Background and Purpose-Spasticity is a disabling complication of stroke and different noninvasive treatments are used to reduce muscle hypertonia. Shock waves are defined as a sequence of single sonic pulses largely used in the treatment of diseases involving bone and tendon as well as muscular contractures. The effect and duration of extracorporeal shock wave therapy (ESWT) was investigated on muscle hypertonia of the hand and wrist. Methods-A total of 20 patients affected by stroke associated with severe hypertonia in upper limbs were evaluated.Placebo stimulation was performed 1 week before active stimulation in each patient. Evaluation was performed using the National Institutes of Health and Ashworth scales and video monitoring with a digital goniometer before and immediately after placebo or active stimulation. Motor nerve conduction velocity from abductor digiti minimi were recorded. Patients were monitored at 1, 4, and 12 weeks after active treatment. Results-After active ESWT, patients showed greater improvement in flexor tone of wrist and fingers compared with placebo stimulation. At the 1-and 4-week follow-up visits, a significant decrease of passive muscle tonicity was noted on muscles in all patients receiving active treatment. At 12 weeks after therapy, 10 of the 20 patients showed persistent reduction in muscle tone. There were no adverse events associated with ESWT. Key Words: extracorporeal shock wave therapy Ⅲ muscle spasticity Ⅲ rehabilitation Ⅲ shock waves Ⅲ stroke I ncrease in muscle tone in the hands and wrists is a major problem in the management of chronic hemiparetic patients and may seriously impair dressing, washing, and other activities of daily living. 1 Motor neuron syndrome in stroke patients is a collection of symptoms including motor defects, increased reflexes, and muscle hypertonia, which produce a series of complications causing changes in the rheologic components of muscles and subsequent stiffness in tendons and joints. 1 In stroke, the hypertonia in muscles is partially related to spinal hyperexcitability in addition to fibrosis and changes in connective tissues that are responsible for passive rigidity of muscles. 1 Recent studies have reported that muscular injections of botulinum toxin type A decreases muscular tone in hypertonic muscles of the hand, with improvement in the use of the upper limb and a decrease in complications. [2][3][4][5] However, in a small number of patients, the development of neutralizing antibodies can reduce the efficacy of treatment. In addition, the dosage of botulinum is not always sufficient to treat extensive and severe hypertonia in upper and lower limbs. Rehabilitation and different noninvasive treatments, particularly on the connective components, should be also considered. Conclusions-ESWTShock waves are defined as a sequence of single sonic pulses characterized by high peak pressure (100 MPa), fast pressure rise (Ͻ10 ns), and short duration (10 s). Different studies and clinical experiments have demonstrated the efficacy of shock waves ...

Shock waves (SW), defined as a sequence of single sonic pulses characterised by high peak pressure (100 MPa), a fast rise in pressure (< 10 ns) and a short lifecycle (10 micros), are conveyed by an appropriate generator to a specific target area at an energy density ranging from 0.03 to 0.11 mJ/mm(2). Extracorporeal SW (ESW) therapy was first used on patients in 1980 to break up kidney stones. During the last ten years, this technique has been successfully employed in orthopaedic diseases such as pseudoarthosis, tendinitis, calcarea of the shoulder, epicondylitis, plantar fasciitis and several inflammatory tendon diseases. In particular, treatment of the tendon and muscle tissues was found to induce a long-time tissue regeneration effect in addition to having a more immediate anthalgic and anti-inflammatory outcome. In keeping with this, an increase in neoangiogenesis in the tendons of dogs was observed after 4-8 weeks of ESW treatment. Furthermore, clinical observations indicate an immediate increase in blood flow around the treated area. Nevertheless, the biochemical mechanisms underlying these effects have yet to be fully elucidated. In the present review, we briefly detail the physical properties of ESW and clinical cases treated with this therapy. We then go on to describe the possible molecular mechanism that triggers the anti-inflammatory action of ESW, focusing on the possibility that ESW may modulate endogenous nitric oxide (NO) production either under normal or inflammatory conditions. Data on the rapid enhancement of endothelial NO synthase (eNOS) activity in ESW-treated cells suggest that increased NO levels and the subsequent suppression of NF-kappaB activation may account, at least in part, for the clinically beneficial action on tissue inflammation.

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Here, we show that extracorporeal shock waves (ESW), at a low energy density value, quickly increase neuronal nitric oxide synthase (nNOS) activity and basal nitric oxide (NO) production in the rat glioma cell line C6. In addition, the treatment of C6 cells with ESW reverts the decrease of nNOS activity and NO production induced by a mixture of lipopolysaccharides (LPS), interferon-c (IFN-c) plus tumour necrosis factor-a (TNF-a). Finally, ESW treatment efficiently downregulates NF-jB activation and NF-jB-dependent gene expression, including inducible NOS and TNF-a. The present report suggests a possible molecular mechanism of the anti-inflammatory action of ESW treatment.

A single active shock wave stimulation produced a significant long-lasting reduction in hypertonia in the plantar flexors in children with cerebral palsy.