Disclosures: Simon Page, PhD: No financial relationships or conflicts of interest

Background and/or Objectives: When upper-limb spasticity is a major contributing factor to daily impairment, botulinum toxin (BoNT) injections are often used to produce a selective reduction in muscle tone while optimizing the potential for occupational therapies to improve range of motion and enhance motor ability and functional skills. We have previously reported that treatment with abobotulinumtoxinA given in combination with a personalized home exercises therapy program (HETP) reduces upper-limb spasticity with high rates of goal attainment (Delgado et al, DMCN 63: 592-600). We provide further information on the types of goals chosen, including some real examples that exemplify the tailored, goal-driven treatment plans that the children received during the study.

Design: Double-blind, randomized, controlled study (NCT02106351).

Setting: International study in 32 specialist centers.

Participants: Children (2-17 years) with CP (GMFCS I-IV) and spasticity in ≥1 upper-limb.

Interventions: Children received abobotulinumtoxinA injections into the primary target muscle group (elbow/wrist flexors) and other upper-limb muscles that were selected based on clinical presentation and to support the individualized treatment goals set at baseline. All children followed an HETP (minimum of 5 x 15-minute sessions/week), which included stretches and exercises specifically chosen to facilitate goal achievement and engagement in activities.

Main Outcome Measures: Goal attainment scaling (GAS).

Results: Across the study sample, the most frequent primary goals (Cycle 1) were ‘involving the affected arm more in daily activities’ (29.8%) followed by ‘reaching’ (19.7%). In this presentation, we will use real life examples to show how injection parameters (muscle injection patterns) and HETP (exercises and activities chosen) were tailored to clinical presentations for maximal goal attainment.

Conclusions: In this study, the process of goal setting was found to be useful in guiding the development of an individualized exercise program which optimized goal attainment following injection of abobotulinumtoxinA and has the potential to improve clinical practice.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/case-examples-demonstrating-goal-setting-and-the-development-of-individualized-home-therapy-programs-from-a-phase-iii-study-of-abobotulinumtoxina-for-pediatric-upper-limb-spasticity/