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Torque threshold angle (TTA) of ankle plantar flexor before extracorporeal shock wave therapy (ESWT) and after sham stimulation, and at immediately 1 week and 4 weeks after ESWT. *Statistically significant compared with baseline (p<0.05).
Source publication
To evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in subacute stroke patients.
We studied thirty hemiplegic subacute stroke patients with ankle plantar flexor spasticity. ESWT was applied for 1 session/week, with a total of 3 sessions at the musculotendinous junction of medial and lateral gastrocnemius musc...
Context in source publication
Context 1
... after the sham stimulation, immediately after the treatment, one week after the treatment, and four weeks after the sec, the p-values were 0.008, 0.020, and 0.001, respectively. At one week and four weeks after the treat- ment, although the values increased compared to the basal evaluation, the differences were not statistically sig- nificant (Fig. ...Similar publications
Almost 1 million Americans are affected by plantar fasciitis (PF), which is the commonest cause of chronic heel pain. This condition is often managed conservatively, and many rehabilitation protocols, some with the aid of orthoses, have been adopted, with good-to-excellent clinical results. Although most cases of chronic PF can be successfully mana...
Citations
... Conversely, radial shock wave devices concentrate their maximum energy at the probe tip and distribute it radially into the tissue. Recent studies have suggested that both focused and radial shock wave therapies are effective in reducing spasticity in stroke patients [43][44][45][46]. In our study, focused ESWT was used. ...
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.
... Only one study, that by Guo et al. (2019), gathered a study group of more than 100 patients, more precisely, 120 patients [53]. The large majority of studies involved a smaller number of patients; the number ranged from 20 to 60 patients [29,32,34,[80][81][82][83]85,88,[90][91][92]. For oursystematic review, we also qualified a case study conducted on one patient [89]. ...
... To check upper-limb recovery, the researchers mainly used the Fugl-Meyer Assessment for Upper Extremity (FMA-UE) [29,34,53,85,88,91,92] and in some individual cases, the Action Research Arm Test (ARAT) was used [88]. Muscle tension and spasticity status weretested using the Modified Ashworth Scale (MAS), Ashworth Scale (AS), Tardieu Scale, and Modified Tardieu Scale (MTS) [29,32,34,53,[80][81][82][83][84][85][87][88][89][90]92]. Yuan et al. (2023) did not check their patients' muscle tension status using the above scales [91]. ...
... The shockwave pressure parameters used ranged from 1.2 to 2.5 Ba [34,84], a frequency of 4-18 Hz, and energy pulses of 0.03-0.93 mJ/mm 2 [29,32,81,82,84]. None of the authors, except for Savevska et al. (2016), specified the parameters required for shockwave treatment. ...
Stroke is a severe injury of the central nervous system (CNS) and one of the leading causes of long-term disability and mortality. One of the main symptoms of neurological diseases is spasticity. This is defined as a motor condition characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks and resulting in the hyperexcitability of the stretch reflex. Rehabilitation after a stroke is focused on relearning lost skills and regaining independence. Many new methods in neurorehabilitation have been introduced. This review concentrates on the current evidence for extracorporeal shockwave therapy (ESWT) as a noninvasive alternative to treat spasticity. We present the effect of EWST and radial EWST interventions to post-stroke patients with spasticity in the upper limb. Our collected data suggest that different parameters of shockwaves can be used to achieve functional improvementsin the upper limb after a stroke. Our accumulated data imply that ESWT is safe and can be used for pain relief, reduced muscle tension, and an increased range of motion. According to many studies, complications after shockwave treatment are infrequent. Transient complications after shockwave therapy (ESWT) include redness, tingling, pain, and bruising. We reviewed clinical trials that present the possible benefits in upper-limb function after shockwave therapy for post-stroke patients. In this article, we used many database search engines, including PEDro. In the stroke rehabilitation literature, a key methodological problem is the design of double-blind studies, which very often are not feasible.
... by aetiology of spasticity (children [<18 years] with CP and adults [>18 years] with chronic stroke) for the effectiveness of ESWT; Table S3: Meta-regression models according to mean age, percentage of women, treatment duration, frequency (Hz), energy (mJ/mm 2 ), and impact (shots/muscle) for the effectiveness of ESWT; Figure S1: Quality assessment of the included studies using the Cochrane Collaboration's tool for assessing risk of bias (RoB2); Figure S2: Quality assessment using the Cochrane Collaboration's tool for assessing risk of bias (RoB2); Figure S3: Funnel plot for lower limbs; and Figure S4: Funnel plot for upper limbs. References [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] are cited in Supplementary Materials. ...
... The studies included in this systematic review were published between 2005 and 2022. All included studies were RCTs [24][25][26][27][28][29][30][31][32][33][34][35][36][37], except for two, which were CCTs [37,38]. Study participants (704) were both children and adults (aged between 26.9 ± 13.1 months and 66.9 ± 4.9 years) with spasticity caused by different aetiologies, such as CP [23,24,28,31,39], chronic stroke [26,27,29,30,[32][33][34][35][36]38], or multiple sclerosis [37]. ...
... The minimum frequency was 4 Hz, the The studies included in this systematic review were published between 2005 and 2022. All included studies were RCTs [24][25][26][27][28][29][30][31][32][33][34][35][36][37], except for two, which were CCTs [37,38]. Study participants (704) were both children and adults (aged between 26.9 ± 13.1 months and 66.9 ± 4.9 years) with spasticity caused by different aetiologies, such as CP [23,24,28,31,39], chronic stroke [26,27,29,30,[32][33][34][35][36]38], or multiple sclerosis [37]. ...
Background: Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies. Methods: A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale. Results: Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment. Conclusions: These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults.
... extracorporeal shock wave therapy (esWt) is a sequence of single sonic pulses characterized by high peak pressure (100 MPa), fast pressure rises less than10 ns and short duration about 10 μs. it was previously used to treat renal stones and different musculoskeletal problems [6][7][8][9][10]. eventually it was considered a treatment for spasticity [11]. the mechanisms of action of esWt is still unknown but studies suggest that esWt, besides its mechanical effect, enhances biologic responses including the expression of angiogenesis-related growth factors such as endothelial nitric oxide synthase [12], vessel endothelial growth factor, and proliferating cell nuclear antigen. ...
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.
... All the studies included patients with muscle spasticity > 1+ and excluded patients with contractures and taking any surgical or active pharmacological management for spasticity. Seven studies [18,24,28,29,33,36,37] used the radial and six studies [4,25,30,31,34,35] used focused ESWT, while one did not mention any type of ESWT [27] and one study used both radial and focused types of ESWT [26]. As far as the site of application of ESWT is concerned in five studies ESWT was applied at the myotendinous junction [4,[24][25][26]28,30,31], seven studies applied ESWT at the muscle belly [4,18,26,29,30,33,34], one study applied at both at the myotendinous junction and muscle belly [27] and two studies did not report the site of therapy [35,37]. ...
... Seven studies [18,24,28,29,33,36,37] used the radial and six studies [4,25,30,31,34,35] used focused ESWT, while one did not mention any type of ESWT [27] and one study used both radial and focused types of ESWT [26]. As far as the site of application of ESWT is concerned in five studies ESWT was applied at the myotendinous junction [4,[24][25][26]28,30,31], seven studies applied ESWT at the muscle belly [4,18,26,29,30,33,34], one study applied at both at the myotendinous junction and muscle belly [27] and two studies did not report the site of therapy [35,37]. According to the parameters of ESWT, frequency range used was between 2-10 HZ, but most of the studies used 4-5 Hz. ...
... Range of motion was measured by either digital or manual goniometer in nine studies [24][25][26][28][29][30][31]33,34], other studies measured peak torque and torque threshold by a dynamometer. Three studies assessed lower limb motor function. ...
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.
... 84,85 Other mechanisms proposed include the reduction of motor neuron excitability, specifically reducing alpha motor neuron hyperexcitability. 86 ...
This article explores phenol neurolysis, cryoneurolysis and extracorporeal shock wave as treatments for spasticity.
... Treatment significantly improves the verbal numeric pain scale, neck disability index and range of motion [54]. Moon et al. [55] conducted a study using fESWT in patients with subacute stroke, including ankle plantar flexor spasticity. Treatment was applied once a week for three weeks, at the musculotendinous junction of the medial and lateral gastrocnemius muscles. ...
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.
... In recent years, mounting evidence that demonstrates ESWT is a secure and efficient alternative for reducing muscle spasticity has been collected [16,17]. Although the mechanism behind the effects of ESWT in spasticity remains uncertain, pertinent studies have suggested the following possibilities: inducing NO production [18,19], reducing motor neuron excitability [20], dysfunction in neuromuscular transmission [21], affecting rheological properties, and appearing fibrosis of chronic hypertonic muscles [22]. ...
Background
This study intended to analyze the application of extracorporeal shock wave therapy in medicine and to evaluate the quality of related literature.
Methods
All publications were extracted from 2000 to 2021 from the Web of Science Core Collection (WoSCC). The literature characteristics were depicted by VOSviewer (version 1.6.15) and the online bibliometric website (http://bibliometric.com/). The future trends and hotspots were conducted by Bibliographic Item Co-occurrence Matrix Builder (version 2.0) and gCLUTO software.
Results
We analyzed 1774 articles corresponding to the criteria for ESWT publications from 2000 to 2021. Most studies were conducted within the United States and China which besides have the most cooperation. The most published research institutions are Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, and Kaohsiung Medical University. Six research hotspots were identified by keyword clustering analysis: Cluster0: The effects of ESWT on muscle spasticity; Cluster1: The application of ESWT in osteoarthritis (OA); Cluster2: Therapeutic effect of ESWT on tendon diseases; Cluster3: Early application of ESWT/ESWL in urolithiasis; Cluster4: The Role of angiogenesis in ESWT and the efficiency of ESWT for penile disease; Cluster5: The Special value of radial extracorporeal shock wave therapy (rESWT).
Conclusions
A comprehensive and systematic bibliometric analysis of ESWT was conducted in our study. We identified six ESWT-related research hotspots and predicted future research trends. With the gradual increase of research on ESWT, we find that ESWT is used more and more extensively, such in musculoskeletal disease, bone delay union, neurological injury, andrology disorders, lymphedema, and so on. In addition, the mechanism is not destructive damage, as initially thought, but a restorative treatment. Furthermore, delayed union, cellulite, burn, and diabetic foot ulcers may be the future direction of scientific study.
... At present, there is no uniform standard for the therapeutic parameters of ESWT treatment for spasticity, including the intensity, frequency, number of pulse, duration of session, which needs more in-depth clinical research. 87) shows that ESWT has longterm clinical efficacy in relieving lower limb spasticity, reducing pain intensity and increasing range of activity in stroke patients, but Bae et al. found that EWST has immediate efficacy (88). It may be that the inclusion criteria of Bae et al. include patients with mild spasticity, which is not enough to achieve lasting effects. ...
Spasticity is one of the most common complications after stroke. With the gradual intensification of spasticity, stroke patients will have a series of problems such as joint ankylosis and movement restriction, which affect the daily activities and increase the burden on patients' families, medical staff and society. There are many ways to treat post-stroke spasticity before, including physical therapy and exercise therapy, drug therapy, surgery and so on, but not satisfied because of a few shortcomings. In recent years, many researchers have applied extracorporeal shock wave therapy (ESWT) for the treatment of post-stroke spasm and achieved good clinical effect, because it is non-invasive, safe, easy to operate, low cost and other advantages compared with other treatment methods. This article reviews the research progress and existing problems of ESWT in the treatment of post-stroke spasticity.
... Although the mechanism behind the effects of ESWT in spasticity remains uncertain, pertinent studies have suggested the following possibilities: inducing NO production(17, 18), reducing motor neuron excitability (19), dysfunction in neuromuscular transmission (20), affecting rheological properties, and appearing brosis of chronic hypertonic muscles (21). ...
Background: This study intended to analyze the application of extracorporeal shock wave therapy in medicine and to evaluate the quality of related literature.
Methods: All publications were extracted from 2000 to 2021 from the Web of Science Core Collection (WoSCC). The literature characteristics were depicted by VOSviewer (version 1.6.15) and the online bibliometric website (http://bibliometric.com/). The future trends and hotspots were conducted by Bibliographic Item Co-occurrence Matrix Builder (version 2.0) and gCLUTO software.
Results: We analyzed 1774 articles corresponding to the criteria for ESWT publications from 2000 to 2021. Most studies were conducted within the United States and China which besides have the most cooperation. The most published research institutions are Chang Gung University, Kaohsiung Chang Gung Memorial Hospital, and Kaohsiung Medical University. JOURNAL OF ORTHOPAEDIC RESEARCH, AMERICAN JOURNAL OF SPORTS MEDICINE, and JOURNAL OF SURGICAL RESEARCH are the top three most-cited journals. The keyword cluster analysis divides the 30 keywords with the highest frequency into 6 clusters.
Conclusions: With the gradual increase of research on ESWT, we find that ESWT is used more and more extensively, such in musculoskeletal disease, bone delay union, neurological injury, andrology disorders, lymphedema, and so on. In addition, the mechanism is not destructive damage, as initially thought, but a restorative treatment. Furthermore, delayed union, cellulite, burn, and diabetic foot ulcers may be the future direction of scientific study.
