Module 3 – Individualized Management

Jointly provided by

Supported by an educational grant from Ipsen Biopharmaceuticals, Inc.

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Release date: March 1, 2017

Valid through: March 1, 2018

Media: Internet

Estimated Time to Complete Activity: 30 minutes

Intended Audience

This initiative is intended for physiatrists, neurologists, orthopedists, pediatricians, and other healthcare providers who treat patients with spasticity.


Treatment of patients with spasticity due to upper motor neuron syndromes, including traumatic brain injury, stroke, and cerebral palsy is multifaceted, involving chemodenervation, systemic medications, surgical therapy, rehabilitation efforts, and home care. In this roundtable, clinical experts discuss the importance of accurate patient assessment and treatment options, highlighting the need for individualized management. Emphasis is placed on setting appropriate, customized goals for each patient and using these goals to determine treatment decisions. Treatment options are then discussed in more detail, including optimal use of botulinum toxin.


The goal of this activity is to provide physiatrists, neurologists, orthopedists, pediatricians, and other healthcare professionals involved in the care of patients with spasticity with a detailed overview of the most up-to-date clinical knowledge and strategies for the optimal care of these patients.

Learning Objectives

Upon completion of this activity, the participant should be able to:

  • DEVELOP appropriate, individualized goals of treatment in consultation with the patient and family members.
  • DESIGN optimal individualized management plans, including pharmacotherapy, chemodenervation, surgical treatment, follow-up care, and rehabilitation interventions.
  • DISCUSS factors influencing the choice of botulinum toxin.

Credit Available

  • Physicians — maximum of 0.5 AMA PRA Category 1 Credit

All other healthcare professionals completing this course will be issued a statement of participation.


Katharine E. Alter, MD (Course Director)

Pediatric/Adult Physiatrist
Mount Washington Pediatric Hospital
Clinical Assistant Professor, Pediatrics, Physical Medicine Rehabilitation
AT Still University
Mesa, Arizona

Edward R. Dabrowski, MD

System Director
Pediatric Physical Medicine and Rehabilitation
Beaumont Children's Hospital
Royal Oak, Michigan

Mauricio R. Delgado, MD, FAAN, FRCPC

Professor of Neurology
University of Texas Southwestern Medical Center
Director of Pediatric Neurology and Neurorehabilitation
Texas Scottish Rite Hospital for Children
Dallas, Texas

Mark Gormley, Jr, MD

Pediatric Rehabilitation Medicine Physician
Section Chief
Pediatric Physical Medicine and Rehabilitation
Gillette Children's Specialty Healthcare
Saint Paul, Minnesota

Cindy B. Ivanhoe, MD

Professor, Physical Medicine and Rehabilitation
Baylor College of Medicine
Chief Medical Officer, Mentis Neuro Health
Attending Physician, TIRR Memorial Hermann Brain Injury and Stroke Program
Houston, Texas

Physician Continuing Medical Education

Accreditation Statement

This activity has been planned and implemented by Dannemiller and ASiM. In support of improving patient care, Dannemiller is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credit Designation

Dannemiller designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit.™ Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosures of Conflicts of Interest

In accordance with the Accreditation Council for Continuing Medical Education (ACCME), Dannemiller requires that any person who is in a position to control the content of a CME activity must disclose all relevant financial relationships they have with a commercial interest.

The following faculty member has stated that she has no financial relationships with commercial interests: Katherine E. Alter, MD.

The following faculty members have financial relationships with commercial interests:
Dr Dabrowski reports serving as a site PI for Ipsen, for the current UE abobotulinumtoxinA trial, and for the Allergan LE onabotulinumtoxinA trial; serving as a global PI for the Merz XARA trial; serving on the advisory board for Ipsen; and serving as a consultant and on a speakers’ bureau for US Medical (Solstice).

Dr Delgado reports serving as an investigator for Ipsen Biopharmaceuticals Inc.

Dr Gormley reports serving as an investigator for Allergan Inc and Ipsen Biopharmaceuticals Inc.

Dr Ivanhoe reports serving on a speakers’ bureau for Allergan Inc, Medtronic, Merz, and Ipsen Biopharmaceuticals Inc.

Bernard Abrams, MD, Independent Reviewer; Jennifer Hodge, Assistant Director Medical Education, Dannemiller; Lou Settembrino, Vice President, ASiM; Mary Camillo, Director, Department of Fulfillment Services, ASiM; Cathy Zehr, Director, Logistical Services, ASiM; Chris Ohnsman, MD, Medical Director; and, Lisa Mangione, Senior Editor, Department of Fulfillment Services, ASiM have no financial relationships with commercial interests.

To resolve identified/potential conflicts of interest, the educational content was fully reviewed by a member of the Dannemiller Clinical Content Review Committee who has nothing to disclose. The resulting certified activity was found to provide educational content that is current, evidence based and commercially balanced.

Hardware and Software Requirements

This site is best viewed with an HTML5 compatible browser, this list includes the current versions of Microsoft Internet Explorer, Mozilla Firefox, Google Chrome, and Apple's Safari. You can visit the independent (3rd party) site to determine if you have the latest version of your browser. Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. That software may be: Adobe Flash, Apple Quicktime, Adobe Acrobat, Microsoft Powerpoint, Windows Media Player, and Real Networks Real One Player. Where such software is required it will be indicated.

Off-Label Statement

Off label statement provided: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by FDA. The opinions expressed in the educational activity are those of the faculty. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings. Further, attendees/participants should appraise the information presented critically and are encouraged to consult appropriate resources for any product or device mentioned in this program.


The content and views presented in this educational activity are those of the authors and do not necessarily reflect those of Dannemiller, ASiM, and Ipsen Biopharmaceuticals, Inc. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. Therefore, healthcare professionals and other individuals should review and consider other publications and materials on the subject matter before relying solely upon the information contained within this educational activity.

Method of Participation

Participants should first read the objectives and other introductory CME information and then proceed to the educational activity. To receive credit for this activity, participants should log into the activity, complete the preassessment, review and complete the enduring web-based activity, and complete the postassessment and evaluation in order to receive credit. Credit is provided through January 31, 2018. No credit will be given after this date. There is no fee to participate in this activity.

This program consists of video and slides synced with voiceover audio along with interactive questions.

In the event you have questions about this activity or are unable to retrieve the certificate, please e-mail and a certificate will be emailed within 2 weeks.

Technical Questions – Please contact ASiM at 908-253-9001 or


Module 3 – Individualized Management
Edward R. Dabrowski, MD, and Cindy B. Ivanhoe, MD

Postassessment and Evaluation