Effect of Different Energy Levels of Radial Shock Wave Therapy on Spasticity in Patients With Stroke

Abstract

Background and purpose: Spasticity in the hands and a wrist is a major problem in the management of stroke patients. Different energy levels of shock wave therapy (SWT) have been used for treatment of spasticity. So, the purpose of the study was to compare the effect of two different energy levels of radial SWT on spastic muscles of the hand and wrist in patients affected by stroke. Materials and Methods:Patients randomly assigned into two groups. Group A received the low energy radial SWT while group B received the medium energy radial SWT. Spasticity of wrist and fingers was evaluated using Modified Ashworth Scale (MAS), range of motion (ROM) of the wrist was evaluated using digital goniometer and pain was measured by Visual Analogue Scale (VAS).Results: there was a significant decrease in MAS scores of the wrist flexors and fingers flexors muscles post treatment for both groups (P<0.05). The ROM was significantly increased post treatment from (48.46±2.09) to (70.02±3.23) for group A and from (49.15±1.95) to (79.13±3.42) for group B. Also VAS scores was a significantly decreased in both groups post treatment. Conclusion:Radial SWT is an effective therapeutic tool in reducing flexor spasticity of the wrist and hand in patients with stroke. Moreover, the medium energy level was superior to the low energy level in regarding to the measured treatment outcomes.

The effectiveness of extracorporeal shock wave therapy for improving upper limb spasticity and functionality in stroke patients: a systematic review and meta-analysis

“…The energy levels oscillated between one and four bars. Fouda et al 25 compared two energy levels, for radial extracorporeal shockwave (2 bar, 0.1 mJ/mm 2 , low energy) versus radial extracorporeal shockwave (four bar, 0.18 mJ/ mm 2 , medium energy). The results favoured the medium energy group (see Supplemental Table S2).…”

“…The PRISMA diagram (see Figure 1) summarizes the results of the scientific literature search. Sixteen randomized controlled trials were included: these were by Bae et al, 15 Santamato et al, 16 Fouda et al, 17 Dymarek et al, 18 Kim et al, 19 Li et al, 20 Yoon et al, 21 Duan et al, 22 Guoxing et al, 23 Guo et al, 24 Fouda et al, 25 Kamaluddin et al, 26 Park et al, 27 Wu et al, 28 Ahmed et al, 29 and Li et al 30 Studied identified but not included are shown in Appendix 2. No author responded when contacted for additional information.…”

“…Radial extracorporeal shock waves should be applied to muscle belly, as it has a more superficial effect. Focused extracorporeal shock waves should be applied to the tendinous joint or muscle motor point, as it reaches a medium level of energy 25 in the focus located deeper within the body tissues.…”