The Current State of Knowledge on the Clinical and Methodological Aspects of Extracorporeal Shock Waves Therapy in the Management of Post-Stroke Spasticity—Overview of 20 Years of Experiences

Abstract

In many patients after stroke, spasticity develops over time, resulting in a decrease in the patient’s independence, pain, worsening mood, and, consequently, lower quality of life. In the last ten years, a rich arsenal of physical agents to reduce muscle tone such as extracorporeal shock therapy (ESWT) wave has come through. The aim of this narrative review article is to present the current state of knowledge on the use of ESWT as a supplement to the comprehensive rehabilitation of people after stroke suffering from spasticity. The PubMed and PEDro databases were searched for papers published in English from January 2000 to December 2020, 22 of which met inclusion criteria for clinical studies related to post-stroke spasticity management with ESWT. A total of 22 studies including 468 post-stroke patients—11 reports with the upper limb (267 patients) and 10 reports within the lower limb (201 patients), as well as one report including both upper and lower limb. We focused our attention on clinical and methodological aspects. Therefore, we performed the assessment of enrolled studies in terms of methodological quality using the PEDro and level of evidence using the National Institute for Health and Clinical Excellence (NICE) guidelines. Furthermore, we indicated implications for clinical practice in using ESWT for post-stroke spasticity management. Moreover, we discussed a suggestion for future research directions. In conclusion, an ESWT effectively reduces muscle tone in people with spastic limb after stroke. Further, ESWT is safe and free of undesirable side effects. The mechanism of action of ESWT on muscles affected by spasticity is still unknown. To date, no standard parameters of ESWT in post-stroke spasticity regarding intensity, frequency, location, and the number of sessions has been established. Further research, meeting the highest standards, is needed to establish uniform muscle stimulation parameters using ESWT.

Evaluation of radial Extracorporeal Shock Wave Therapy (rESWT) as a treatment option in chronic post-stroke upper limb management

“…For reduction in post-stroke upper limb spasticity, rESWT is a promising treatment option which is safe and free of adverse side effects. The mechanism behind the action of rESWT of spastic muscle is still not clear 17 but one study was mentioned that there were a potential anti-spastic effect to regulate vasculature with rESWT 11 .…”

Recent Advances in the Treatment of Spasticity: Extracorporeal Shock Wave Therapy

“…Currently, BTX is expensive and not accessible in some countries [49]. As ESWT emerged as a new non-pharmacological alternative for managing spasticity [9,10], studies comparing the effects of BTX and ESWT started to appear in the literature. Of note, some authors also reported synergistic effects when the two methods were applied concomitantly.…”

“…In recent years, increasing evidence has been collected of extracorporeal shock wave therapy (ESWT) being a safe and effective alternative for reducing muscle spasticity. Indeed, ESWT is considered a valuable adjuvant modality to standard treatment and rehabilitation [9,10]. Accordingly, this narrative review will focus on the current evidence pertaining to the etiology, duration, and outcomes of ESWT in spasticity.…”

Overview of Physical and Pharmacological Therapy in Enhancing Bone Regeneration Formation During Distraction Osteogenesis

“…Extracorporeal shock wave therapy (ESWT) is a kind of sound wave with mechanical characteristics that generates energy through the extreme compression of the medium caused by vibration and high-speed movement ( Opara et al, 2021 ). In the past decades, the functions of ESWT in the treatment of multiple disorders has been gradually realized (non-union of long bone fracture, pain relief, tissue regeneration, neuroprotection, chondroprotection and calcified tendinopathy) ( Simplicio et al, 2020 ).…”