Extracorporeal shock wave therapy for the treatment of poststroke plantar-flexor muscles spasticity: a prospective open-label study.
OBJECTIVE
To assess the use of extracorporeal shock wave therapy (ESWT) for the treatment of equinus foot after stroke and to correlate the ESWT effect on spastic plantar-flexor muscles with echo intensity on the Heckmatt scale.


METHODS
The prospective open-label study examined 23 patients with poststroke lower limb spasticity. Adults with spastic equinus foot after stroke received one ESWT session on hypertonic plantar-flexor muscles. The effect on spasticity, degree of passive ankle dorsiflexion, and neurophysiological values were evaluated. Before treatment, participants underwent a sonography evaluation of calf muscles to identify echo intensity on the Heckmatt scale.


RESULTS
Immediately after the session, ESWT induced a statistically significant reduction in muscle tone, increasing passive ankle dorsiflexion motion. At 30 days of follow-up, the effect persisted only in patients with echo intensity of spastic plantar-flexor muscles graded I, II, or III on the Heckmatt scale without any action related to spinal excitability. Mild adverse events were reported after the treatment but were resolved in a few days.


CONCLUSIONS
ESWT is safe and efficacious for the treatment of poststroke plantar-flexor muscles spasticity, reducing muscle tone and improving passive ankle dorsiflexion motion. The effect was long lasting in subjects with echo intensity of calf muscles graded I, II, or III but was brief for echo intensity graded IV on the Heckmatt scale. The ESWT effect did not appear to be related to spinal excitability.
Department of Physical Medicine and Rehabilitation-"OORR Hospital,", University of Foggia, Foggia, Italy.
Andrea
A
Santamato
Department of Physical Medicine and Rehabilitation-"OORR Hospital,", University of Foggia, Foggia, Italy.
Maria Francesca
MF
Micello
Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Istituto Superiore di Sanità (ISS), Roma, Italy.
Francesco
F
Panza
Sector of Hygiene, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
Francesca
F
Fortunato
Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Istituto Superiore di Sanità (ISS), Roma, Italy.
Giancarlo
G
Logroscino
Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
Alessandro
A
Picelli
Clinical Neurophysiology and Functional Neuroimaging Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Section of Neurology, University Hospital, Verona, Italy.
Paolo
P
Manganotti
Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
Nicola
N
Smania
Department of Physical Medicine and Rehabilitation-"OORR Hospital,", University of Foggia, Foggia, Italy.
Pietro
P
Fiore
Department of Neurological and Psychiatric Sciences, University of Bari, Bari, Italy.
Maurizio
M
Ranieri
D000328:Adult; D000842:Ankle / Q000503:physiopathology; D003295:Convulsive Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005528:Foot / Q000503:physiopathology; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology* / Q000534:rehabilitation*; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000503:physiopathology; D011446:Prospective Studies; D016059:Range of Motion, Articular; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D014463:Ultrasonography
Heckmatt scale; echo intensity; extracorporal shock wave therapy; plantar-flexor muscles spasticity