Extracorporeal Shock Wave Therapy for the Treatment of Poststroke Plantar-Flexor Muscles Spasticity: A Prospective Open-Label Study

Abstract

ESWT is safe and efficacious for the treatment of poststroke plantar-flexor muscles spasticity, reducing muscle tone and improving passive ankle dorsiflexion motion. The effect was long lasting in subjects with echo intensity of calf muscles graded I, II, or III but was brief for echo intensity graded IV on the Heckmatt scale. The ESWT effect did not appear to be related to spinal excitability.

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

“…Apparently with more time past the stroke, the changes in muscle architecture become more similar to the changes of an atrophic muscle [16]. It was revealed that the gastrocnemius muscle is the most susceptible muscle of the lower extremity to non-use which was detected by the changes in the muscle architecture [27].…”

“…The positive effect of ESWT on spasticity reduction in different upper motor neuron diseases such as cerebral palsy [7][8][9][10], stroke [11][12][13][14][15][16] and multiple sclerosis [17] has been shown in previous studies. Positive effect of ESWT on the feet plantar surface contact has been also shown in studies which applied ESWT over the spastic ankle plantar flexor muscles [7,9].…”

“…ESWT is defined as a series of single sonic pulse characterized by spike pressure (100 MPa), rapid rise (<10 ns), and brief duration (10 µs), applied by an appropriate generator to a specific target area with the range of 0.003-0.89 mJ/mm 2 energy density [6]. Previous studies evaluated the effect of ESWT on spasticity in different neurological conditions such as cerebral palsy [7][8][9][10], stroke [11][12][13][14][15][16] , and multiple sclerosis [17]. In previous studies with ESWT to treat post-stroke plantarflexor spasticity, the effects were not evaluated in terms of clinical, functional, and muscle architecture measures altogether.…”

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

“…The necessity of new noninvasive treatment methods for spasticity has been raised because spasticity cannot be controlled sometimes even with diverse treatment methods as well as due to the existing side effects of oral drugs and the invasiveness of local treatment methods [12]. Recent studies indicated that shock wave therapy (SWT) is an effective method for treating spasticity, it is being considered as a new alternative treatment method for spasticity [13][14][15][16][17][18]. The radial SWT is a new noninvasive alternative therapeutic method based on technology generating non-focused shockwaves.…”

“…The most important parameter of SWT for the outcome of treatment is the energy [23]. Different energy levels have been used in the previous studies for treatment of spasticity without any proven clinical benefits for certain energy level over the other [13][14][15][16][17][18][19][20][21][22]. 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.…”