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Objective: To create a consensus statement on the considerations for treatment of anticoagulated patients with botulinum toxin A (BoNTA) intramuscular injections for limb spasticity., Design: We used the Delphi method., Setting: A multiquestion electronic survey., Participants: Canadian physicians (N=39) who use BoNTA injections for spasticity management in their practice., Interventions: After the survey was sent, there were e-mail discussions to facilitate an understanding of the issues underlying the responses. Consensus for each question was reached when agreement level was ≥75%., Main Outcome Measures: Not applicable., Results: When injecting BoNTA in anticoagulated patients: (1) BoNTA injections should not be withheld regardless of muscles injected; (2) a 25G or smaller size needle should be used when injecting into the deep leg compartment muscles; (3) international normalized ratio (INR) level should be ≤3.5 when injecting the deep leg compartment muscles; (4) if there are clinical concerns such as history of a fluctuating INR, recent bleeding, excessive or new bruising, then an INR value on the day of injection with point-of-care testing or within the preceding 2-3 days should be taken into consideration when injecting deep compartment muscles; (5) the concern regarding bleeding when using direct oral anticoagulants (DOACs) should be the same as with warfarin (when INR is in the therapeutic range); (6) the dose and scheduling of DOACs should not be altered for the purpose of minimizing the risk of bleeding prior to BoNTA injections., Conclusions: These consensus statements provide a framework for physicians to consider when injecting BoNTA for spasticity in anticoagulated patients. These consensus statements are not strict guidelines or decision-making steps, but rather an effort to generate common understanding in the absence of evidence in the literature., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To develop an interactive computer program that facilitates uniformity and accuracy in the collection and assessment of spinal cord-impairment data., Design: A computer program that captures and processes clinical examination information in graphical form using the 2002 American Spinal Injury Association (ASIA) guidelines. This program calculates motor and sensory level, neurological level, the ASIA impairment scale (AIS) grade and zone of partial preservation., Participants/methods: The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) were encoded and a graphic representation of the standard ASIA data-capturing form (with permission) was produced using Adobe Flash programming technology by the Division of Multimedia at the University of Saskatchewan., Results: Testing by the development team has been successful in producing accurate ASIA-impairment data., Conclusion: Adapting the ISNCSCI system to a computer-generated format is possible and will promote uniformity in the collection and interpretation of impairment data. This program can also be used to educate health-care personnel, including residents and medical students, on classifying the impairment in traumatic spinal cord injury.