Early clinical predictors of post stroke spasticity

Figures & data

Table 1. Basic data of participants with/without post-stroke spasticity (PSS)

n (%)	all	no PSS	PSS	p
Number	145	111	34
Sex (female)	63 (43.4)	49 (44.1)	14 (41,2)	>0.05^b
Age (mean±sd, years)	71 ± 11	71 ± 12	73 ± 10	>0.05^a
Arterial hypertension	89 (61.4)	71 (64.0)	18 (52.9)	>0.05^b
Diabetes mellitus	27 (18.6)	23 (20.7)	4 (11.8)	>0.05^b
Hypercholesterolimia	36 (24.8)	33 (29.7)	3 (8.8)	<0.05^b
LDL	9 (6.2)	7 (6.3)	2 (5.9)	>0.05^b
Nikotin abusus	99 (68.3)	86 (77.5)	13 (38.2)	<0.01^b
Atrial fibrillation	20 (13.7)	15 (13.5)	5 (14.7)	>0.05^b
Cardiac pacemaker	1 (0.7)	1 (0.9)	0 (0)	>0.05^b
Coronary artery disease (stent)	15 (10.3)	13 (11.7)	2 (5.9)	>0.05^b
Peripheral arterial occlusive disease	6 (4.1)	6 (5.4)	0 (0)	>0.05^b
Carotid endarterectomy	4 (2.8)	4 (3.6)	0 (0)	>0.05^b
Left hemispheric stroke	63 (43.4)	49 (44.1)	14 (41.2)	>0.05^b
Right hemispheric stroke	65 (44.9)	50 (45.0)	15 (44.1)
Both hemispheric stroke	17 (11.7)	12 (10.8)	5 (14.7)
TOAST classifikation (%)				>0.05^b
TOAST-I		15.0	14.9
TOAST-II		14.2	11.4
TOAST-III		25.0	28.1
TOAST-IV		0.7	0.9
TOAST-Va		2.7	1.8
TOAST-Vb		26.4	26.3
TOAST-Vc		16	16.6

mean ± sd: mean values ± standard deviation; LDL: light density lipid

^aT-Test

^bChi-Quadrat Test

Figure 1. Study flow chart

Table 2. Severity of increased Velocity-dependent muscle tone (PSS) using REPAS

n (%)			REPAS 1–3	REPAS 4–10	REPAS >10
Arm	Right	12 (35.3)	4 (11.8)	6 (17.6)	2 (5.9)
	Left	22 (64.7)	9 (26.5)	9 (26.5)	4 (11.8)
	All	34 (100)	13 (38.3)	15 (44.1)	6 (17.6)
Leg	Right	9 (26.5)	3 (8.8)	5 (14.7)	1 (2.9)
	Left	12 (35.3)	6 (17.6)	4 (11.8)	2 (5.9)
	All	21 (61.8)	9 (26.5)	9 (26.5)	3 (8.8)

REPAS: the Resistance to Passive movement Scale; PSS: post-stroke spasticity

Figure 2. Movements affected by increased velocity-dependent muscle tone (post-stroke spasticity)

Table 3. The distribution of paresis and clinical parameters in patients with/without PSS

Motor deficit			all	no PSS	PSS	p
Monoparesis n (%)	Arm	Left	6 (4.1)	4 (3.6)	2 (5.9)	<0.01^b
		Right	9 (6.2)	4 (3.6)	5 (14.7)
	Leg	Left	2 (1.4)	1 (0.9)	1 (2.9)
		Right	1 (0.7)	1 (0.9)	0 (0)
Hemiparesis n (%)	Arm	Left	21 (14.5)	11 (9.9)	10 (29.4)
		Right	16 (11.0)	10 (9.0)	6 (17.6)
	Leg	Left	12 (8.3)	5 (4.5)	7 (20.6)
		Right	5 (3.4)	3 (2.7)	2 (5.9)
Tetraparesis n (%)			2 (1.4)	1 (0.9)	1 (2.9)
Total numbers (%)			74 (51.0)	40 (36.0)	34 (100)
BMRC n, Median (IQR)			145 5 (3.3–5.0)	111 5 (4.5–5.0)	34 0 (0–3.3)	<0.01^c
Disorder of Cerebral Nerves, n (%)			65 (44.8)	46 (41.4)	19 (55.9)	<0.01^b
Increased reflex, n (%)			15 (10.3)	6 (5.4)	9 (26.5)	<0.01^b
Babinski sign, n (%)			12 (8.3)	5 (4.5)	7 (20.6)	<0.01^b
Mean Median (IQR)
MMSE, points			27.2 28 (26–30)	28.1 29 (27–30)	24.2 26 (22–28)	<0.01^c
SCP, points			0.29 0 (0–0)	0.04 0 (0–0)	1.05 0 (0–1.63)	<0.01^c
Neglect (CBS), points			0.48 0 (0–0)	0.12 0 (0–0)	1.87 0 (0–0)	<0.01^c
MRS, grades			1.9 1 (0–4)	1.0 1 (0–1)	3.9 4 (4–5)	<0.01^c
BI, points			80.9 100 (75–100)	92.3 100 (90–100)	42.5 37.5 (19–69)	<0.01^c
AROM, grades			2.4 3 (2.3–3)	2.8 3 (3–3)	0.9 0 (0–2)	<0.01^c
BMRC, grades			3.8 5,0 (3.1–5.0)	4.5 5.0 (4.5–5)	1.3 0 (0–3.3)	<0.01^c
AHAs, grades			4.2 5.0 (4.0–5.0)	4.8 5.0 (5.0–5.0)	2.3 1.0 (1.0–4.3)	<0.01^c
NHPT, seconds			55.5 3.0 (19–65)	34.2 23 (18–31)	125.4 150 (128–150)	<0.01^c
Esslinger Transfer Scale, grades			0.97 0 (0–2)	0.48 0 (0–0)	2.62 3 (2–4)	<0.01^c
NIHSS, points			2.9 1(0–4.0)	1.2 0(0–1.0)	8.6 9(4.8–11.3)	<0.01^c
FAC, mean ± SD, grades			3.6 ± 1.8	4.2 ± 1.2	1.4 ± 1.7	<0.05^a

PSS: post-stroke spasticity; BMRC: British Medical Research Council

^aT-Test

^bChi-Quadrat Test

^cMann-Whitney-Test, IQR: interquartile range 25–75, mean ± SD: mean ± standard deviation. MMSE: Mini-Mental State Examination, SCP: Scale for Contraversive Pushing, CBS: Catherine Bergego Scale, MRS: modified ranking scale, BI: Barthel Index, AROM: Active Range of Motion, BMRC: British Medical Research Council for Muscle Strength, AHAs: Arm-Hand Activity scale, NHPT: nine hole peg test, ET: Esslinger Transfer Scale, NIHSS: National Institutes of Health Stroke Scale, FAC: Functional Ambulation Category

Table 4. Clinical assessments (Category) significantly correlating with post-stroke spasticity (PSS)

n (%)	Values	All	no PSS	PSS	p
MMSE	27–30 18–26 10–17 ≤ 9	107 (73.8) 35 (24.1) 1 (0.7) 2 (1.4)	92 (82.9) 18 (16.2) 1 (0.9) 0 (0)	15 (44.1) 17 (50.0) 0 (0) 2 (5.9)	<0.01^a
NIHSS	0–2 3–7 8–15 15 ≤	97 (67.0) 27 (18.6) 18 (12.4) 3 (2.0)	94 (84.7) 15 (13.5) 2 (1.8) 0 (0)	3 (8.8) 12 (35.3) 16 (47.1) 3 (8.8)	<0.01^a
MRS	0–2 3 ≤4	102 (70.4) 6 (4.1) 37 (25.5)	98 (88.3) 3 (2.7) 10 (9.0)	4 (11.8) 3 (8.8) 27 (79.4)	<0.01^a
BI	0–30 35–80 85–95 100	18 (12.4) 27 (18.6) 17 (11.7) 83 (57.2)	2 (1.8) 15 (13.5) 14 (12.6) 80 (72,1)	16 (47.1) 12 (35.3) 3 (8.8) 3 (8.8)	<0.01^a
BMRC	<4 4 5	35 (24.1) 12 (8,3) 98 (67.6)	9 (8.1) 31 (28.0) 71 (64.0)	26 (76.5) 8 (23.5) 0 (0)	<0.01^a
AROM	0 0 < X < 50% 50 ≤ X < 100% 100%	24 (16.6) 4 (2.8) 6 (4.1) 111 (76.5)	4 (3.6) 1 (0.9) 1 (0.9) 105 (94.6)	20 (58.9) 3 (8.8) 5 (14.7) 6 (17.6)	<0.01^a
AHAs	1–3 4 5	31 (21.4) 7 (4.8) 107 (73.8)	7 (6.3) 5 (4.5) 99 (89.2)	24 (70.6) 2 (5.9) 8 (23.5)	<0.01^a
ET	2–4 1 0	43 (29.7) 10 (6.9) 92 (63.4)	16 (14.4) 8 (7.2) 87 (78.4)	27 (79.4) 2 (5.9) 5 (14.7)	<0.01^a
FAC	0–3 4 5	52 (35.9) 19 (13.1) 74 (51.0)	22 (19.8) 19 (17.1) 70 (63.1)	30 (88.2) 0 (0) 4 (11.8)	<0.01^a
n		145	111	34

PSS: post-stroke spasticity

^a: Mann-Whitney-Test, Q2(Q1-Q3), MMSE: Mini-Mental State Examination, SCP: Scale for Contraversive Pushing, CBS: Catherine Bergego Scale, MRS: modified ranking scale, BI: Barthel Index, AROM: Active Range of Motion, BMRC: British Medical Research Council for Muscle Strength, AHAs: Arm-Hand Activity scale, ET: Esslinger Transfer Scale, NIHS: National Institutes of Health Stroke Scale, FAC: Functional Ambulation Category

Figure 3. Statistically independent parameters correlating with post-stroke spasticity (PSS)