Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis

Abstract

[Purpose] The purpose of this meta-analysis was to assess the effects of extracorporeal shock wave therapy (ESWT) on reducing spasticity immediately and 4 weeks after application of ESWT. [Subjects and Methods] We searched PubMed, TCL, Embase, and Scopus from their inception dates through June 2013. The key words “muscle hypertonia OR spasticity” were used for spasticity, and the key words “shock wave OR ESWT” were used for ESWT. Five studies were ultimately included in the meta-analysis. [Results] The Modified Ashworth Scale (MAS) grade was significantly improved immediately after ESWT compared with the baseline values (standardized mean difference [SMD], −0.792; 95% confidence interval [CI], −1.001 to −0.583). The MAS grade at four weeks after ESWT was also significantly improved compared with the baseline values (SMD, −0.735; 95% CI, −0.951 to −0.519). [Conclusion] ESWT has a significant effect on improving spasticity. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed.

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

“…In the last five years, a few review studies have provided primary evidence to support the use of ESWT for the upper and lower limb spasticity: one meta-analysis of clinical trials on all types of spasticity in patients after brain injury, 40 two meta-analyses of randomized controlled trials (RCTs) on spasticity in post-stroke patients, 41,42 one narrative review on muscle hypertonia and dystonia, 43 and one authorized narrative review on upper and lower limb spasticity in post-stroke patients. 44 Additionally, several studies have confirmed utility of ESWT in reducing spasticity among patients with cerebral palsy (CP, 8 studies on the total sample of 124 patients, 4 used fESWT and 4 rESWT) [45][46][47][48][49][50][51][52] and multiple sclerosis (MS, 1 study involved a group of 34 patients treated with rESWT).…”

Analysis of the Histological Effect of the Shock Waves on the Integrated Musculature of the Quadriceps of Wistar Rats

“…It is believed that tissue neovascularization results from the release of angiogenic growth and proliferation factors, including endothelial nitric oxide synthase (eNOS), vascular endothelial growth factor (VEGF) and nuclear cell proliferation antigen (PCNA) [1,6,12]. In the context of tissue injuries, vessel elongation is identi ed as one of the main agents promoting the release of these mediators through the in ux of calcium into endothelial cells and phosphorylation of phosphatidylinositol-3-kinase (PI3K) [13,14]. In spite of the lack of speci c studies on skeletal muscle, the literature points out that the use of shock wave therapy is capable of stimulating the same pathway and stimulating the activation and proliferation of endothelial cells similar to what occurred in the injury [6,13].…”

Effect of Extracorporeal Shock Wave Therapy on Hamstring Tightness in Healthy Subjects: A Pilot Study

“…There are few studies on the effects of ESWT for treatment of muscle problems. In spastic muscles of patients affected by brain lesion, ESWT reduces muscle tone in the short term 1213. In myofascial pain syndrome, ESWT significantly reduces muscle pain immediately after treatments 11.…”

“…This position was sustained for 1 minute, followed by 10 seconds of rest, and was repeated for five sets. The opposite hamstring muscle was stretched in the same way 1213…”