Title : Spasticity management and the use of radial shock waves in post-stroke patients
Abstract:
Aims: Recent studies predict that the number of people diagnosed with stroke in the European Union will rise by 27% by 2047, driven by an aging population and improved survival rates. One of the most common complications following stroke is upper limb spasticity. As spasticity progresses, patients face challenges such as reduced joint mobility, stiffness, contractures, and pain, which significantly impair daily functioning and increase the burden on families and healthcare providers. Although various treatments exist, such as physical therapy, exercise therapy, pharmacological interventions, and surgical procedures, heir effectiveness remains limited and often associated with adverse effects. This study aims to assess the efficacy of radial shock wave therapy in improving upper limb motor function, reducing muscle tone, and alleviating pain in patients with post-stroke upper limb spasticity.
Material and Methods: This study examined 62 stroke patients with spasticity (MAS ≥ 2) who completed the entire treatment regimen. The patients were randomized in a 1:1 ratio into two groups: a control group and a study group. Hospitalization, during which the patients received radial shock wave therapy (rESWT), lasted six weeks. Treatment included kinesiotherapy, physical therapy, one-on-one sessions with a physical therapist, occupational therapy, psychological care, speech therapy, and medical care. Patients in the study group received an additional four rESWT treatments at weekly intervals. The results were measured using the FMA-UE, VAS, ADL, and MAS scales. Assessments were performed before the first rESWT treatment, immediately after the first treatment, and six days after the fourth treatment.
Results: In the study group, changes were observed in all analyzed parameters: FMA-UE (p<.0001), VAS (p<.0116), MAS (p<.0001), and ADL (p<.0001) at intervals.
- In the study group, an increase in FMA-UE and ADL values was noted already in the first week after the procedure compared to the baseline level, and after 5 weeks these parameters showed further statistically significant improvement compared to the results obtained one week after the intervention.
- In the case of MAS, a decrease in values was observed one week after the procedure compared to the pre-procedure status, while after 5 weeks this decrease was significantly greater than after the first week.
- The VAS FU and VAS for the wrist did not show significant changes in the first week after the procedure, but after 5 weeks a significant decrease was noted compared to the baseline values (VAS FU: p=0.0200/VAS wrist: p=0.0268).
Conclusion: The combination of intensive neurorehabilitation with rESWT in stroke patients with MAS ≥ 2 muscle spasticity may be effective in reducing forearm flexor muscle spasticity, improving hand function, and increasing functional independence. Improvements in upper limb motor function and reductions in muscle tone occur independently of changes in pain perception among patients.
