Abstract

Introduction: Achieving successful control of spasticity can represent a significant therapeutic challenge. The numerous complications need to be anticipated and properly managed through a complex and personalized therapeutic approach.
Objectives: Depending on the degree of spasticity, its duration, and the motor control in the targeted segment, the therapeutic objectives can vary considerably concerning spasticity in the context of stroke (AVC).
Materials and Methods: Four case studies are presented, involving patients with stroke and spasticity ranging from grade 1+ to 4 (measured using the Modified Ashworth Scale-MAS), with varying duration and motor control in the affected segments. These patients underwent a conservative rehabilitation treatment and received botulinum toxin administration. Evaluating spasticity is crucial to determine treatment effectiveness and plan medical applications. It also helps measure and, ultimately, decide the goals of rehabilitation treatment. Therefore, different functional clinical scales are used based on the characteristics of spasticity in each case, allowing for a better dynamic evaluation and quantification of motor impairment, leading to more accurate setting and monitoring of therapeutic objectives and methods.
Result and Discussion: Consistent application of botulinum toxin treatment for high-intensity spasticity led to long-term improvement in pain syndrome in the affected limb and prevented further damage to periarticular tissues. For cases of low-intensity spasticity in a limb with mild motor deficits, restoring functionality to almost normal levels required the use of different functional scales, and botulinum toxin administration was needed at intervals longer than three months, with progressively smaller doses.
Conclusion: Considering the variability in the functional status of patients with stroke and spasticity, both functional evaluation and rehabilitation treatment objectives differ significantly. Therefore, the injection of botulinum toxin calls for a personalized approach based on the patient, regarding dosage and administration intervals.

Keywords:Botulinum toxin injection; Patients; Stroke; Therapeutic challenge; Treatment effectiveness; Self-Esteem