Botulinum toxin injection and intense rehabilitation program: a single institution experience of a multidisciplinary care approach for spasticity

Abstract

Spasticity is the velocity-dependent increase in muscle tone due to upper motor neuron lesions. It is becoming an important health issue as the incidence of stroke is increasing in our aging population. Spasticity gives rise to major impairment in motor functions and activities of daily living as well as pain and difficulty with nursing care. Botulinum toxin (BTX) can be injected to the affected muscles to relieve spasticity by blocking transmission across neuromuscular junctions. The temporary paralysis so induced provides a window of opportunity for prompt, intense rehabilitation. In this article, we present our 2.5-year experience with BTX injection and a patient-specific rehabilitation program provided by a multidisciplinary team, which consists of neurosurgeons, nurses, physiotherapists, occupational therapists and prosthetic orthotists. We found that this multidisciplinary management could lead to improvement in patients’ goal attainment, caregiver burden and biomechanical assessment. The approach is feasible within our healthcare setting and our promising findings indicate its wider adoption in this locality.