The tight arm is not a stretching problem — early spasticity
| Patient | 55F, subacute phase |
|---|---|
| Lesion | MCA territory, moderate |
| Severity | NIHSS 9 |
| Days since onset | 12 |
| Before the strokeIndependent; chef, right hand dominant. | |
| Also on the chart | Hypertension |
| PrecautionsPalm skin check every session; No forced finger extension | |
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What is the spasticity plan?
The teaching
Early spasticity is a management plan, not a wrestling match: position the limb, use it in tasks, refer for focal toxin when a named function is blocked — and measure the unblocking. The Modified Ashworth grade is a descriptor of resistance, and the day it becomes the goal is the day the hand stops being the point.
- Skin breakdown in the palm — hygiene access becomes urgent
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the five-domain examination, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Katalinic OM et al. Cochrane Database Syst Rev. 2010. Winstein CJ et al. Stroke. 2016 · Bohannon RW, Smith MB. Phys Ther. 1987. Winstein CJ et al. Stroke. 2016