Stroke Rounds: Early Post-Acute Period Predicts Spastic Limbs

I really don't give a shit about predictions. What the hell will prevent spasticity from settling in? That is the question to research. Everything else about spasticity is worthless including anything Dr. William M. Landau has to say.
http://www.medpagetoday.com/Cardiology/Strokes/53116?xid=nl_mpt_cardiodaily_2015-08-18&eun=g0d3r
Sensorimotor function soon after a stroke predicts limb spasticity longer term, a prospective Swedish study showed.

The best model for predicting any spasticity at 12 months post-stroke was based on measurements of upper limb flexion and extension at 10 days after the stroke (85% sensitivity, 90% specificity), according to Arve Opheim, PT, PhD, of the University of Gothenburg, Sweden, and colleagues.

For predicting persistence of severe spasticity, the best model was based on assessment of spasticity at 4 weeks post-stroke, with 91% sensitivity and 92% specificity, they reported online in Neurology.

While smaller prior studies have suggested a range of early predictors (reduced sensorimotor function and activities of daily living, muscle weakness, left-sided paresis, and smoking), Opheim's study identified sensorimotor function as the most important predictor both for any and for severe spasticity at 12 months post-stroke.

"This emphasizes the importance of assessing patients regularly and accurately during rehabilitation," Thierry M. Lejeune, MD, PhD, and Gaëtan Stoquart, MD, PhD, both of Université Catholique de Louvain in Brussels, wrote in an accompanying editorial. "Ideally, this assessment should not focus only on neurologic impairments."

"Early identification of patients at risk of developing spasticity should improve the quality of care," they added. "They should be regularly assessed and would benefit from early treatment to avoid long-term complications (e.g., contractures), especially for the most impaired patients or those with reduced access to specialists." (Early identification will do no fucking good because there is no cure for spasticity and specialists will be able to do nothing.)

The study included 117 first-time stroke patients in the Gothenburg area who had documented arm paresis at day 3 post-stroke and were assessed for spasticity in elbow and wrist using the modified Ashworth Scale (MAS) subsequently at 10 days, 4 weeks, and 12 months after their stroke.

The sample comprised consecutive patients admitted to the largest acute stroke unit at a single center over an 18-month period in 2009–2010 as a part of the Stroke Arm Longitudinal Study at the University of Gothenburg (SALGOT) looking into recovery of upper extremity function.