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STEP Spasticity


How the Best Minds Get Even Better


STEP Interventional Spasticity Certificate Program

Propel Yourself and Your Practice to the Forefront of Spasticity Expertise

AAPM&R is arming members with training to help them prepare and lead in competitive landscapes. Following the success of the highly-acclaimed STEP Ultrasound Certificate Program, we are excited to announce the launch of the STEP Interventional Spasticity Certificate Program.

STEP stands for Skills, Training, Evaluation and Performance. The STEP Interventional Spasticity Certificate Program teaches and assesses interventional spasticity skills using a standardized, progressive, and competency-based curriculum with both online and live components.

When you earn the STEP Interventional Spasticity Program Certificate, you:

  • Gain confidence by representing the highest standard in the field
  • Enhance your career opportunities
  • Earn visibility and credibility in spasticity management
  • Communicate to patients and employers that you are committed to excellence
  • Earn AMA PRA Category 1 Credits™ and meet American Board of Physical Medicine and Rehabilitation (ABPMR) Maintenance of Certification® (MOC®) Part II and Part IV requirements

Participants move through a series of 3 STEPs. Those who complete all the required STEPs earn a Certificate of Completion.

Learning Objectives

After completion of the STEP Interventional Spasticity Program, participants should be able to:

  • Have in-depth understanding of spasticity and its impact on patients
  • Assess the advantages and disadvantages of all treatment options (i.e., pumps, oral medications, surgeries)
  • Synthesize an optimal dynamic treatment plan for spasticity interventions
  • Discuss the pharmacology of injectable agents
  • Prepare and administer injectable toxins and nerve blocks
  • Recognize and assess functional anatomy related to spasticity (i.e., motion analysis)
  • Utilize multiple localization methods (EMG, US, hands/eyes, muscles, landmarks) for chemodenervation and nerve blocks
  • Recognize appropriate candidates for targeted drug delivery
  • Perform basic pump programming (increase/decrease, bridge bolus) on the most commonly used delivery systems
  • Recognize the utility of complex pump programming
  • Handle ITB emergencies
  • Identify the resources necessary to establish, manage, and grow a spasticity practice




Spasticity management has been identified as an area of clinical interest for most physiatrists. Upon completion of this course, the participant should be able to insert interventional spasticity techniques into their clinical practice. The expertise of the faculty is elite. The opportunity for close contact with these talented clinicians has never been duplicated.” - Michael F. Saulino, MD, PhD, FAAPMR, Program Director




Physiatrists are truly the leaders in neuro-musculoskeletal care. We need to ensure our skill set in interventional spasticity is improving health and bettering patients. During this program, you will learn so much from the top experts in the field. You will leave feeling confident and comfortable with treating your spasticity patients the best way possible. “- Monica Verduzco-Gutierrez, MD, FAAPMR, Program Director

Who Should Participate

Physiatrists who received limited exposure to this clinical area during residency and general physiatrists looking to add interventional muscle over-activity management to their practice, both in private practice and academic medical centers.


STEP 1: Online Program


Assess your current interventional spasticity knowledge with a baseline pre-exam and fill in your gaps and knowledge with a robust online curriculum which includes 30+ slide lectures, demonstration videos, and assessments.

  1. Baseline Pre-Exam with 25 Questions
  2. Online Curriculum = 16 CME credits


STEP 2: Live Course 


Reassess your interventional spasticity knowledge with an interval test and receive hands-on training from experts in the field at the live course.

  1. Live Step 2 Interventional Spasticity Course (2021 Date TBD).
    • (15.25 MOC® Part II Self-assessment Credits)
  2. Online Post-Exam with 25 Questions
  3. Case Log


STEP 3: Assessments and Certificate 


Complete and pass the final online and in-person skills assessment to receive your Certificate of Completion.

  1. Online Final Post-Exam with 50 Questions
    • 80% minimum passing score required
  2. In-Person Skills Assessment: 2021 (Date and Location TBD)
    • Passing score will be required


Pathway to the STEP Interventional Spasticity Certificate

It is expected that it can take at least a year for a participant to complete this program depending on availability of registration spots for the program's live events and participant's completion of each program component. Because this is a structured program, all steps must be completed in the order listed above (Step 1 > Step 2 > Step 3) and the entry point must start with Step 1.

CME Credit

This STEP program offers 31.25 AMA PRA Category 1 Credits™:

  • Online Curriculum offers 16 AMA PRA Category 1 Credits
  • Live Course offers 15.25 AMA PRA Category 1 Credits


Recommended prerequisites for successful completion of the program are:

  • At least 3 years of PM&R residency. 4th year PM&R residents may participate but should have their ACGME-required 20 toxin injections and 10 US scanning completed.
  • Some familiarity with ultrasound and EMG principles.
  • A sound working knowledge of MSK anatomy and kinesiology.

Invest in Your Future

Full STEP Interventional Spasticity Certificate Program:

AAPM&R Member: $2,500
Nonmember: $3,500


Registration will re-open once 2021 Step 2 live course dates become available.  


Temporary Cancellation Policy

Now through December 31, 2020, AAPM&R will give a full refund upon request, without any fees or penalties, to any individual who registered for the STEP Program and is unable to participate for any reason. 

PLEASE NOTE: For participants who have begun the STEP Program, refunds may not be issued for live or online components already completed or in progress. STEP program registrants with questions about refunds may contact

Thank You, Volunteers!

We would like to thank the following STEP Interventional Spasticity Workgroup members for dedicating their time, knowledge, and skills to the development of this program.

  • Michael F. Saulino, MD, PhD, FAAPMR, Co-Chair
  • Monica Verduzco-Gutierrez, MD, FAAPMR, Co-Chair
  • Alberto Esquenazi, MD, FAAPMR
  • Reza Farid, MD, FAAPMR
  • Michael C. Munin, MD, FAAPMR
  • Marilyn S. Pacheco, MD, FAAPMR
  • Andrea P. Toomer, MD, FAAPMR
  • Thomas K. Watanabe, MD, FAAPMR

The Academy is also grateful to our volunteers who contributed to the development of the online program development and test-item writing!

  • Roy L. Adair, MD
  • Abraham Alfaro, PhD, DO
  • Katharine E. Alter, MD
  • Keith D Baldwin, MD, MSPT, MPH- 
  • Gerald S. Bilsky, MD
  • Kristin E. Caldera, DO
  • Jeimylo C. de Castro, MD
  • Jennifer E. Doble, MD
  • Franklin SP Domingo, MD
  • Steve V. Escaldi, DO
  • Nicholas A. Godby, MD
  • Fatma Gul, MD
  • Shivani Gupta, DO
  • Patricia J. Hantsch, MD
  • Kimberly Heckert, MD
  • Didem Inanoglu, MD
  • Cindy B. Ivanhoe, MD
  • Mary Ann Keenan, MD
  • Nicholas C. Ketchum, MD
  • Heakyung Kim, MD
  • Linda E. Krach, MD
  • Christina Kwasnica, MD
  • John Lin, MD
  • Sheng Li, MD PhD
  • John R. McGuire, MD
  • Daniel K. Moon, MD
  • Marisa Moreta, DO
  • Patricia Nance, MD
  • Atul T. Patel, MD, MHSA
  • Natasha L. Romanoski, DO
  • Mary E. Russel, DO, MS
  • Erik T. Shaw, DO
  • Jose A. Urquidez, MD
  • Heather W. Walker, MD

Thank You to Our Exhibitors!



Saol logo FINAL

Partial support of the STEP Interventional Spasticity Certificate Program has been provided through an educational grant from Allergan, Ipsen Biopharmaceuticals, Inc., Merz North America, Inc. and Saol Therapeutics, in compliance with ACCME Standards for Commercial Support.