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Spasticity, or greater muscle resistance, is a major disabling condition following stroke. Recovery of lost motor function in patients with stroke may be affected by spasticity, which most commonly develops in elbow and ankle muscles. However, despite its clinical relevance, the natural development of spasticity over the first 3 months after stroke is not clearly understood. Indeed, common clinical measures of spasticity such as the Modified Ashworth Scale (MAS) do not take into account the neurophysiological origin of spasticity and lack reliability and objectivity.
The objective of this study is to examine the natural history of the development of spasticity among patients with stroke over the first 3 months using a new neurophysiological measure (TSRT, the tonic stretch reflex threshold angle) and its velocity sensitivity (mu) in comparison to MAS and other common clinical tests. In addition, detailed brain imaging will be used to understand the relationship between damage to brain regions relevant to the development of spasticity and TSRT/mu values.
It is hypothesized that 1) TSRT/mu will indicate the presence of spasticity earlier than MAS/clinical tests; 2) TSRT/mu measures will be more closely related to motor impairments and activity limitations than MAS; 3) the lesion severity (identified by imaging) will be related to the change in TSRT/mu values.
Outcomes will be measured in a pilot cohort of 12 patients hospitalized for first-ever stroke. Measurements will be taken at the bedside within the 1st week of the patient's admission and will be done once per week for 12 weeks with a follow-up at week 16. Brain Imaging will be done around the 6th week post-stroke.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Acute stroke patients | 12 weekly evaluations starting within the first week post-stroke. Follow-up assessment at week 16. MRI at week 6. |
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| Measure | Description | Time Frame |
|---|---|---|
| TSRT | Tonic stretch reflex threshold measured in the elbow flexors or ankle plantarflexors | up to 16 weeks |
| Mu | Velocity sensitivity of the TSRT | up to 16 weeks |
| Modified Ashworth Scale (MAS) | Measure of the increase of muscle resistance to stretch felt by examiner in the elbow flexors or ankle plantarflexors | up to 16 weeks |
| Reflexes | Measured in the elbow flexors or ankle plantarflexors | up to 16 weeks |
| Measure | Description | Time Frame |
|---|---|---|
| Active Range of Motion (AROM) | Measured in elbow or ankle for flexion and extension | up to 16 weeks |
| Passive Range of Motion (PROM) | Measured in elbow or ankle for flexion and extension |
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Inclusion Criteria:
Exclusion Criteria:
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Patients will be recruited from acute care facilities such as general hospitals and stroke units in Montreal area hospitals.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Mindy F. Levin, PT, PhD | Contact | 450-688-9550 | 84371 | mindy.levin@mcgill.ca |
| Alice Misana, PT | Contact | 450-688-9550 | 84655 | alice.misana@mail.mcgill.ca |
| Name | Affiliation | Role |
|---|---|---|
| Theodore Wein, MD | Montreal Neurological Institute | Principal Investigator |
| Alexander Thiel, MD | Jewish General Hospital - McGill University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Jewish General Hospital | Recruiting | Montreal | Quebec | H3T 1E2 | Canada |
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| ID | Term |
|---|---|
| D020521 | Stroke |
| D000083242 | Ischemic Stroke |
| D000083302 | Hemorrhagic Stroke |
| D009128 | Muscle Spasticity |
| D004194 | Disease |
| ID | Term |
|---|---|
| D002561 | Cerebrovascular Disorders |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
| D009422 | Nervous System Diseases |
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| up to 16 weeks |
| Semmes-Weinstein filaments | Measure of the sensory threshold in index and thumb or first toe and middle-plantar surface of the foot | up to 16 weeks |
| Maximal Voluntary Force (MVF) | Measured in the elbow flexors and extensors, and in the ankle dorsiflexors and plantarflexors | up to 16 weeks |
| Fugl-Meyer Assessment Upper Limb/Lower Limb (FMA - UL/LL) | Assessment of motor function, balance, sensation and joint function in the upper and lower limb | up to 16 weeks |
| Berg Balance Scale | Measure of balance in standing | up to 16 weeks |
| Box and Blocks Test (BBT) | Number of blocks moved by the more-affected arm compared to the less-affected arm | up to 16 weeks |
| Timed Up and Go (TUG) | Activity measure of whole body function | up to 16 weeks |
| Marie-Helene Boudrias, PT, PhD |
| McGill University |
| Study Chair |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D009135 | Muscular Diseases |
| D009140 | Musculoskeletal Diseases |
| D009122 | Muscle Hypertonia |
| D020879 | Neuromuscular Manifestations |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010335 | Pathologic Processes |