1000 Section - Ultrasound image guided injection of botulinum toxin for the management of spasticity: An implementation case study for practice recommendations and a governance framework.

A case study to demonstrate the implementation of the National Framework for ultrasound guided injection of botulinum toxin in the management of spasticity. The following case study outlines a real case using the Point of Care Ultrasound (PoCUS) framework from recent clinical practice where ultrasound was used to localise muscle for the injection of BoNT for spasticity management. The person in this case study was a 62-year-old woman.

Case Description:

Methods:

Single case implementation example of the scope of practice, competence and governance framework for ultrasound guided injection of botulinum toxin.

Results:

In the case illustration, the administration of BoNT using ultrasound guidance with 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 primary outcome using Goal Attainment Scaling (GAS) showed achievement of all the planned goals (‘T’ score = 50). Goal attainment using GAS was also indicative of achievement of all planned goals for intervention and shows an overall positive outcome.

Discussions:

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.

Conclusions:

Our framework for PoCUS practice is demonstrated through this case and can be applied internationally to improve practice for botulinum toxin administration.