Research progress in extracorporeal shock wave therapy for upper limb spasticity after stroke

Duan, Haoyang; Lian, Yawen; Jing, Yuling; Xing, Jingsong; Li, Zhenlan

doi:10.3389/fneur.2023.1121026

Cited by 9 publications

(12 citation statements)

References 93 publications

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“…Highlighted details: In recent years, clinical studies have demonstrated that ESWT can be used to treat spasticity after a stroke. Duan et al [ 31 ] compiled potential ESWT mechanisms of interest. First, ESWT stimulates the production of nitric oxide, following which it reduces the level of acetylcholine at the neuromuscular junction, thereby alleviating muscle spasms.…”

Section: Resultsmentioning

confidence: 99%

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

Suputtitada,

Chatromyen,

Chen

et al. 2024

Toxins

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This article aims to provide a concise overview of the best available evidence for managing post-stroke spasticity. A modified scoping review, conducted following the PRISMA guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR), involved an intensive search on Medline and PubMed from 1 January 2000 to 31 August 2023. The focus was placed on high-quality (GRADE A) medical, rehabilitation, and surgical interventions. In total, 32 treatments for post-stroke spasticity were identified. Two independent reviewers rigorously assessed studies, extracting data, and evaluating bias using GRADE criteria. Only interventions with GRADE A evidence were considered. The data included the study type, number of trials, participant characteristics, interventions, parameters, controls, outcomes, and limitations. The results revealed eleven treatments supported by GRADE A evidence, comprising 15 studies. Thirteen were systematic reviews and meta-analyses, and two were randomized control trials. The GRADE A treatments included stretching exercises, static stretching with positional orthosis, transcutaneous electrical stimulation (TENS), extracorporeal shock wave therapy (ESWT), peripheral magnetic stimulation, non-invasive brain stimulation, botulinum toxin injection, dry needling, intrathecal baclofen, whole body vibration, and localized muscle vibration. In conclusion, this modified scoping review highlights the multimodal treatments supported by GRADE A evidence as being effective for improving functional recovery and quality of life in post-stroke spasticity. Further research and exploration of new therapeutic options are encouraged.

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Section: Resultsmentioning

confidence: 99%

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

Suputtitada,

Chatromyen,

Chen

et al. 2024

Toxins

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“…The results of our study showed that there was no statistically signi cant difference in the effect of low vs. medium rESWT on forearm spasticity of the upper limbs, which may be due to several reasons. First, rESWT spreads around in the form of divergence, with a wide range of energy involved, and the energy decreases with increasing propagation distance [23]. However, the forearm muscles are numerous and slender, and the super cial muscles are palpable on the body surface [24], while the lower EFD can penetrate the deep muscles.…”

Section: Discussionmentioning

confidence: 99%

Comparing the effect of radial extracorporeal shock waves with different energy flux densities on forearm spasticity after stroke: A randomized controlled trial

Li,

Huang,

et al. 2023

Preprint

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Background To explore the effect of radial extracorporeal shock wave therapy (rESWT) on forearm spasticity in stroke patients and to compare the effect of low energy flux density (EFD) and medium EFD rESWT on forearm spasticity after stroke. Methods Ninety stroke patients who met the inclusion criteria of this study were randomly divided into a control group, intervention group A and intervention group B, with 30 patients in each group. The control group received placebo rESWT. Group A received a low EFD (energy flux density of 0.08 mJ/mm2); Group B received a medium EFD (energy flux density of 0.16 mJ/mm2). The interventions continued for 4 weeks, once a week. Muscle tension and muscle stiffness were evaluated by the modified Ashworth scale (MAS), and shear wave velocity (SWV) was measured by ultrasound elastography before and after treatment. Results ① MAS: After treatment, the MAS scores of muscle groups in intervention groups A and B were lower than those before treatment, and the differences were statistically significant (P < 0.01). After treatment, the MAS scores of the wrist flexor muscle group in groups A and B were significantly lower than that in the control group (P < 0.05). ② SWV: After treatment, the SWV of the flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), flexor carpi radialis (FCR), and pronator teres (PT) in group A were significantly lower than those before treatment (P < 0.05), and the SWV of FDS, FDP, flexor carpi ulnaris (FCU), FCR, and PT in group B were significantly lower than those before treatment (P < 0.05). The SWVs of FDS, FDP and FCR in group A were significantly lower than those in the control group (P < 0.05). The SWVs of the FDS, FDP, FCR and PT in group B were significantly lower than those in the control group (P < 0.05). Conclusion Both low- and medium-EFD rESWT are effective for forearm spasticity in stroke patients. The effect of medium EFD rESWT is slightly better than that of low EFD rESWT, but the difference is not significant. Trial registration: Clinical trial registration numbers and date of registration: ChiCTR2300075610, Registered 11 September 2023.

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“…The effects of ESWT on spasticity are thought to involve multiple mechanisms, including nitric oxide production, rheological property changes, motor neuron excitability reduction, and induction of neuromuscular transmission dysfunction ( 6 – 8 , 16 , 21 ).…”

Section: Eswt For Muscle Spasticity and Sensitization Theorymentioning

confidence: 99%

“…This effect may disrupt the functional link between actin and myosin, causing the connective tissue within the spastic muscle to loosen. ESWT may also cause vasodilation via enzymatic and non-enzymatic nitric oxide synthesis, increasing blood flow to the area and influencing the secretion of interleukins involved in inflammation and growth factor activation ( 6 – 8 , 16 , 21 ).…”

Section: Eswt For Muscle Spasticity and Sensitization Theorymentioning

confidence: 99%

Emerging theory of sensitization in post-stroke muscle spasticity

Suputtitada

2023

Front. Rehabil. Sci.

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Spasticity, characterized by a velocity-dependent increase in muscle tone and exaggerated reflexes, is a common complication in individuals with upper motor neuron syndrome, such as stroke survivors. Sensitization, the heightened responsiveness of the nervous system to sensory stimuli, has emerged as a potential cause of spasticity. This perspective article explores three emerging treatments targeting sensitization. Recent studies have investigated novel treatment modalities for spasticity, including Extracorporeal Shockwave Therapy (ESWT), repetitive peripheral magnetic stimulation (rPMS), and needling. ESWT has shown promising results in reducing spasticity in both the upper and lower extremities, potentially through mechanisms such as nitric oxide production, rheological property changes, and neuromuscular transmission dysfunction. rPMS offers a non-invasive approach that may reduce spasticity by increasing sensory input, enhancing cortical activation, and exerting tissue-softening effects. Needling has also demonstrated positive effects on spasticity reduction. The high heterogeneity observed indicates the need for more rigorous research to confirm these findings. Recently, mechanical needling and sterile water injection invented by the author is also promising for reducing spasticity through removing sensitization. In conclusion, the emerging treatment options discussed in this perspective article provide promising avenues for addressing sensitization in spasticity and improving motor function. However, further research is needed to validate their findings, optimize treatment protocols, and investigate their long-term effects on motor recovery and overall quality of life in individuals with spasticity.

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Research progress in extracorporeal shock wave therapy for upper limb spasticity after stroke

Cited by 9 publications

References 93 publications

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review

Comparing the effect of radial extracorporeal shock waves with different energy flux densities on forearm spasticity after stroke: A randomized controlled trial

Emerging theory of sensitization in post-stroke muscle spasticity

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