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Post-stroke spasticity affects roughly 30% of survivors within the first year and remains one of the most common reasons patients are referred to physiatry. This update summarizes current evidence for a stepped approach that combines targeted stretching, oral agents, focal chemodenervation, and, when indicated, intrathecal baclofen. Early identification matters. Physiatrists should screen at every follow-up using the Modified Ashworth Scale and functional goals set with the patient and caregiver. Botulinum toxin injections remain first-line for focal spasticity interfering with hygiene, positioning, or gait, and outcomes improve when paired with a structured therapy program in the two weeks following injection. This article walks through a case-based decision tree, dosing guidance, and coding notes for outpatient practice.
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