Dear Colleagues,

Stroke remains a leading cause of disability and individuals with concomitant spasticity are found to have a marked decrease in quality of life and significant reduction in activities of daily living. The impact of this disease process in not only on the patient but provides a significant burden to family members as well as health care systems. While stroke therapy has advanced significantly over the past decade, namely, through advances in imaging and endovascular therapy, these significant advances should not overshadow the evolution of spasticity treatment.  Over the past decade, innovations have occurred, better defining spasticity patterns, and we have gathered significant knowledge in functional anatomy and the evolution of spasticity over time. Preliminary predictors of spasticity have been identified and refinement in chemo enervation dosing and muscle selection for specific patterns have been refined.  With the introduction of ultrasound into the armamentarium for modalities to inject botulinum toxin, new insights into rheological changes in muscle in individuals with spasticity have emerged. Only now are we beginning to understand what these change may invoke in our treatment paradigms. Adjunct therapies are now commonly being used in addition to botulinum toxin to maximize patient outcome. Furthermore, surgical interventions in conjunction with botulinum toxin are now emerging as novel efficacious therapies in treating post stroke spasticity.  Finally, over the past decade, we have developed a variety of means of evaluating patients with spasticity and recognized the need to identify goals that encompass the entire health care team as well as the patient and their caregivers.  All of the aforementioned changes over the past decade have significantly improved our knowledge base and permitted us to improve patient quality of life.

1. Current understanding of post stroke spasticity: epidemiology and pathophysiology;
2. Advances in predictors of spasticity;
3. Use of botulinum toxin for the treatment of upper limb spasticity;
4. Use of botulinum toxin for the treatment of lower limb spasticity;
5. Understanding functional anatomy, common mistakes in muscle selection;
6. Early use of botulinum toxin for the treatment of post stroke spasticity;
7. Adjunct therapies in the treatment of post stroke spasticity;
8. Surgical interventions for upper limb spasticity—evaluation and selection of candidates;
9. Surgical interventions for lower limb spasticity evaluation and selection of candidates;
10. Indications for nerve blocks;
11. Establishing goals and how to evaluate spasticity long term following chemodenervation.

Dr. Theodore Wein
Guest Editor

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