Abstract T MP38: A Simple Bedside Grading Scale Can Predict Severe Post-Stroke Upper-Limb Spasticity
Background: Upper-limb spasticity is a disabling complication after stroke; however, there is no clinical standard grading scale to predict spasticity. This study aims to identify a bedside grading scale with the information collected during the acute stroke phase to predict upper-limb spasticity in the chronic phase.
Methods: This is a prospective cohort study of 44 patients with first-ever acute ischemic strokes with various degrees of motor impairment. Modified Ashworth Spasticity Scale (MASS) was used as a clinical assessment tool for spasticity assessment with biceps, wrist and finger flexors at 90 days (± 14 days). The highest value was used and severe spasticity is defined as MASS>=3. NIH Stroke Scale (NIHSS) is assessed between 2 to 5 days after stroke and 90 days (± 14 days) after stroke. Infarction volume was measured based on the lesion on MRI/DWI. Independent predictors of upper-limb spasticity at days were identified by logistic regression. A risk stratification scale was developed with weighting of independent predictors based on strength of association.
Results: Factors independently associated with upper-limb spasticity are NIHSS Arm score at baseline (p<0.001), location of lesion (p=0.003) and stroke lesion volume (p=0.004). The proposed grading scale is summation of individual points as followed: NIHSS Arm Score: =4 (1 point), <4(0 point); lnfarct location: subcortical lesion only or cortical lesion only (0 point), both subcortical and cortical lesions (1 point); infarct volume: >=20 cc (1 point), <20cc (0 point). None of 12 patients with score of 0 (0%) and 9 out of 10 patients with score of 3 (90%) developed severe spasticity. The likelihood of developing severe upper-limb spasticity increases steadily with grading scale score.
Conclusion: A simple bedside grading scale can predict severe post-stroke limb spasticity at 90 days. It needs validation with an external dataset.
Author Disclosures: W. Feng: Research Grant; Modest; UL1RR029882 SCTR Discovery Grant Award/NIH/NCRR CTSA. A. Gundran: None. M. Athreya: None. L. Perry: None. S. Kautz: None. R.J. Adams: None.
- © 2014 by American Heart Association, Inc.