Radial extracorporeal shock wave therapy (rESWT) in the treatment of spasticity in cerebral palsy: A randomized, placebo-controlled clinical trial

Vidal, Xavier; Morral, Antoni; Costa, Lluís; Tur, M.

doi:10.3233/nre-2011-0720

Cited by 55 publications

(44 citation statements)

References 24 publications

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“…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). 53…”

Section: Current Evidence On Shock Wavesmentioning

confidence: 99%

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

Dymarek

Ptaszkowski

Ptaszkowska

et al. 2020

CIA

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Purpose: This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT). Methods: PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done. Results: A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87 ±10.45 years and duration of stroke: 40.49±25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: Δ=34.45% of grade for fESWT and Δ=34.97% for rESWT that gives a slightly better effect of rESWT (Δ=0.52%) for spasticity (p<0.05), and Δ=38.83% of angular degrees for fESWT and Δ=32.26% for rESWT that determines the more beneficial effect of fESWT (Δ=6.57%) for range of motion (p<0.05), and Δ=18.32% for fESWT and Δ=22.27% for rESWT that gives a slightly better effect of rESWT (Δ=3.95%) for alpha motor neuron excitability (p<0.05). The mean PEDro score was 4.70±2.5 points for fESWT and 5.71±2.21 points for rESWT, thus an overall quality of evidence grade of moderate ("fair" for fESWT and "good" for rESWT). Three studies in fESWT and four in rESWT obtained Sackett's grading system's highest Level 1 of evidence. Conclusion: The studies affirm the effectiveness of ESWT in reducing muscle spasticity and improving motor recovery after stroke.

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Section: Current Evidence On Shock Wavesmentioning

confidence: 99%

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

Dymarek

Ptaszkowski

Ptaszkowska

et al. 2020

CIA

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“…Amelio and Manganotti [22] reported that when the soleus muscle and the medial and lateral gastrocnemius muscles were stimulated once with 1,500 times and 0.030 mJ/mm 2 in 12 child patients aged eight years on average, the treatment effects immediately after the treatment were maintained up to four weeks after the treatment, but were not statistically significant at three months after the treatment. In a study conducted by Vidal et al [23], when the upper/lower limb muscles with severe spasticity were stimulated three times with 2,000 times and 0.10 mJ/mm 2 in 15 cerebral palsy patients aged 31 years on average, the treatment effects immediately after the treatment were maintained up to two months after the treatment; however, the level of spasticity returned to that before the treatment at three months after the treatment. The reason as to why the treatment effects were maintained longer in the aforementioned two studies compared to the present study (although these studies were similar to the present study in that the treatment effects immediately after the treatment gradually decreased to become not statistically significant at three months after treatment) is considered to be the differences in energy per unit area.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Extracorporeal Shock Wave Therapy on Lower Limb Spasticity in Subacute Stroke Patients

et al. 2013

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ObjectiveTo evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in subacute stroke patients.MethodsWe studied thirty hemiplegic subacute stroke patients with ankle plantar flexor spasticity. ESWT was applied for 1 session/week, with a total of 3 sessions at the musculotendinous junction of medial and lateral gastrocnemius muscles. Patients were evaluated both clinically and biomechanically at baseline, after sham stimulation, and at immediately 1 week and 4 weeks after ESWT. For clinical assessment, Modified Ashworth Scale (MAS), clonus score, passive range of motion of ankle, and Fugl-Myer Assessment for the lower extremity were used. A biomechanical assessment of spasticity was conducted by an isokinetic dynamometer. Two parameters, peak eccentric torque (PET) and torque threshold angle (TTA), were analyzed at the velocities of 60°/sec, 180°/sec, and 240°/sec.ResultsAfter sham stimulation, there were no significant changes between each assessment. MAS and PET (180°/sec and 240°/sec) were significantly improved immediately and 1 week after ESWT. However, these changes were not significant at 4 weeks after ESWT. PET (60°/sec) and TTA (60°/sec, 180°/sec, and 240°/sec) were significantly improved immediately after ESWT. Yet, these changes were not significant at 1 week and 4 weeks after ESWT as well.ConclusionLower limb spasticity in subacute stroke patients was significantly improved immediately after ESWT. Although the therapeutic effect of ESWT reduced with time and therefore was not significant at 4 weeks after ESWT, the degree of spasticity was lower than that of the baseline. Future studies with a larger sample of patients are warranted in order to verify the protocols which can optimize the effect of ESWT on spasticity.

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“…Muscle Nerve 57: [466][467][468][469][470][471][472]2018 Extracorporeal shock wave therapy (ESWT) can improve function without inducing weakness in patients who suffer from spasticity and dystonia. [1][2][3][4] However, the mechanism of ESWT in the treatment of impaired muscle coordination has not been clarified. In a previous study, we applied radial extracorporeal shock waves (rESWs) to the gastrocnemius muscle of Sprague-Dawley rats and discovered, using a rhodamine-a-bungarotoxin binding method, that rESW-exposed muscles exhibited degeneration of acetylcholine receptors (AChRs).…”

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confidence: 99%

Extracorporeal shock wave treatment can selectively destroy end plates in neuromuscular junctions

et al. 2017

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Radial extracorporeal shock wave therapy (rESWT) in the treatment of spasticity in cerebral palsy: A randomized, placebo-controlled clinical trial

Cited by 55 publications

References 24 publications

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

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

The Effect of Extracorporeal Shock Wave Therapy on Lower Limb Spasticity in Subacute Stroke Patients

Extracorporeal shock wave treatment can selectively destroy end plates in neuromuscular junctions

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