Impact of Extracorporeal Shock Wave Therapy on Spastic HandFunction with Assistive Devices in Children with Cerebral Palsy

Abstract

Background:The spastic cerebral palsy isconsidered the most common of cerebral palsy types. Spasticity of upper limbs is major problem in children that affected on hand function during grasping and through using assistive devices as walker and canes. Shock wave treatment on spastic muscles of upper limbs in stroke patients performed a significant decrease in muscle tone.The aim of current study was to determine the impact of extracorporeal shock wave therapy (ESWT) on spastic muscle of hand in children with spastic cerebral palsy.Methods:Thirty twohemiplegic spastic cerebral palsy patients from both sexes were recruited in this study.The children were divided randomly into two groups equal in number; GroupӀ(control)consisted of 16 children(7 boys and 9 girls) with mean±standard deviation age of 6.68±2.63years received exercises program only (3sessions/week for two months, GroupӀӀ(experimental)included (10 boys and 6 girls)with mean±standard deviation age of 6.37±1.44 years received the same exercises program in addition to sessions by extracorporeal shock wave therapy(BTL-6000WT) with energy flux(0.003mJ/mm²),frequency (10Hz)and (one session/week) for 8 weeks .The two groups were evaluated before and after therapy by Modified Ashworth Scale (MAS) and Modified House function Classification (MHC).Results:The results showed a statistically significant improvement in spasticity and hand function post treatment.Conclusion:We concluded that the ESWT is effective in decreasingspasticity(muscle tone) of upper extremities and enhancinghand function for patients with spastic cerebral palsyto help those children become independent and participate in different daily activities as grasping of walker or canes.

Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury

“…Five studies 56,69–71,77 solely provided the number of patients of each level of the MAS before and after treatment. The results of these studies showed that the ESWT could decrease the MAS when compared with the control group ( P < 0.05), in stroke patients 47,48,56,59,69–71,77 and in children with CP 44 . Pooled data of the 26 RCTs 28,42,43,45,46,49,51–55,58,60–62,65,66,68,72–76,78,80,81 showed that ESWT significantly decreased the MAS score (standardized mean difference = −0.97, 95% CI = −1.23 to −0.71, I 2 = 77%, P < 0.00001; Supplementary Fig.…”

“…Moreover, only four studies 46 – 48 , 55 provided a clinical trial registration number. In summary, 22 studies 41 – 43 , 48 , 49 , 51 – 54 , 59 – 61 , 65 , 67 , 69 , 72 , 73 , 75 – 78 , 81 were rated as having a “high risk of bias,” and 20 studies 28 , 44 – 47 , 50 , 55 – 58 , 62 – 64 , 66 , 68 , 70 , 71 , 74 , 79 , 80 were rated as having “some concerns.”…”

“…Dymarek et al 42 concluded that ESWT could decrease the activity of surface electromyography in spastic muscles. Park et al 50 and Sairong 77 confirmed that ESWT was 28 Some Low Low Low Some Some S2 41 Some High High Low Some High S3 42 Some Some Low High Some High S4 43 Some High High Low Some High S5 44 Some Some Low Low Some Some S6 45 Some Some Low Low Some Some S7 46 Low Some Low Low Some Some S8 47 Some Some Low Low Some Some S9 48 Some Low Low Low High High S10 49 Some Some Low High Some High S11 50 Some Some Low Low Some Some S12 51 Some High High High Some High S13 52 Some High High High Some High S14 53 Some High High High Some High S15 54 Low High High High Some High S16 55 Low Some Low Low Some Some S17 56 Some Some Low Low Some Some S18 57 Some Some Low Low Some Some S19 58 Some Some Low Low Some Some S20 59 Some Some Low High Some High S21 60 Some Some Low High Some High S22 61 Some Some Low High Some High S23 62 Low Some Low Low Some Some S24 63 Some Some Low Low Some Some S25 64 Some Some Low Low Some Some S26 65 Some Some Low High Some High S27 66 Some Some Low Low Some Some S28 67 Some High High Low Some High S29 68 Low Some Low Low Some Some S30 69 Some Some Low High Some High S31 70 Some Low Low Low Some Some S32 71 Some Some Low Low Some Some S33 72 Some Some Low High Some High S34 73 Some Some Low High Some High S35 74...…”

“…The results of these studies showed that the ESWT could decrease the MAS when compared with the control group ( P < 0.05), in stroke patients 47,48,56,59,[69][70][71]77 and in children with CP. 44 Pooled data of the 26 RCTs 28,42,43,45,46,49,[51][52][53][54][55]58,[60][61][62]65,66,68,[72][73][74][75][76]78,80,81 showed that ESWT significantly decreased the MAS score (standardized mean difference = −0.97, 95% CI = −1.23 to −0.71, I 2 = 77%, P < 0.00001; Supplementary Fig. 2, Supplemental Digital Content 6, http://links.lww.com/PHM/B538).…”

“…A total of 35 studies 28,[42][43][44][45][46][47][48][49][51][52][53][54][55][56][58][59][60][61][62]65,66,[68][69][70][71][72][73][74][75][76][77][78]80,81 reported the MAS; however, the data of MAS from nine articles 44,47,48,56,59,[69][70][71]77 could not be synthesized. Two studies 44,48 only presented the baseline of MAS scores and difference of MAS scores before and after treatment. The other two studies 47,59 provided dichotomous outcomes of MAS.…”