The management of spasticity in CP is complex and is a major challenge to the treatment team. The ultimate goal of any therapy program must be to achieve the child's maximum potential in motor skills. Unfortunately, the scientific evidence for various physical therapy treatment options for children with CP is limited. Botulinum neurotoxin (BoNT) is a widely used and effective pharmacological treatment for focal muscle over-activity. An alternative to BoNT treatment is focal intramuscular treatment with phenol and alcohol, with the aim to improve activity limitations and other outcomes in children and adults with spasticity. However, focal intramuscular injection of BoNT, phenol and alcohol is not without problems: (i) BoNT is expensive and not available in many countries; (ii) a significant risk of focal intramuscular injection of alcohol and phenol is persisting pain; and (iii) all these procedures are invasive and, thus, not without risk when applied under difficult hygienic conditions. With regard to post-stroke spasticity, a recent Cochrane review concluded that, at best, there was 'low level' evidence for the effectiveness of outpatient multidisciplinary rehabilitation in improving active function and impairments following BoNT treatment for upper limb spasticity in adults with chronic stroke.