Shockwave therapy for spasticity in cerebral palsy

NewsBot · Apr 2, 2010

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Effect of shock wave stimulation on hypertonic plantar flexor muscles in patients with cerebral palsy: A placebo-controlled study.
Amelio E, Manganotti P.
J Rehabil Med. 2010 Feb 24. doi: 10.2340/16501977-0522. [Epub ahead of print]

Background: Extracorporeal shock wave therapy has been reported to be effective in reducing muscle hypertonia in adults.

Aim: To evaluate the effect of shock wave treatment of spastic muscles in children with cerebral palsy.

Methods: Twelve children with spastic equinus foot (6 boys, 6 girls; mean age 8 years (standard deviation (SD) 2.31)) were monitored. Clinical (Ashworth Scale, passive range of motion) and instrumental (pedobarography) examination were performed. This is an open study with one placebo treatment session, followed 6 weeks later by one active shock wave treatment session. Gastrocnemius muscles and soleus muscles were treated.

Results: After placebo stimulation no clinical or instrumental effect was seen. After a single active shock wave stimulation a significant decrease in the Ashworth Scale (from 3 to 2), an increase in the range of motion (from 20 degrees to 50 degrees), and an increase in the whole plantar surface area of the treated limb (from 40.3 to 80.2 cm2) were observed in all patients. This effect lasted for 4 weeks in all patients.

Conclusions: A single active shock wave stimulation produced a significant long-lasting reduction in hypertonia in the plantar flexors in children with cerebral palsy.
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Admin2 · Apr 3, 2010

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NewsBot · Aug 21, 2014

This clinical trial was just registered:
The Effect of Extracorporeal Shock Wave Therapy on Spasticity

The effect of traditional treatment for spasticity is barely satisfactory. The shock wave has been used to treat the spasticity with expressively response and the effect could persist for 1-3 months in different studies. However most sutdies lack the sham or control group. The purpose of this study was to assess the effect of shock wave for spasticity in wrist and hand
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NewsBot · Jan 24, 2016

Therapeutic Effect of Extracorporeal Shock Wave Therapy According to Treatment Session on Gastrocnemius Muscle Spasticity in Children With Spastic Cerebral Palsy: A Pilot Study
Dong-Soon Park et al
Ann Rehabil Med. 2015 Dec;39(6):914-921

Objective
To investigate the therapeutic effect of extracorporeal shockwave therapy (ESWT) according to treatment session on gastrocnemius muscle spasticity in children with spastic cerebral palsy (CP).

Methods
Twelve children with spastic CP underwent 1 ESWT and 2 sham ESWT sessions for gastrocnemius (group 1) or 3 ESWT sessions (group 2) once per week for 3 weeks. Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle plantar-flexor muscles with knee extension, and median red pixel intensity (RPI) of color histogram of medial gastrocnemius on real-time sonoelastography (RTS) were measured before ESWT, immediately after the first and third ESWT, and at 4 weeks after the third ESWT.

Results
Mean ankle PROM was significantly increased whereas as mean ankle MAS and median gastrocnemius RPI were significantly decreased in both groups after the first ESWT. Clinical and RTS parameters before ESWT were not significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 1. However, they were significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 2. Mean ankle PROM, mean ankle MAS, and median gastrocnemius RPI in group 2 were significantly different from that in group 1 at 4 weeks or immediately after the third ESWT.

Conclusion
The therapeutic effect of ESWT on spastic medial gastrocnemius in children with spastic CP is dependent on the number of ESWT sessions.
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NewsBot · Oct 18, 2019

Effect of extracorporeal shock wave therapy on muscle spasticity in patients with cerebral palsy: meta-analysis and systematic review.
Kim HJ et al
Eur J PhysRehabil Med. 2019 Oct 15

INTRODUCTION:
Recently, clinical trials have been performed to evaluate the efficacy of extracorporeal shock wave therapy (ESWT) in patients with cerebral palsy (CP). However, various studies adopted different clinical scales, making it insufficient to draw a definite conclusion about the efficacy of ESWT in reducing spasticity after cerebral palsy. The purpose of this meta-analysis was to assess the effects of ESWT on reducing spasticity after applying ESWT in patients with CP.

EVIDENCE ACQUISITION:
In accordance with the PRISMA statement, authors searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials and Scopus from their inception dates through December 11th 2018. We included randomised controlled trials in any language that using ESWT for the purpose of ameliorating spasticity in patients with CP. We assessed spasticity measured by modified Ashworth Scale (MAS), range of motion (ROM) and baropodometric values as outcomes.

EVIDENCE SYNTHESIS:
Two authors independently extracted and verified data. Meta- analysis was completed where possible, otherwise data were synthesised narratively. From a total of 206 articles, 16 manuscripts were selected and 5 of them were ultimately included in this meta-analysis.

CONCLUSIONS:
MAS grade as primary outcome was significantly improved after ESWT compared to that in the control group (mean difference [MD]: -0.62; 95% confidence interval [CI]: -1.52 to -0.18). ROM after ESWT was also significantly improved compared to that in the control groups (MD: 18.01; 95% CI: 6.11 to 29.91). Baropodometric measures showed significantly increases in foot contact area during gait (SMD: 29.00; 95% CI: 11.08 to 46.92), but not significantly in peak pressure under the heel (MD: 15.12; 95% CI: -1.85 to 32.10)immediately after ESWT. No serious side effects were observed in any patient after ESWT. ESWT may be a valid alternative to existing treatment options targeting spasticity diminishment and ROM improvement in CP patients to maintain healthy lifestyles and normalize spastic gait pattern. Further standardization of treatment protocols including treatment intervals and intensities needs to be established and long-term follow up studies are needed to verify our results.
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NewsBot · Sep 5, 2022

Effect of extracorporeal shock wave therapy on spastic equinus foot in children with unilateral cerebral palsy
Hatem A Emara et al
J Taibah Univ Med Sci. 2022 Feb 26;17(5):794-804

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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