Spasticity Video Challenge: A Look at Methods for Addressing Difficult Cases

Treatment of patients with spasticity due to upper motor neuron syndromes, including traumatic brain injury, stroke, and cerebral palsy, is multifaceted, involving chemodenervation, systemic medications, surgical therapy, rehabilitation efforts, and home care. Optimal care begins with the recognition that each patient’s impairments are unique and must be assessed carefully to determine the impact of muscle overactivity, loss of dexterity, and weakness on passive and active function in the context of the patients’ goals. While botulinum toxin plays a major role in providing symptomatic relief and functional improvement from hypertonia, it should rarely be used as a standalone treatment.

This symposium archive will provide participants with the opportunity to assess remaining challenges in the care of patients with spasticity. In addition to reviewing appropriate use of chemodenervation and other treatments, this activity will also highlight techniques for improved communication between physicians and patients regarding the causes of functional impairments, individualized treatment options, customized goals of treatment, and the need for post-intervention rehabilitation and home programs via interactive video case presentations.

The content for this activity is based on the satellite symposium, Spasticity Video Challenge: A Look at Methods for Addressing Difficult Cases, that was presented at the AAPM&R Annual Assembly in New Orleans, Louisiana on October 22, 2016.


This archived symposium activity is intended for physiatrists, neurologists, and other healthcare professionals involved in the care of patients with spasticity. No prerequisites required. No prerequisites required.



Upon completion of this activity, participants will be better able to do the following:

  1. IDENTIFY strategies to improve the assessment of spasticity, recognizing its impact on passive function, active function, quality of life, and treatment outcomes.
  2. DEVELOP appropriate, individualized goals of treatment.
  3. DESIGN optimal individualized management plans, including pharmacotherapy, chemodenervation, surgical treatment, follow-up care, and rehabilitation interventions.
  4. DETERMINE appropriate dosing for BoNT formulations and review injection techniques.


Katharine E. Alter, MD (Chair)
Senior Physiatrist
Mount Washington Pediatric Hospital
Clinical Assistant Professor, Pediatrics,
Physical Medicine Rehabilitation
AT Still University
Mesa, Arizona

Mark Gormley, Jr, MD
Pediatric Rehabilitation Medicine Physician
Section Chief
Pediatric Physical Medicine and Rehabilitation
Gillette Children's Specialty Healthcare
Saint Paul, Minnesota

Atul T. Patel, MD, MHSA
Kansas City Bone and Joint Clinic
Overland Park, Kansas

Disclosure of Conflicts of Interest

It is the policy of the Elsevier Office of Continuing Medical Education that all faculty, instructors, and planners disclose real or apparent conflicts of interest relating to the topics of this educational activity. 

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity:

Name of Faculty or Presenter

Relationship Identified With:

Katharine E. Alter, MD (Chair)

Royalties/patents: Demos Medical Publishing.

Mark Gormley, Jr, MD

Consultant/Advisor: Allergan and Ipsen Biopharmaceuticals, Inc.

Grant/Research  Support: Allergan and Ipsen Biopharmaceuticals, Inc.

Atul T. Patel, MD, MHSA

Grant/Research Support: Allergan, Ipsen Biopharmaceuticals, Inc., and Merz, Inc.

Speaker's Bureau: Allergan, and Merz, Inc.

Non-faculty: Lou Settembrino; Christina M. Ohnsman, MD; Sandy Breslow; Leah Johnson; Alison Kemp; and Bernard M. Abrams, MD hereby state that neither they nor their spouse/life partner have any financial relationships to products or devices with any commercials interest related to the content of this activity of any amount during the past 12 months.

Peer Review

This CME activity has been peer-reviewed by PM&R: The journal of injury, function and rehabilitation.

Financial Support

This activity has been supported by an independent educational grant from Allergan Inc.

Provider Information

Jointly provided by the Elsevier Office of Continuing Medical Education and ASiM.


CME Credit (Physicians)

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the Elsevier Office of Continuing Medical Education and ASiM. The Elsevier Office of Continuing Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

The Elsevier Office of Continuing Medical Education designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits.TM Physicians should claim only the credit commensurate with the extent of their participation in the activity.


For all CME inquiries or special needs, please contact

Disclosure of Unlabeled Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The Elsevier Office of Continuing Medical Education, ASiM, and Allergan Inc. do not recommend the use of any agent outside of the labeled indications.

Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.


Course summary
Available credit: 
  • 1.50 AMA PRA Category 1 Credit(s)™
  • 1.50 Non-physician
Course opens: 
Course expires: 

Available Credit

  • 1.50 AMA PRA Category 1 Credit(s)™
  • 1.50 Non-physician
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