The Effects of Extracorporeal Shock Wave Therapy on Spastic Muscle of the Wrist Joint in Stroke Survivors: Evidence From Neuromechanical Analysis

Yan Leng, Wai Leung Ambrose Lo, Chengpeng Hu, Ruihao Bian, Zhiqin Xu, Xiyao Shan, Dongfeng Huang, Le Li, Yan Leng, Wai Leung Ambrose Lo, Chengpeng Hu, Ruihao Bian, Zhiqin Xu, Xiyao Shan, Dongfeng Huang, Le Li

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.

Keywords: extracorporeal shock ware therapy; muscle mechanical properties; neurorehabilitation; spasticity; stroke; upper extremities.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Leng, Lo, Hu, Bian, Xu, Shan, Huang and Li.

Figures

Figure 1
Figure 1
CONSORT flow diagram.
Figure 2
Figure 2
The apparatus for measurement and therapy adopted in the study. (A) NeuroFlexor; (B) Myotonometer; (C) Electrical impedance myography; (D) Extracorporeal shock wave therapy.
Figure 3
Figure 3
The comparisons of bilateral parameters for each measuring techniques. (A) NF components of wrist flexors (n = 27). (B) Parameter of flexor carpi radialis measured by Myotonometer (n = 27). (C) Parameter of flexor carpi radialis measured by EIM (n = 27). NF, NeuroFlexor; NC, Neural Component; EC, Elasticity Component; VC, Viscosity Component; S, Stiffness; F, Frequency; EIM, Electrical impedance myography; X, Reactance; R, Resistance. *P < 0.05; ** P < 0.001.
Figure 4
Figure 4
Correlation analyses between outcome measures. (A) Correlation between MAS and NC (n = 27). (B) Correlation between MAS and S (n = 27). (C) Correlation between MAS and muscle tone (n = 27). (D) Correlation between EC and F (n = 27). (E) Correlation between NC and X (n = 27). (F) Correlation between VC and phase angle θ (n = 27). NF, NeuroFlexor; NC, Neural Component; EC, Elasticity Component; VC, Viscosity Component; S, Stiffness; F, Frequency; EIM, Electrical impedance myography; X, Reactance; R, Resistance.
Figure 5
Figure 5
The typical resistant force trend curve in each measurement situation recorded by Neuroflexor in one stroke patient. Red trace represents the angle of wrist movement (from flexion to extension). Black dashed trace represents resistant force of paretic side, Blue trace represents resistant force of non-paretic side, pink trace represents resistant force immediately after ESW intervention of paretic side and green trace represents resistant force at 1 week later of paretic side.
Figure 6
Figure 6
Comparisons of each outcome measures before and after extracorporeal shock wave therapy. (A) MAS assessment. (B) Fugl-Meyer assessment. (C) Muscle stiffness measured by Myotonometer. (D) Muscle tone measured by Myotonometer. (E) VC measured by NF. (F) X measured by EIM. NF, NeuroFlexor; NC, Neural Component; EC, Elasticity Component; VC, Viscosity Component; S, Stiffness; F, Frequency; EIM, Electrical impedance myography; X, Reactance; R, Resistance. *P < 0.05; **P < 0.001.

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