The traditional definition of stroke, devised by the World Health Organization (WHO) in 1978, is a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours". Stroke is currently the second cause and may soon become the leading cause of death worldwide ( Feigin 2005). This would assist the therapist's initial decision‐making in the clinical setting when treating upper or lower limb spasticity. A wider range of physical interventions are becoming more available to clinicians but, as the number of interventions increases some guidelines are required for clinicians to choose those with the optimum benefits.Ī systematic review is required to provide clear information on the evidence relating to the effects of different physical interventions for spasticity. standing, active/passive exercises, and positioning) include facilitating neural activity in the damaged cerebral hemisphere, and minimising changes in the viscoelastic properties of connective tissue muscles around the joints ( Stevenson 2010). A more limited volume of research is available for anti‐spasticity medications which is the subject of another Cochrane review currently being developed ( McCrea 2008). A substantial volume of research has been conducted into focal pharmacological agents for spasticity and a Cochrane review of this aspect is currently being developed ( Lyons 2007). According to Stevenson 2010, "management strategies can broadly be described as either physical or pharmacological, rarely is there a place for surgical intervention". Some form of intervention is estimated to be required in cases where spasticity interferes with function, causes pain or where long‐term complications are expected ( Barnes 2001b). If poorly managed, spasticity may lead to the development of long‐term secondary complications such as soft tissue contractures, limited function, painful pressure sores, or social isolation ( Thompson 2005). Additionally, spasticity is often associated with pain, interference with the patient's self‐care and their ability to carry out activities of daily living ( Barnes 2001a). Those with spasticity have significantly lower functional performance, as indicated by the Barthel Index ( Mahoney 1965), and a greater likelihood of having to live in institutional care. It is estimated that 19% of stroke patients develop spasticity during the first three months after the acute event ( Sommerfield 2004), and it has been found that increased muscle tone is present in around 38% of community‐dwelling patients 12 months following their stroke ( Watkins 2002). Although its definition and prevalence vary, spasticity (also referred to as hypertonicity) is a common, persistent and often disabling problem for stroke patients. Stroke is one of the leading causes of death and disease burden among adults ( WHO 2003).
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