Treatment of Spasticity in Patients with Brain Damage with the Association of Focused Shock Waves and Botulinum Toxin

Abstract  | Volume 2 | Issue 2 | JRS Jul – Dec 2022 | Page 26 | Antonio Déniz Cáceres, Pedro Saavedra Santana, María Isabel Marrero Arencibia, Jaime Hernández Alemán ,Almudena Hernández
DOI: 10.13107/jrs.2022.v02.i02.65

Author: Antonio Déniz Cáceres [1], Pedro Saavedra Santana [2], María Isabel Marrero  Arencibia [3], Jaime Hernández Alemán [4], Almudena Hernández [4]

[1] Rehabilitation Service, Hospital Universitario de Gran Canaria Dr. Negrín, Spain.

[2] Department of Mathematics, Universidad de Las Palmas de Gran Canaria, Spain.

[3] Department of Biochemestry and Molecular Biology, Universidad de Las Palmas de Gran Canaria, Spain.

[4] Universidad de Las Palmas de Gran Canaria, Spain.

Address of Correspondence
Dr. Antonio Déniz Cáceres, MD, PhD,
Rehabilitation Service, Hospital Universitario de Gran Canaria Dr. Negrín, Spain.


Introduction: Spasticity is a common complication in patients with brain damage secondary to stroke and multiple sclerosis, generating
disability and reducing the quality of life. In cases of muscles spasticity, we usually use Botulinum toxin injections (BTI) associated with
physiotherapy. Extracorporeal shock wave therapy (ESWT) is a safe, effective, and non-invasive treatment in these patients. Both methods are highly effective but currently are applied separately. Scientific evidence of the combined use of both techniques is scarce. The aim of this study is to assess the results of the association of both treatments (ESWT and BTI). On spasticity in patients secondary to stroke or multiple sclerosis.
Materials and Methods: This is a prospective study, with 6-month follow-up, including 10 adult patients with stroke or multiple sclerosis. ESWT was added to the usual treatment with BTI weekly for 3 weeks. The patients received rehabilitation during the treatment period and during the follow-up period. For statistical analysis in each of the follow-up weeks, the markers analyzed (spasticity and gait speed) were summarized in medians, which were plotted as a weekly function and the paired data were compared with the Wilcoxon test. The data were analyzed with an statistical program version 3.6.1 (R Development Core Team, 2019).
Results and Conclusions: We observed a statistically significant improvement in spasticity that was correlated with an increase in walking speed. The effectiveness of the combined treatment was superior and lasted longer than BTI alone.
Keywords: Shockwaves, Spasticity, Brain damage, Botulinum Toxin


How to Cite this article: Deniz A, Saavedra P, Marrero I, Hernández J, Hernández A | Treatment of Spasticity in Patients with Brain Damage with the Association of Focused Shock Waves and Botulinum Toxin. | Journal of Regenerative Science | Jul – Dec 2022; 2(2): 26.

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Very Low and Low-energetic Extracorporeal Shock Wave Treatment of Spasticity in Children and Adults – A Systematic Review

Systematic Review | Volume 2 | Issue 1 | JRS Jan – Jun 2022 | Page 03-08 | Karsten Knobloch, Henning Lohse-Busch, Andreas Gohritz, Tomas Nedelka

DOI: 10.13107/jrs.2022.v02.i01.33

Author: Karsten Knobloch [1], Henning Lohse-Busch [2], Andreas Gohritz [3], Tomas Nedelk [4,5]

[1] Department of Sports Medicine, SportPraxis Prof. Knobloch, Hannover, Germany.

[2] Zentrum für Bewegungsstörungen, Rheintalklinik Bad Krozingen, Germany.

[3] Department of Neurology, Universitätsspital Basel, Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Suisse.

[4] Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine, Prague, Czech Republic.

[5] Department of Neurology, Czech Technical University, Faculty of Biomedical Engineering, Kladno, Czech Republic.

Address of Correspondence
Prof. Dr. Karsten Knobloch,
SportPraxis Prof. Knobloch, Heiligerstr. 3, D-30159 Hannover, Germany.


Introduction: This systemic review aims to assess the modes and treatment parameters of radial and focused extracorporeal shockwave therapy (ESWT) in spasticity based on the technologies and energy levels involved.
Materials and Methods: 1086 patients from 31 randomized-controlled trials (RCT) or cohort studies are included. 300 children were studied in seven studies (3 RCTs) with two radial and four focused electromagnetic ESWT devices and 14 studies with 443 patients using focused ESWT (electrohydraulic 46 patients, electromagnetic 367 patients, and piezoelectric 30 patients).
Results: In electromagnetic focused ESWT 8 RCTs (n = 323 patients) and three cohort studies (n = 44) used either very low-energetic (0.03–0.05 mJ/mm2) with 1500–2000 shots and 4–5 Hz with 3–5 focused sessions, or low-energetic 0.07–0.12 mJ/mm2 with 1500–2000 shots with 4–5 Hz and 1–3 sessions. The 64 children in the five electromagnetic focused trials were treated with very low-energetic 0.03 mJ/mm2, 1500 shots, and three sessions. 17 studies (n = 687) were using radial technologies with 7 RCTs (n = 349) and ten cohort studies (n = 338). Among the 17 trials, four studies (1 RCT, 3 cohort studies) included 236 children treated with either very low-energetic 0.6–1 bar (two trials) or low-energetic 1.5–3 bar with 5–10 Hz. Energy-wise three radial studies were very low-energetic 0.6–1 bar and 14 studies applied low-energetic radial pressures 1.5–3 bar. Notably, the frequency was mainly 4–8 Hz in the radial studies.
Conclusion: Both, radial and focused very low- to low-energetic ESWT improve function and reduce spasticity significantly. Adverse effects were not noted with the applied very low- to low-energetic device parameters neither among children nor in adults.

Keywords: Spasticity, Extracorporeal shock wave therapy, Extracorporeal shockwave therapy, Children.


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How to Cite this article: Knobloch K, Lohse-Busch H, Gohritz A, Nedelka T | Very Low and Low-energetic Extracorporeal Shock Wave Treatment of Spasticity in Children and Adults–A Systematic Review. | Journal of Regenerative Science | Jan – Jun 2022; 2(1): 03-08.

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