Effectiveness of Extracorporeal Shock Wave Therapy on Postural Control and Balance in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial
Abstract:The aim of this study was to investigate the effects of Extracorporeal Shock Wave Therapy (ESWT) applied to paraspinal muscles on balance and postural control in children with unilateral Cerebral Palsy (CP). A total of 32 children with unilateral CP were included in the study. The children participated in a one-session control to evaluate their reactions to ESWT before randomly assigning them into experimental and control groups. We evaluated children twice: before and after the treatment. We used the Trunk Co… Show more
“… 35 Radinmehr et al 24 found no significant difference in TUG scores in patients with hemiplegia treated with ESWT. Bilek and Tekin 36 did not see a statistically significant difference in TUG scores between groups. Our study found statistically significant differences in the TUGs before and after the treatment.…”
Background:
We aimed to investigate the effect of Extracorporeal Shock Wave Therapy (ESWT) applied to patients with hemiplegia on somatosensory data, spatiotemporal parameters, posture, and muscle tone.
Methods:
This was a double-blind, randomised, controlled trial. Patients were randomised within pairs to either the experimental (ESWT) group (n = 20) or the control group (n = 20). All patients participated in the same conventional stroke rehabilitation program for 60 minutes of treatment a day, 5 times a week for 6 weeks (30 sessions). Patients assigned to the ESWT group received additional ESWT over the plantar fascia 3 days/week for 6 weeks. Timed Up and Go (TUG) test, Modified Ashworth Scale (MAS) score, Posture Assessment Scale for Stroke Patients (PASS), spatiotemporal parameters, Semmes–Weinstein monofilament (SWM) test, and vibration sensation test (VST) were performed in all participant before and after treatment.
Results:
In the ESWT and control groups, statistically, significant differences were obtained in the posttreatment analysis than pre-treatment. Significant differences were found in foot angle, step cycle duration, swing phase, cadence, gait cycle distance, and VST values after ESWT treatment (
P
< .01).
Conclusion:
When combined with a neurological rehabilitation program, it was determined that ESWT applied to the plantar face of the foot in individuals with hemiplegia increased somatosensory functions and was more successful in developing postural control and balance.
“… 35 Radinmehr et al 24 found no significant difference in TUG scores in patients with hemiplegia treated with ESWT. Bilek and Tekin 36 did not see a statistically significant difference in TUG scores between groups. Our study found statistically significant differences in the TUGs before and after the treatment.…”
Background:
We aimed to investigate the effect of Extracorporeal Shock Wave Therapy (ESWT) applied to patients with hemiplegia on somatosensory data, spatiotemporal parameters, posture, and muscle tone.
Methods:
This was a double-blind, randomised, controlled trial. Patients were randomised within pairs to either the experimental (ESWT) group (n = 20) or the control group (n = 20). All patients participated in the same conventional stroke rehabilitation program for 60 minutes of treatment a day, 5 times a week for 6 weeks (30 sessions). Patients assigned to the ESWT group received additional ESWT over the plantar fascia 3 days/week for 6 weeks. Timed Up and Go (TUG) test, Modified Ashworth Scale (MAS) score, Posture Assessment Scale for Stroke Patients (PASS), spatiotemporal parameters, Semmes–Weinstein monofilament (SWM) test, and vibration sensation test (VST) were performed in all participant before and after treatment.
Results:
In the ESWT and control groups, statistically, significant differences were obtained in the posttreatment analysis than pre-treatment. Significant differences were found in foot angle, step cycle duration, swing phase, cadence, gait cycle distance, and VST values after ESWT treatment (
P
< .01).
Conclusion:
When combined with a neurological rehabilitation program, it was determined that ESWT applied to the plantar face of the foot in individuals with hemiplegia increased somatosensory functions and was more successful in developing postural control and balance.
“…ESWT may help improve balance by targeting the affected muscles and neural pathways, promoting neuromuscular re-education, and facilitating motor recovery [ 33 ]. The mechanical stimulation induced by ESWT can increase blood flow [ 28 ], promote cellular responses, and enhance the functionality of affected muscles and joints, thereby improving overall balance and stability [ 34 ]. Several clinical trials and systematic reviews have investigated the effects of ESWT on balance ( Table 1 ) [ 35 ].…”
Section: Effects Of Eswt On Balance Improvement In Strokementioning
Stroke remains a leading cause of disability worldwide, with survivors often experiencing impairments in balance, pain, spasticity, and control that limit their ability to perform daily living activities. Extracorporeal shock wave therapy (ESWT) has emerged as a potential treatment modality to improve these outcomes in stroke patients. This review aims to provide a comprehensive examination of the effects of ESWT on stroke patients, focusing on the theoretical background, balance, pain reduction, muscle spasticity and control, and upper and lower extremities. This study reviewed the use of ESWT in treating balance, pain, and spasticity in stroke patients, focusing on articles published in PubMed between January 2003 and January 2023. Systematic reviews related to stroke were used to provide an overview of stroke, and a total of 33 articles related to balance, pain, and spasticity were selected. ESWT has several shock wave generation methods and application methods, and it has been shown to have positive therapeutic effects on various aspects of rehabilitation for stroke patients, such as improving balance, reducing pain, decreasing muscle spasticity and increasing control, and enhancing functional activities of the upper and lower extremities. The efficacy of ESWT may vary depending on the patient’s condition, application method, and treatment area. Therefore, it is important to apply ESWT according to the individual characteristics of each patient in clinical practice to maximize its potential benefits.
“…A randomized controlled trial (RCT) in 2021 suggested that extracorporeal shock wave therapy given to paraspinal muscles offers significant additive value when paired with NDT in improving balance and postural control in children with hemiplegic CP. Thirty-two CP children were included in the study and the tools used were the trunk control measurement scale, timed up and go, pediatric balance scale, and trunk impairment scale [ 35 ].…”
Section: Reviewmentioning
confidence: 99%
“…Viking speech scale (VSS) [34] 38 Trunk control measurement scale [35,57] 39 Mobility questionnaire [37] 40 Goal Attainment Scale [36,38] 41 3D gait analysis [36] 42 Ultrasonography [37] 43 Mobility questionnaire (MobQue) [37] 44 Root mean square of head accelerations [38] 45 Hip radiographs to measure migration percentage [38] Parent questionnaire rating child mobility […”
Section: Introductionmentioning
confidence: 99%
“…These areas of improvement are summarized in Table1. Gross motor[7,10,11,12,13,14,15,17,18,22,23,24,25,32,37,38,44,45,46,47,51,52,55,60] 2Balance[7,8,28,30,35,43,51,57] 3 Postural control/trunk control[7,8,27,28,35,57]…”
This review aimed to explore the current literature on neurodevelopmental treatment (NDT) in children with cerebral palsy (CP). It also sought to determine what outcome measures are used to analyze the effect of NDT and whether these parameters are in line with the components of the International Classification of Functioning, Disability and Health (ICF). The studies published in the English language between 2000 and 2023 were included based on a search of the databases PEDro, PubMed, and Google Scholar. Studies that examined the effect of NDT on children with CP were included.
We found a total of 54 studies describing the effect of NDT in children with CP and these were included in this literature review. NDT in children with CP was found to have positive outcomes in 41 studies, while 13 studies had contradictory conclusions. Based on our findings, NDT is widely used for the rehabilitation of children with CP globally. The parameters used to assess the improvement mostly included gross motor function, balance, and postural control. The outcome measures used in studies are usually linked to body structure and function or activities domain of the ICF model by the World Health Organization (WHO). However, there is a scarcity of studies on the effect of NDT on participation, which should be the outcome of any rehabilitation program. There is scope for future research to demonstrate the effect of NDT on the participation of children with CP. Further studies with larger sample sizes and homogenous groups are recommended.
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