The Effect of Extracorporeal Shock Wave Therapy on Lower Limb Spasticity in Subacute Stroke Patients

Abstract

ObjectiveTo evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in subacute stroke patients.MethodsWe studied thirty hemiplegic subacute stroke patients with ankle plantar flexor spasticity. ESWT was applied for 1 session/week, with a total of 3 sessions at the musculotendinous junction of medial and lateral gastrocnemius muscles. Patients were evaluated both clinically and biomechanically at baseline, after sham stimulation, and at immediately 1 week and 4 weeks after ESWT. For clinical assessment, Modified Ashworth Scale (MAS), clonus score, passive range of motion of ankle, and Fugl-Myer Assessment for the lower extremity were used. A biomechanical assessment of spasticity was conducted by an isokinetic dynamometer. Two parameters, peak eccentric torque (PET) and torque threshold angle (TTA), were analyzed at the velocities of 60°/sec, 180°/sec, and 240°/sec.ResultsAfter sham stimulation, there were no significant changes between each assessment. MAS and PET (180°/sec and 240°/sec) were significantly improved immediately and 1 week after ESWT. However, these changes were not significant at 4 weeks after ESWT. PET (60°/sec) and TTA (60°/sec, 180°/sec, and 240°/sec) were significantly improved immediately after ESWT. Yet, these changes were not significant at 1 week and 4 weeks after ESWT as well.ConclusionLower limb spasticity in subacute stroke patients was significantly improved immediately after ESWT. Although the therapeutic effect of ESWT reduced with time and therefore was not significant at 4 weeks after ESWT, the degree of spasticity was lower than that of the baseline. Future studies with a larger sample of patients are warranted in order to verify the protocols which can optimize the effect of ESWT on spasticity.

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

“…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

“…It was reported as valid and reliable tool for assessment of spasticity [27,28]. Spasticity of wrist and fingers were measured pre and post treatment using MAS, for convenience in the statistical analysis, MAS 1+ was substituted by 2, and 2, 3, and 4 were substituted by 3, 4, and 5, respectively [12].…”

“…The digital goniometer has adequate concurrent criterion-related validity as a tool for assessment of joint ROM and equivalent inter-and intra-rater reliability to the universal goniometer [24]. Passive ROM of the wrist was measured pre and post treatment by measuring the angles of the maximum flexion and the maximum extension and summing up the angles using digital goniometer [12]. Pain intensity: Visual Analogue Scale (VAS) was used to assess pain intensity.…”

“…In addition, the dosage of botulinum is not always sufficient to treat extensive and severe hypertonia in upper and lower limbs [11]. 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].…”