Damon Hoad ^1* Stephen Ashford ^2,3 Ganesh Bavikatte ⁴ Rachel Farrell ^5,6 Adrian Robertson ⁷ Jörg Wissel ^8,9

• ¹ Warwick Medical School, Faculty of Science, Engineering and Medicine, University of Warwick, Coventry, United Kingdom
• ² Department of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
• ³ London North West University Healthcare NHS Trust, Regional Hyper-acute Rehabilitation Unit, Northwick Park Hospital, London, United Kingdom
• ⁴ Neuro-Rehabilitation Medicine, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
• ⁵ Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, England, United Kingdom
• ⁶ Department of Rehabilitation, National Hospital for Neurology and Neurosurgery,, UCLH NHS Foundation trust, London, United Kingdom
• ⁷ Mid Yorkshire Hospitals NHS Trust, Wakefield, United Kingdom
• ⁸ Other, Berlin, Germany
• ⁹ University of Potsdam, Potsdam, Brandenburg, Germany

Background: Spasticity is a known complication to the hemiplegic shoulder following acquired brain injury. However, there is a current discrepancy between the diagnosis of arm spasticity and the subsequent assessment and treatment of spasticity in people with shoulder involvement.Objective: An expert panel aimed to establish a consensus and provide a simple structured approach to identifying and assessing people with spasticity of the hemiplegic shoulder.Methods: A consensus group of six spasticity experts were interviewed individually via 1-hour video calls to ascertain how they assess people with arm spasticity for shoulder involvement. During an inperson meeting in March 2023, a consensus-building process was used to discuss four topics: a checklist/tool to identify shoulder involvement in upper limb spasticity, measurements/scales for assessing shoulder spasticity, 'red flags' for other conditions affecting the shoulder, and assessment limitations and practicalities.Where there was full agreement on a topic, recommendations to overcome challenges for initial and ongoing assessment of shoulder spasticity and goal-setting were developed, and categorised as Posture, Purposeful activity and Pain ('the three Ps'). Posture should be observed when sitting and walking, as appropriate for the person, and compared to published shoulder spasticity patterns. Purposeful activity should be assessed using a systematic approach. The presence and nature of shoulder pain should be ascertained. Recommendations on impairment-and functionrelated measures are given.This consensus guidance provides practical recommendations on identifying shoulder spasticity to support clinicians in their management of people with neurological shoulder dysfunction.