Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke

Abstract

I.

<p>Shock Waves as a Treatment Modality for Spasticity Reduction and Recovery Improvement in Post-Stroke Adults – Current Evidence and Qualitative Systematic Review</p>

“…The results for ROM with GOM in fESWT groups at M0 were ranged between 9.90 and 56.67 of angular degrees (29.53±8.21 degrees) in comparison to results presented at M1 varied from 16.40 to 59.16 of angular degrees (37.37 ±7.77 degrees), giving a mean difference of clinical improvement in ROM between pre-and post-intervention at Δ=38.83% of angular degrees. 54,63,64,70,72,75 ROM values in rESWT groups at M0 were ranged between 20.30 and 82.85 of angular degrees (42.78±11.81); results presented at M1 varied from 28.00 to 87.23 of angular degrees (51.31±11.88 degrees), giving a mean difference of clinical improvement in ROM between pre-and postintervention at Δ=32.26%. This comparison determines the more beneficial effect of fESWT in the enhancement of ROM compared to rESWT (Δ=6.57%), nevertheless statistically non-significant for M0 (p=0.897), M1 (p=0.…”

“…This resulted in a mean difference showing clinical improvement in spasticity between pre-and post-intervention at Δ=34.45%. 54,[61][62][63][64][70][71][72][73] In turn, the spasticity level in rESWT groups at M0 was ranged between 1.53 and 3.30 grade (2.29±0.59 grade) in comparison to results presented after rESWT application varied from 0.73 to 2.30 (1.42±0.52 grade). This resulted in mean differences showing clinical improvement in spasticity between pre-and postinterventions at Δ=34.97%.…”

“…For purposes of the systematic review, the selected clinical outcomes were analyzed and compared between the baseline (M0) and the first measurement time point after ESWT (M1). The following outcomes were analyzed: (1) spasticity level as Δ% of grade in MAS or MMAS tools in 16 studies (nine studies in fESWT vs 7 studies in rESWT), 54,[61][62][63][64][65][66][67][68][69][70][71][72][73][74] (2) range of motion as Δ% of degree in GOM assessment of nine studies (six studies in fESWT vs three studies in rESWT), 54,63,64,67,68,70,72,75 and (3) selected electrophysiological parameters in such as MNC-V as Δ% of ms, CMAP-L as Δ% of ms, CMAP-A as Δ% of mV, FW-L as Δ% of ms, FW-A as Δ% of μV, HR-L as Δ% of ms and H/M-R as Δ% in six studies (four studies in fESWT vs two studies in rESWT), 65,67,70,73,75 It should be also noted that follow-up observations were undertaken in 12 studies within a mean period of 5.5 weeks (6.2 weeks in fESWT vs 4.7 weeks in rESWT) 54,[62][63][64][65][66]68,70,73 (Table 1).…”

“…It was found that in the ESWT groups the local anesthetic transcutaneous injections were not performed in eight studies. 61,66,[68][69][70][72][73][74] This clinically important issue was not specified in the case of nine articles 54,[62][63][64][65]67,71,75 ( Table 1). Only 11 cases of unexpected ESWT-related side effects were identified (pain n=5, lower limb muscular weakness n=2, petechiae at the treatment site n=3, and small bulla n=1).…”

“…67,73 It should be noted that all side effects were tolerated quite well by all patients and were resolved in a few days. Unfortunately, there were studies with lacking information about the presence or absence of any adverse events [62][63][64]69,70,72 (Table 1).…”