General information on stroke and spasticity
Stroke:
Definition stroke:
A "stroke" describes the sudden "sudden" occurrence of symptoms such as hemiplegia, movement, speech and consciousness disorders. A stroke is also called apoplexy, stroke
or cerebral insult. The cause of a stroke is either a cerebral infarction or a cerebral hemorrhage. Ultimately, this can only be determined with certainty in the clinic using imaging (CT/MRI).
Symptoms:
The brain is supplied with blood by four large arteries. Depending on the location and cause of the stroke, various symptoms may appear as follows:
Headache and dizziness (possibly the first warning symptoms), acute paralysis of a complete side of the body, often affecting the legs or arms, with paralysis of one half of the face (facial paresis) with a drooping corner of the mouth and uncontrolled salivation, sensory disturbances (usually on one side on the paralyzed side), visual disturbances (e.g. double vision, visual field loss), pupillary discrepancy, speech disorders (word-finding disorders), speech disorders (slurred speech), disturbance of balance and movement coordination, etc..
A practical example:
Mr. Andreas Sommer said to his wife: "I'll lie down in the bedroom because I've got these visual disturbances again". Three hours later, when Ms. Sommer worriedly looked after her husband, she found the 72-year-old lying awake in bed. "Andreas, what's going on?". Herr Sommer looks at her questioningly and stammers a few unintelligible syllables. He tries to get up, but he can't. Ms. Sommer immediately called the emergency doctor.
How do I prevent a stroke?
Recognize the stroke risks and prevent them.
Stroke risk factors that can be influenced:
Heart disease (e.g. atrial fibrillation), high blood pressure, stress, alcohol consumption, increased blood lipids, smoking, abdominal obesity, diabetes.
Heart disease
(eg, atrial fibrillation)
High blood pressure
Stress (e.g. burnout)
Alcohol consumption
Most of the risk factors listed have in common that they promote what is known as arteriosclerosis.
In arteriosclerosis, substances such as cholesterol, blood cells, connective tissue and calcium salts are deposited on the inside of the blood vessels.
As a result of the deposition, the normally elastic vessel wall becomes increasingly rigid and its smooth inner wall becomes rough. The rough spots allow further deposits. These grow and the vessel narrows more and more. Small components of the blood get stuck and form blood clots (thrombi). If the blood clot breaks loose, it can lead to an ischemic stroke.
A hemorrhagic stroke can occur when the blood vessels in the brain have a weak wall structure, such as from arterosclerosis.
Ischemic stroke
What is an ischemic stroke (brain attack)?
An ischemic stroke causes an interruption in blood flow to the brain. The brain is supplied with blood via four large arteries (these are blood vessels that pump the oxygenated blood in the lungs from the heart to the systemic circulation/brain).
The blockage of the blood flow in an artery occurs due to various causes such as a thrombus (blood clot) and means that the brain cells are no longer supplied with oxygen and nutrients.
Hemorrhagic stroke
What is a hemorrhagic stroke (brain bleeding)?
A hemorrhagic stroke occurs when there is bleeding into the brain tissue. This can occur when the blood vessels in the brain have weak wall structure, vascular malformations, or the vessels are under abnormally high pressure, such as high blood pressure.
Depending on the extent and localization in the brain, the cerebral hemorrhage causes massive symptoms such as very severe headaches.
Preventive action
Move more often.
This has a positive impact on cardiovascular and vascular health, blood pressure and weight.
Less alcohol & nicotine. Nicotine causes narrowing of the arteries, accelerates the pulse and the blood becomes more viscous.
Alcohol can prolong the blood clotting time in some people and temporarily increase the heart rate and constrict the blood vessels.
Lower your weight.
Being overweight affects blood sugar and blood pressure. Eating healthy and losing weight directly lowers blood pressure in most people and reduces the risk of stroke.
Take care of yourself.
It is difficult to give blanket advice. Taking care of yourself is very important.
Spastic
How does spasticity come about?
The most common cause of spasticity is a stroke. Spasticity is damage to the central nervous system (CNS) and thus to the brain, spinal cord or their connections. Some of these areas are connected to the skeletal muscles via the nerve tracts and in this way control our movements. And it is precisely these areas that are affected by spasticity.
Spasticity, also known as spasm or spasticity, derives from the Greek word "spasmós" meaning spasm. Damage to the central nervous system (CNS) causes a pathological increase in muscle tension or muscle tone. The overactive muscles lead to a permanent hardening and stiffening, the so-called spastic paralysis.
The muscle is permanently put into a state of excitation by the nerves. This can range from a slight increase in the muscle's intrinsic tension (increased muscle tone) to a definite command for a muscle to contract (muscle tightening). The activity and outgoing movements of the muscle can no longer be controlled under these circumstances. Spastic paresis or paralysis occurs.
Spasticity usually develops within the first 30 days after the stroke in about a quarter of those affected. The spasticity often worsens over the next few months to a year.
Muscle stiffness often leads to painful and disabling postures. As a result, the quality of life is severely impaired and everyday activities can no longer be carried out. Spasticity is not a disease, but a symptom of the central nervous system (brain 🧠 or spinal cord) being severely damaged, for example after a stroke or traumatic brain injury.
Spasm is not the same as spasm!
Spastic paralysis can vary in severity and side effects. This has to do with how badly certain areas of the brain or the spinal cord were affected. Spastic paralysis can manifest itself as mild muscle stiffness with minor limitations in movement or as permanent muscle cramps with severe limitations up to complete inability to move.
Spastic paralysis can affect individual muscles or entire areas of the body. If there is only a locally occurring spasm, one also speaks of a focal spasm. If all limbs are affected, the spasticity is referred to as generalized.
Different dimensions of spasticity are presented below:
- Monospasticity: When one leg or arm is affected by the spasticity.
- Paraspasticity: When both arms or legs are affected by the spasm.
- Hemispasticity: One arm and one leg are affected by the spasticity on one side of the body.
- Tetraspasticity:
All extremities are affected by affected by spasticity. Depending on the severity, the neck and trunk muscles can also be affected.
More symptoms
The damage to the brain or spinal cord can present other symptoms of spasticity. These include, for example:
- Sensitivity disorders
- Paralysis
- Difficult coordination
- Uncontrolled muscle movements
- Lack of strength
- Pain
This is what spasticity in the arm can look like
The different levels of spasticity in the muscles result in posture patterns that are often typical. The posture and movement pattern in the case of spastic paralysis of the arm or leg can be assigned to one of the following patterns for most of those affected, with the transitions being fluid.
How do I recognize spasticity?
At the onset of the stroke, symptoms such as paralysis or loss of speech appear, but lesions in the central nervous system begin to form at this point. In the weeks or months that follow, spastic movement disorders can occur as a late consequence, which have a major impact on the further course of recovery. It is assumed that around 250,000 patients in Germany have spasticity. Damage to the central sensorimotor system results in muscle tension, clonus, spasms and spastic dystonia, which severely impair motor function. Increased muscle tone and altered soft tissue and muscle fiber density are also characteristic of spasticity. The flexion and extension movement of several joints z. B. Arm abductors/adductors, elbows, flexors and extensors, knee extensors, hamstrings, wrist and fingers can be tested and evaluated. The Ashworth and Tardieu scales are used to assess the degree of spasticity, the Zorowitz questionnaire allows spasticity to be identified (see below).
What parameters does a doctor use to evaluate?
Ashworth-Skala
The Ashworth scale is used to rate muscle spasticity on a point scale. The increase in muscle tension is measured in the passive state. Doctors first examine the patient's physical conditions before using medical technology such as CT, MRI for neurological tests and imaging. The finding of muscle stiffness, i.e. the severity of the spasticity, provides information about the limitations in everyday life. In addition, muscle strength, muscle tone, joint mobility and pain intensity are evaluated by the doctor.
Modified Ashworth scale
The original Ashworth scale was a 5-point scale designed to easily measure and rate spasticity. This scale was later modified to a 6-point scale by Bohannon and Smith (1987).
Please ask your attending doctor which point scale your assessment resulted in.
Tardieu-Skala
Compared to the Modified Ashworth Scale, the Tardieu Scale is better suited to distinguishing contractures or restricted mobility from spasticity.
Two measurements are made: quality of muscle response and angle of muscle response at slow and fast speeds.
Please ask your attending doctor which point scale your assessment resulted in.
Zorowitz Questionnaire (to be completed by the patient)
The Zorowitz Questionnaire is one of the first practical instruments for spasticity, complementing the Ashworth and Tardieu scales previously described. When the Ashworth and Tardieu scales are used to assess the degree of spasticity, this 13-item spasticity tool is designed to detect spasticity. It should be noted that the screening tool is patient-completed and therefore does not capture the perspective of the caregivers.
Here you can download the Zorowitz questionnaire as a pdf file:
Barthel-Index
The Barthel Index systematically records a patient's basic everyday functions.
Different areas of activity of the patient are evaluated with points.
Please ask your attending doctor what your rating is on the Barthel Index.
Modified Rankin Scale (mRS)
The mRS is a standardized measure that describes the extent of disability after a stroke.
Please ask your attending physician what evaluation your mRS resulted in.
Body-Mass-Inde (BMI)
The body mass index (BMI) helps the doctor to assess whether you are normal, overweight or underweight.
The BMI is calculated using the following formula:
Body weight (in kilograms) divided by height (in cm) squared.
Here is a link to a free BMI calculator:
www.anad.de/essstoerungen/bmi-rechner/?gclid=Cj0KCQjw3v6SBhCsARIsACyrRAko-z20cCDPb2umQVg9XE91ZCHLAp-BdoBsXork5OMq8cunpq8Yqm0aAjCSEALw_wcB
Geriatric Depression Scale (GDS)
The GDS is a geriatric assessment tool, also known as the Yesavage Depression Test.
With the help of a questionnaire, which is to be filled out by the patient, any indications of an existing depression in old age or a depressive mood can be given.
You can download the questionnaire as a pdf file here:
Understand medical terms better
Apoplex = synonym for stroke.
Aspiration pneumonia = pneumonia caused by swallowing disorders after a stroke
Amnesia = temporal and/or substantive memory loss.
Aphasia = speech disorder
Ataxia = coordination disorder.
Apraxia = Disorder in the ability to carry out purposeful movements or actions in a meaningful and orderly manner, often occurs together with aphasia.
Arteriosclerosis = colloquially "vascular calcification", whereby material, fats present in the blood ("atherosclerosis") and calcium deposit on the inner walls of the blood vessels and narrow or block the vessels.
Decubitus = pressure sore that can result from long-term immobility and the resulting reduced blood flow to the contact surface.
Dysarthria = speech disorder
Dysphagia = Swallowing disorder
Embolus = endogenous or foreign material (e.g. blood clot) that is washed further in the bloodstream and blocks the vessel. The source can be vascular sclerosis or a clot from the heart in atrial fibrillation.
Facial paralysis = facial paralysis
hemorrhage = bleeding
Hemianopsia = one-sided loss of visual field.
Hemiparesis = partial paralysis of one side of the body.
Hemiplegia = complete paralysis of one side of the body.
Cerebral hemorrhage = bleeding in the head that can lead to a hemorrhagic stroke. The bleeding can occur either in the brain or between the meninges.
Cerebral infarction = the most common stroke, characterized by a lack of blood flow in the brain due to vascular occlusion due to arteriosclerosis or embolism.
Cerebral edema = swelling in the brain, can occur with major strokes and cause further damage due to intracranial pressure.
Hypertension = high blood pressure, is one of the risk factors that favor the development of a stroke.
Ischemia = reduced blood flow
Clonus = spasmodic muscle twitching.
Contracture = shortening and hardening of a tissue (muscles or joints), which often leads to a restriction of movement and occurs with prolonged spasticity.
Muscle tone = state of tension of a muscle.
Neglect = Disturbance of attention characterized by neglecting one part of the room or one half of the body.
Neuroplasticity = the ability of the brain to make functional, structural, and adaptive changes after changing physiological demands or damage.
paresis = paralysis
Pathological reflexes = "morbid" reflexes that only occur after an illness.
Pusher symptoms = disturbance of perception that leads to an active pressing of the unaffected limb to the affected limb.
Stroke = Syndrome that develops from a sudden disturbance of blood flow in the brain and includes various symptoms and signs.
Sensitivity = perception of touch, pain, temperature or sense of position (joint position). Losses, especially in the senses of pain and temperature, can also lead to painful hypersensitivity.
Spasm = Krampf
Spasticity = pathological increase in muscle tension (spasm = cramp), usually the result of damage to the brain or spinal cord. Usually leads to greater disability of movement and in the long term to contractures.
Stroke unit = specialized ward in a hospital that carries out the acute treatment of people after a stroke.
Platelet function inhibitors = "blood thinners" to prevent the progression of arteriosclerosis and thus another stroke.
Transient ischemic attack (TIA) = temporary disturbance of blood flow in the brain, with the symptoms usually disappearing after minutes or a few hours.
Thrombectomy = stroke therapy, whereby the blood clot is dissolved mechanically.
Thrombolysis = stroke therapy, whereby the blood clot is eliminated by an infusion with a special drug.
Thrombus = "blood clot" that can lead to the occlusion of a vessel with the consequent impairment of the blood and oxygen supply to the region supplied.
Vision loss = complete loss of vision.
Sources:
Correll, A. Spastik nach Schlaganfall. CV 17, 30–34 (2017).
https://doi.org/10.1007/s15027-017-1220-z
Duden Wörterbuch
https://www.duden.de/woerterbuch
Medizinwissen suchen, KnowHow teilen - DocCheck Flexikon
https://flexikon.doccheck.com/de/Spezial:Mainpage
Nolte, C.H., Müller-Nordhorn, J., Jungehülsing, G.J. et al. Symptome, Risikofaktoren und Ätiologie von transitorisch ischämischer Attacke und Schlaganfall. Nervenarzt 76, 1231–1238 (2005).
https://doi.org/10.1007/s00115-005-1928-3
Nolte, C., Endres, M. Akutversorgung des ischämischen Schlaganfalls. Internist 53, 585–594 (2012).
https://doi.org/10.1007/s00108-011-3003-4
LL_22_2012_akuttherapie_des_ischaemischen_schlaganfalls.pdf (dsg-info.de)
Schlaganfall (Apoplex): Warnzeichen, Ursachen, Therapie - NetDoktor
https://www.netdoktor.de/krankheiten/schlaganfall/
Correll, A. Spastik nach Schlaganfall. CV 17, 30–34 (2017).
https://doi.org/10.1007/s15027-017-1220-z
Note: For reasons of better legibility, the masculine form is used for personal designations. Corresponding terms generally apply to all genders in terms of equal treatment. The shortened form of language is for editorial reasons only and does not include any rating.