Twitchell and Brunnstrom, and may be known as the Brunnstrom Approach. Initially, post-stroke individuals have flaccid paralysis. As recovery begins, and progresses, basic movement synergies will develop into more complex and difficult movement combinations. Concurrently, spasticity may develop and become quite severe before it begins to decline (if it does at all). Although an overall pattern of motor recovery exists, there is much variability between each individual's recovery. As previously described, the role of spasticity in stroke rehabilitation is controversial. However, physiotherapy can help to improve motor performance, in part, through the management of spasticity. Repetitive task training (RTT), which involves the active practice of task-specific motor activities, improves upper and lower limb function, with improvements being sustained 6-months post-treatment. More research is needed on the type and amount of training. Unaddressed spasticity will result in the maintenance of abnormal resting limb postures which can lead to contracture formation. In the arm, this may interfere with hand hygiene and dressing, whereas in the leg, abnormal resting postures may result in difficulty transferring. In order to help manage spasticity, physiotherapy interventions should focus on modifying or reducing muscle tone. Strategies include mobilizations of the affected limbs early in rehabilitation, along with elongation of the spastic muscle and sustained stretching. In addition, the passive manual technique of rhythmic rotation can help to increase initial range. Activating the antagonist (muscle) in a slow and controlled movement is a beneficial training strategy that can be used by post-stroke individuals. Splinting, to maintain muscle stretch and provide tone inhibition, and cold (i.e. in the form of ice packs), to decrease neural firing, are other strategies that can be used to temporarily decrease the extent of spasticity. The focus of physiotherapy for post-stroke individuals is to improve motor performance, in part, through the manipulation of muscle tone. Oral drug therapies Oral medications used for the treatment of spasticity include: diazepam (Valium), dantrolene sodium, baclofen, tizanidine, clonidine, gabapentin, and even cannabinoid-like compounds.³ The exact mechanism of these medications is not fully understood, but they are thought to act on neurotransmitters or neuromodulators within the central nervous system (CNS) or muscle itself, or to decrease the stretch reflexes. The problem with these medications is their potential side effects and the fact that, other than lessening painful or disruptive spasms and dystonic postures, drugs in general have not been shown to decrease impairments or lessen disabilities. Intrathecal drug therapy