Early Recognition and Intervention for Poststroke Spasticity: A Scientific Statement From the American Heart Association

Spasticity and related motor disorders are common and often disabling complications after stroke, affecting an estimated 30% to 80% of survivors. Spasticity can impair functional mobility, reduce independence, and increase caregiver burden. Secondary complications, including pain, restricted range of motion, skin breakdown, and joint contractures, further degrade quality of life, limit rehabilitation outcomes, and increase health care costs. Despite the availability of options to manage spasticity and mitigate its effects, timely diagnosis and intervention remain key challenges. Many patients receive treatment only after spasticity has become well established, and others receive no treatment at all due to persistent disparities in recognition, access, and delivery of treatment for spasticity, contributing to long-term disability and increased costs of care. This scientific statement reviews the rationale, established and emerging evidence, and strategic approaches for improving early recognition and intervention for poststroke spasticity. Early intervention is defined as treatment initiated within the first 3 months after stroke onset, potentially before development of secondary impairment from poorly controlled spasticity. Recognizing spasticity as a multidomain clinical syndrome-including involuntary muscle overactivity, impaired voluntary motor control, and passive tissue remodeling-offers important opportunities to improve timely diagnosis and treatment. Progress will also depend on a deeper understanding of the time course and pathophysiology of spasticity through both animal and human models. This scientific statement also outlines strategies to close gaps in recognition and care, including expanding and training the specialist workforce; developing innovative, scalable approaches for early detection and management; and strengthening care pathways and access to meet the substantial unmet needs of patients with poststroke spasticity.