Identification and Management of Post-Stroke Spasticity

Abstract Background Spasticity is thought to affect up to 40% of people with severe weakness after stroke, with 15% of those experiencing severe and disabling spasticity. Untreated, it can lead to pain, increased dependence, contracture and other motor impairments (National clinical guideline for stroke for the UK and Ireland, 2023). Guidelines recommend that people with motor weakness should be assessed for spasticity, and spasticity guidelines recommend that all people with problematic spasticity should be managed within a specialist service, using physical and pharmacological management as appropriate (Royal College of Physicians, 2018). The objective of this study was to determine the prevalence of spasticity reported by patients attending a post stroke review clinic, and the subsequent management of these patients. Methods Participants: All patients attending a post-stroke review clinic between March 2023 and April 2024. Data: All patients were asked if they experience stiffness, cramping or spasms. Responses and subsequent onward referrals were recorded. Where patients were referred onward for further assessment and management, the interventions employed were recorded. Analysis was performed using descriptive statistics. Results During the data collection period, 270 patients visited the clinic. Stiffness, cramps or spasms were reported by 32 (11.9%), with the majority of these (n=27, 84%) referred to a specialist physiotherapist with expertise in spasticity management for comprehensive assessment. Of the referred patients, 5 (18.5%) did not attend their appointments, 5 (18.5%) are still awaiting appointments, 6 (22.2%) were diagnosed with non-neural stiffness, and 9 (33.3%) received botulinum toxin injections at a specialist physiotherapist-led spasticity clinic. Conclusion Data from this exploratory study indicates the importance of assessing spasticity in patients post stroke and highlights the importance of access to a physiotherapist with specialist knowledge and skills in spasticity management.