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Lee J, Yang SN. Effectiveness of Extracorporeal Shock Wave Therapy after Botulinum Toxin Injection for Post-Stroke Upper Extremity Spasticity: A Randomized Controlled Study. Toxins (Basel) 2024; 16:197. [PMID: 38668622 PMCID: PMC11054781 DOI: 10.3390/toxins16040197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/29/2024] Open
Abstract
Post-stroke spasticity is a common complication that limits the functional performance of patients. Botulinum toxin (BTx) is an effective treatment for spasticity. Numerous researchers have applied extracorporeal shock wave therapy (ESWT) to address post-stroke spasticity, yielding positive clinical outcomes. We aimed to clarify the add-on effects of ESWT on BTx therapy for spasticity in patients with post-stroke. Sixteen eligible patients with upper extremity spasticity after stroke were recruited for this study. They were randomized to either a BTx with focused ESWT treatment group or a BTx alone group. Spasticity, measured using the modified Ashworth score (MAS) and modified Tardieu scale (MTS), showed statistically significant improvements in the elbow and wrist flexor muscles in both BTx + ESWT group and BTx alone groups. However, no significant differences were observed between the two groups with time flow. The BTx + ESWT group showed significantly decreased MAS of the finger flexors at follow-up and increased R1 (MTS) of the finger flexors at 3 weeks after treatment, which was not observed in the BTx alone group. This is the first study to identify the add-on effect of ESWT on BTx injections to improve post-stroke upper limb spasticity.
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Affiliation(s)
- Junhee Lee
- Department of Physical Medicine and Rehabilitation, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea;
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Seung Nam Yang
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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Nada DW, El Sharkawy AM, Elbarky EM, Rageh ESM, Allam AES. Radial extracorporeal shock wave therapy as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. A randomized controlled study. Disabil Rehabil 2023:1-9. [PMID: 37926696 DOI: 10.1080/09638288.2023.2278185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
PURPOSE To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. METHODS 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. RESULTS After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. CONCLUSION ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients.
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Affiliation(s)
- Doaa Waseem Nada
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amira Mohamed El Sharkawy
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Elham Mahmoud Elbarky
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - El Sayed Mohamed Rageh
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Abdallah El Sayed Allam
- Department of Rheumatology, Rehabilitation and Physical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Afzal B, Noor R, Mumtaz N, Bashir MS. Effects of extracorporeal shock wave therapy on spasticity, walking and quality of life in poststroke lower limb spasticity: a systematic review and meta-analysis. Int J Neurosci 2023:1-15. [PMID: 37824712 DOI: 10.1080/00207454.2023.2271164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To determine the effects of extracorporeal shock wave therapy (ESWT) on lower limb function, walking, and quality of life in patients with lower limb poststroke spasticity. DATA SOURCES A comprehensive and systematic electronic database search of PubMed, Web of Science, ProQuest thesis Dissertation checks, Google Scholar was conducted from January 2010 to March 2022. REVIEW METHOD Initially, the bibliography was screened to identify randomized and nonrandomized controlled trials evaluating the effects of ESWT on lower limb spasticity and functional outcomes in stroke patients. Two reviewers independently screened the title and abstract, full-text articles, extracted data, and assessed the quality of the selected studies. The primary evaluation outcome was spasticity assessed by Modified Ashworth Scale (MAS), and the secondary outcomes were walking performance and quality of life measured on different scales. DATA SYNTHESIS Out of the total of 483 records, 15 studies (389 participants) were finally found eligible for inclusion. A meta-analysis was performed and beneficial effects of ESWT were observed in the experimental group compared with the control group on spasticity. MAS: Standard mean difference (SMD = 0.626), (95%CI = -0.133, 1.119), (p < 0.01), ROM: (SMD = 0.573), (95%CI = 0.074, 1.072), (p < 0.02). The result for before and after ESWT application on TUG: (SMD = 0.174), (95%CI=-0.151, 0.499), (p = 0.29). The results for walking performance were not significant and inconclusive which may be due to the heterogeneity of the studies included. CONCLUSION Evidence suggests that ESWT has promising effects in reducing spasticity and improving lower limb motor function. However, uncertainty exists regarding its effectiveness in walking performance.
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Affiliation(s)
- Binash Afzal
- Department of Physical Therapy, Riphah College of Rehabilitation Sciences, Riphah International University, Lahore, Pakistan
| | - Rabiya Noor
- Department of Physical Therapy, Riphah College of Rehabilitation Sciences, Riphah International University, Lahore, Pakistan
| | - Nazia Mumtaz
- Department of Speech and Language Pathology, Riphah College of Rehabilitation And Allied Health Sciences, Riphah International University, Lahore, Pakistan
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Campanini I, Bò MC, Bassi MC, Damiano B, Scaltriti S, Lusuardi M, Merlo A. Outcome measures for assessing the effectiveness of physiotherapy interventions on equinus foot deformity in post-stroke patients with triceps surae spasticity: A scoping review. PLoS One 2023; 18:e0287220. [PMID: 37824499 PMCID: PMC10569611 DOI: 10.1371/journal.pone.0287220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 06/01/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE Equinus foot deformity (EFD) is the most common deviation after stroke. Several physiotherapy interventions have been suggested to treat it. However, studies evaluating the efficacy of these treatments vary widely in terms of assessment modalities, type of data analysis, and nomenclature. This scoping review aimed to map current available evidence on outcome measures and the modalities employed to assess the effectiveness of physiotherapy programs for the reduction of triceps surae (TS) spasticity and EFD in patients with stroke. METHODS Scoping review methodological frameworks have been used. Three databases were investigated. Primary literature addressing TS spasticity in adult patients with stroke using physiotherapy interventions was included. Findings were systematically summarized in tables according to the intervention used, intervention dosage, control group, clinical, and instrumental outcome measures. RESULTS Of the 642 retrieved studies, 53 papers were included. TS spasticity was assessed by manual maneuvers performed by clinicians (mainly using the Ashworth Scale), functional tests, mechanical evaluation through robotic devices, or instrumental analysis and imaging (such as the torque-angle ratio, the H-reflex, and ultrasound images). A thorough critical appraisal of the construct validity of the scales and of the statistics employed was provided, particularly focusing on the choice of parametric and non-parametric approaches when using ordinal scales. Finally, the complexity surrounding the concept of "spasticity" and the possibility of assessing the several underlying active and passive causes of EFD, with a consequent bespoke treatment for each of them, was discussed. CONCLUSION This scoping review provides a comprehensive description of all outcome measures and assessment modalities used in literature to assess the effectiveness of physiotherapy treatments, when used for the reduction of TS spasticity and EFD in patients with stroke. Clinicians and researchers can find an easy-to-consult summary that can support both their clinical and research activities.
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Affiliation(s)
- Isabella Campanini
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Maria Chiara Bò
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
- Merlo Bioengineering, Parma, Italy
| | | | - Benedetta Damiano
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Sara Scaltriti
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
| | - Mirco Lusuardi
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Reggio Emilia, Correggio, Italy
| | - Andrea Merlo
- Neuromotor and Rehabilitation Department, LAM–Motion Analysis Laboratory, San Sebastiano Hospital, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Correggio, Italy
- Merlo Bioengineering, Parma, Italy
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Śniegucka K, Soroko-Dubrovina M, Zielińska P, Dudek K, Žuffová K. The Effect of Radial Extracorporeal Shock Wave Therapy (rESWT) on the Skin Surface Temperature of the Longissimus Dorsi Muscle in Clinically Healthy Racing Thoroughbreds: A Preliminary Study. Animals (Basel) 2023; 13:2028. [PMID: 37370538 DOI: 10.3390/ani13122028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/13/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Radial extracorporeal shock wave therapy (rESWT) is increasingly being used to treat musculoskeletal injuries in horses. The aim of this study was to assess the influence of rESWT on the skin surface temperature of the longissimus dorsi muscle in clinically healthy racing horses. A total of 24 thoroughbreds were divided into a study group (n = 12) and an rESWT-sham group (n = 12). The study group underwent rESWT, whereas the rESWT-sham group had rESWT without probe activation in the treated area. Both groups underwent thermographic examination before and just after rESWT to determine and compare skin surface temperatures. Palpation examination was performed after the first and second thermography examination to assess longissimus dorsi muscle tone. Additionally, thermographic examination was repeated 10 min after the rESWT. In both groups, there was an increase in skin surface temperature just after rESWT, and a decrease 10 min after it to below the initial value. In the study group, the skin surface temperature just after rESWT was higher than in the rESWT-sham group. Additionally, in the study group the average muscle tone before rESWT was significantly higher than just after the procedure, whereas in the rESWT-sham group the average change in muscle tone was not significant. The results proved that rESWT increases skin surface temperature of the longissimus dorsi muscle in clinically healthy horses. Further research is necessary in order to configure shockwave treatment with appropriate parameters for effective and safe therapy.
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Affiliation(s)
- Karolina Śniegucka
- Institute of Animal Breeding, Wroclaw University of Environmental and Life Sciences, 51-630 Wroclaw, Poland
| | - Maria Soroko-Dubrovina
- Institute of Animal Breeding, Wroclaw University of Environmental and Life Sciences, 51-630 Wroclaw, Poland
| | - Paulina Zielińska
- Department of Surgery, Wroclaw University of Environmental and Life Sciences, 50-366 Wroclaw, Poland
| | - Krzysztof Dudek
- Center for Statistical Analysis, Wroclaw Medical University, 50-368 Wroclaw, Poland
| | - Kristína Žuffová
- Equine Clinic, Brno University of Veterinary and Pharmaceutical Sciences, 612-42 Brno, Czech Republic
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Comino-Suárez N, Gómez-Soriano J, Ceruelo-Abajo S, Vargas-Baquero E, Esclarín A, Avendaño-Coy J. Extracorporeal shock wave for plantar flexor spasticity in spinal cord injury: A case report and review of literature. World J Clin Cases 2023; 11:127-134. [PMID: 36687177 PMCID: PMC9846994 DOI: 10.12998/wjcc.v11.i1.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 11/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Approximately 65%-78% of patients with a spinal cord injury (SCI) develop any symptom of spasticity. The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy (rESWT) on plantar flexor spasticity in a patient with incomplete SCI.
CASE SUMMARY An 18-year-old man with an incomplete SCI completed five sessions of rESWT. The primary outcomes were the changes in ankle-passive range of motion (A-PROM) and passive resistive force to ankle dorsiflexion. The outcomes were assessed at baseline (T0), immediately after treatment (T1) and 1 wk after the end of treatment (T2). The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0. The passive resistive force to ankle dorsiflexion at low velocity decreased by 33% at T1 and 55% at T2 in the gastrocnemius muscle and by 41% at T1 and 39% at T2 in the soleus muscle compared with T0. At high velocity, it also decreased by 44% at T1 and 30% at T2 in the gastrocnemius muscle compared with T0. However, in the soleus muscle, the change was minor, with a decrease of 12% at T1 and increased by 39% at T2 compared with T0.
CONCLUSION In this patient, the findings showed that rESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term. Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.
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Affiliation(s)
- Natalia Comino-Suárez
- Toledo Physiotherapy Research Group, Faculty of Physiotherapy and Nursery, Castilla La Mancha University, Toledo 45071, Toledo, Spain
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group, Faculty of Physiotherapy and Nursery, Castilla La Mancha University, Toledo 45071, Toledo, Spain
| | - Silvia Ceruelo-Abajo
- Department of Physical and Rehabilitation Medicine, Hospital Nacional de Parapléjicos, Sescam, Toledo 45071, Toledo, Spain
| | - Eduardo Vargas-Baquero
- Department of Physical and Rehabilitation Medicine, Hospital Nacional de Parapléjicos, Sescam, Toledo 45071, Toledo, Spain
| | - Ana Esclarín
- Department of Physical and Rehabilitation Medicine, Hospital Nacional de Parapléjicos, Sescam, Toledo 45071, Toledo, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group, Faculty of Physiotherapy and Nursery, Castilla La Mancha University, Toledo 45071, Toledo, Spain
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Effect and Optimal Timing of Extracorporeal Shock-Wave Intervention to Patients With Spasticity After Stroke: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2023; 102:43-51. [PMID: 35394471 DOI: 10.1097/phm.0000000000002019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study investigated the efficacy of extracorporeal shock wave therapy as well as the optimal intervention timing for extracorporeal shock wave therapy for patients with spasticity after stroke. DESIGN A search of randomized controlled trials was conducted in different electronic databases. We performed a meta-analysis to measure the effect of extracorporeal shock wave therapy versus sham interventions on spasticity and limb functionality. The meta-regression analysis was performed to determine the adequate intervention timing of extracorporeal shock wave therapy. The follow-up period of the outcomes was divided into the short (<2 wks), mid (>2 wks and ≤4 wks), and long (>4 wks and ≤3 mos) terms. RESULTS Thirteen studies with 677 participants were evaluated. Spasticity significantly improved throughout the follow-up duration. Limb functionality significantly improved in the short-term follow-up period. The meta-regression analysis showed that patients with stroke duration less than 45 mos may be benefited from extracorporeal shock wave therapy in improving limb function in all follow-up periods. CONCLUSIONS Extracorporeal shock wave therapy is an effective method for reducing spasticity in patients with stroke, and the effect could be maintained for up to 3 mos. Its effects on limb functionality could persist for at least 2 wks. Patients who had stroke for less than 45 mos may have significant benefit from extracorporeal shock wave therapy in all follow-up periods.
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Campanini I, Bò MC, Salsi F, Bassi MC, Damiano B, Scaltriti S, Lusuardi M, Merlo A. Physical therapy interventions for the correction of equinus foot deformity in post-stroke patients with triceps spasticity: A scoping review. Front Neurol 2022; 13:1026850. [DOI: 10.3389/fneur.2022.1026850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveEquinus foot deformity (EFD) is the most common deformity following a stroke. Several approaches have been suggested for its correction, including pharmacological, surgical, and physical therapy (PT) interventions. This scoping review aims to map and synthesize the available evidence focusing on physical therapy treatments for EFD caused by triceps surae (TS) spasticity.MethodsScoping review methodological frameworks have been used. Pubmed, Cinahl, and Cochrane databases were searched for primary literature. Studies focusing on the treatment of EFD in adult stroke patients were included only when the intervention involved PT treatments and presented at least one outcome measure for the functional and/or structural condition of the TS. Data were systematically collected and reported in tables inclusive of type of intervention, sample characteristics, dosage, comparators, outcomes, follow-up timeline, and treatment efficacy. A narrative synthesis was also added.ResultsOf the 642 experimental or observational screened studies, 53 were included, focusing on stretching exercises, shock waves, electrical stimulation, dry needling, TENS, vibration therapy, ultrasounds, cryotherapy, and active physiotherapy. Patients with EFD benefited from specific physical therapy treatments. These usually resulted in Modified Ashworth Scale reduction, typically by 1 point, and an increase in ROM. Interventions consisting of shock waves, dry needling, and electrostimulation showed the best results in reducing EFD. Heterogeneous dosage and delivery mode generally limited conclusions.ConclusionsThis scoping review summarized available primary literature based on PT treatments for the correction of EFD. By highlighting the remaining gaps in knowledge, it provides a reference for future studies on this pathology. Further investigations are necessary to pinpoint the best dosage and delivery methods. Future studies should investigate whether early rehabilitation programs started during the acute phase might help prevent or limit the development of secondary deformities.
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Mihai EE, Popescu MN, Iliescu AN, Berteanu M. A systematic review on extracorporeal shock wave therapy and botulinum toxin for spasticity treatment: a comparison on efficacy. Eur J Phys Rehabil Med 2022; 58:565-574. [PMID: 35412036 PMCID: PMC9980509 DOI: 10.23736/s1973-9087.22.07136-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The complexity of spasticity requires a continuous effort in terms of more adapted treatments for patients, and accurate management. Through this systematic review, we aimed to evaluate and compare the effectiveness of extracorporeal shock wave therapy (ESWT) with botulinum toxin type A (BoNT-A) on reducing spasticity both in children and adults. EVIDENCE ACQUISITION An electronic search of PubMed/Medline, Scopus, Ovid Medline(R), and search engine of Google Scholar was performed. Publications ranging from January 2010 to January 2021, published in the English language and available as full-texts were eligible for inclusion and they were searched without any country restriction. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. EVIDENCE SYNTHESIS A total of five studies were included in the present systematic review. Screening of the references, data extraction, and risk of bias assessment were performed by two independent authors. The methodological quality and risk of bias were conducted using the Physiotherapy Evidence Database (PEDro) Scale. The primary outcome was spasticity grade assessed by the Modified Ashworth Scale (MAS) and/or Modified Tardieu Scale (MTS). Additional outcomes were active range of motion (AROM), passive range of motion (PROM), upper extremity Fugl-Meyer Assessment (UE-FMA), pain intensity assessed through Visual Analogue Scale (VAS), spasm frequency scale (SFS), sonographic parameters, between-group comparison, and treatment response rate. CONCLUSIONS A beneficial effect on spasticity was found for both treatments: evidence showed that ESWT and BoNT-A can ameliorate spasticity considering parameters such as MAS, MTS, AROM, PROM, UE-FMA, VAS and SFS in post-stroke, multiple sclerosis, and cerebral palsy patients. Further research is required to strengthen the evidence, and more suitable study protocols are highly needed.
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Affiliation(s)
- Emanuela E Mihai
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Marius N Popescu
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania - .,Department of Physical and Rehabilitation Medicine, Elias University Emergency Hospital, Bucharest, Romania
| | - Alina N Iliescu
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Berteanu
- Department of Physical and Rehabilitation Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,Department of Physical and Rehabilitation Medicine, Elias University Emergency Hospital, Bucharest, Romania
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Zhang HL, Jin RJ, Guan L, Zhong DL, Li YX, Liu XB, Xiao QW, Xiao XL, Li J. Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2022; 101:615-623. [PMID: 35152251 PMCID: PMC9197142 DOI: 10.1097/phm.0000000000001977] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury. DESIGN Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software. RESULTS Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies. CONCLUSIONS Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Emara HA, Al-Johani AH, Khaled OA, Ragab WM, Al-Shenqiti AM. Effect of extracorporeal shock wave therapy on spastic equinus foot in children with unilateral cerebral palsy. J Taibah Univ Med Sci 2022; 17:794-804. [PMID: 36050947 PMCID: PMC9396049 DOI: 10.1016/j.jtumed.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives This study aims to investigate the effects of radial extracorporeal shock wave therapy on selective motor control, spasticity, gross motor function, and balance in children with unilateral cerebral palsy. Methods This randomised controlled study recruited 34 children aged 7–9 with spastic unilateral cerebral palsy. They were randomly allocated to either the control or study group. Both groups undertook traditional exercises for 12 weeks. The study group received shock waves (one session/week) on the calf muscle (1500 shocks, frequency of 4 Hz, energy of 0.030 mJ/mm2). All children were evaluated at baseline and after 12 weeks using the Modified Ashworth Scale, a Biodex System 4 isokinetic dynamometer, dimensions D (standing) and E (walking) of the Gross Motor Function Measure – 88, the Trost Selective Motor Control test, and the single leg standing test. Results Mixed analysis of variance and Mann–Whitney results showed significant improvement in eccentric peak torque, torque threshold angles, gross motor function, selective motor control, and balance in the study group compared with the control group (p < 0.05). Conclusions Shock wave therapy may be a valuable instrument for reducing spasticity, improving the ability to isolate and control movement, and consequently, improving balance and gross motor function in children with unilateral cerebral palsy.
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Reebye R, Balbert A, Bensmail D, Walker H, Wissel J, Deltombe T, Francisco G. Module 2: Nonsurgical management of Spasticity. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2022. [DOI: 10.4103/2349-7904.347808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mihai EE, Mihai IV, Berteanu M. Effectiveness of Radial Extracorporeal Shock Wave Therapy and Visual Feedback Balance Training on Lower Limb Post-Stroke Spasticity, Trunk Performance, and Balance: A Randomized Controlled Trial. J Clin Med 2021; 11:jcm11010147. [PMID: 35011889 PMCID: PMC8745149 DOI: 10.3390/jcm11010147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/18/2022] Open
Abstract
Stroke remains one of the leading causes of disability in adults, and lower limb spasticity, affected stance, and balance impact everyday life and activities of such patients. Robotic therapy and assessment are becoming important tools to clinical evaluation for post-stroke rehabilitation. The aim of this study was to determine in a more objective manner the effects of visual feedback balance training through a balance trainer system and radial extracorporeal shock wave therapy (rESWT), along with conventional physiotherapy, on lower limb post-stroke spasticity, trunk control, and static and dynamic balance through clinical and stabilometric assessment. The study was designed as a randomized controlled trial. The experimental group underwent conventional physiotherapy, visual feedback balance training, and rESWT. The control group underwent conventional physiotherapy, visual feedback training and sham rESWT. The statistical analysis was performed using GraphPad Software and MATLAB. Primary clinical outcome measures were The Modified Ashworth Scale (MAS), passive range of motion (PROM), Visual Analogue Scale (VAS), and Clonus score. Secondary outcome measures were trunk performance, sensorimotor, and lower limb function. Stabilometric outcome measures were trunk control, static balance, and dynamic balance. Visual feedback training using the Prokin system and rESWT intervention, along with conventional physiotherapy, yielded statistically significant improvement both on clinical and stabilometric outcome measures, enhancing static and dynamic balance, trunk performance, sensorimotor outcome, and limb function and considerably diminishing lower limb spasticity, pain intensity, and clonus score in the experimental group.
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Affiliation(s)
- Emanuela Elena Mihai
- Physical and Rehabilitation Medicine Department, Carol Davila University of Medicine and Pharmacy Bucharest, 050451 Bucharest, Romania; (E.E.M.); (M.B.)
| | - Ilie Valentin Mihai
- Department of Telecommunications, University Politehnica of Bucharest, 060042 Bucharest, Romania
- Correspondence:
| | - Mihai Berteanu
- Physical and Rehabilitation Medicine Department, Carol Davila University of Medicine and Pharmacy Bucharest, 050451 Bucharest, Romania; (E.E.M.); (M.B.)
- Physical and Rehabilitation Medicine Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
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Yang E, Lew HL, Özçakar L, Wu CH. Recent Advances in the Treatment of Spasticity: Extracorporeal Shock Wave Therapy. J Clin Med 2021; 10:jcm10204723. [PMID: 34682846 PMCID: PMC8539559 DOI: 10.3390/jcm10204723] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/24/2022] Open
Abstract
Spasticity is a common sequala of the upper motor neuron lesions. For instance, it often occurs in the first 4 weeks after stroke and is seen in more than one-third of stroke survivors after 12 months. In recent years, extracorporeal shock wave therapy (ESWT) has been recognized as a safe and effective method for reducing muscle spasticity. Possible/relevant mechanisms include nitric oxide production, motor neuron excitability reduction, induction of neuromuscular transmission dysfunction, and direct effects on rheological properties. There are two types of ESWT, focused and radial, with the radial type more commonly applied for treating muscle spasticity. Concerning the optimal location for applying ESWT, the belly muscles and myotendinous junction seem to produce comparable results. The effects of ESWT on spasticity are known to last at least four to six weeks, while some studies report durations of up to 12 weeks. In this review, the authors will focus on the current evidence regarding the effectiveness of ESWT in spasticity, as well as certain technical parameters of ESWT, e.g., the intensity, frequency, location, and number of sessions. The pertinent literature has been reviewed, with an emphasis on post-stroke upper limbs, post-stroke lower limbs, cerebral palsy, and multiple sclerosis. In short, while ESWT has positive effects on parameters such as the modified Ashworth scale, mixed results have been reported regarding functional recovery. Of note, as botulinum toxin injection is one of the most popular and effective pharmacological methods for treating spasticity, studies comparing the effects of ESWT and botulinum toxin injections, and studies reporting the results of their combination, are also reviewed in this paper.
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Affiliation(s)
- En Yang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 100, Taiwan;
| | - Henry L. Lew
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA;
- Department of Communication Sciences and Disorders, John A Burns School of Medicine, University of Hawaii, Honolulu, HI 96822, USA
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara 06100, Turkey;
| | - Chueh-Hung Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei 100, Taiwan;
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
- Department of Physical Medicine and Rehabilitation, College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Correspondence: or ; Tel.: +886-3-6677600-532080
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Comparative Analysis of the Effect of Low-Frequency Repeated Transcranial Magnetic Stimulation and Extracorporeal Shock Wave on Improving the Spasm of Flexor after Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:7769581. [PMID: 34475965 PMCID: PMC8407985 DOI: 10.1155/2021/7769581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022]
Abstract
Poststroke spasticity (PSS) patients with muscle spasticity are effectively relieved by low-frequency repetitive transcranial magnetic stimulation (rTMS) or extracorporeal shock wave treatment (ESWT). However, there are relatively few reports about the difference in the efficacy of rTMS and ESWT for PSS. In this study, we examined and recorded the levels of UE motor section of the Fugl–Meyer Motor Assessment Scale (FMA-UE), myoelectric signal time-domain range integral values (iEMG), Modified Ashworth Scale (MAS), and Modified Barthel Index (MBI) before and after treatment to observe the differences in treatment effects between rTMS and ESWT in patients with PSS. 66 patients with PSS were enrolled in the study and signed an informed consent form, and the study was approved by the Ethics Committee of the First Hospital of Soochow University (2019008). The patients were divided into rTMS group, ESWT group, and regular group according to the random number table method, and there were 22 patients in each group. The rTMS group and ESWT group were treated with rTMS and ESWT on the basis of conventional treatment in the regular group, 5 times a week, and the total treatment time was 4 weeks. The results of the study showed that iEMG, MAS, FMA-UE, and MBI scores in the rTMS, ESWT, and regular groups were significantly ameliorated after treatment compared with those before treatment. The efficacy of the ESWT group was significantly better than in the regular group and slightly better than in the rTMS group, as shown by the iEMG, MAS, FMA-UE, and MBI scores, and the iEMG score of the ESWT group was significantly better than the rTMS group, while there were no significant differences in other indexes. The FMA-UE and MBI scores in the rTMS group were significantly better than those in the regular group after treatment in the rTMS group; however, the comparison between iEMG and MAS scores was not statistically significant. It can be seen that both rTMS and ESWT can alleviate upper limb flexor spasm, improve upper limb motor function, and improve activities of daily living in patients with PSS. Among them, ESWT has better antispasmodic effect and better short-term treatment effect.
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Improved Function in a Runner With Hereditary Spastic Paraparesis With Use of Extracorporeal Shockwave Therapy: Personal Clinical Experience. Am J Phys Med Rehabil 2021; 100:e66-e68. [PMID: 32732747 DOI: 10.1097/phm.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 59-yr-old male marathon runner presented with recent diagnosis of hereditary spastic paraplegia in the setting of gait deviation and spasticity. He noted asymmetric wear pattern of his right shoe and toe drag, with recent development of left lower limb pain and cramping attributed to spasticity. He elected to proceed with radial extracorporeal shockwave treatment targeting the affected muscles. The night following initial treatment, he was able to run 2 mins per mile faster over a 4-mile run with resolution of toe drag. He completed six sessions of radial extracorporeal shockwave treatment along with maintaining regular cardiovascular exercise and strength training. He was seen 6 wks after a series of treatment with recent worsening and toe drag that recurred. He completed further sessions with return to improved function seen after his initial series of shockwave and ability to return to running up to 13 miles. His neurologic symptoms remained controlled without noted progression. This case illustrates the potential use of radial extracorporeal shockwave treatment in spasticity management of hereditary spastic paraplegia and that more frequent sessions may be required to maintain benefits of treatment.
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Yoldaş Aslan Ş, Kutlay S, Düsünceli Atman E, Elhan AH, Gök H, Küçükdeveci AA. Does extracorporeal shock wave therapy decrease spasticity of ankle plantar flexor muscles in patients with stroke: A randomized controlled trial. Clin Rehabil 2021; 35:1442-1453. [PMID: 33906450 DOI: 10.1177/02692155211011320] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of radial extracorporeal shock wave therapy on ankle flexor spasticity in stroke survivors and to reveal changes in the fibroelastic components of muscle. DESIGN Randomized controlled trial. SETTING Inpatient neuro-rehabilitation clinic of a university hospital. PARTICIPANTS Stroke patients with ankle flexor spasticity. INTERVENTIONS Patients were randomized to three groups; radial extracorporeal shock wave therapy, sham, or control. Active and sham therapy were administered two sessions/week for two weeks. All patients received conventional rehabilitation. MAIN MEASURES The primary outcome was Modified Ashworth Scale. Secondary outcomes were the Tardieu Scale and elastic properties of plantar flexor muscles assessed by elastography (strain index). All assessments were performed before, immediately after the treatment, and four weeks later at follow-up. RESULTS Fifty-one participants were enrolled (active therapy n = 17, sham n = 17, control n = 17). Modified Ashworth scores showed a significant decrease in the active therapy group (from 2.47 ± 0.72 to 1.41 ± 0.62) compared to sham (from 2.19 ± 1.05 to 2.06 ± 1.12) and control (from 2.06 ± 0.85 to 2.00 ± 0.73) groups immediately after the treatment (P < 0.001). Tardieu results were also in concordance (P < 0.001), however this effect was not preserved at follow-up. Elastic properties of the ankle flexors were improved in all groups at both assessments after the therapy showing significant decreases in strain index (P < 0.001). However, there was no difference among the groups in terms of improvement in elastography. CONCLUSION Radial extracorporeal shock wave therapy has short-term anti-spastic effects on ankle flexor muscles when used as an adjunct to conventional rehabilitation.
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Affiliation(s)
| | - Sehim Kutlay
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Haydar Gök
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ayse Adile Küçükdeveci
- Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey
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Leng Y, Lo WLA, Hu C, Bian R, Xu Z, Shan X, Huang D, Li L. The Effects of Extracorporeal Shock Wave Therapy on Spastic Muscle of the Wrist Joint in Stroke Survivors: Evidence From Neuromechanical Analysis. Front Neurosci 2021; 14:580762. [PMID: 33551718 PMCID: PMC7859269 DOI: 10.3389/fnins.2020.580762] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
Background: This study combined neuromechanical modeling analysis, muscle tone measurement from mechanical indentation and electrical impedance myography to assess the neural and peripheral contribution to spasticity post stroke at wrist joint. It also investigated the training effects and explored the underlying mechanism of radial extracorporeal shock wave (rESW) on spasticity. Methods: People with first occurrence of stroke were randomly allocated to rESW intervention or control group. The intervention group received one session of rESW therapy, followed by routine therapy which was the same frequency and intensity as the control group. Outcome measures were: (1) NeuroFlexor method measured neural component (NC), elastic component (EC) and viscosity component (VC), and (2) myotonometer measured muscle tone (F) and stiffness (S), (3) electrical impedance myography measured resistance (R), reactance (X) and phase angle (θ); (4) modified Asworth scale; (5) Fugl Meyer Upper limb scale. All outcome measures were recorded at baseline, immediately post rESW and at 1-week follow-up. The differences between the paretic and non-paretic side were assessed by t-test. The effectiveness of rESW treatment were analyzed by repeated-measures one-way analysis of variance (ANOVA) at different time points. Results: Twenty-seven participants completed the study. NC, EC, and VC of the Neuroflexor method, F and S from myotonometer were all significantly higher on the paretic side than those from the non-paretic side. R, X, and θ from electrical impedance were significantly lower on the paretic side than the non-paretic side. Immediately after rESW intervention, VC, F, and S were significantly reduced, and X was significantly increased. The clinical scores showed improvements immediate post rESW and at 1-week follow-up. Conclusions: The observed changes in upper limb muscle properties adds further support to the theory that both the neural and peripheral components play a role in muscle spasticity. ESW intervention may be more effective in addressing the peripheral component of spasticity in terms of muscle mechanical properties changes. The clinical management of post stroke spasticity should take into consideration of both the neural and non-neural factors in order to identify optimal intervention regime.
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Affiliation(s)
- Yan Leng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chengpeng Hu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruihao Bian
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqin Xu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiyao Shan
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongfeng Huang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Le Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
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Svane C, Nielsen JB, Lorentzen J. Nonsurgical Treatment Options for Muscle Contractures in Individuals With Neurologic Disorders: A Systematic Review With Meta-Analysis. Arch Rehabil Res Clin Transl 2021; 3:100104. [PMID: 33778477 PMCID: PMC7984980 DOI: 10.1016/j.arrct.2021.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate whether nonsurgical treatment can reduce muscle contractures in individuals with neurologic disorders. The primary outcome measure was muscle contractures measured as joint mobility or passive stiffness. Data Sources Embase, MEDLINE, Cumulative Index to Nursing and Allied Health, and Physiotherapy Evidence Database in June-July 2019 and again in July 2020. Study Selection The search resulted in 8020 records, which were screened by 2 authors based on our patient, intervention, comparison, outcome criteria. We included controlled trials of nonsurgical interventions administered to treat muscle contractures in individuals with neurologic disorders. Data Extraction Authors, participant characteristics, intervention details, and joint mobility/passive stiffness before and after intervention were extracted. We assessed trials for risk of bias using the Downs and Black checklist. We conducted meta-analyses investigating the short-term effect on joint mobility using a random-effects model with the pooled effect from randomized controlled trials (RCTs) as the primary outcome. The minimal clinically important effect was set at 5°. Data Synthesis A total of 70 trials (57 RCTs) were eligible for inclusion. Stretch had a pooled effect of 3° (95% CI, 1-4°; prediction interval (PI)=−2 to 7°; I2=66%; P<.001), and robot-assisted rehabilitation had an effect of 1 (95% CI, 0-2; PI=−8 to 9; I2=73%; P=.03). We found no effect of shockwave therapy (P=.56), physical activity (P=.27), electrical stimulation (P=.11), or botulinum toxin (P=.13). Although trials were generally of moderate to high quality according to the Downs and Black checklist, only 18 of the 70 trials used objective measures of muscle contractures. In 23 trials, nonobjective measures were used without use of assessor-blinding. Conclusions We did not find convincing evidence supporting the use of any nonsurgical treatment option. We recommend that controlled trials using objective measures of muscle contractures and a sufficiently large number of participants be performed.
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Key Words
- BTX, botulinum toxin
- CCT, controlled clinical trial
- Contracture
- Nervous System Diseases
- PI, prediction interval
- PICO, patient, intervention, comparison, outcome
- PROM, passive range of motion
- RCT, randomized controlled trial
- Range of motion, articular
- Rehabilitation
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Affiliation(s)
- Christian Svane
- Department of Neuroscience, University of Copenhagen, Copenhagen.,Elsass Foundation, Charlottenlund, Denmark
| | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen, Copenhagen.,Elsass Foundation, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, Copenhagen.,Elsass Foundation, Charlottenlund, Denmark
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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. J Clin Med 2021; 10:jcm10020261. [PMID: 33445623 PMCID: PMC7826726 DOI: 10.3390/jcm10020261] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/20/2020] [Accepted: 01/08/2021] [Indexed: 12/13/2022] Open
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.
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Corrado B, Di Luise C, Servodio Iammarrone C. Management of Muscle Spasticity in Children with Cerebral Palsy by Means of Extracorporeal Shockwave Therapy: A Systematic Review of the Literature. Dev Neurorehabil 2021; 24:1-7. [PMID: 31674272 DOI: 10.1080/17518423.2019.1683908] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The purpose of this systematic review was to investigate the effectiveness of extracorporeal shockwave therapy for the management of muscle spasticity in children with cerebral palsy. An electronic database search was performed to identify studies relevant to the research question. Assessment of the quality of evidence in all relevant studies was performed with the help of the Oxford Center for Evidence-based Medicine guide. Four studies met our inclusion criteria for review: one was a low-quality randomized controlled clinical trial, two were individual case-control studies and one was a case series study. Reduction in muscle stiffness and improvement in joint range of motion were the outcomes in all of the selected studies that used extracorporeal shockwave therapy. However, considering the limited evidence provided by these studies, further research is needed to support the use of extracorporeal shockwave therapy in the management of muscle spasticity in children with cerebral palsy.
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Long-Term Efficacy of Extracorporeal Shock Wave Therapy on Lower Limb Post-Stroke Spasticity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2020; 10:jcm10010086. [PMID: 33383655 PMCID: PMC7795167 DOI: 10.3390/jcm10010086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 01/14/2023] Open
Abstract
The purpose of this systematic review and meta-analysis is to evaluate the long-term efficacy of Extracorporeal Shock Wave Therapy (ESWT) on reducing lower limb post-stroke spasticity in adults. A systematic electronic search of PubMed/ MEDLINE, Physiotherapy Evidence Database (PEDro), Scopus, Ovid MEDLINE(R), and search engine of Google Scholar was performed. Publications that ranged from January 2010 to August 2020, published in English, French, Spanish, Portuguese, and Italian language and available as full texts were eligible for inclusion and they were searched without any restrictions of country. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and followed the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Two authors screened the references, extracted data, and assessed the risk of bias. The primary outcome was spasticity grade mainly assessed by the Modified Ashworth Scale (MAS). Secondary outcomes were passive range of motion (PROM), pain intensity, electrophysiological parameters, gait assessment, and adverse events. A total of seven recent randomized controlled trials (RCTs) were included in the systematic review and meta-analysis, and a beneficial effect on spasticity was found. The high level of evidence presented in this paper showed that ESWT ameliorates spasticity considering the parameters: MAS: standardized mean difference (SMD) = 0.53; 95% confidence interval (95% CI): (0.07–0.99); Modified Tardieu Scale (MTS): SMD = 0.56; 95% CI: (0.01–1.12); Visual Analogue Scale (VAS): SMD = 0.35; 95% CI: (−0.21–0.91); PROM: SMD = 0.69; 95% CI: (0.20–1.19). ESWT presented long-term efficacy on lower limb post-stroke spasticity, reduced pain intensity, and increased range of motion. The effect of this novel and non-invasive therapy was significant and the intervention did not present adverse events, proving a satisfactory safety profile.
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Martínez IM, Sempere-Rubio N, Navarro O, Faubel R. Effectiveness of Shock Wave Therapy as a Treatment for Spasticity: A Systematic Review. Brain Sci 2020; 11:brainsci11010015. [PMID: 33374359 PMCID: PMC7823267 DOI: 10.3390/brainsci11010015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/19/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The purpose of this study was to collect and analyse the available scientific evidence on the effectiveness of shock wave therapy as a treatment for spasticity. METHODS the search was performed in the following databases: PubMed, PEDro, Cochrane, Embase, and the Virtual Health Library. All publications from November 2009 to November 2019 were selected that included a sample of patients with spasticity and prior suspension of botulinum toxin, to whom shock wave therapy was applied. The methodological quality of the articles was evaluated using the Jadad scale and the pyramid of quality of scientific evidence. RESULTS 25 studies involving 866 participants with spasticity were selected. The results obtained suggest that shock wave therapy appears to be effective in reducing spasticity levels irrespective of the age of the participants, the type of injury, and the tool used to measure the effect. CONCLUSIONS shock wave therapy reports evidence of improvement in motor function, motor impairment, pain, and functional independence, applied independently of botulinum toxin. However, due to the heterogeneity of the protocols, there is no optimum protocol for its application, and it would be appropriate to gain more high-quality scientific evidence through primary studies.
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Affiliation(s)
- Isabel María Martínez
- Faculty of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Asociación de Familiares y Enfermos de Parkinson de Villarrobledo, Centro de Rehabilitación Neurológica (Neurovilla), 02600 Albacete, Spain
| | - Nuria Sempere-Rubio
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Research Unit in Clinical Biomechanics (UBIC), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain
- Correspondence:
| | - Olga Navarro
- Department of Nursery, Catholic University of Valencia, 46001 Valencia, Spain;
- Isntituto ITACA, Universitat Politècnica de València, 46022 València, Spain
| | - Raquel Faubel
- Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
- Joint Research Unit in Biomedical Engineering, IIS La Fe-Universitat Politècnica de València, 46026 Valencia, Spain
- PTinMOTION, Physiotherapy in Motion, Multispeciality Research Group, Department of Physiotherapy, Universitat de València, 46010 València, Spain
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Megna M, Marvulli R, Farì G, Gallo G, Dicuonzo F, Fiore P, Ianieri G. Pain and Muscles Properties Modifications After Botulinum Toxin Type A (BTX-A) and Radial Extracorporeal Shock Wave (rESWT) Combined Treatment. Endocr Metab Immune Disord Drug Targets 2020; 19:1127-1133. [PMID: 30843498 DOI: 10.2174/1871530319666190306101322] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 11/22/2022]
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.
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Affiliation(s)
- Marisa Megna
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Riccardo Marvulli
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giacomo Farì
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giulia Gallo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Franca Dicuonzo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Pietro Fiore
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giancarlo Ianieri
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari "Aldo Moro", Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy
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Li G, Yuan W, Liu G, Qiao L, Zhang Y, Wang Y, Wang W, Zhao M, Wang Y, Wang J. Effects of radial extracorporeal shockwave therapy on spasticity of upper-limb agonist/antagonist muscles in patients affected by stroke: a randomized, single-blind clinical trial. Age Ageing 2020; 49:246-252. [PMID: 31846499 DOI: 10.1093/ageing/afz159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND the effects of radial extracorporeal shock wave therapy (rESWT) were assessed on agonist/antagonist muscles in stroke patients with elbow spasticity, the duration of effects and influence on function. METHODS patients were randomly assigned into groups: control (A, n = 25), rESWT on agonist muscles (B, n = 27) and rESWT on antagonist muscles (C, n = 30) groups. Conventional physical therapy was given to three groups for 3 weeks, six times a week, and besides, rESWT was given at 4-day intervals for five consecutive treatments, B received rESWT on agonist muscles and C received rESWT on antagonist muscles. The primary outcome was Modified Ashworth Scale (MAS) scores. Modified Tardieu Scale, Visual Analogue Scale (VAS), Fugl-Meyer Assessment and swelling scale (SS) scores were secondary outcomes. Indicators were assessed at baseline, after five treatments and after 4 weeks follow-up. RESULTS the rate of treatment was determined by changes in MAS, which was 16.0 (A), 70.4 (B) and 63.3% (C) after rESWT treatments, and was 24.0 (A), 74.1 (B) and 66.7% (C) after 4 weeks follow-up. Improvements were achieved for R1 (P < 0.01), R2 (P < 0.01) and VAS (P < 0.01) after five rESWT interventions. At 4 weeks, significant improvements were achieved for R1 (P < 0.01) and VAS (P < 0.01). CONCLUSIONS rESWT is an effective therapy for spasticity after stroke, with lasting effects on both agonist and antagonist muscles after 4 weeks. rESWT relieved pain but had no effect on active function or swelling of the upper limbs.
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Affiliation(s)
- Gaiyan Li
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Wenchao Yuan
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Gongliang Liu
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Lei Qiao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Ying Zhang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Yan Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Wei Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Minglei Zhao
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Yanmin Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
| | - Jie Wang
- Department of Rehabilitation, Shanghai Xuhui Central Hospital, Shanghai 200030, China
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Dymarek R, Ptaszkowski K, Ptaszkowska L, Kowal M, Sopel M, Taradaj J, Rosińczuk J. Shock Waves as a Treatment Modality for Spasticity Reduction and Recovery Improvement in Post-Stroke Adults - Current Evidence and Qualitative Systematic Review. Clin Interv Aging 2020; 15:9-28. [PMID: 32021129 PMCID: PMC6954086 DOI: 10.2147/cia.s221032] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/18/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose This systematic review examines intervention studies using extracorporeal shock wave therapy (ESWT) application in post-stroke muscle spasticity with particular emphasis on the comparison of two different types of radial (rESWT) and focused shock waves (fESWT). Methods PubMed, PEDro, Scopus, and EBSCOhost databases were systematically searched. Studies published between the years 2000 and 2019 in the impact factor journals and available in the English full-text version were eligible for inclusion. All qualified articles were classified in terms of their scientific reliability and methodological quality using the PEDro criteria. The PRISMA guidelines were followed and the registration on the PROSPERO database was done. Results A total of 17 articles were reviewed of a total sample of 303 patients (age: 57.87±10.45 years and duration of stroke: 40.49±25.63 months) who were treated with ESWT. Recent data confirm both a subjective (spasticity, pain, and functioning) and objective (range of motion, postural control, muscular endurance, muscle tone, and muscle elasticity) improvements for post-stroke spasticity. The mean difference showing clinical improvement was: ∆=34.45% of grade for fESWT and ∆=34.97% for rESWT that gives a slightly better effect of rESWT (∆=0.52%) for spasticity (p<0.05), and ∆=38.83% of angular degrees for fESWT and ∆=32.26% for rESWT that determines the more beneficial effect of fESWT (∆=6.57%) for range of motion (p<0.05), and ∆=18.32% for fESWT and ∆=22.27% for rESWT that gives a slightly better effect of rESWT (∆=3.95%) for alpha motor neuron excitability (p<0.05). The mean PEDro score was 4.70±2.5 points for fESWT and 5.71±2.21 points for rESWT, thus an overall quality of evidence grade of moderate (“fair” for fESWT and “good” for rESWT). Three studies in fESWT and four in rESWT obtained Sackett’s grading system’s highest Level 1 of evidence. Conclusion The studies affirm the effectiveness of ESWT in reducing muscle spasticity and improving motor recovery after stroke.
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Affiliation(s)
- Robert Dymarek
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, Wroclaw, Poland
| | | | - Mateusz Kowal
- Department of Physiotherapy, Opole Medical School, Opole, Poland
| | - Mirosław Sopel
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Taradaj
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education, Katowice, Poland.,College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Canada
| | - Joanna Rosińczuk
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
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Cabanas-Valdés R, Calvo-Sanz J, Urrùtia G, Serra-Llobet P, Pérez-Bellmunt A, Germán-Romero A. The effectiveness of extracorporeal shock wave therapy to reduce lower limb spasticity in stroke patients: a systematic review and meta-analysis. Top Stroke Rehabil 2019; 27:137-157. [DOI: 10.1080/10749357.2019.1654242] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Rosa Cabanas-Valdés
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Jordi Calvo-Sanz
- Physiotherapy Department Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Rehabilitation Department, Hospital Asepeyo Sant Cugat del Vallès, Barcelona, Spain
| | - Gerard Urrùtia
- Centro Cochrane Iberoamericano, Institut d’Investigació Biomèdica Sant Pau, CIBERESP, Barcelona, Spain
| | - Pol Serra-Llobet
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Ana Germán-Romero
- Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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Radinmehr H, Ansari NN, Naghdi S, Tabatabaei A, Moghimi E. Comparison of Therapeutic Ultrasound and Radial Shock Wave Therapy in the Treatment of Plantar Flexor Spasticity After Stroke: A Prospective, Single-blind, Randomized Clinical Trial. J Stroke Cerebrovasc Dis 2019; 28:1546-1554. [PMID: 30935809 DOI: 10.1016/j.jstrokecerebrovasdis.2019.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 02/16/2019] [Accepted: 03/01/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This study aimed to compare the effects of therapeutic ultrasound (US) and radial extracorporeal shock wave therapy (rESWT) in the treatment of plantar flexor spasticity after stroke. MATERIALS AND METHODS In this prospective, single-blind, randomized clinical trial, 32 patients (age range 42-78 years; male 19) with stroke were randomly divided into two groups: The US group (n = 16) received the continuous ultrasound, intensity 1.5 w/cm2, frequency 1 MHz, and duration 10 minutes. The rESWT group (n = 16) was treated with rESWT, 0.340 mJ/mm2, 2000 shots. Both groups received the treatments for 1 session. The H-reflex tests of Hmax/Mmax ratio and H-reflex latency, the Modified Modified Ashworth Scale (MMAS), active range of motion (AROM), passive range of motion (PROM), passive plantar flexor torque (PPFT), and the timed "up and go" test (TUG) were blinded assessed at baseline (T0), immediately post-treatment (T1), and one hour follow-up (T2). RESULTS The H-reflex tests did not improve across the groups. However, the MMAS spasticity scores, AROM and PROM, PPFT, and TUG improved significantly within groups. The results found no significant differences between groups for all outcome measures. CONCLUSIONS The US and rESWT had similar effects, and the rESWT was not more effective than the US in improving ankle plantar flexor spasticity after stroke.
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Affiliation(s)
- Hojjat Radinmehr
- Department of Physiotherapy, School of Rehabilitation, Hamadan University of Medical Science, Hamadan, Iran.
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Science, Tehran, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Soofia Naghdi
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Science, Tehran, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Azade Tabatabaei
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Science, Tehran, Iran
| | - Ehsan Moghimi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Oh JH, Park HD, Han SH, Shim GY, Choi KY. Duration of Treatment Effect of Extracorporeal Shock Wave on Spasticity and Subgroup-Analysis According to Number of Shocks and Application Site: A Meta-Analysis. Ann Rehabil Med 2019; 43:163-177. [PMID: 31072083 PMCID: PMC6509586 DOI: 10.5535/arm.2019.43.2.163] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/11/2018] [Indexed: 12/30/2022] Open
Abstract
Objective To investigate duration of the treatment effect of extracorporeal shockwave therapy (ESWT) on spasticity levels measured with Modified Ashworth Scale (MAS) regardless of the patient group (stroke, multiple sclerosis, and cerebral palsy) and evaluate its spasticity-reducing effect depending on the number of shocks and site of application. Methods PubMed, EMBASE, the Cochrane Library, and Scopus were searched from database inception to February 2018. Randomized controlled trials and cross-over trials were included. All participants had spasticity regardless of cause. ESWT was the main intervention and MAS score was the primary outcome. Among 122 screened articles, 9 trials met the inclusion criteria. Results The estimate of effect size showed statistically significant MAS grade reduction immediately after treatment (standardized mean difference [SMD]=-0.57; 95% confidence interval [CI], -1.00 to -0.13; p=0.012), 1 week after (SMD=-1.81; 95% CI, -3.07 to -0.55; p=0.005), 4 weeks after (SMD=-2.35; 95% CI, -3.66 to -1.05; p<0.001), and 12 weeks after (SMD=-1.07; 95% CI, -2.04 to -0.10; p=0.03). Meta-regression and subgroup analysis were performed for the ‘immediately after ESWT application’ group. The prediction equation obtained from metaregression was -1.0824+0.0002* (number of shocks), which was not statistically significant. Difference in MAS grade reduction depending on site of application was not statistically significant either in subgroup analysis (knee and ankle joints vs. elbow, wrist, and finger joints). Conclusion ESWT effectively reduced spasticity levels measured with MAS regardless of patient group. Its effect maintained for 12 weeks. The number of shocks or site of application had no significant influence on the therapeutic effect of ESWT in reducing spasticity. Ongoing trials with ESWT are needed to address optimal parameters of shock wave to reduce spasticity regarding intensity, frequency, and numbers.
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Affiliation(s)
- Jae Ho Oh
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Hee Dong Park
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Seung Hee Han
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Ga Yang Shim
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
| | - Kyung Yeul Choi
- Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Korea
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Clinical study of combined mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients. Int J Rehabil Res 2019; 42:31-35. [PMID: 30211721 PMCID: PMC6382037 DOI: 10.1097/mrr.0000000000000316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mirror therapy is a simple, inexpensive, and patient-oriented method that has been shown to reduce phantom sensations and pain caused by amputation and improve range of motion, speed, and accuracy of arm movement and function. Extracorporeal shock wave therapy (ESWT) is a new, reversible, and noninvasive method for the treatment of spasticity after stroke. To investigate the therapeutic effect of the combination of mirror and extracorporeal shock wave therapy on upper limb spasticity in poststroke patients. We randomly assigned 120 patients into four groups: A, B, C, and D. All groups received conventional rehabilitation training for 30 min per day, five times a week, for 4 weeks. Moreover, participants in groups A, B, and C also added mirror therapy, ESWT, and a combination of mirror and ESWT, respectively, for 20 min per day. Motor recovery and spasticity were measured using Fugl–Meyer assessment and modified Ashworth scale. The differences in the Fugl–Meyer assessment and modified Ashworth scale scores in group C were significantly greater than those of group D at all observed time points after treatment and were significantly greater than those of groups A and B (P<0.05), but no significant differences were observed between groups A and B until 12 months. Upper extremity spasticity was improved by combined mirror and ESWT.
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Ultrasonographic Evaluation for the Effect of Extracorporeal Shock Wave Therapy on Gastrocnemius Muscle Spasticity in Patients With Chronic Stroke. PM R 2019; 11:363-371. [DOI: 10.1016/j.pmrj.2018.08.379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/12/2018] [Indexed: 11/15/2022]
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Park SK, Yang DJ, Uhm YH, Yoon JH, Kim JH. Effects of extracorporeal shock wave therapy on upper extremity muscle tone in chronic stroke patients. J Phys Ther Sci 2018; 30:361-364. [PMID: 29581652 PMCID: PMC5857439 DOI: 10.1589/jpts.30.361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/02/2017] [Indexed: 11/30/2022] Open
Abstract
[Purpose] The purpose of this study was to examine the effects of extracorporeal shock
wave therapy (ESWT) on upper extremity muscle tone in chronic stroke patients. [Subjects
and Methods] For this study, 30 stroke patients participated in this study and they were
divided into ESWT group and sham-ESWT group, each group consisted of 15 patients. ESWT and
sham-ESWT was performed by the patients for two times a week, for eight weeks. MyotonPRO
was used to measure muscle tone. [Results] According to the results of the comparisons
between the groups, after intervention, upper extremity muscle tone were significantly
higher in the ESWT group than in the sham-ESWT group. [Conclusion] This study showed that
ESWT is effective for improving decrease of muscle tone in chronic stroke patients.
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Affiliation(s)
- Seung Kyu Park
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Dae Jung Yang
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Yo Han Uhm
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Jong Hyuk Yoon
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
| | - Je Ho Kim
- Department of Physical Therapy, Graduate School of Physical Therapy, Sehan University: 1113 Noksaek-ro, Samho-eup, Yeongam-gun, Jeollanam-do, Republic of Korea
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Guo P, Gao F, Zhao T, Sun W, Wang B, Li Z. Positive Effects of Extracorporeal Shock Wave Therapy on Spasticity in Poststroke Patients: A Meta-Analysis. J Stroke Cerebrovasc Dis 2017; 26:2470-2476. [PMID: 28918085 DOI: 10.1016/j.jstrokecerebrovasdis.2017.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 07/20/2017] [Accepted: 08/13/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Spasticity is a common and serious complication following a stroke, and many clinical research have been conducted to evaluate the effect of extracorporeal shock wave therapy (ESWT) on muscle spasticity in poststroke patients. This meta-analysis aimed to evaluate the therapeutic effect on decreasing spasticity caused by a stroke immediately and 4 weeks after the application of shock wave therapy. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases for relevant studies through November 2016 using the following item: (Hypertonia OR Spasticity) and (Shock Wave or ESWT) and (Stroke). The outcomes were evaluated by Modified Ashworth Scale (MAS) grades and pooled by Stata 12.0 (Stata Corp, College Station, TX, USA). RESULTS Six studies consisting of 9 groups were included in this meta-analysis. The MAS grades immediately after ESWT were significantly improved compared with the baseline values (standardized mean difference [SMD], -1.57; 95% confidence intervals [CIs], -2.20, -.94). Similarly, the MAS grades judged at 4 weeks after ESWT were also showed to be significantly lower than the baseline values (SMD, -1.93; 95% CIs, -2.71, -1.15). CONCLUSIONS ESWT for the spasticity of patients after a stroke is effective, as measured by MAS grades. Moreover, no serious side effects were observed in any patients after shock wave therapy. Nevertheless, our current study with some limitations such as the limited sample size only provided limited quality of evidence; confirmation from a further systematic review or meta-analysis with large-scale, well-designed randomized control trials is required.
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Affiliation(s)
- Peipei Guo
- The Graduate School of Peking Union Medical College, Beijing
| | - Fuqiang Gao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Tingting Zhao
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Wei Sun
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China.
| | - Bailiang Wang
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
| | - Zirong Li
- Centre for Osteonecrosis and Joint-Preserving & Reconstruction, Department of Orthopedic Surgery, Beijing Key Laboratory of Arthritic and Rheumatic Diseases, China-Japan Friendship Hospital, National Health and Family Planning Commission of the People's Republic of China, Beijing, China
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Hong JO, Park JS, Jeon DG, Yoon WH, Park JH. Extracorporeal Shock Wave Therapy Versus Trigger Point Injection in the Treatment of Myofascial Pain Syndrome in the Quadratus Lumborum. Ann Rehabil Med 2017; 41:582-588. [PMID: 28971042 PMCID: PMC5608665 DOI: 10.5535/arm.2017.41.4.582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/19/2016] [Indexed: 11/06/2022] Open
Abstract
Objective To compare the effectiveness of extracorporeal shock wave therapy (ESWT) and trigger point injection (TPI) for the treatment of myofascial pain syndrome in the quadratus lumborum. Methods In a retrospective study at our institute, 30 patients with myofascial pain syndrome in the quadratus lumborum were assigned to ESWT or TPI groups. We assessed ESWT and TPI treatment according to their affects on pain relief and disability improvement. The outcome measures for the pain assessment were a visual analogue scale score and pain pressure threshold. The outcome measures for the disability assessment were Oswestry Disability Index, Roles and Maudsley, and Quebec Back Pain Disability Scale scores. Results Both groups demonstrated statistically significant improvements in pain and disability measures after treatment. However, in comparing the treatments, we found ESWT to be more effective than TPI for pain relief. There were no statistically significant differences between the groups with respect to disability. Conclusion Compared to TPI, ESWT showed superior results for pain relief. Thus, we consider ESWT as an effective treatment for myofascial pain syndrome in the quadratus lumborum.
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Affiliation(s)
- Jin Oh Hong
- Department of Rehabilitation Medicine and Rehabilitation, Institute of Neuromuscular Disease, Yonsei University College of Medicine & Gangnam Severance Hospital, Seoul, Korea
| | - Joon Sang Park
- Department of Rehabilitation Medicine and Rehabilitation, Institute of Neuromuscular Disease, Yonsei University College of Medicine & Gangnam Severance Hospital, Seoul, Korea
| | - Dae Geun Jeon
- Department of Rehabilitation Medicine and Rehabilitation, Institute of Neuromuscular Disease, Yonsei University College of Medicine & Gangnam Severance Hospital, Seoul, Korea
| | - Wang Hyeon Yoon
- Department of Rehabilitation Medicine and Rehabilitation, Institute of Neuromuscular Disease, Yonsei University College of Medicine & Gangnam Severance Hospital, Seoul, Korea
| | - Jung Hyun Park
- Department of Rehabilitation Medicine and Rehabilitation, Institute of Neuromuscular Disease, Yonsei University College of Medicine & Gangnam Severance Hospital, Seoul, Korea
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Yoon SH, Shin MK, Choi EJ, Kang HJ. Effective Site for the Application of Extracorporeal Shock-Wave Therapy on Spasticity in Chronic Stroke: Muscle Belly or Myotendinous Junction. Ann Rehabil Med 2017; 41:547-555. [PMID: 28971038 PMCID: PMC5608661 DOI: 10.5535/arm.2017.41.4.547] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/10/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To compare the effect of extracorporeal shock-wave therapy (ESWT) applied at the muscle belly and myotendinous junction on spasticity in the upper and lower limbs of chronic stroke patients. METHODS Of the 151 patients, a total of 80 patients with stroke-induced spasticity on the elbow flexor and 44 patients on the knee flexor were enrolled for a prospective, randomized clinical trial. The patients were divided into control, muscle belly, and myotendinous junction groups, and a total of three ESWT sessions (0.068-0.093 mJ/mm2, 1,500 shots) were conducted at one per week. A Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) were collected at the baseline and at 1 week after each session. RESULTS After interventions, the MAS and MTS of both the belly and the junction groups showed positive effects from the ESWT on spasticity in the elbow and knee flexors, but the control group did not. The results also tended to improve after each session until the entire intervention was completed. However, there was no significant difference between the belly and junction groups. CONCLUSION ESWT could be effective for treating chronic spasticity after stroke when applied to muscle belly or myotendinous junction.
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Affiliation(s)
- Sang Ho Yoon
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Min Kyung Shin
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Eun Jung Choi
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyo Jung Kang
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
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Naro A, Leo A, Russo M, Casella C, Buda A, Crespantini A, Porcari B, Carioti L, Billeri L, Bramanti A, Bramanti P, Calabrò RS. Breakthroughs in the spasticity management: Are non-pharmacological treatments the future? J Clin Neurosci 2017; 39:16-27. [DOI: 10.1016/j.jocn.2017.02.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 12/16/2022]
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Radinmehr H, Nakhostin Ansari N, Naghdi S, Olyaei G, Tabatabaei A. Effects of one session radial extracorporeal shockwave therapy on post-stroke plantarflexor spasticity: a single-blind clinical trial. Disabil Rehabil 2017; 39:483-490. [PMID: 26971745 DOI: 10.3109/09638288.2016.1148785] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose To examine the effects of radial extracorporeal shockwave therapy (rESWT) on plantarflexor spasticity after stroke. Method Twelve patients with stroke were randomly included for this prospective, single-blind clinical trial. Patients received one rESWT session (0.340 mJ/mm2, 2000 shots) on plantarflexor muscle. The Modified Modified Ashworth Scale (MMAS), H-reflex tests, ankle range of motion (ROM), passive plantarflexor torque (PPFT) and timed up and go test (TUG) were measured at baseline (T0), immediately after treatment (T1) and one hour after the end of the treatment (T2). Results Patients had improved the MMAS scores for both the gastrocnemius and the soleus muscles, active and passive ROM, PPFT and TUG over time after rESWT. For the PPFT, it was greater at high velocity than at low velocity, and there was a significant three-way interaction between time, knee position (extended/flexed) and velocity (low/high). The H-reflex latency had decreased at T1, but there was no significant effect on Hmax/Mmax ratio. Conclusions The rESWT improved plantarflexor spasticity, and the effects sustained for one hour, whereas it was not effective in improving spinal excitability. Implications for Rehabilitation One session radial extracorporeal shock wave therapy (rESWT) is safe and effective in improving post stroke plantarflexor spasticity, ankle active and passive range of motion, passive torque, and walking capability. The spasticity scores improved for both the gastrocnemius and the soleus muscles and persisted one hour after rESWT. The magnitude of resistive plantarflexor passive torque in the knee extended position and high velocity was larger over time suggesting greater gastrocnemius spasticity than soleus. The rESWT had no significant effects on alpha motorneuron excitability.
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Affiliation(s)
- Hojjat Radinmehr
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Noureddin Nakhostin Ansari
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Soofia Naghdi
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Gholamreza Olyaei
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
| | - Azadeh Tabatabaei
- a Department of Physiotherapy, School of Rehabilitation , Tehran University of Medical Sciences , Tehran , Iran
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Lee JH, Sung YB, Jang SH. Nerve growth factor expression in stroke induced rats after shock wave. J Phys Ther Sci 2016; 28:3451-3453. [PMID: 28174471 PMCID: PMC5276780 DOI: 10.1589/jpts.28.3451] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 09/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigates effects of extracorporeal shock wave therapy on nerve growth factor expression in stroke in rats. [Subjects and Methods] Sixteen eight-week-old Sprague-Dawley rats were used and randomly divided into two groups: an experimental group, a control group. The experimental group received extracorporeal shock wave therapy after the stroke. The spinal cord encompassing the lumbar 4-lumbar 5 level was then removed for Western blot analysis. [Results] There was a significant difference in nerve growth factor expression between the groups after the impairment. [Conclusion] Application of extracorporeal shock wave therapy increased the expression of nerve growth factor and nerve growth factor postulated to promote nerve growth factor upregulation through formation of a microenvironment at the spinal cord level related to the injured area.
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Affiliation(s)
- Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University, Republic of Korea
| | - Youn-Bum Sung
- Department of Physical Therapy, Korea National University of Transportation, Republic of Korea
| | - Sang-Hun Jang
- Department of Physical Therapy, Institute for Health Science, Gimcheon University, Republic of Korea
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Lee JH. Knee joint angle of intracerebral hemorrhage-induced rats after extracorporeal shock wave therapy. J Phys Ther Sci 2016; 28:3122-3124. [PMID: 27942132 PMCID: PMC5140812 DOI: 10.1589/jpts.28.3122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/21/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the impact on rat knee joints of extracorporeal shock wave therapy after experimentally induced intracerebral hemorrhage. [Subjects and Methods] Sprague-Dawley (SD) rats were divided into an experimental group that received extracorporeal shock wave therapy after central nervous system injury (n=10) and a control group that did not receive any therapeutic intervention after central nervous system injury (n=10). The Dartfish program was used to evaluate the SD rats' locomotion. [Results] There was a significant difference between the control group and the experimental group in the change of knee joint angle during midstance after the intervention. [Conclusion] In conclusion, at extracorporeal shock wave therapy for central nervous system injury was confirmed to be effective at reducing knee joint angle, confirming it is a good physical therapy intervention, based on its efficacy.
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Affiliation(s)
- Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University, Republic of Korea
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Extracorporeal Shock Wave Stimulation as Alternative Treatment Modality for Wrist and Fingers Spasticity in Poststroke Patients: A Prospective, Open-Label, Preliminary Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:4648101. [PMID: 27504139 PMCID: PMC4967701 DOI: 10.1155/2016/4648101] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 05/13/2016] [Accepted: 06/08/2016] [Indexed: 12/18/2022]
Abstract
Objective. To evaluate the effectiveness of radial shock waves (rESW) for wrist and fingers flexors spasticity in stroke patients. Methods. Twenty patients with upper limb muscle spasticity were enrolled in the study and treated with a single session of rESW. The spasticity level of the radio carpal (RC) and finger (FF) joints was assessed using Modified Ashworth Scale (MAS). The resting bioelectrical activity of the flexor carpi radialis (FCR) and flexor carpi ulnaris (FCU) was examined using surface electromyography (sEMG). Trophic conditions were measured using infrared thermal (IRT) imaging. All measurements were conducted at baseline (t0), immediately after rESW (t1), and 1 (t2) and 24 (t3) hours following rESW. Results. Significant reduction in MAS was observed for the RC joint in t1, as well as for the FF joints in t1, t2, and t3. A significant decrease in sEMG was shown for the FCR muscle in t1 and t2, as well as for the FCU muscle in t1 and t3. Also, a significant increase in IRT value was observed in t3 only. Conclusions. A single session of rESW could be an effective alternative treatment for reduction of limb spasticity and could lead to improvement of trophic conditions of the spastic muscles.
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Kim SH, Ha KW, Kim YH, Seol PH, Kwak HJ, Park SW, Ryu BJ. Effect of Radial Extracorporeal Shock Wave Therapy on Hemiplegic Shoulder Pain Syndrome. Ann Rehabil Med 2016; 40:509-19. [PMID: 27446789 PMCID: PMC4951371 DOI: 10.5535/arm.2016.40.3.509] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 10/20/2015] [Indexed: 01/18/2023] Open
Abstract
Objective To investigate the effect of radial extracorporeal shock wave therapy (rESWT) on hemiplegic shoulder pain (HSP) syndrome. Methods In this monocentric, randomized, patient-assessor blinded, placebo-controlled trial, patients with HSP were randomly divided into the rESWT (n=17) and control (n=17) groups. Treatment was administered four times a week for 2 weeks. The visual analogue scale (VAS) score and Constant-Murley score (CS) were assessed before and after treatment, and at 2 and 4 weeks. The Modified Ashworth Scale and Fugl-Meyer Assessment scores and range of motion of the shoulder were also assessed. Results VAS scores improved post-intervention and at the 2-week and 4-week follow-up in the intervention group (p<0.05). Respective differences in VAS scores between baseline and post-intervention in the intervention and control groups were –1.69±1.90 and –0.45±0.79, respectively (p<0.05), between baseline and 2-week follow-up in the intervention and control groups were –1.60±1.74 and –0.34±0.70, respectively (p<0.05), and between baseline and 4-week follow-up in the intervention and control groups were –1.61±1.73 and –0.33±0.71, respectively (p<0.05). Baseline CS improved from 19.12±11.02 to 20.88±10.37 post-intervention and to 20.41±10.82 at the 2-week follow-up only in the intervention group (p<0.05). Conclusion rESWT consisting of eight sessions could be one of the effective and safe modalities for pain management in people with HSP. Further studies are needed to generalize and support these results in patients with HSP and a variety conditions, and to understand the mechanism of rESWT for treating HSP.
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Affiliation(s)
- Sung Hwan Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Kang Wook Ha
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Yun Hee Kim
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Pyong-Hwa Seol
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Ho-Jun Kwak
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Seung-Wan Park
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Seoul, Korea
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Li TY, Chang CY, Chou YC, Chen LC, Chu HY, Chiang SL, Chang ST, Wu YT. Effect of Radial Shock Wave Therapy on Spasticity of the Upper Limb in Patients With Chronic Stroke: A Prospective, Randomized, Single Blind, Controlled Trial. Medicine (Baltimore) 2016; 95:e3544. [PMID: 27149465 PMCID: PMC4863782 DOI: 10.1097/md.0000000000003544] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Recently, studies have reported that extracorporeal shock wave therapy (ESWT) is a safe, noninvasive, alternative treatment for spasticity. However, the effect of ESWT on spasticity cannot be determined, because most studies to date have enrolled small patient numbers and have lacked placebo-controlled groups and/or long-term follow-up. In addition, whether varying the number of ESWT sessions would affect the duration of the therapeutic effect has not been investigated in a single study. Hence, we performed a prospective, randomized, single blind, placebo-controlled study to investigate the long-term effect of radial ESWT (rESWT) in patients with poststroke spasticity and surveyed the outcome of functional activity.Sixty patients were randomized into 3 groups. Group A patients received 1 session of rESWT per week for 3 consecutive weeks; group B patients received a single session of rESWT; group C patients received one session of sham rESWT per week for 3 consecutive weeks. The primary outcome was Modified Ashworth Scale of hand and wrist, whereas the secondary outcomes were Fugl-Meyer Assessment of hand function and wrist control. Evaluations were performed before the first rESWT treatment and immediately 1, 4, 8, 12, and 16 weeks after the last session of rESWT.Compared to the control group, the significant reduction in spasticity of hand and wrist lasted at least 16 and 8 weeks in group A and B, respectively. Three sessions of rESWT had a longer-lasting effect than one session. Furthermore, the reduction in spasticity after 3 sessions of rESWT may be beneficial for hand function and wrist control and the effect was maintained for 16 and 12 weeks, respectively.rESWT may be valuable in decreasing spasticity of the hand and wrist with accompanying enhancement of wrist control and hand function in chronic stroke patients.
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Affiliation(s)
- Tsung-Ying Li
- From the Department of Physical Medicine and Rehabilitation (T-YL, C-YC, L-CC, H-YC, S-LC, S-TC, Y-TW), Tri-Service General Hospital, School of Medicine; School of Public Health, National Defense Medical Center (Y-CC), Neihu District, Taipei; Department of Physical Medicine and Rehabilitation (L-CC), Hualien Armed Forces General Hospital, Hualien County; and Department of Rehabilitation (S-TC), Taichung Veterans General Hospital, Taiwan Boulevard, Taichung, Taiwan, Republic of China
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Wang T, Du L, Shan L, Dong H, Feng J, Kiessling MC, Angstman NB, Schmitz C, Jia F. A Prospective Case-Control Study of Radial Extracorporeal Shock Wave Therapy for Spastic Plantar Flexor Muscles in Very Young Children With Cerebral Palsy. Medicine (Baltimore) 2016; 95:e3649. [PMID: 27175689 PMCID: PMC4902531 DOI: 10.1097/md.0000000000003649] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To assess the effects of radial extracorporeal shock wave therapy (rESWT) on plantar flexor muscle spasticity and gross motor function in very young patients with cerebral palsy (CP).The design was case-control study (level of evidence 3).The setting was the Department of Pediatric Neurology and Neurorehabilitation, First Hospital of Jilin University, Changchun, China.Those with a diagnosis of CP and spastic plantar flexor muscles were recruited between April 2014 and April 2015.According to the parents' decision, patients received 1 ESWT session per week for 3 months, with 1500 radial shock waves per ESWT session and leg with positive energy flux density of 0.03 mJ/mm, combined with traditional conservative therapy (rESWT group) or traditional conservative therapy alone (control group).The Modified Ashworth Scale (MAS) (primary outcome measure) and passive range of motion (pROM) measurements were collected at baseline (BL), 1 month (M1), and 3 months (M3) after BL. The Gross Motor Function Measure (GMFM)-88 was collected at BL and M3.Sixty-six patients completed the final review at 3 months and were included in the study. Subjects ranged in age from 12 to 60 months (mean age 27.0 ± 13.6 months; median age 22.0 months; 33.3% female). For the rESWT group (n = 34), mean MAS grades at BL, M1, and M3 were 2.6, 1.9, and 1.5 on the left side and 1.9, 1.7, and 1.2 on the right side. For the control group (n = 32), mean MAS grades at BL, M1, and M3 were 2.5, 2.4, and 2.1 on the left side and 1.8, 1.8, and 1.5 on the right side. The within-subject effects time × side and time × treatment were statistically significant (P < 0.01). Similar results were found for the improvement of mean pROM. GMFM-88 improved from BL to M3, but showed no statistically significant difference between the groups. There were no significant complications.This study demonstrates that the combination of rESWT and traditional conservative therapy is more effective than traditional conservative therapy alone in the treatment of spasticity in very young patients with CP.
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Affiliation(s)
- Tiantian Wang
- From the Department of Pediatric Neurology and Neurorehabilitation (TW, LD, LS, HD, JF, FJ) ; the Institute of Pediatrics (FJ), First Hospital of Jilin University, Changchun, China; the Neurological Research Center (FJ), First Hospital of Jilin University, Changchun, China; and the Extracorporeal Shock Wave Research Unit (MCK, NBA, CS), Department of Neuroanatomy, Ludwig-Maximilians-University of Munich, Munich, Germany
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Dymarek R, Ptaszkowski K, Słupska L, Halski T, Taradaj J, Rosińczuk J. Effects of extracorporeal shock wave on upper and lower limb spasticity in post-stroke patients: A narrative review. Top Stroke Rehabil 2016; 23:293-303. [PMID: 27077981 DOI: 10.1080/10749357.2016.1141492] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Effective treatment strategies for post-stroke muscle spasticity are still a significant interdisciplinary issue and challenge for neurologists, neurosurgeons, physiatrists nurses and physiotherapists. Extracorporeal shock wave (ESW) treatment is a well-supported physical modality used in a wide range of musculoskeletal disorders. The list of justified indications for ESW treatment and scientific areas of investigations is continuously evolving and adapting to different pathologies, including spasticity after stroke. OBJECTIVES To analyze the relevant available research and clinical studies demonstrated that the treatment potentials and effectiveness of ESW procedure including mechanisms of the anti-spastic action within hypertonic muscles after stroke. LITERATURE SEARCH A computer research was performed using MEDLINE, PubMed, PEDro, CINAHL, and EMBASE databases. Assessment of eligibility of papers was determined by two independent reviewers. The inclusion criteria comprised: publication in peer-reviewed journals, studies published in the last 10 years, involving clinical trials, full-version available and written in English only. DISCUSSION A total of 91 articles were collected, 83 of which were non relevant. Ultimately, 8 clinical studies within a total of 195 patients met inclusion criteria for this review. Only one randomized controlled trial was found and then scored using the Cochrane-based assessment. The other studies involving were analyzed separately according to their methodological quality in a descriptive manner. CONCLUSIONS ESW was found to be safe and effective. The mechanism of ESW action is still under investigation.
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Affiliation(s)
- Robert Dymarek
- a Department of Nervous System Diseases , Wroclaw Medical University , Bartla 5 Street, 51-618 Wroclaw , Poland
| | - Kuba Ptaszkowski
- b Department of Physiotherapy , Wroclaw Medical University , Grunwaldzka 2 Street, 50-355 Wroclaw , Poland
| | - Lucyna Słupska
- c Institute of Physiotherapy , Public Higher Medical Professional School in Opole , Katowicka 68 Street, 45-061 Opole , Poland
| | - Tomasz Halski
- c Institute of Physiotherapy , Public Higher Medical Professional School in Opole , Katowicka 68 Street, 45-061 Opole , Poland
| | - Jakub Taradaj
- d Department of Physiotherapy Basics , Academy School of Physical Education in Katowice , Mikolowska 65 Street, 40-065 Katowice , Poland
| | - Joanna Rosińczuk
- a Department of Nervous System Diseases , Wroclaw Medical University , Bartla 5 Street, 51-618 Wroclaw , Poland
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Kim TG, Bae SH, Kim GY, Kim KY. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis. J Phys Ther Sci 2015; 27:523-6. [PMID: 25729207 PMCID: PMC4339177 DOI: 10.1589/jpts.27.523] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 09/10/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients.
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Affiliation(s)
- Tae Gon Kim
- Department of Physical Therapy, Dongshin University,
Republic of Korea
| | - Sea Hyun Bae
- Department of Physical Therapy, Cheongam College, Republic
of Korea
| | - Gye Yeop Kim
- Department of Physical Therapy, College of Health and
Welfare, Dongshin University: 252 Daeho-dong, Naju-si, Chonnam 520-714, Republic of
Korea
| | - Kyung Yoon Kim
- Department of Physical Therapy, College of Health and
Welfare, Dongshin University: 252 Daeho-dong, Naju-si, Chonnam 520-714, Republic of
Korea
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Lee JY, Kim SN, Lee IS, Jung H, Lee KS, Koh SE. Effects of Extracorporeal Shock Wave Therapy on Spasticity in Patients after Brain Injury: A Meta-analysis. J Phys Ther Sci 2014; 26:1641-7. [PMID: 25364134 PMCID: PMC4210419 DOI: 10.1589/jpts.26.1641] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 04/10/2014] [Indexed: 02/02/2023] Open
Abstract
[Purpose] The purpose of this meta-analysis was to assess the effects of extracorporeal shock wave therapy (ESWT) on reducing spasticity immediately and 4 weeks after application of ESWT. [Subjects and Methods] We searched PubMed, TCL, Embase, and Scopus from their inception dates through June 2013. The key words "muscle hypertonia OR spasticity" were used for spasticity, and the key words "shock wave OR ESWT" were used for ESWT. Five studies were ultimately included in the meta-analysis. [Results] The Modified Ashworth Scale (MAS) grade was significantly improved immediately after ESWT compared with the baseline values (standardized mean difference [SMD], -0.792; 95% confidence interval [CI], -1.001 to -0.583). The MAS grade at four weeks after ESWT was also significantly improved compared with the baseline values (SMD, -0.735; 95% CI, -0.951 to -0.519). [Conclusion] ESWT has a significant effect on improving spasticity. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed.
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Affiliation(s)
- Jin-Youn Lee
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Soo-Nyung Kim
- Department of Obstetrics and Gynecology, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - In-Sik Lee
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Heeyoune Jung
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Kyeong-Soo Lee
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicinek, Konkuk University Medical Center and Konkuk University School of Medicine, Konkuk University, Republic of Korea
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Effect of radial shock wave therapy on pain and muscle hypertonia: a double-blind study in patients with multiple sclerosis. Mult Scler 2014; 21:622-9. [DOI: 10.1177/1352458514549566] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Radial shock wave therapy (RSWT) has been extensively used in rehabilitative medicine to treat pain, and more recently muscle hypertonia, in patients with cerebral palsy and stroke. Objectives: To assess the long-term effects of RSWT in a cohort of subjects affected by multiple sclerosis (MS) who were suffering from painful hypertonia of ankle extensor muscles. Methods: In this randomised, double blind, placebo-controlled study, we treated 34 patients with four sessions of RSWT (once weekly) and treated 34 patients with placebo. Participants were assessed at baseline, 1 week after the first session, and 1 week and 4 weeks after the last session. We measured pain using the visual analogue scale for pain, while we assessed muscle tone using the modified Ashworth scale and evaluated spinal excitability using the H-reflex. Results: After RSWT, muscle tone decreased 1 week after the last session and pain decreased at all the follow-up evaluations, while spinal excitability was unaffected. No significant changes were found after the placebo treatment. Conclusions: RSWT can reduce pain and muscle tone in MS patients without adverse effects. The lack of RSWT effects on spinal excitability supports the idea that RSWT is likely to act on non-reflex hypertonia, for example reducing muscle fibrosis.
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Shock waves in the treatment of muscle hypertonia and dystonia. BIOMED RESEARCH INTERNATIONAL 2014; 2014:637450. [PMID: 25309915 PMCID: PMC4182298 DOI: 10.1155/2014/637450] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/30/2014] [Accepted: 08/14/2014] [Indexed: 12/28/2022]
Abstract
Since 1997, focused shock waves therapy (FSWT) has been reported to be useful in the treatment of muscle hypertonia and dystonia. More recently, also radial shock wave therapy (RSWT) has been successfully used to treat muscle hypertonia. The studies where FSWT and RSWT have been used to treat muscle hypertonia and dystonia are reviewed in this paper. The more consistent and long lasting results were obtained in the lower limb muscles of patients affected by cerebral palsy with both FSWT and RSWT and in the distal upper limb muscles of adult stroke patients using FSWT. The most probable mechanism of action is a direct effect of shock waves on muscle fibrosis and other nonreflex components of muscle hypertonia. However, we believe that up to now the biological effects of shock waves on muscle hypertonia and dystonia cannot be clearly separated from a placebo effect.
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