When a patient is referred for possible reconstructive surgery for their hemiplegic limb, they will come to see us in the clinic and often the surgeons or the surgeons with the therapists together will perform the physical examination. We will then determine which procedures would be the most effective in this case. Sometimes we can determine this based on the physical examination alone and sometimes we need to do additional procedures such as the injections of lidocaine, botox, or the EMG. If those procedures are required, there’s often a second visit involved. We undertake these interventions or these studies, we then see the patient back afterwards to assess the effect of those interventions. If they accomplished what we hope they would accomplish, we will then plan for surgery. Surgery is typically an outpatient procedure, usually lasting less than three hours and the patient would go home the same day. Pain usually is not significant and incisions usually close with absorbable sutures and skin glue so the patient can shower the same day or without any adverse effect of the wound. The patient usually within the same week is referred to physical therapy and began training and learning how to use the limb in its new configuration. The patient usually is referred to physical therapy and they will begin that therapy within a week of surgery. Immediately, the use of the limb will have changed and they will begin to learn how to use the limb in a more functional way.