An Observational Study Comparing Measures of Spasticity: Brunnstrom and Lance

Abstract Introduction: Motor impairment post-stroke is a feature of the upper motor neuron syndrome (UMNS). The Brunnstrom Recovery Staging (BRS) is an accepted measure of its progression. It has limited generalisability and accuracy. This study proposes the Lance Scale (LS) as an alternative. The two measures are then compared. Materials and Methods: This cross-sectional study compares the LS in comparison to BRS in a cohort of stroke survivors. There were 103 participants. Inclusion criteria were those having a first new middle cerebral artery region ischaemic stroke, hemiplegia, encountered within 3 weeks of the event, Modified Ashworth Scale (MAS) 0–3 and able to obey one-step commands. Exclusion criteria were as follows: tone of MAS 4, spastic dystonia, prior strokes or any concurrent orthopaedic, psychiatric or neurodegenerative disorders. Information related to age, gender and affected side was collected along with the Alberta Stroke Programme Early CT Score (ASPECTS). Tone and selective voluntary motor control were assessed at the affected elbow. Values were assigned using both BRS and LS. The two were compared for representativeness of the UMNS. LS differs from BRS in that it accounts for all possible tone variants and links to the ASPECTS. Results: The LS provides a more accurate and detailed representation of clinical findings. In the High ASPECTS group, the onset of spasticity did not correlate at all with the BRS (rho = 0.12, P = 0.4). In the intermediate ASPECTS group, the onset of spasticity did not correlate with the BRS (rho = −0.04, P = 0.8). In the low ASPECTS group, the onset of spasticity most closely correlated with the BRS (rho = −0.4, P = 0.1). Regardless of the ASPECTS subgroup, the LS accurately described each presentation. Conclusion: The Lance score is a more detailed and accurate measure to represent the motor recovery in the UMNS. It can help frame the existing literature, facilitating custom clinical decision-making.