Extracorporeal Shock Wave Therapy May Be Helpful in Treating Spasticity In CP Children, Review Suggests

Extracorporeal shock wave therapy (ESWT) — delivering acoustic energy like a person might feel at a concert — may be helpful in treating spasticity in children with cerebral palsy, a recent review and meta-analysis suggests.

While no serious side effects were observed in any patients, more research is needed to validate shock wave therapy as a treatment for CP, the investigators said.

Titled “Effect of extracorporeal shock wave therapy on muscle spasticity in patients with cerebral palsy: meta-analysis and systemic review,” the paper was published in the European Journal of Physical and Rehabilitation Medicine.

Spasticity — the continuous contraction of certain muscles — affects the majority of children with cerebral palsy (CP). Management of this symptom can be complex and multifaceted, and include occupational therapy, injections of botulinum toxin, and electrical stimulation.

Extracorporeal shock wave therapy (ESWT) involves the delivery of waves of acoustic energy — sort of like how people can “feel” sound waves at a concert. Originally used to help dislodge kidney stones, the therapy has attracted attention in recent years as a possible treatment for spasticity.

The researchers behind the new analysis aimed to summarize the current scientific literature on ESWT as a treatment for spasticity in CP children. To this end, they screened available scientific literature for relevant studies, of which they found five.

In total, the studies included 104 people with cerebral palsy. Most were children, though one study also included adults. Two-thirds of the study participants were male.

There were methodological differences between the studies — specifically, variations in exactly how ESWT was applied. Generally, however, the studies compared ESWT to a control treatment, and used the Modified Ashworth scale (MAS) as an endpoint for spasticity. The MAS, which basically measures muscles’ ability to stretch, goes from 0 to 5, with higher scores indicating greater spasticity.

Combining the data from all the studies, when measured immediately after therapy, ESWT resulted in a decrease of 0.62 on the MAS scale in treated patients relative to the controls.

Significant improvements were recorded in range of motion following the shock wave therapy when measured within 4 weeks after treatment, again relative to what was observed among the controls. The results also showed significant increases in foot contact area during walking immediately after treatment.

There was a tendency to improve the peak pressure under the heel during walking, although this result was not statistically significant.

The researchers noted that “management of spasticity in children with CP is challenging,” and said more and larger studies were needed to examine the use of ESWT as a potential treatment. However, they said that “no serious side effects were observed in any patient after shock wave therapy.”

ESWT “may be a valid alternative to existing treatment options targeting spasticity diminishment and range of motion improvement in cerebral palsy patients,” without unwanted side effects, the researchers said.

However, they also noted that the available data reviewed in the analysis is somewhat weak. Notably, the sample size was quite small, follow-up was typically short, and methodological variations study-to-study made it difficult to draw broad conclusions with certainty, they said.

“Further standardization of treatment protocols including treatment sessions and intensities needs to be established and long-term follow up studies are needed to verify our results,” the researchers said.