Clinical efficacy of ultrasound-guided stellate ganglion block combined with extracorporeal shock wave therapy on limb spasticity in patients with ischemic stroke

Abstract

Introduction To observe the clinical efficacy of ultrasound-guided stellate ganglion block (SGB) + extracorporeal shock wave therapy (ESWT) for limb spasticity in patients with ischemic stroke. Methods A total of 60 patients with post-stroke limb spasticity in our hospital were selected and randomly divided into four groups (n = 15). In the control group, patients received routine rehabilitation training. Based on routine rehabilitation training, SGB group patients underwent ultrasound-guided SGB, ESWT group patients received ESWT, and SGB + ESWT group patients received ultrasound-guided SGB combined with ESWT. The total treatment course was one month. The Modified Barthel Index (MBI) score, Fugl-Meyer Assessment and upper limb rehabilitation training system were applied to evaluate the activities of daily living, upper limb motor function and upper limb performance before and after treatment. Finally, the improvement after treatment was compared among different groups. Results After treatment, compared with the control group, the MBI score and the upper limb score based on Fugl-Meyer Assessment in the SGB, ESWT, and SGB + ESWT groups were significantly increased (P < 0.05). Furthermore, compared with the SGB and ESWT groups, SGB + ESWT exhibited a higher upper limb function score (P < 0.05), while the MBI score was not significantly different (P > 0.05). In terms of upper limb performance ability, patients in the SGB, ESWT and SGB + ESWT groups had better fitting degree, participation and exertion of exercise than those in the control group, and the SGB + ESWT group patients had the same movement trajectory as robots. Conclusion Ultrasound-guided SGB and ESWT can reduce the muscle tension of patients, alleviate spasticity, promote the motor function of the upper limb, and improve the working performance of patients. However, the effect of SGB combined with ESWT is better.

Extracorporeal Shockwave Treatment as Additional Therapy in Patients with Post-Stroke Spasticity of Upper Limb—A Narrative Review

“…Only one study, that by Guo et al (2019), gathered a study group of more than 100 patients, more precisely, 120 patients [53]. The large majority of studies involved a smaller number of patients; the number ranged from 20 to 60 patients [29,32,34,[80][81][82][83]85,88,[90][91][92]. For oursystematic review, we also qualified a case study conducted on one patient [89].…”

“…For oursystematic review, we also qualified a case study conducted on one patient [89]. To check upper-limb recovery, the researchers mainly used the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) [29,34,53,85,88,91,92] and in some individual cases, the Action Research Arm Test (ARAT) was used [88]. Muscle tension and spasticity status weretested using the Modified Ashworth Scale (MAS), Ashworth Scale (AS), Tardieu Scale, and Modified Tardieu Scale (MTS) [29,32,34,53,[80][81][82][83][84][85][87][88][89][90]92].…”

“…Muscle tension and spasticity status weretested using the Modified Ashworth Scale (MAS), Ashworth Scale (AS), Tardieu Scale, and Modified Tardieu Scale (MTS) [29,32,34,53,[80][81][82][83][84][85][87][88][89][90]92]. Yuan et al (2023) did not check their patients' muscle tension status using the above scales [91]. Tabra et al (2021) used an electrophysiological assessment of spasticity based on the Hmax/Mmax amplitude ratio as a reliable measure of α motor neuron excitability and spasticity [92].…”

“…Tabra et al (2021) used an electrophysiological assessment of spasticity based on the Hmax/Mmax amplitude ratio as a reliable measure of α motor neuron excitability and spasticity [92]. The study's authors did not use common measures of muscle tone: AS, MAS, TS, or MTS.On a case-by-case basis, the researchers used the National Institutes of Health Stroke Scale (NIHSS) to assess the severity of selected symptoms and monitor the condition of stroke patients [82], voluntary control grading (VCG) [88] to assess the voluntary control of the affected hand, the Motricity Index to assess motor impairment [92], the Modified Barthel Index (MBI) [91] and Barthel Index (BI) [32] to assess daily activities, the Disability Assessment Scale (DAS) [89] to assess the functional disability of the upper limb, and the Mini Mental State Examiation-Korea (MMSE-K) to assess cognitive function [85]. Manganotti et al(2005) used video monitoring with a digital goniometer to assess patients' range of motion [80].…”

“…The number of strokes applied by shockwave cartridges ranged from 1000 to 6000 strokes [34,82]. However, clinicians most often used values in the range of 1000-3000 strokes [29,32,53,83,87,[90][91][92]. The shockwave pressure parameters used ranged from 1.2 to 2.5 Ba [34,84], a frequency of 4-18 Hz, and energy pulses of 0.03-0.93 mJ/mm 2 [29,32,81,82,84].…”