Reduce Inefficiencies in Management of Spasticity

Inclusion Criteria: * Currently admitted for an acute hemorrhagic or ischemic stroke; recurrent stroke allowed if no spasticity at baseline * NIHSS score of \> 0 on items 5 or 6 (required of at least 1 limb) * Willingness to participate in the study for 24 months * Able to sign consent form or availability of a legally authorized representative to sign * Able to read/write in English * Identified MD for follow up post hospitalization Exclusion Criteria: * Botulinum toxin use for any indication within the past 12 weeks * Acute life threatening illness * Prior limb injury or neurological diagnosis that limited movement in the now affected limb(s) * Any terminal illness that would limit participation in study follow ups * Known spasticity or other movement disorders that impact tone