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Background: Spasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement. Objective: An expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder. Methods: A consensus group of six spasticity experts were interviewed individually via 1-h video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an in-person meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, 'red flags' for other conditions affecting the shoulder, and assessment limitations and practicalities. Results: Where there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorized as Posture, Purposeful activity and Pain ('the three Ps'). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment- and function-related measures are given. Conclusion: This consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction. [ABSTRACT FROM AUTHOR]

Introduction: Upper and lower limb spasticity is commonly associated with central nervous system disorders including stroke, traumatic brain injury, multiple sclerosis, cerebral palsy, and spinal cord injury, but little is known about the concurrent treatment of upper and lower limb spasticity with botulinum toxins. Objective: To evaluate onabotulinumtoxinA (onabotA) utilization and to determine if concurrent onabotA treatment of the upper and lower limbs has supported improvements in participants with spasticity. Design: Sub‐analysis of a 2‐year, international, prospective, observational registry (ASPIRE, NCT01930786). Setting: International clinic sites (54). Participants: Adult spasticity participants across etiologies, who received ≥1 concurrent onabotA treatment of the upper and lower limbs during the study. Intervention: Participants were treated with onabotA at the clinician's discretion. Outcomes: Baseline characteristics and outcomes of disability (Disability Assessment Scale [DAS]), pain (Numeric Pain Rating Scale [NPRS]), participant satisfaction, physician satisfaction, and quality of life (QoL; Spasticity Impact Assessment [SIA]) were evaluated. Adverse events were monitored throughout the study. Results: Of 744 participants enrolled, 730 received ≥1 dose of onabotA; 275 participants received treatment with onabotA in both upper and lower limbs during ≥1 session; 39.3% of participants were naïve to onabotA for spasticity. The mean (SD) total dose per treatment session ranged from 421.2 (195.3) to 499.6 (188.6) U. The most common baseline upper limb presentation was clenched fist (n = 194, 70.5%); lower limb was equinovarus foot (n = 219, 66.9%). High physician and participant satisfaction and improvements in pain, disability and QoL were reported after most treatments. Nine participants (3.3%) reported nine treatment‐related adverse events; two participants (0.7%) reported three serious treatment‐related severe adverse events. No new safety signals were identified. Conclusion: More than a third of enrolled participants received at least one concurrent onabotA treatment of the upper and lower limbs, with reduced pain, disability, and improved QoL after treatment, consistent with the established safety profile of onabotA for the treatment of spasticity. [ABSTRACT FROM AUTHOR]

Neurological infections are a medical emergency, and although death rates have improved most survivors have acquired brain injury, which often presents in primary care in the months after infection and needs early referral. [ABSTRACT FROM AUTHOR]

Background: Physical, cognitive and emotional sequelae in patients with traumatic brain injury (TBI) have been identified; some as late as two years post-injury. To aid in the specialist management of such patients, a multidisciplinary neurotrauma clinic was initiated at a tertiary centre.  Aim: This study sought to describe the clinical features of patients who attended the clinic. Methods: Patient data was collected under several categories: basic demographics, mechanism and severity of injury, initial CT findings and management, hospital stay and discharge details, symptoms in clinic and actions performed by clinic staff (medication changes, referrals to other services, etc.). Results:Three hundred and five patients met the inclusion criteria. Mean age was 47.5 and most patients were male (72.1%). Commonest mechanism of injury was falls (53.1%). 17.4% of injuries were classed as mild, 68.2% moderate and 14.1% severe. Commonest injury locations were frontal (21.6%) and temporal (16.1%) with contusions (37.4%) and subdural hematomas (27.9%) the commonest type of injury on initial CT scan. The most frequent physical complaints were headache (47.9%) and memory problems (42.0%). 7.9% complained of new seizures since TBI. 41.6% were referred to further services: most frequently psychology (19.3%) and neuropsychiatry (18.4%). Of 184 known to be employed before their injury, 48.4% of these returned to work before their last appointment. 28.5% were unable to continue driving. Conclusion: Our study provides an insight into the reality of long term sequelae of TBI, especially those at the more severe end of the spectrum, who are likely to present to tertiary or specialist services. Information gathered in this study about characteristics of the TBI population and their outcomes allows for better targeting of suitable patients for referral to a multidisciplinary clinic and improved resource planning. [ABSTRACT FROM AUTHOR]