Post-stroke spastic movement disorder (PS-SMD) develops in up to 40% of stroke survivors after a first ever stroke within the first year. Chronic PS-SMD is often associated with severe disabilities and complications, emphasizing the importance of its early recognition and early adequate management. Extensive research has aimed to accurately predict and sensitively detect a PS-SMD. Symptomatic therapies include conventional rehabilitation and local intramuscular injections of botulinum toxin A (BoNT-A). The latter is widely used, but primarily in the chronic phase of stroke. However, recent studies have shown the safety and efficacy of BoNT-A therapy even in the acute phase and early sub-acute phase after stroke, i.e., within three months post-stroke, leading to an improved long-term outcome in stroke rehabilitation. Local BoNT-A injections evolve as the primary approach in focal, multifocal, and segmental chronic or acute/subacute PS-SMD. Patients at high risk for or manifest PS-SMD should be identified by an early spasticity risk assessment. By doing so, PS-SMD can be integral part of the patient-centered goal-setting process of a multiprofessional spasticity-experienced team. The benefit of an early PS-SMD treatment by BoNT-A should predominate putative degenerative muscle changes due to long-term BoNT-A therapy by far. This, as early treatment effectively avoids complications typically associated with a PS-SMD, i.e., contractures, pain, skin lesions. The management of PS-SMD requires a comprehensive and multidisciplinary approach. Early assessment, patient-centered goal setting, early intervention, and early use of BoNT-A therapy prevents from PS-SMD complications and may improve rehabilitation outcome after stroke.

Citations

• How many stroke survivors develop problematic spasticity requiring pharmacological therapy? An international (Europe and USA) observational study protocol
  Richard D Zorowitz, Laura Serrano Barrenechea, Simon Butet, Sergiu Groppa, David Hernández Herrero, Rama Prasad, Susan Sandars, Seema Meloni, Simon Page, Pascal Maisonobe, Alessandro Picelli
  BMJ Open.2025; 15(1): e087404.     CrossRef
• The Role of Botulinum Toxin Type-A in Spasticity: Research Trends from a Bibliometric Analysis
  Salvatore Facciorusso, Stefania Spina, Alessandro Picelli, Alessio Baricich, Gerard E. Francisco, Franco Molteni, Jörg Wissel, Andrea Santamato
  Toxins.2024; 16(4): 184.     CrossRef
• Botulinum Toxin in Treatments for Abnormal Movements
  María Gabriela González Chico, Xaviera Elizabeth Medina Godoy, Miliana Esperanza Estupiñan Bazurto, María José López Becerra
  Más Vita.2024; 6(2): 82.     CrossRef
• Botulinum Toxin Type A (BoNT-A) Use for Post-Stroke Spasticity: A Multicenter Study Using Natural Language Processing and Machine Learning
  María Jesús Antón, Montserrat Molina, José Gabriel Pérez, Santiago Pina, Noemí Tapiador, Beatriz De La Calle, Mónica Martínez, Paula Ortega, María Belén Ruspaggiari, Consuelo Tudela, Marta Conejo, Pedro Leno, Marta López, Carmen Marhuenda, Carlos Arias-Ca
  Toxins.2024; 16(8): 340.     CrossRef
• Risk factors for post-stroke spasticity: a retrospective study
  Chuanxi Zhu, Lingxu Li, Long Qiu, Guangcheng Ji
  Frontiers in Neurology.2024;[Epub]     CrossRef
• Early is Better, Then, How Early and How to Apply: Practical Approach of Botulinum Toxin Injection
  Joon-Ho Shin
  Annals of Rehabilitation Medicine.2023; 47(6): 439.     CrossRef

Development in motor skills and abnormal movement patterns in developing child are clearly observed and easily identified by the parents. Motor delay and movement disorder are common presentations for children with developmental disorders. Therefore, assessment for motor development and movement disorder become the major developmental focus of early in life. Physical examination has been considered as a key element for identifying developmental motor disorder. Traditionally, development of tone, primitive reflexes, postural reaction and motor milestone are commonly used as the evaluation tools for early identification of children at high risk for developmental disorder. Recently the assessment of the quality of general move-ments was introduced as a new form of neuromotor assessment of young infant. Therefore, clinical usefulness of the assessments for detecting neurological dysfunction was briefly reviewed in this paper. As well, there are a lot of movement disorders shown in child. The movement disorders can be separated into transient, paroxysmal and chronic ones according to their evolution. Since the knowledge of the movement disorders in each category enables us to understand the evolution of movement disorders, avoid unnecessary tests and treatments, and also give the proper information to the parents, the movement disorders were briefly reviewed in this paper. (J Korean Acad Rehab Med 2006; 30: 545-553)