Ultrasound image guided injection of botulinum toxin for the management of spasticity: an implementation case study for practice recommendations and a governance framework.

Abstract

A case study to demonstrate the implementation of the National Framework for ultrasound guided injection of botulinum toxin (BoNT) in the management of spasticity in people with stroke or brain injury. Single case implementation example of the scope of practice, competence, and governance framework for point of care ultrasound (PoCUS) guided injection of BoNT. In this case illustration, application of the PoCUS framework resulted in accurate toxin placement and a positive treatment outcome with reduced spasticity. Splint application to maintain range of movement was easier and personal care in cleaning and washing the palm of the hand aligned to treatment goals improved. The use of ultrasound imaging in guided injection using the PoCUS framework provides a potential increase in treatment accuracy, effectiveness, and safety, which is both reassuring to the clinician and positive for people requiring treatment, particularly those with greater risk factors such as anticoagulation. The development of practice-based skills and competency in areas such as image optimisation, interpretation, and needle visualisation are integral to developing practice in this approach to spasticity management and substantial progress can be made with structured and focused learning for rehabilitation.