Selecting Goals and Target Muscles for Botulinum Toxin A Injection Using the Goal Oriented Facilitated Approach to Spasticity Treatment (GO-FAST) Tool

Abstract

The objective of this article is to introduce the GO-FAST Tool (developed by the Toxnet group) to clinicians working in the field of neurological rehabilitation, specifically post-stroke spasticity management. The concepts utilized in the Tool and described in this article can be broadly grouped into five topics: the principles of patient-centred goal-setting; an algorithm for setting SMART (specific, measurable, attainable, realistic, and timed) treatment goals; goal-related target muscles and botulinum toxin type A dose determinants; goal attainment follow-up, scoring, and interpretation; and the multimodal approach to spasticity management. The Tool can enhance clinical practice by providing guided assistance with goal-setting and target muscle selection for botulinum toxin type A treatment. It also provides support with the follow-up evaluation of goal attainment and calculation of treatment success. The Tool is designed to be used by clinicians with varying levels of expertise in the field of neurological rehabilitation and post-stroke spasticity management, from those who are new to the field to those with many years of experience. A case study is presented in the Results Section of the article to illustrate the utility of the Tool in setting SMART treatment goals in the management of patients with post-stroke spasticity.

Botulinum toxin A injection for post-stroke upper limb spasticity and rehabilitation practices from centers across Asian countries

“…It is increasingly accepted that spasticity care should be goal oriented ( 24 , 25 ), and the results of this study support the utility of goal attainment scaling as a practical way to assess the effectiveness of BoNT-A injections ( 26 ). Our findings indicate good rates of overall goal achievement in the Asian subgroup with clinically relevant ( 27 ) improvements in GAS T scores over one treatment cycle.…”

“…Another significant difference in injection technique was the relatively low use of guidance techniques in Asian countries versus the international study. While it is generally well accepted that the It is increasingly accepted that spasticity care should be goal oriented (24,25), and the results of this study support the utility of goal attainment scaling as a practical way to assess the effectiveness of BoNT-A injections (26). Our findings indicate good rates of overall goal achievement in the Asian subgroup with clinically relevant (27) improvements in GAS T scores over one treatment cycle.…”

Role of Diagnostic Nerve Blocks in the Goal-Oriented Treatment of Spasticity with Botulinum Toxin Type A: A Case–Control Study

“…The DNB is a safe procedure that can be performed in the neurorehabilitation medicine setting and plays an increasingly key role in the management of patients with spasticity. Our data add to this notion, in that they document that DNBs may not only predict the effect of BoNT-A treatment on injected muscles in patients with disabling spasticity, but may also allow better achievement of treatment goals according to the requirements and preferences of individual patients according to the SMART framework [ 16 , 18 ].…”

BOTOX’s Mechanism, Diversity Considerations, and Therapeutic Potential in Cosmetic, Medical, and Dental Practice

“…Conversely, incobotulinumtoxinA shows a similar onset to onabotulinumtoxinA but may sustain effects for up to six months or more, contingent upon the treated area and individual patient factors [57]. Considering the target muscle or tissue and desired outcomes, carefully weighing these distinctions when selecting the appropriate therapy for specific applications is fundamental [58]. The varied formulations of BOTOX offer diverse benefits and considerations, necessitating a thorough evaluation of each patient's unique needs and conditions to determine the most suitable treatment [55].…”

“…Its versatility extends to jawline sculpting and addressing aesthetic concerns such as gummy smiles or bunny lines around the nose [6]. Beyond aesthetics, BOTOX exhibits therapeutic efficacy in alleviating muscle pain and spasticity [58]. It also serves as a treatment for hyperhidrosis and migraines and diminishes drooling in Parkinson's disease patients [42].…”