Effective Site for the Application of Extracorporeal Shock-Wave Therapy on Spasticity in Chronic Stroke: Muscle Belly or Myotendinous Junction

Sang Ho Yoon, Min Kyung Shin, Eun Jung Choi, Hyo Jung Kang, Sang Ho Yoon, Min Kyung Shin, Eun Jung Choi, Hyo Jung Kang

Abstract

Objective: To compare the effect of extracorporeal shock-wave therapy (ESWT) applied at the muscle belly and myotendinous junction on spasticity in the upper and lower limbs of chronic stroke patients.

Methods: Of the 151 patients, a total of 80 patients with stroke-induced spasticity on the elbow flexor and 44 patients on the knee flexor were enrolled for a prospective, randomized clinical trial. The patients were divided into control, muscle belly, and myotendinous junction groups, and a total of three ESWT sessions (0.068-0.093 mJ/mm2, 1,500 shots) were conducted at one per week. A Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS) were collected at the baseline and at 1 week after each session.

Results: After interventions, the MAS and MTS of both the belly and the junction groups showed positive effects from the ESWT on spasticity in the elbow and knee flexors, but the control group did not. The results also tended to improve after each session until the entire intervention was completed. However, there was no significant difference between the belly and junction groups.

Conclusion: ESWT could be effective for treating chronic spasticity after stroke when applied to muscle belly or myotendinous junction.

Keywords: High-energy shock waves; Muscle spasticity; Stroke.

Conflict of interest statement

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. Flowchart of the study participants.…
Fig. 1. Flowchart of the study participants. Control group, no extracorporeal shock wave therapy (ESWT) application; belly group, ESWT applied at the muscle belly; junction group, ESWT applied at the myotendinous junction.
Fig. 2. Effects of ESWT in the…
Fig. 2. Effects of ESWT in the elbow flexor and knee flexor. (A, B) MAS and MTS in the elbow flexor group, (C, D) MAS and MTS in the knee flexor group. *p<0.05, compared to the control group using an independent t-test or Mann-Whitney U-test. a)p<0.05, compared to the baseline values using repeated-measures analysis of variance or Wilcoxon signed-rank test with Bonferroni correction within each group. b)p<0.05, compared to the value after session 1 using repeated-measures analysis of variance or Wilcoxon signed-rank test with Bonferroni correction within each group. ESWT, extracorporeal shock wave therapy; MAS, Modified Ashworth Scale; MTS, Modified Tradieu Scale.

References

    1. Lance JW. The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture. Neurology. 1980;30:1303–1313.
    1. Li S, Francisco GE. New insights into the pathophysiology of post-stroke spasticity. Front Hum Neurosci. 2015;9:192.
    1. Sunnerhagen KS, Francisco GE. Enhancing patient-provider communication for long-term post-stroke spasticity management. Acta Neurol Scand. 2013;128:305–310.
    1. Wissel J, Verrier M, Simpson DM, Charles D, Guinto P, Papapetropoulos S, et al. Post-stroke spasticity: predictors of early development and considerations for therapeutic intervention. PM R. 2015;7:60–67.
    1. Demetrios M, Gorelik A, Louie J, Brand C, Baguley IJ, Khan F. Outcomes of ambulatory rehabilitation programmes following botulinum toxin for spasticity in adults with stroke. J Rehabil Med. 2014;46:730–737.
    1. Santamato A, Micello MF, Ranieri M, Valeno G, Albano A, Baricich A, et al. Employment of higher doses of botulinum toxin type A to reduce spasticity after stroke. J Neurol Sci. 2015;350:1–6.
    1. Dymarek R, Ptaszkowski K, Słupska L, Halski T, Taradaj J, Rosinczuk J. Effects of extracorporeal shock wave on upper and lower limb spasticity in post-stroke patients: a narrative review. Top Stroke Rehabil. 2016;23:293–303.
    1. Romeo P, Lavanga V, Pagani D, Sansone V. Extracorporeal shock wave therapy in musculoskeletal disorders: a review. Med Princ Pract. 2014;23:7–13.
    1. Zelle BA, Gollwitzer H, Zlowodzki M, Buhren V. Extracorporeal shock wave therapy: current evidence. J Orthop Trauma. 2010;24(Suppl 1):S66–S70.
    1. Lee JY, Kim SN, Lee IS, Jung H, Lee KS, Koh SE. Effects of extracorporeal shock wave therapy on spasticity in patients after brain injury: a meta-analysis. J Phys Ther Sci. 2014;26:1641–1647.
    1. Kenmoku T, Ochiai N, Ohtori S, Saisu T, Sasho T, Nakagawa K, et al. Degeneration and recovery of the neuromuscular junction after application of extracorporeal shock wave therapy. J Orthop Res. 2012;30:1660–1665.
    1. Bae H, Lee JM, Lee KH. The effects of extracorporeal shock wave therapy on spasticity in chronic stroke patients. J Korean Acad Rehabil Med. 2010;34:663–669.
    1. Kaya T, Karatepe AG, Gunaydin R, Koc A, Altundal Ercan U. Inter-rater reliability of the Modified Ashworth Scale and modified Modified Ashworth Scale in assessing poststroke elbow flexor spasticity. Int J Rehabil Res. 2011;34:59–64.
    1. Abolhasani H, Ansari NN, Naghdi S, Mansouri K, Ghotbi N, Hasson S. Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study. BMJ Open. 2012;2
    1. Boyd RN, Morris ME, Graham HK. Management of upper limb dysfunction in children with cerebral palsy: a systematic review. Eur J Neurol. 2001;8(Suppl 5):150–166.
    1. Yoo SD, Kim HS, Jung PK. The effect of shock wave therapy on upper limb spasticityin the patients with stroke. J Korean Acad Rehabil Med. 2008;32:406–410.
    1. Sohn MK, Cho KH, Kim YJ, Hwang SL. Spasticity and electrophysiologic changes after extracorporeal shock wave therapy on gastrocnemius. Ann Rehabil Med. 2011;35:599–604.
    1. Moon SW, Kim JH, Jung MJ, Son S, Lee JH, Shin H, et al. The effect of extracorporeal shock wave therapy on lower limb spasticity in subacute stroke patients. Ann Rehabil Med. 2013;37:461–470.
    1. Mariotto S, Cavalieri E, Amelio E, Ciampa AR, de Prati AC, Marlinghaus E, et al. Extracorporeal shock waves: from lithotripsy to anti-inflammatory action by NO production. Nitric Oxide. 2005;12:89–96.
    1. Mariotto S, de Prati AC, Cavalieri E, Amelio E, Marlinghaus E, Suzuki H. Extracorporeal shock wave therapy in inflammatory diseases: molecular mechanism that triggers anti-inflammatory action. Curr Med Chem. 2009;16:2366–2372.
    1. Sharma JN, Al-Omran A, Parvathy SS. Role of nitric oxide in inflammatory diseases. Inflammopharmacology. 2007;15:252–259.
    1. Manganotti P, Amelio E. Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke. Stroke. 2005;36:1967–1971.
    1. Whitehead CL, Hillman SJ, Richardson AM, Hazlewood ME, Robb JE. The effect of simulated hamstring shortening on gait in normal subjects. Gait Posture. 2007;26:90–96.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever