Effects of Extracorporeal Shock Wave Therapy on Muscle Spasticity in Post-Stroke Patients: An Ultrasonography and Clinical-Base Study

Abstract

Purpose:To investigate the effect of single session Extracorporeal Shock Wave Therapy (ESWT) over the ankle plantar flexor muscles on the spasticity, muscle architecture, and gait in chronic stroke patients. Methods:This quasi-experimental, single group study had a repeated measures design. A total of 17 post-stroke patients were selected by convenience sampling method, and received 2000 shots of ESWT on the ankle plantar flexor muscles of the affected side in one session. Outcome measures consisted of Modified Modified Ashworth Scale (MMAS), bilateral leg circumference, and muscle architecture parameters (pennation angle, fascicle length, and muscle thickness) of the medial head of the gastrocnemius muscle, timed up and go (TUG) test, self-reported visual analog scale (VAS) of spasticity, and ankle passive Range of Motion (pROM). All outcomes were measured at 2 times: before the intervention and 30 minutes after the intervention. The muscle architecture parameters and leg circumference were also measured immediately after the intervention. Statistical analysis was done using SPSS 18.0. Repeated measures analysis of variance (ANOVA) was performed to evaluate the effects of intervention in time.Results: Wilcoxon test revealed significant improvement in MMAS. Significant improvement in VAS, pROM, and TUG test results is also noted by means of the paired t test. ANOVA showed significant time×side interaction for the pennation angle and leg circumference. Significant effect of time was also shown by ANOVA for leg circumference. Post hoc analyses showed a significant difference for the leg circumference before the intervention and 30 minutes after it. ANOVA showed no significant change in fascicle length and muscle thickness. Spearman's rho revealed significant positive correlation between the changes of the ankle pROM and improvement of the fascicle length. Conclusion:According to the results single session of ESWT over the spastic plantar flexors muscle can improve clinical measures of muscle spasticity and motor function. More studies are needed to clarify the underlying mechanisms for the antispastic effect of ESWT.

Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke

“…For the PA and MT, mean scores were decreased after ESWT treatment. These finding are similar to those from another study that showed ESWT can change the scores of MFL, MT, and PA [16].…”

“…It is known that muscle fascicular change is important as an underlying mechanism for spasticity. The correlation between the spasticity score and muscle architecture of the spastic medial gastrocnemius muscle has been shown in previous studies . In the present study, we analyzed the correlation between the changes in muscle architecture and the changes in clinical measures.…”

“…Several previous studies that applied ESWT to patients with post-stroke muscle spasticity showed different results through various assessments [8][9][10][11][12][13][14][15][16]. The reason for the differences in the results was assumed to be the differences in the mechanisms of shock wave generation, energy per unit area, the number of applications, site of application, and patients' duration of illness [14].…”

“…Extracorporeal shock wave therapy (ESWT) is a physical modality that has been used for various musculoskeletal problems [5][6][7]. Several studies have applied ESWT to patients with poststroke spasticity [8][9][10][11][12][13][14][15][16]. A few authors proposed that direct effect of ESWT on connective tissue stiffness and muscle fibrosis is the main mechanism for its effects on spasticity [10,11].…”

“…One recently published study investigated the effect on muscle architecture in addition to clinical assessments of a single session of ESWT over ankle flexor muscle. However, it was a single group study without a control group and had a repeated measures design .…”