ABSTRACT
Sometimes, despite optimum multidisciplinary input with close attention to minimising trigger or aggravating factors, spasticity cannot be managed appropriately with a combination of physical measures and oral medication alone. As outlined in Chapter 6, focal therapies such as botulinum toxin or peripheral nerve blocks may be useful; however, if the problem is more widespread (such as with bilateral lower limb spasticity) then intrathecal baclofen (ITB) or phenol (IP) are further options to consider.
