More than a black box of rehabilitation: Characterizing therapy programmes following botulinum toxin injections for spasticity in adults with stroke

Objectives: To describe ambulatory rehabilitation programmes (physical and occupational therapy activities and interventions) following botulinum toxin injections for poststroke spasticity using a stroke rehabilitation taxonomy. To explore the relationship between therapy provided and injected limb/s and treatment goals. Design: Prospective, observational cohort study. Participants: Stroke survivors (n = 47) participating in ambulatory rehabilitation programmes following botulinum toxin injections for upper limb, lower limb or upper and lower limb spasticity. Methods: Standardized therapy documentation forms were completed prospectively for each occupational and physical therapy session. Main outcomes were the proportion of: total therapy time spent in various therapeutic activities; total sessions during which each intervention was used to facilitate the activities most time was spent in; and goals related to each activity category. Sub-analysis was carried out for participants, based on limb/s injected. Results: Most time was spent in "upper extremity control" activities as the upper limb was more often injected. A large proportion of therapy time was spent in activities remediating "performance skills or body structure and function impairments". In the upper and lower limb, and upper limb groups 38.7% and 46.2% of goals, respectively, related to this activity category, but less than 10% in the lower limb group. Little time was spent in community participation and leisure activities, whilst over one-third of lower limb group goals related to this category. Conclusion: Ambulatory rehabilitation programmes following botulinum toxin injections for post-stroke spasticity varied depending on limb/s injected and reflected treatment goals to some extent.