The effectiveness of best practise therapy after Botulinum Toxin A injections for adults diagnosed with neurological impairment and onset of spasticity.

This project will evaluate a client-centred motor-training intervention to improve functional outcome after botulinum toxin injection (BoNT-A) for people with a neurological injury (stroke or brain injury). Spasticity is common following stroke and those with greater spasticity typically experience less recovery. Current treatment for spasticity is to provide BoNT-A, an antispasticity drug. Some evidence exists to support the use of BoNT-A, but all studies recommend that BoNT-A be provided in conjunction with physical therapy. However, little direct evidence exists for optimum type, dosage and timing of therapy. Participants will be recruited on a consecutive admission basis from hospital outpatient spasticity clinic and receive an 8-week intervention which will include intensive one-on-one physiotherapy, behavioural strategies to increase patient motivation, and a task-specific home exercise program. A distinguishing feature of the program is that it is tailored to the specific needs of each participant, patients are extended to receive intensive physiotherapy practice, and the content is driven by the Clinical Guidelines for Stroke Management (National Stroke Foundation, 2010). Outcomes will be assessed at baseline, post-intervention, and at 3 months following the conclusion of intervention and will include assessment of functional movement, quality of life, and cost.