Onset, time course and prediction of spasticity after stroke or traumatic brain injury.

OBJECTIVE: To describe spasticity from the onset of acquired brain injury, time course over the first year and factors associated with prediction of the development of spasticity.

METHODS: Recent relevant literature known to the authors, along with a complementary search yielding a total of 9 articles, represented the base for this scoping review.

RESULTS: Spasticity can be seen in the first week after brain injury and is more common in the upper than lower extremity. The severity of upper-limb impairment is a major factor in the development of spasticity during the first year after stroke. The prevalence of severe spasticity seems to increase during the first year. The combination of reduced arm motor function and spasticity in an early phase (4 weeks post-stroke) is an important predictor of the development of severe spasticity after 12 months. Spontaneous reduction in spasticity was seldom reported but may occur, especially in mild forms of spasticity.

CONCLUSION: Signs of spasticity can often be noted within the first 4 weeks after brain injury and is more common in the upper than lower extremity. Impaired sensorimotor function is a predictor. These findings highlight the importance to follow up patients with increased risk of developing severe spasticity to be able to start adequate spasticity treatment and prevent the negative consequences of spasticity. Understanding spasticity onset and progression also provides a basis for the development of effective therapies.