Ann Rehabil Med.  2015 Dec;39(6):914-921. 10.5535/arm.2015.39.6.914.

Therapeutic Effect of Extracorporeal Shock Wave Therapy According to Treatment Session on Gastrocnemius Muscle Spasticity in Children With Spastic Cerebral Palsy: A Pilot Study

• Park DS
• Kwon DR
• Park GY
• Lee MY

• KMID: 2165617
• DOI: http://doi.org/10.5535/arm.2015.39.6.914

Abstract

OBJECTIVE
To investigate the therapeutic effect of extracorporeal shockwave therapy (ESWT) according to treatment session on gastrocnemius muscle spasticity in children with spastic cerebral palsy (CP).
METHODS
Twelve children with spastic CP underwent 1 ESWT and 2 sham ESWT sessions for gastrocnemius (group 1) or 3 ESWT sessions (group 2) once per week for 3 weeks. Modified Ashworth Scale (MAS) score, passive range of motion (PROM) of the ankle plantar-flexor muscles with knee extension, and median red pixel intensity (RPI) of color histogram of medial gastrocnemius on real-time sonoelastography (RTS) were measured before ESWT, immediately after the first and third ESWT, and at 4 weeks after the third ESWT.
RESULTS
Mean ankle PROM was significantly increased whereas as mean ankle MAS and median gastrocnemius RPI were significantly decreased in both groups after the first ESWT. Clinical and RTS parameters before ESWT were not significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 1. However, they were significantly different from those immediately after the third ESWT or at 4 weeks after the third ESWT in group 2. Mean ankle PROM, mean ankle MAS, and median gastrocnemius RPI in group 2 were significantly different from that in group 1 at 4 weeks or immediately after the third ESWT.
CONCLUSION
The therapeutic effect of ESWT on spastic medial gastrocnemius in children with spastic CP is dependent on the number of ESWT sessions.

Keyword

Spasticity; Cerebral palsy; Extracorporeal shock wave therapy; Gastrocnemius muscle; Sonoelastography

MeSH Terms

Ankle
Cerebral Palsy*
Child*
Elasticity Imaging Techniques
Humans
Knee
Muscle Spasticity*
Muscle, Skeletal*
Muscles
Pilot Projects*
Range of Motion, Articular
Shock*

Figure

• 

  Fig. 1 Representative longitudinal RTS image and red color histogram of medial gastrocnemius (GCM) muscle before and after three ESWT sessions. Yellow polygons and freehand selections depict the region of interest for quantitative analysis of the medial GCM stiffness on color histogram. (A) Baseline RTS image showing predominantly red color in the medial GCM muscle. The median RPI of the medial GCM was 140.4 at baseline. (B, C) Follow-up RTS images showing purple to yellow colors after ESWT. The median RPI was 124.2 at immediately after ESWT treatment (B) and 129.4 at 4 weeks after 3 weekly ESWT treatments (C). RTS, real-time sonoelastography; ESWT, extracorporeal shockwave therapy; RPI, red pixel intensity.

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