Effectiveness of Radial Extracorporeal Shock Wave Therapy and Visual Feedback Balance Training on Lower Limb Post-Stroke Spasticity, Trunk Performance, and Balance: A Randomized Controlled Trial

Abstract

Stroke remains one of the leading causes of disability in adults, and lower limb spasticity, affected stance, and balance impact everyday life and activities of such patients. Robotic therapy and assessment are becoming important tools to clinical evaluation for post-stroke rehabilitation. The aim of this study was to determine in a more objective manner the effects of visual feedback balance training through a balance trainer system and radial extracorporeal shock wave therapy (rESWT), along with conventional physiotherapy, on lower limb post-stroke spasticity, trunk control, and static and dynamic balance through clinical and stabilometric assessment. The study was designed as a randomized controlled trial. The experimental group underwent conventional physiotherapy, visual feedback balance training, and rESWT. The control group underwent conventional physiotherapy, visual feedback training and sham rESWT. The statistical analysis was performed using GraphPad Software and MATLAB. Primary clinical outcome measures were The Modified Ashworth Scale (MAS), passive range of motion (PROM), Visual Analogue Scale (VAS), and Clonus score. Secondary outcome measures were trunk performance, sensorimotor, and lower limb function. Stabilometric outcome measures were trunk control, static balance, and dynamic balance. Visual feedback training using the Prokin system and rESWT intervention, along with conventional physiotherapy, yielded statistically significant improvement both on clinical and stabilometric outcome measures, enhancing static and dynamic balance, trunk performance, sensorimotor outcome, and limb function and considerably diminishing lower limb spasticity, pain intensity, and clonus score in the experimental group.

Conventional physical therapy combined with extracorporeal shock wave leads to positive effects on spasticity in stroke survivors: a prospective observational study

“… 26 , 28 The results of our study are in line with other trials given that clinical and instrumental data supported the effectiveness of ESWT in reducing the grade of muscle spasticity in children with CP, as well as in post-stroke adults. 6 , 12 , 29 Positive effects of rESWT delivered during a CPT protocol were also noticed for outcomes such as sensorimotor and lower limb function, balance, and gait. A possible explanation for these positive changes after ESWT could be that in children with CP the plantar surface area increased, and consequently, the gait pattern also improved leading to better stability and balance control.…”

A Comprehensive Review of the Effects of Extracorporeal Shock Wave Therapy on Stroke Patients: Balance, Pain, Spasticity

“…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 ]. These studies have generally reported positive outcomes, with improvements in balance and postural control following ESWT treatment.…”