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(Stroke. 2004;35:1787.)
© 2004 American Heart Association, Inc.

Letters to the Editor

Spasticity After Stroke: Why Bother?

Department of Neurology, School of Medicine, Washington University in Saint Louis, Saint Louis, Missouri

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Perseveration of behavior is a significant clinical symptom among intentional disorders of organic brain disease, attributed by some authors especially to prefrontal brain impairment. However, the perseverative preoccupation of professional neurologists and therapists with the purpose of overpowering the spasticity ogre seems to be an endemic, intractably-taught delusion that afflicts both academic scholars and clinicians.^1,2

In 1951, Thomas Twitchell published a 37-page analysis of the clinical course of recovery of 121 acute hemiplegic stroke patients in the Boston City Hospital.³ Early on they were examined daily, and 25 were carefully followed for weeks or months until they reached a stable status of recovery or disability. Twitchell described in great detail both the usual and exceptional patterns of functional recovery, along with the associated patterns of reflex phenomena. Following transient flaccidity associated with acute paralysis, resistance to passive stretch evolved during the first several days.

Twitchell concluded, "The great disability which results when recovery is halted in the phase of heightened proprioceptive activity has prompted many earlier investigations. Walshe (1919) clarified the previously confused views as to the nature of spasticity, and showed its identity with the type of exaggeration of postural reflexes seen in decerebrate rigidity. The analysis of Sherrington and his collaborators subsequently identified the stretch reflex as the fundamental reaction of such disorder. It has often been assumed that if spasticity could be abolished, willed movement could be more effectively performed. The present study indicates that the first movements to appear following hemiplegia are themselves . . . [Full Text of this Article]

Disa K. Sommerfeld, PT, PhD

Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden, and Neurotec Department, Division of Physiotherapy, Karolinska Institute, Huddinge, Sweden

Elsy Eek, PT, MSc

Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden

Anna-Karin Svensson, PT, MSc Lotta Widén Holmqvist, PT, PhD

Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden

Magnus H. von Arbin, MD, PhD

Stroke Unit, Division of Internal Medicine, Karolinska Institutet, Stockholm, Sweden

This article has been cited by other articles:

				J. Udby Blicher and J. F. Nielsen Evidence of Increased Motoneuron Excitability in Stroke Patients Without Clinical Spasticity Neurorehabil Neural Repair, January 1, 2009; 23(1): 14 - 16. [Abstract] [PDF]