Department of Geriatric Medicine, Danderyd Hospital, Danderyd, Sweden.
Am J Phys Med Rehabil. 2012 Sep;91(9):814-20. doi: 10.1097/PHM.0b013e31825f13a3.
The objective of this study was to present an overview of the prevalence of spasticity after stroke as well as of test instruments and treatments. Recent studies show that spasticity occurs in 20%-30% of all stroke victims and in less than half of those with pareses. Although spasticity may occur in paretic patients after stroke, muscle weakness is more likely to be the reason for the pareses. Spasticity after stroke is more common in the upper than the lower limbs, and it seems to be more common among younger than older people. To determine the nature of passive stretch, electromyographic equipment is needed. However, the Modified Ashworth Scale, which measures the sum of the biomechanical and neural components in passive stretch, is the most common instrument used to grade spasticity after stroke. Treatment of spasticity with physiotherapy is recommended, although its beneficial effect is uncertain. The treatment of spasticity with botulinum toxin in combination with physiotherapy is suggested to improve functioning in patients with severe spasticity. A task-specific approach rather than a neurodevelopmental approach in assessing and treating a patient with spasticity after stroke seems to be preferred.
本研究旨在概述卒中后痉挛的发生率，以及测试工具和治疗方法。最近的研究表明，所有卒中患者中有 20%-30%出现痉挛，而弛缓性瘫痪患者中不到一半出现痉挛。尽管卒中后可能会在弛缓性瘫痪患者中出现痉挛，但肌肉无力更可能是弛缓性瘫痪的原因。卒中后痉挛在上肢比下肢更常见，在年轻人中似乎比老年人更常见。为了确定被动拉伸的性质，需要肌电图设备。然而，改良 Ashworth 量表是最常用于评估卒中后痉挛的工具，它测量被动拉伸的生物力学和神经成分的总和。建议采用物理疗法治疗痉挛，但疗效不确定。联合物理疗法使用肉毒毒素治疗痉挛可改善严重痉挛患者的功能。在评估和治疗卒中后痉挛患者时，似乎更倾向于采用任务特异性方法，而不是神经发育方法。
