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Satellite Symposium Proceedings Movement Disorders Comprehensive Care of Patients with Spastic Paresis – A Long-Term Commitment Report of the Proceedings of a Symposium at the International Society of Physical and Rehabilitation Medicine World Congress; Berlin, June 22 nd 2015 Expert review by: Anthony Ward, 1 Wolfgang Jost, 2 Robert Jech 3 and Jean-Michel Gracies 4 1. North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke-on-Trent, UK; 2. Parkinson’s Disease Clinic Wolfach, University of Freiburg, Germany; 3. Department of Neurology, Charles University, Prague, Czech Republic; 4. Henri Mondor University Hospital, Créteil, France Abstract Spastic paresis is a frequent complication of lesions to central motor pathways. Patients who develop spasticity require specialised rehabilitation programmes to alleviate their symptoms, help them to relearn motor skills and regain some independence. Long-term management of patients with spastic paresis requires a comprehensive approach that addresses the patient’s physical needs and mental wellbeing, and continues throughout all stages of the rehabilitation process. There are three pillars of success for long-term rehabilitation programmes in spastic paresis. Since most human behaviour is goal-directed, the first is to employ patient-centred goal setting to engage and motivate patients to play an active part in their own rehabilitation. Goals should be meaningful for and achievable by the patient, and revised as necessary. The second foundation of success is to ensure detailed clinical assessment, using appropriate spasticity assessment scales to inform Botulinum toxin treatment plans -doses and muscles to be injected. Lastly, the use of guided self-rehabilitation programmes encourages an active role for patients in their treatment and maximises outcomes. This paper summarises proceedings from the Comprehensive Care of Patients with Spastic Paresis: A Long-Term Commitment symposium, at the International Society of Physical and Rehabilitation Medicine World Congress, 2015. Keywords Spastic paresis, spasticity, patient care, goal setting, goal attainment, guided self-rehabilitation contract Disclosures: Anthony Ward has been supported by Ipsen, Allergan, Merz and Medtronic for lecturing at educational events, participating in advisory boards and consultancy work. He has also received funding from Ipsen and Allergan to host educational workshops and seminars and received educational grants from Allergan to conduct clinical research trials. Wolfgang Jost is speaker and advisor for Allergan, IPSEN and Merz. Robert Jech served as a consultant and received research grant support from Abbvie, Allergan, Cardion, Ipsen and Medtronic. He received grants from the Czech Ministry of Education, the Czech Ministry of Health and the Charles University in Prague. Jean-Michel Gracies served as a consultant and received research grant support from Allergan, Ipsen and Merz. Acknowledgements: Editorial assistance was provided by Jane Tricker at MedSense, High Wycombe, UK (funded by Ipsen). This article reports the proceedings of a sponsored satellite symposium and as such has not been subject to the journal’s usual peer-review process. Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any noncommercial use, distribution, adaptation, and reproduction provided the original author(s) and source are given appropriate credit. Received: 6 January 2016 Published Online: 24 February 2016 Citation: European Neurological Review, 2016;11(1):36–40 Correspondence: Wolfgang Jost, Parkinson’s Disease Clinic Wolfach, University of Freiburg, Germany E: w.jost@parkinson-klinik.de Support: Preparation of this paper was supported by Ipsen. Ipsen did not contribute to the content of the manuscript, with the exception of a courtesy review. Spastic paresis is a frequent complication of lesions to central motor pathways including the upper motor neuron, and is deeply distressing for patients, not only because of the physical effects on their bodies but also due to the emotional impact of the lack of control of limb movements that may deprive them of their independence. 1 Patients who develop spasticity require ongoing rehabilitation programmes, initiated as early as possible, to alleviate their symptoms, help them to relearn motor skills and, ultimately, to regain at least some of their independence. 2 Patients’ expectations of treatment often focus on their need for greater function (and hence independence). 3 They may wish to be able to let themselves into the house unaided, to be able to drive or to reduce the frequency with which they have to replace their shoes due to wear. 36 Typically, rehabilitation programmes are now based on intramuscular injections of botulinum toxin and muscle stretching and training exercises to overcome paresis. Recent clinical studies have suggested that intensive exercise in long-term guided self-rehabilitation programmes (in which the patient is coached by an expert therapist but works mainly on his or her own) may significantly improve outcomes for patients. 3,4 Patient-orientated goal setting and attainment scaling (GAS) can be used to align physicians’ and patients’ objectives for rehabilitation to tailor these to the individual patient’s needs. 5,6 The Comprehensive Care of Patients with Spastic Paresis: A Long-Term Commitment symposium, presented as part of the International Society TOU C H ME D ICA L ME D IA