Reebye Rajiv, Jacinto Luis Jorge, Balbert Alexander, Biering-Sørensen Bo, Carda Stefano, Draulans Nathalie, Molteni Franco, O'Dell Michael W, Picelli Alessandro, Santamato Andrea, Verduzco-Gutierrez Monica, Walker Heather, Wissel Joerg, Francisco Gerard E
Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
Adult Rehabilitation Service, Alcoitão Rehabilitation Medicine Center, Estoril, Portugal.
Front Neurol. 2024 Aug 30;15:1432330. doi: 10.3389/fneur.2024.1432330. eCollection 2024.
Spasticity management should be provided within the context of a comprehensive person-centered rehabilitation program. Furthermore, active goal setting for specific spasticity interventions is also important, with a well-established "more is better" approach. It is critical to consider adjunctive therapy and multimodal approaches if patients are not attaining their treatment goals. Often used interchangeably, there may be confusion between the terms adjunctive and multimodal therapy. Yet it is imperative to understand the differences between these approaches to achieve treatment goals in spasticity management. Addition of a secondary pharmacologic or non-pharmacologic treatment to optimize the efficacy of the initial modality, such as adding electrical stimulation or casting to BoNT-A, is considered an adjunctive therapy. Adjunctive therapy is time-specific and requires the added therapy be initiated within a specific period to enhance the primary treatment; usually within 2 weeks. Multimodal therapy is an integrated, patient-centric program of pharmacologic and non-pharmacologic strategies utilized in a concurrent/integrated or sequential manner to enhance the overall treatment effect across a variety of spasticity-associated impairments (e.g., neural and non-neural components). Moreover, within a multimodal approach, adjunctive therapy can be used to help enhance the treatment effect of one specific modality. The objectives of this paper are to clarify the differences between adjunctive and multimodal therapies, provide a brief evidence-based review of such approaches, and highlight clinical insights on selecting multimodal and adjunctive therapies in spasticity management.
痉挛管理应在以患者为中心的全面康复计划背景下进行。此外，针对特定痉挛干预措施积极设定目标也很重要，采用已确立的“越多越好”方法。如果患者未达到治疗目标，考虑辅助治疗和多模式方法至关重要。辅助治疗和多模式治疗这两个术语经常互换使用，可能会造成混淆。然而，了解这些方法之间的差异对于实现痉挛管理的治疗目标至关重要。添加第二种药物或非药物治疗以优化初始治疗方式的疗效，例如在肉毒毒素A治疗中添加电刺激或支具，被视为辅助治疗。辅助治疗有时间限制，需要在特定时间段内开始添加的治疗以增强主要治疗效果；通常在2周内。多模式治疗是一种以患者为中心的综合计划，采用药物和非药物策略，以并行/综合或顺序方式使用，以增强针对各种与痉挛相关的损伤（如神经和非神经成分）的整体治疗效果。此外，在多模式方法中，辅助治疗可用于帮助增强一种特定治疗方式的治疗效果。本文的目的是阐明辅助治疗和多模式治疗之间的差异，提供对此类方法的简要循证综述，并强调在痉挛管理中选择多模式和辅助治疗的临床见解。
