[Spasticity must be treated by botulinum toxin with rehabilitaiton]

In rehabilitation medicine, botulinum toxin (BTX) as adjunct to other interventions for spasticity can result in a useful and effective therapeutic tool treating disabled stroke patients with spasticity. Other than spasticity, non-reflex motor disorders (muscle stiffness, shortness and contracture) can complicate clinical course and hamper rehabilitative process of stroke patients. After treating spasticity by BTX, the paralysis might be improved by changing muscular imbalance following stroke. We also have to face unique and difficult to treat clinical conditions abnormal posture and movement disorders due to chronic severe stroke patients. The effectiveness of BTX in treating some of these conditions is also provided. Since, neurologically disabled stroke patients can show complex dysfunction, prior to initiating BTX therapy, specific functional limitations, goals and expected outcomes of treatment should be evaluated and discussed with family and caregivers. BTX also might improve not only care, passive function, but also improve active function in stroke patients with intensive rehabilitation with rTMS, tDC, electrical stimulation, stretching and other rehabilitation strategy. Therefore BTX might change rehabilitation medicine.