Post-Stroke Spasticity (PSS) Setting Up a PSS Clinic: Experience and Results

Stroke is a leading cause of long-term disability. As a consequence of stroke and associated upper motor neuron (UMN) syndrome, stroke survivors are often left with muscle over activity, including spasticity. Spasticity is characterized by over- activity in muscles after injury to the central nervous system. When left untreated, post-stroke spasticity (PSS) can lead to contractures, pain and deformity, involuntary movement, and greater functional impairments (eg, reduced mobility, self-care and dressing). Spasticity is a common symptom after stroke, arising in about 30% of patients, and usually occurs within the first few days or weeks [1]. However, the onset of spasticity is highly variable and can occur in the short- medium or long-term post-stroke period [2]. Post-stroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Patients with poststroke spasticity often demonstrate recognizable antigravity postural patterns (Fig 1) characterized by shoulder adduction, elbow and wrist flexion in the upper limb, hip adduction, knee extension and ankle plantar flexion in the lower limb. This “hemiplegic” posture, which is thought to result from increased motor neuron activity in antigravity muscles, significantly interferes with body image, balance and gait. BoNT-A, one of the most potent biologic toxins known to man acts by blocking neuromuscular transmission via inhibiting acetylcholine release [3]. BoNT-A treatment in post-stroke upper and lower limb spasticity is a safe and effective procedure to decrease muscle tone and increase the range of motion. More recent studies are demonstrating the importance for the rehabilitation therapist intervention to work alongside the physician to create more positive and significant effects on active function [4]. Daily stretching exercise is the key for the long-lasting benefits. BoNT-A Injections, Ultrasound guided technique, performed by a Physician in combination with physiotherapy and outcomes measurements are used to improve upper and lower limb function in stroke patients with spasticity in the clinical setting [5]. We would like to share our experience on the benefit of the ultrasound guided technique to target the muscles and our results in setting up a spasticity clinic for post-stroke patients.