#032 – Extracorporeal Shock Waves Therapy for Spasticity

Estimated reading time: 2 minutes, 3 seconds.

Extracorporeal Shock Waves Therapy (ESWT) effectively reduces muscle tone in people with spastic limb after stroke

Overview of 20 Years of Experiences (narrative review). (Open Access)

Summarize over 20 years of scientific accomplishments and practical experiences in ESWT for spasticity.

22 studies including 468 post-stroke adults, 11 reports with the upper limb (267 patients) and 10 reports within the lower limb (201 patients), and 1 report on bother upper and lower limbs.

ESWT for upper limb spasticity

The mean number of ESWT session performed for UL muscles was 3.73 including 2227 pulses delivered with frequency of 6.78 Hz, pressure of 1.91 bars and EFD of 0.09 mJ/mm^2.
6 Studies used radial shock wave therapy (rSWT) and 6 studies used focused shock wave therapy (fSWT)
All 12 articles showed that ESWT reduces spasticity when compared to sham SWT, electrical stimulation or BTX-A.
The longest follow-up time was 6 months.
One study found that ESWT is a non-inferior treatment alternative to BTX-A for wrist and elbow flexors spasticity, and EWST is better for PROM and UL-FMA scores.
Mean PEDro score was 5.79 indicating the level B of recommendation accordingly with the NICE guidelines.

ESWT for lower limb spasticity

The mean number of ESWT sessions performed for LL muscles was 2.00 including 1750 pulses delivered with frequency of 4.56 Hz, pressure of 1.77 bars and EFD of 0.011 mJ/mm2.
9 Studies used fSWT, 2 studies used rSWT and 1 study did not specify.
10/11 studies found ESWT can reduce spasticity, compared to sham, fSWT-rSWT or ultrasound.
The longest follow-up time was 6 months.
PEDro score was 4.73 indicating the level C of recommendation accordingly with the NICE guidelines.

ESWT effectively reduces muscle tone in people with spastic limb after stroke.
ESWT procedures are safe and free of undesirable side effects.
The mechanism of action of ESWT on muscles affected by spasticity is still unknown.
No standard parameters of ESWT in post-stroke spasticity regarding intensity, frequency, location, and a number of sessions have been established.

Note

The short follow-up time is always the problem with spasticity research, also, we need higher quality research for spasticity.

An RCT found that positive psychology exercises represent a potential effective complementary treatment that result in benefits on pain which can be readily implemented into daily living. (Restricted Access)
No strong evidence is available for wearing an arm sling on balance and gait for stroke patients according to this systematic review. (Open Access)
Perturbation-based balance training did not prove advantageous for performance on a measure of reactive stepping ability for patients with incomplete spinal cord injury or disease according to this RCT. (Open Access)