Long-Term Botulinum Toxin Cycle at Nine Months
| Patient | 58M, chronic phase |
|---|---|
| Lesion | MCA territory, moderate |
| Severity | NIHSS 5 |
| Days since onset | 270 |
| Before the strokeFactory supervisor, right-hand dominant, social drinker | |
| Also on the chartHypertension; Former smoker | |
| PrecautionsInjection-site soreness for a few days; Do not confuse reduced tone with new strength | |
Test yourself
How should this third cycle be run?
The teaching
Toxin is a means, not a plan — reassess goals every cycle (Turner-Stokes 2005) The post-injection window is for task practice; that is where function changes Judge cycles by goal attainment, not by tone scores alone (NICE NG236 2023)
- New pain, swelling, or skin breakdown in the injected limb — reassess before the next cycle
- Generalised weakness after injection — report and review the dose
Read next
The full sequence
This page carries the case’s first decision. The full sequence — every decision, the five-domain examination, and the debrief that grades you — is in the drill, and the library is included with membership.
Sources on this page: Turner-Stokes 2005, Clinical Rehabilitation, goal attainment scaling in spasticity management. NICE guideline NG236 2023, stroke rehabilitation in adults