“…These difficulties have led authors to encourage the development/use of outcome measures that are sensitive [26], functionally relevant to spasticity [27], are based on the patient and team negotiated goal-focused outcomes [26,28,29] and able to simultaneously measure both positive and negative UMN features [19] and are practical in nature [30]. A goal-directed approach should also be extended to determining BTX-A injection strategy; for example, muscle selection and dose, however, there is no current evidence to support this concept [27].…”