The aim of this study is to investigate the validity and Inter-rater reliability for early recognition of spasticity by nurses and physiotherapists using the decision tree tool.

The Spastic Movement Disorder (SMD) Decision Tree was designed as a tool to aid nurses, therapists and other healthcare professions recognize potential signs of disabling spasticity in the upper limb of post-stroke patients. The present study assesses validity and inter-rater reliability of the SMD Decision Tree comparing nurses and therapists with gold-standard procedure performed by rehabilitation doctors. Agreement was tested for "referral to specialist indicated" and "no referral to specialist indicated".

Inclusion Criteria:

• Participants with a first sub-acute and chronic infarction of the middle cerebral artery / basal ganglia hemorrhage longer than four weeks after the event
• Between 18-80 years old
• Preserved insight and judgment capacity
• Adequate language and task comprehension, attention span for 15 minutes

Exclusion Criteria:

• Participants with other neurological disorders
• Participants who received BoNT-A treatment < 3 months before inclusion
• Reduced vigilance and attention span (less than 15 minutes)
• Participants with adult representation
• Participants with severe language impairment / impairment of movement and action sequences

Male, Female, and Diverse were eligible.

Study participants are post-stroke survivors and patients of the Gailtal Clinic in Hermagor.

Participants were either sub-acute in-patients as part of the post-stroke rehabilitation program or chronic out-patients.

Participants are recruited using consecutive participant sampling. All sub-acute patients in the rehabilitation ward who fulfill inclusion criteria and agree to participate are enrolled. Additionally, chronic patients scheduled for botulinum toxin injections on the study day are also enrolled in the study.