Pain and Muscles Properties Modifications After Botulinum Toxin Type A (BTX-A) and Radial Extracorporeal Shock Wave (rESWT) Combined Treatment

Abstract

Background and Objective: Spasticity (most common disability in upper motor neuron syndrome or UMNS) caused an inability of patients’ to perform daily activities and a decrease inquality of life. One of the promising methods nowadays, but still not widely used in everyday practice, for spasticity reduction is extracorporeal shock wave. The aim of this study was to evaluate the objective clinical effects of combined treatment botulinum toxin type A and radial Extracorporeal Shock Wave Therapy in spasticity post stroke. Methods: We considered 30 subjects (14 female and 16 male) with post stroke spasticity of Biceps Brachii, Superficial Flexor Digitorum, Gastrocnemius Medialis and Lateralis and we divided patients into two groups (group A received botulinum toxin injection and physiotherapy while group B received botulinum toxin injection, rESWT and physiotherapy). Assessments were performed before treatment (t0), after 1 (t1), 2 (t2) e 3 (t3) months using Modified Ahworth Scale, Visual Analogical Scale for pain and MyotonPro® device (to assessed myometric evaluation of muscles tone and stiffness). Results: Visual Analogical Scale, Modified Ahworth Scale, muscles tone and stiffness statistically decreased until t3 in the group A and in the group B, but the differences between the two groups were significant at the t1 only. Conclusion: Radial Extracorporeal Shock Wave Therapy could be an effective physical treatment aimed at the reduction of upper and lower limbs spasticity and could lead to the improvement of trophic conditions of the spastic muscles in post-stroke.

Efficacy of botulinum toxin A combined with extracorporeal shockwave therapy in post-stroke spasticity: a systematic review

“…The full text of 10 articles was then scrutinized, and 4 articles were excluded because they did not meet the inclusion criteria or had missing study results (Figure 1). Finally, 6 RCTs were included in this systematic review (37)(38)(39)(40)(41)(42).…”

Real-Time Muscle Activity and Joint Range of Motion Monitor to Improve Shoulder Pain Rehabilitation in Wheelchair Basketball Players: A Non-Randomized Clinical Study

“…Therapeutic exercise is feasible, but there is a need to develop a standardized set of exercises that can be customized to the specific characteristics of wheelchair users and that can be faster to receive benefits [ 27 ]. Moreover, there is a lack in terms of functional outcomes assessment as these are often self-reported, so it is more difficult to achieve both the correct control of rehabilitation treatments and a more satisfactory recovery [ 28 , 29 , 30 , 31 ]. In this sense, sEMG could represent a great opportunity to refine the assessments available to rehabilitators.…”

Objective Methods of Muscle Tone Diagnosis and Their Application—A Critical Review

“…This use can contribute not only to the general validation of methods according to the rules of evidence-based medicine, but also in clinical practice for the assessment of individually implemented interventions on specific patients. For example, MRE has already been used to assess the effect of eccentric exercise [ 110 ] or positive thermotherapy [ 111 ], USE in instrumental massage [ 112 ] and botulinum toxin application [ 113 ], Myoton to assess the effectiveness of petrissage (deep muscle massage) and lymphatic drainage [ 114 ] and ischemic compression of myofascial trigger points [ 115 ], neurodynamics and instrumental soft tissue mobilization [ 116 ], strengthening and stretching exercises [ 117 ], aquatic exercise and electrical neuromodulation [ 118 ], dry needling [ 119 ], botulinum toxin and shock wave application [ 120 ], mobilization [ 121 ], and many other therapeutic modalities.…”