• Melissa T Nott, Hannah L H Barden, and Ian J Baguley.
• School of Community Health, Charles Sturt University, Albury, Australia. mnott@csu.edu.au.
• J Rehabil Med. 2014 Oct 1; 46 (9): 864-8.

ObjectivesEvaluate upper-limb goal attainment following botulinum toxin-A, map goals to the International Classification of Functioning, Disability and Health (ICF) and explore associations between client goals, clinical indicators of spasticity and the Botulinum Toxin-A injection strategy adopted by the treating physician.DesignPre-test/post-test.ParticipantsTwenty-eight community-dwelling adults with acquired brain injury.MethodsGoal attainment was measured using the Goal Attainment Scale (GAS) 4 weeks post-injection. Goals were linked to the ICF. Clinical measures including the Modified Ashworth Scale (MAS), Tardieu Spasticity Angle (TSA) and Action Research Arm Test (ARAT) were collected pre-injection for determining association with injection strategy.ResultsGoals represented the ICF domains of Body Structure/Function and Activity/Participation. Approximately half the goals were achieved 4 weeks post-injection and GAS T-scores improved significantly. Activity/Participation goals were equally likely to be achieved as Body Structure/Function goals. Pre-injection ARAT scores were correlated with GAS change, whereas MAS and TSA scores were not. TSA was a stronger indicator of muscle selection for botulinum toxin-A injections than MAS. Goals were directly associated with botulinum toxin-A injections for distal hand function, but not for proximal upper-limb function.ConclusionGoal setting and review provides a clinically useful process for measuring upper-limb botulinum toxin-A outcomes.

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