The pathophysiological and clinical implications of neuro-muscular changes following cerebrovascular accident.

This review evaluates research investigating spasticity, weakness, stiffness and central nervous system plasticity following cerebrovascular accident. The term spasticity is frequently applied to a variety of movement impairments exhibited by stroke patients, impairments which may actually represent weakness or alterations in mechanical properties of muscle. Experimental research indicates spasticity occurs in response to stretch of relaxed hemiparetic muscle. In actively contracting muscle of stroke patients, research findings have shown reduced EMG activity and weakness of muscles of both affected and unaffected sides of the body. Additionally, in actively contracting hemiparetic muscle, evidence has revealed non-reflex mediated stiffness which can be attributed in part to changes in connective tissue arising from disuse secondary to hemiparesis. Clinical implications of these scientific findings are presented for the physiotherapy management of cerebrovascular accident.