female ; Humans ; hypertonia ; Male ; Medical sciences ; Middle Aged ; Muscle Contraction - physiology ; muscle contracture ; Muscle Spasticity - physiopathology ; Neurology ; reflex hyperexcitability ; spasticity ; stroke ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Brain (London, England : 1878), 1996-10, Vol.119 (5), p.1737-1749</ispartof><rights>1997 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Oct 1996</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c527t-b0e180b9a7505d13dd1e4bf2c31029a37d43ff79603f4f0ed3823ff3e1dc4d503</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2475004$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8931594$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>O'Dwyer, N. J.</creatorcontrib><creatorcontrib>Ada, L.</creatorcontrib><creatorcontrib>Neilson, P. D.</creatorcontrib><title>Spasticity and muscle contracture following stroke</title><title>Brain (London, England : 1878)</title><addtitle>Brain</addtitle><description>Summary 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cerebrovascular Disorders - physiopathology</subject><subject>Elbow - physiopathology</subject><subject>Female</subject><subject>Humans</subject><subject>hypertonia</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Muscle Contraction - physiology</subject><subject>muscle contracture</subject><subject>Muscle Spasticity - physiopathology</subject><subject>Neurology</subject><subject>reflex hyperexcitability</subject><subject>spasticity</subject><subject>stroke</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0006-8950</issn><issn>1460-2156</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><recordid>eNqFkMtr3DAQh0VoSbZJ7r0ETCm5eTOjh2UdQ-gmhYWGPKD0ImQ9ihOvvZFskvz31XaXPfTS08D8vplhPkI-I8wRFLtoomn7C0Q1F3OUTB6QGfIKSoqi-kBmAFCVtRJwRD6l9ASAnNHqkBzWiqFQfEbo_dqksbXt-F6Y3hWrKdnOF3box2jsOEVfhKHrhte2_12kMQ7P_oR8DKZL_nRXj8nj4tvD1U25_HH9_epyWVpB5Vg24LGGRhkpQDhkzqHnTaCWIVBlmHSchSBVBSzwAN6xmuYG8-gsdwLYMTnf7l3H4WXyadSrNlnfdab3w5S0rIWglLH_ghQqFFLyDH75B3waptjnJzQqsVEDmCHYQjYOKUUf9Dq2KxPfNYLeSNd_pessXQu9kZ5HznZ7p2bl3X5gZznnX3e5SdZ0IZretmmPUZ4VwQYrt1ibRv-2j0181lU-I_TNz1_67hbp8m7xoBfsD30GmMM</recordid><startdate>19961001</startdate><enddate>19961001</enddate><creator>O'Dwyer, N. J.</creator><creator>Ada, L.</creator><creator>Neilson, P. D.</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>19961001</creationdate><title>Spasticity and muscle contracture following stroke</title><author>O'Dwyer, N. J. ; Ada, L. ; Neilson, P. D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c527t-b0e180b9a7505d13dd1e4bf2c31029a37d43ff79603f4f0ed3823ff3e1dc4d503</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cerebrovascular Disorders - physiopathology</topic><topic>Elbow - physiopathology</topic><topic>Female</topic><topic>Humans</topic><topic>hypertonia</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Muscle Contraction - physiology</topic><topic>muscle contracture</topic><topic>Muscle Spasticity - physiopathology</topic><topic>Neurology</topic><topic>reflex hyperexcitability</topic><topic>spasticity</topic><topic>stroke</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>O'Dwyer, N. J.</creatorcontrib><creatorcontrib>Ada, L.</creatorcontrib><creatorcontrib>Neilson, P. 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J.</au><au>Ada, L.</au><au>Neilson, P. D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Spasticity and muscle contracture following stroke</atitle><jtitle>Brain (London, England : 1878)</jtitle><addtitle>Brain</addtitle><date>1996-10-01</date><risdate>1996</risdate><volume>119</volume><issue>5</issue><spage>1737</spage><epage>1749</epage><pages>1737-1749</pages><issn>0006-8950</issn><eissn>1460-2156</eissn><coden>BRAIAK</coden><abstract>Summary 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.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>8931594</pmid><doi>10.1093/brain/119.5.1737</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Aged Aged, 80 and over Biological and medical sciences Cerebrovascular Disorders - physiopathology Elbow - physiopathology Female Humans hypertonia Male Medical sciences Middle Aged Muscle Contraction - physiology muscle contracture Muscle Spasticity - physiopathology Neurology reflex hyperexcitability spasticity stroke Vascular diseases and vascular malformations of the nervous system |
title | Spasticity and muscle contracture following stroke |
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