Top Things to Know: Early Recognition & Intervention for Poststroke Spasticity
Published: January 29, 2026
Prepared by Sujani Bandela, MD, Writing Group Vice Chair, and Mark Goldberg, MD, Writing Group Chair
- Poststroke spasticity is common, disabling, and costly, affecting 30–80% of stroke survivors and contributing to impaired mobility, increased caregiver burden, and substantially higher health care costs.
- Poststroke spasticity remains underrecognized and undertreated. Many patients experience delayed diagnosis or no treatment, allowing preventable complications such as pain, loss of range of motion, and joint contractures to develop.
- Spasticity is a multidomain motor disorder rather than simply increased muscle tone, reflecting the interaction of involuntary muscle overactivity, impaired voluntary motor control, and progressive passive tissue remodeling.
- Spasticity arises from injury to specific descending motor pathways, including corticospinal and related systems, leading to abnormal activation of descending motor circuits and intraspinal reflexes. Improved understanding of pathophysiology may support more effective, targeted therapies.
- Evidence supports proactive, multimodal treatment approaches to poststroke spasticity. Early use of therapies such as botulinum toxin, task-specific training, functional electrical stimulation, and mobilization, especially when combined with rehabilitation, can reduce spasticity severity.
- High-risk patients can be identified early and warrant proactive monitoring. Larger strokes, corticospinal tract involvement, and limited early motor recovery are strongly associated with spasticity development.
- Spasticity can interfere with the brain’s critical window for recovery, as early emergence may limit voluntary movement, increase pain, and reduce engagement in task-specific rehabilitation when neuroplastic potential is greatest.
- Early treatment, defined as within 3 months after stroke, may improve long-term outcomes. Randomized clinical trials are needed to determine whether early spasticity-directed interventions enhance durable functional recovery and reduce overall burdens of care.
- Access to spasticity care remains a major challenge due to workforce shortages, insurance barriers, and geographic disparities, particularly affecting under-resourced and rural populations.
- Innovative, coordinated multidisciplinary care models may improve early recognition and access. Health care professional education, telehealth, remote technology, and scalable care pathways offer opportunities for earlier and more equitable spasticity care.
Citation
Bandela S, McPherson L, Harvey RL, Awosika O, Aggarwal D, Liu CY, Raghavan P, Goldberg MP, on behalf of the American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Basic Cardiovascular Sciences; and Council on Lifestyle and Cardiometabolic Health.
Early recognition and intervention for poststroke spasticity: a scientific statement from the American Heart Association. Stroke. Published online January 29, 2026. doi: 10.1161/STR.0000000000000515