Post-stroke spasticity (PSS) is a condition that affects up to one in four stroke survivors. Spasticity can cause painful stiffness, contractures, and loss of mobility. In long-term care (LTC), where more than 20% of residents have a history of stroke, spasticity is often present but under-recognized. Registered Practical Nurses (RPNs) make up most of the nursing workforce in LTC and managing PSS can add to the physical and emotional demands of their care. Despite this, there has been little research focused on how RPNs understand and respond to spasticity in everyday practice. As part of a WeRPN-funded RPN Research Fellowship, we explored this issue by asking: What do RPNs know about post-stroke spasticity? How does it impact their work and the residents they care for? And what supports are needed to improve care?
A Collaborative Research Journey
This project was a true collaboration between academic mentor Dr. Amanda McIntyre and RPN Research Fellow Jennifer Walker. Through a series of semi-structured interviews with 26 staff members working at Mount Center for Long Term Care in London, Ontario, we gathered deep, practice-based insights into how spasticity is experienced and managed on the frontlines. For Jennifer, the Fellowship was a chance to grow personally and professionally. Jennifer reflected, “Being part of this project opened my eyes to how research can drive meaningful change in LTC,” she said. “It gave me confidence to contribute in new ways, and I’m excited to continue working with Amanda on future projects.”
What We Learned: Seven Key Themes
The nursing staff we spoke with brought forward rich, firsthand experiences of caring for residents with PSS. Seven major themes emerged:
1. Spasticity Is Common But Not Always Recognized
While many staff observed symptoms like stiffness or contractures, the term “spasticity” was not always familiar or consistently used. Estimates of how common it was varied widely.
2. Resident Quality of Life Is Deeply Affected
Spasticity interfered with nearly every activity of daily living, from toileting and dressing to mobility and recreation. Residents often experienced frustration, chronic pain, and a loss of independence. The psychological toll was especially evident in those who were cognitively aware of their limitations.
3. Spasticity Increases Staff Workload and Burnout
Staff described the physical demands of caring for residents with tight limbs, the time required for transfers and repositioning, and the need for two-person assists or mechanical lifts. This added to emotional strain and sometimes led to feelings of burnout.
4. Management Strategies Are Inconsistent
Treatment approaches varied widely, and staff often felt unsure about the best strategy. While physiotherapy, stretching, and botulinum toxin injections were often effective, not all residents had access.
5. There Is No Standardized Model of Care
All participants reported that there was no formal approach to managing spasticity. Care was largely reactive and dependent on individual experience and informal team collaboration.
6. Training Gaps Limit Confidence and Care Quality
Most staff had received little to no formal education on spasticity and learned primarily through experience. There was a strong desire for more structured training, especially hands-on workshops and in-services.
7. Resident and Family Involvement Is Inconsistent
While staff tried to include residents and families in care planning, this was often limited by cognitive impairment or systemic barriers. Participants emphasized the need to align care with residents’ goals and preferences.
What We’re Doing Next
These findings confirm that spasticity is a serious condition that impacts both residents and staff, yet it often flies under the radar. To build on this work, we launched a follow-up quantitative study assessing the prevalence and impact of spasticity among nearly 300 residents. We’re also preparing to pilot a new Spasticity Screening Tool in LTC practice to help RPNs identify the condition earlier and respond more consistently. Our goal is to make post-stroke spasticity visible and manageable within the realities of LTC.
A Call to Action
RPNs are essential in providing high quality care in LTC settings. Our research highlights the need for greater education, standardized tools, and formal care pathways that support both residents and the nurses who care for them. We hope our work encourages other RPNs to ask important questions, pursue professional development, and participate in research that improves care.
We would like to graciously acknowledge the support of this work by the Registered Practical Nurses Association of Ontario (WeRPN). We also thank St. Joseph’s Health Care London and the team at Mount Hope for their ongoing support.
