Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke

Abstract

Recently, studies have reported that extracorporeal shock wave therapy (ESWT) is a safe, noninvasive, alternative treatment for spasticity. However, the effect of ESWT on spasticity cannot be determined, because most studies to date have enrolled small patient numbers and have lacked placebo-controlled groups and/or long-term follow-up. In addition, whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of radial ESWT (rESWT) in patients with poststroke spasticity and surveyed the outcome of functional activity.Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.

Effect of Different Energy Levels of Radial Shock Wave Therapy on Spasticity in Patients With Stroke

“…The results of present study were in agreement with previous studies that showed that radial SWT has a positive effect on spasticity in patients with stroke and cerebral palsy [11,[20][21][22]29]. Standard guidelines for the use of SWT on soft tissue have not been established.…”

“…Standard guidelines for the use of SWT on soft tissue have not been established. However repeated sessions of radial SWT result in a more noticeable and longer-lasting effect [22]. Radial SWT is characterized by having a larger therapeutic area compared with focused SWT.…”

“…The most important parameter of SWT for the outcome of treatment is the energy [23]. Different energy levels have been used in the previous studies for treatment of spasticity without any proven clinical benefits for certain energy level over the other [13][14][15][16][17][18][19][20][21][22]. So, the purpose of the study was to compare the effect of two different energy levels of radial SWT on spastic muscles of the hand and wrist in patients affected by stroke.…”

“…The radial SWT is a new noninvasive alternative therapeutic method based on technology generating non-focused shockwaves. It doesn't require anesthesia or analgesics with high comfort of the therapy, also it does not cause muscle weakness in patients with stroke [19][20][21][22]. The most important parameter of SWT for the outcome of treatment is the energy [23].…”

A method of hand motor control assessment in patients with post-stroke spasticity

“…In their research, Keng et al revealed that 3 months post stroke, spasticity occurred in 33% of the patients [6]. The level of spasticity is usually assessed with Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) [7][8][9][10][11][12][13][14][15]. …”