Goal Attainment Scaling in Individuals with Upper Limb Spasticity Post Stroke

Area of Science:

• Neurorehabilitation
• Occupational Therapy
• Movement Science

Background:

• Spasticity is a common impairment following stroke, significantly impacting functional recovery.
• Goal-oriented rehabilitation is recognized as effective for improving function in stroke survivors.
• Standardized frameworks like the International Classification of Functioning, Disability and Health (ICF) can structure rehabilitation goals.

Purpose of the Study:

• To map rehabilitation goals of post-stroke individuals with spasticity using the Goal Attainment Scale (GAS) and ICF.
• To evaluate the impact of botulinum toxin A (BoNTA) on occupational performance relative to the type of rehabilitation goals set.

Main Methods:

• Thirty-one patients with spasticity in an outpatient clinic participated.
• Each patient set one rehabilitation goal, received BoNTA injections in the affected upper limb, and underwent standard rehabilitation for four weeks.
• Goals were categorized using the ICF framework, and changes in Modified Ashworth Scale (MAS) were assessed.

Main Results:

• The majority of participants (27/31) achieved or exceeded their rehabilitation goals.
• Goals were predominantly related to Activity/Participation (55%) and Body Structures and Function (45%) within the ICF.
• Both positioning and activities of daily living (ADL/IADL) goal groups showed reduced spasticity (MAS) after BoNTA treatment, with the positioning group being older and more impaired.

Conclusions:

• Mapping patient goals to the ICF provides specific targets for intervention and a common language for interdisciplinary teams.
• BoNTA treatment demonstrated effectiveness in reducing spasticity for individuals pursuing both positioning and ADL/IADL goals.
• Further research could focus on developing goal/item banks to enhance the application of GAS in spasticity management.