Effective Site for the Application of Extracorporeal Shock-Wave Therapy on Spasticity in Chronic Stroke: Muscle Belly or Myotendinous Junction

Abstract

ObjectiveTo compare the effect of extracorporeal shock-wave therapy (ESWT) applied at the muscle belly and myotendinous junction on spasticity in the upper and lower limbs of chronic stroke patients.MethodsOf the 151 patients, a total of 80 patients with stroke-induced spasticity on the elbow flexor and 44 patients on the knee flexor were enrolled for a prospective, randomized clinical trial. The patients were divided into control, muscle belly, and myotendinous junction groups, and a total of three ESWT sessions (0.068–0.093 mJ/mm2, 1,500 shots) were conducted at one per week. A Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) were collected at the baseline and at 1 week after each session.ResultsAfter interventions, the MAS and MTS of both the belly and the junction groups showed positive effects from the ESWT on spasticity in the elbow and knee flexors, but the control group did not. The results also tended to improve after each session until the entire intervention was completed. However, there was no significant difference between the belly and junction groups.ConclusionESWT could be effective for treating chronic spasticity after stroke when applied to muscle belly or myotendinous junction.

<p>Shock Waves as a Treatment Modality for Spasticity Reduction and Recovery Improvement in Post-Stroke Adults – Current Evidence and Qualitative Systematic Review</p>

“…This resulted in a mean difference showing clinical improvement in spasticity between pre-and post-intervention at Δ=34.45%. 54,[61][62][63][64][70][71][72][73] In turn, the spasticity level in rESWT groups at M0 was ranged between 1.53 and 3.30 grade (2.29±0.59 grade) in comparison to results presented after rESWT application varied from 0.73 to 2.30 (1.42±0.52 grade). This resulted in mean differences showing clinical improvement in spasticity between pre-and postinterventions at Δ=34.97%.…”

“…For purposes of the systematic review, the selected clinical outcomes were analyzed and compared between the baseline (M0) and the first measurement time point after ESWT (M1). The following outcomes were analyzed: (1) spasticity level as Δ% of grade in MAS or MMAS tools in 16 studies (nine studies in fESWT vs 7 studies in rESWT), 54,[61][62][63][64][65][66][67][68][69][70][71][72][73][74] (2) range of motion as Δ% of degree in GOM assessment of nine studies (six studies in fESWT vs three studies in rESWT), 54,63,64,67,68,70,72,75 and (3) selected electrophysiological parameters in such as MNC-V as Δ% of ms, CMAP-L as Δ% of ms, CMAP-A as Δ% of mV, FW-L as Δ% of ms, FW-A as Δ% of μV, HR-L as Δ% of ms and H/M-R as Δ% in six studies (four studies in fESWT vs two studies in rESWT), 65,67,70,73,75 It should be also noted that follow-up observations were undertaken in 12 studies within a mean period of 5.5 weeks (6.2 weeks in fESWT vs 4.7 weeks in rESWT) 54,[62][63][64][65][66]68,70,73 (Table 1).…”

“…It was found that in the ESWT groups the local anesthetic transcutaneous injections were not performed in eight studies. 61,66,[68][69][70][72][73][74] This clinically important issue was not specified in the case of nine articles 54,[62][63][64][65]67,71,75 ( Table 1). Only 11 cases of unexpected ESWT-related side effects were identified (pain n=5, lower limb muscular weakness n=2, petechiae at the treatment site n=3, and small bulla n=1).…”

“…67,73 It should be noted that all side effects were tolerated quite well by all patients and were resolved in a few days. Unfortunately, there were studies with lacking information about the presence or absence of any adverse events [62][63][64]69,70,72 (Table 1).…”

Stuburo stabilizavimo pratimų ir smūginės bangos terapijos efektyvumas, esant juosmeninės srities radikulopatijai

“…Nors kû no pa dë ties val dy mas ir pa lai ky mas yra bû ti ni tiek sta ti në mis, tiek di na mi në mis ap lin kos sà ly go mis, ta èiau di na mi në po stu ra li në kon tro lë tu ri di des ná vaid me ná kasdie ni nia me gy ve ni me. Pa ge rë jus po stu ra li nei kon tro lei, kai tai ko mas re a bi li ta ci nis gy dy mas, su ma þë ja skaus mas griau èiø ir rau me nø sis te mos su tri ki mø at ve jais [19]. Uþ -sie nio ða liø au to riai nu ro do, kad apa ti nës nu ga ros da lies skaus mas sà ly go ja su tri ku sià po stu ra li nae kon tro lae ir jos val dy mà [20,21].…”