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when we think about treatment modalities typically you start off with the least invasive and then you progress but very often you need to use more than one strategy so an individual for example who has spasticity of the lower extremity lets say specifically the calf muscle is being overactive you might start off with teaching them how to stretch that muscle out and then you might use other modalities like botulinum toxin injections so injecting an agent that actually stops the communication between the nerve and the muscle temporarily so that that reflex is decreased so an example I can think of as an individual that I treated he had recently acquired spinal cord injury but he was actually doing practicing walking in his therapy there during inpatient rehabilitation and he had fairly good strength of the lower extremities and fairly good balance but whatever he would progress to weight-bearing on his feet they would start fluttering up and down and because of that clonise developing w