Clinician's Commentary on Choi et al.

Spasticity affects functional abilities and increases caregivers' burdens.2,3 To address these issues, botulinum toxin type A (BoNTA) has recently been successfully used to manage spasticity after upper motor neuron lesions, such as stroke or cerebral palsy, have occurred. However, the main goals of the intervention are to rehabilitate and return function and to decrease disability, all of which improve a patient's quality of life. Although randomized trials have indicated a statistically significant effect of BoNTA on decreasing spasticity, its effect on improving active limb function is equivocal.4,5 Its impact has perhaps been less clear because of the types of assessment used to measure function. Standard clinical assessments of function such as the Barthel Index are indicators only of the overall assessment of bodily function, whereas BoNTA is a focal intervention on the muscles. Depicting changes in a standardized assessment with a battery of tasks would be difficult, whereas only a few sub-tasks would be affected by a BoNTA injection. As a result, it is unrealistic to expect to notice changes in standardized clinical assessments. To measure the effectiveness of BoNTA in an adult with spasticity, setting goals for intervention and evaluation of the intervention is recommended as a best practice guideline.