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This module discusses the pathophysiology of spasticity and the lesions underlying the condition. It considers the clinical presentation of spasticity and outlines the relevant clinical history that should be documented. The positive and negative signs of spasticity are explained. Clinical presentations of spasticity are discussed, and an illustrated table of spastic limb postures details how the muscles involved in each individual's condition may be identified. The main systems for assessing the severity of the condition, the Ashworth Scale, the modified Ashworth scale, and the Tardieu Scale, are explained. The likelihood of spasticity developing following a stroke and the probable long-term outcomes are considered. The value of involving patients in their own treatment regimens, by defining and setting goals, using the SMARTER system is explained, and the need to continually assess and refine treatment with time as the condition progresses is also discussed.

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Spasticity management should be part of a well-coordinated and comprehensive rehabilitation program that is patient-centric and goal-specific. There are a variety of options available for the treatment of spasticity. A usual approach is starting with the least invasive treatment modalities initially and gradually increasing to more complex interventions as this is required. This curriculum considers oral antispasticity drugs in terms of mechanism of action, clinical use, efficacy, and adverse events. It also presents other treatment options, such as chemical neurolysis using phenol and alcohol and chemodenervation using botulinum toxin A (BoNT-A). Therapeutic intramuscular injections of BoNT-A require sound patient selection, accurate muscle selection, and precise localization. The common methods for achieving these are described. The importance of physiotherapy is explained, along with the necessity to combine treatment modalities to address spasticity and the various components of the upper motor neuron syndrome. Recognizing differences in various health-care systems across countries and regions, the authors aim to present various treatment options. While this section of the curriculum highlights the importance of an interdisciplinary effort in managing spasticity, it is understandable that not all treatment options are available uniformly. The challenge to clinicians is to make the most of the management options on hand to optimize outcomes.

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This module outlines the history of the development of surgical interventions for treating spasticity and discusses when surgical intervention is most appropriate for managing spasticity. A range of surgical techniques are considered; intrathecal baclofen, neurotomy, and muscle or tendon lengthening and transfer procedures. The implications and limitations of the surgical techniques are considered. The need for a multidisciplinary team to deliver optimal surgical treatment is also considered.

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With many recent advancements in spasticity treatment, more patients are surviving critical illness and injury but are left with ongoing disability that needs constant treatment. Such treatment will change as the patient's condition evolves. Constant appraisal of treatment efficacy and patient progress is therefore an important component of spasticity management, and physicians need to be familiar with how to troubleshoot treatment regimens when outcomes of that regimen become suboptimal. This module considers how to optimize the use and outcomes of major treatment modalities and provides drug and device maintenance algorithms to guide the treating team.

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