Article

Hypertonicity is common in patients with upper limb dysfunction following
hemiplegic stroke and is associated with greater impairment, worse function, and
lower health-related quality of life. In addition to increased rest activity,
abnormal patterns of muscle activation, such as spastic co-contraction, may
contribute to disability. In the upper limb, flexor muscles are more commonly
involved distally, and at the shoulder, spasticity of adductors, flexors, and
internal rotators is most often observed. Prior to interventions, a history
regarding prior interventions, comorbid diagnoses, and limitations imposed by
abnormal tone should be elicited. Commonly used scales to assess hypertonicity
include the Modified Ashworth, the Modified Tardieu, the Spasm Frequency, the
Disability Assessment, the Fugl-Meyer, and the Motor Assessment Scales. Treatment
interventions for upper limb hypertonicity include stretching, splinting,
strengthening of antagonist muscles, oral medications, and focal injections
(phenol or botulinum toxins). Intrathecal baclofen may also impact upper limb
tone. For focal injections, correct identification of muscles contributing to
problematic tone is evaluated by eliciting resistance to movement at rest and
observation of patterns of tightness as the limb is used functionally. The
botulinum toxins have been shown to decrease tone in stroke survivors and improve
active and passive functioning. Because secondary changes such as contractures
and weakness may occur with prolonged hypertonicity, therapy to improve range of
motion, strengthen weakened muscles, and incorporate use of the limb should be
considered following focal injections, oral medications, or intrathecal pump
placement.

Langue : ANGLAIS