The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury.Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software.Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies.Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation.Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity.Advanced.The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. 

Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury

Objective The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury. Design Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software. Results Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies. Conclusions Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity. Level Advanced Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

https://journals.lww.com/ajpmr/Abstract/9000/Extracorporeal_shock_wave_therapy_on_spasticity.97485.aspx

Abstract Background: The spastic cerebral palsy isconsidered the most common of cerebral palsy types. Spasticity of upper limbs is major problem in children that affected on hand function during grasping and through using assistive devices as walker and canes. Shock wave treatment on spastic muscles of upper limbs in stroke patients performed a significant decrease in muscle tone.The aim of current study was to determine the impact of extracorporeal shock wave therapy (ESWT) on spastic muscle of hand in children with spastic cerebral palsy.Methods:Thirty twohemiplegic spastic cerebral palsy patients from both sexes were recruited in this study.The children were divided randomly into two groups equal in number; GroupӀ(control)consisted of 16 children(7 boys and 9 girls) with mean±standard deviation age of 6.68±2.63years received exercises program only (3sessions/week for two months, GroupӀӀ(experimental)included (10 boys and 6 girls)with mean±standard deviation age of 6.37±1.44 years received the same exercises program in addition to sessions by extracorporeal shock wave therapy(BTL-6000WT) with energy flux(0.003mJ/mm2),frequency (10Hz)and (one session/week) for 8 weeks .The two groups were evaluated before and after therapy by Modified Ashworth Scale (MAS) and Modified House function Classification (MHC).Results:The results showed a statistically significant improvement in spasticity and hand function post treatment.Conclusion:We concluded that the ESWT is effective in decreasingspasticity(muscle tone) of upper extremities and enhancinghand function for patients with spastic cerebral palsyto help those children become independent and participate in different daily activities as grasping of walker or canes.

Sadiq Nassir Farhan

Papers

Impact of Extracorporeal Shock Wave Therapy on Spastic HandFunction with Assistive Devices in Children with Cerebral Palsy