Our Clinical Director, Peter Sanderson, and Senior Physiotherapist Michelle Brennan recently co-hosted a webinar with ABI Solutions, exploring why early diagnosis, multidisciplinary team (MDT) collaboration, and tailored treatment (not just injection therapy) are all key to improving outcomes in neurorehabilitation.
It’s easy to default to botulinum toxin. But that’s not the full picture.
When managing spasticity in neurological rehabilitation, one treatment often dominates the conversation: Botulinum Toxin.
And while it has an important role, focusing on a single intervention risks missing the bigger picture – effective spasticity management isn’t just about one treatment.
It’s about getting the right diagnosis, at the right time, and building the right plan around the individual.
That’s where outcomes are won or lost.
Start with what actually matters: the person
In neurorehabilitation, clinical success isn’t defined by tone reduction alone.
It’s defined by:
- Whether someone can sleep comfortably
- Whether they can engage with family
- Whether they can return to meaningful daily activities.
In other words: quality of life.
Too often, treatment focuses on impairment without fully considering how that translates into real-world function. But the two are inseparable and, overlooking that link is where care can fall short.
If the diagnosis isn’t right, the treatment won’t be either
Terms like spasticity, dystonia, and dyskinesia are frequently used interchangeably. But they shouldn’t be.
- Spasticity is velocity-dependent and linked to altered neural input
- Dystonia involves involuntary muscle contractions and abnormal postures
- Many patients present with mixed patterns.
Why does this matter? Because each presentation requires a different approach. Misclassification doesn’t just affect terminology, it directly impacts:
- Treatment selection
- Timing of intervention
- Long-term functional outcomes.
Timing is everything
One of the most consistent themes in the neurorehabilitation evidence base is this: Early intervention leads to better outcomes.
Following neurological injury:
- Cellular changes begin within 24 hours
- Abnormal muscle tone can develop within 8–12 weeks
- Contractures can develop in up to 66% of stroke patients within 6 months.
Delays don’t just slow progress, they increase the risk of:
- Pain
- Fixed contractures
- Reduced function
- Increased long-term care needs.
By the time spasticity is “obvious”, opportunities may already have been missed.
This isn’t just theory.
In a recent article featuring our Clinical Director, Peter Sanderson, the importance of early, accurate intervention in spasticity management is explored in more detail — particularly how delays can impact long-term function and cost of care.
You can read the full article, by clicking here.
The real answer is rarely one treatment
Botulinum Toxin has a clear role, but, it is most effective when used as part of a broader, coordinated approach.
That might include:
- Physiotherapy
- Occupational therapy
- Splinting and positioning
- Medication management
- Injection therapy
- Surgical options where appropriate.
The key is not what is used, but how and when it is used together.
Less, but better intervention
There’s a common misconception that more treatment leads to better outcomes.
In reality: The least amount of intervention needed, done well, often delivers the best results.
Over-treatment can:
- Mask underlying issues
- Introduce unnecessary side effects
- Complicate recovery.
The goal is precision:
- Target the right muscles
- Use the right dose
- Combine therapies effectively.
That requires experience, clinical reasoning, and a clear understanding of the patient’s presentation.
Prevention should be the priority
Unmanaged or poorly managed spasticity doesn’t stay static – it progresses. The consequences can be significant:
- Pain and discomfort
- Loss of function
- Secondary complications (e.g. pressure sores, respiratory issues)
- Increased cost of care.
Many of these outcomes are preventable but, only with:
- Early identification
- Proactive management
- Ongoing review.
This is where multidisciplinary team working really matters
No single clinician or discipline can manage complex cases in isolation. The best outcomes happen when case managers, therapists, medical specialists and families are aligned around a shared plan.
Because ultimately, it’s not about who delivers the treatment. It’s about ensuring the patient gets the right intervention at the right time.
So where does Botulinum Toxin fit?
It absolutely has a role.
But it should never be:
- The starting point by default
- The only intervention considered
- Or a substitute for clear diagnosis and planning.
Instead, it should sit within a structured, clinically reasoned pathway—used when appropriate, and alongside other interventions.
Final thought
Spasticity management is evolving.
We’re moving away from:
- Reactive treatment
- Single-intervention thinking
- Delayed escalation.
And towards:
- Earlier, more accurate diagnosis
- Joined-up MDT decision-making
- Truly personalised rehabilitation plans.
Because when you get that right, you don’t just manage spasticity. You change outcomes.
Need support with a complex case?
If you’re managing a client with spasticity and want to have a second pair of eyes on the approach or explore treatment options, our team is always happy to help. Drop us an email with case details: referrals@psp-uk.co.uk or fill in our contact form