title: A Prospective Case-Control Study of Radial Extracorporeal Shock Wave Therapy for Spastic Plantar Flexor Muscles in Very Young Children With Cerebral Palsy.
abstract: To assess the effects of radial extracorporeal shock wave therapy (rESWT) on plantar flexor muscle spasticity and gross motor function in very young patients with cerebral palsy (CP).The design was case-control study (level of evidence 3).The setting was the Department of Pediatric Neurology and Neurorehabilitation, First Hospital of Jilin University, Changchun, China.Those with a diagnosis of CP and spastic plantar flexor muscles were recruited between April 2014 and April 2015.According to the parents' decision, patients received 1 ESWT session per week for 3 months, with 1500 radial shock waves per ESWT session and leg with positive energy flux density of 0.03 mJ/mm, combined with traditional conservative therapy (rESWT group) or traditional conservative therapy alone (control group).The Modified Ashworth Scale (MAS) (primary outcome measure) and passive range of motion (pROM) measurements were collected at baseline (BL), 1 month (M1), and 3 months (M3) after BL. The Gross Motor Function Measure (GMFM)-88 was collected at BL and M3.Sixty-six patients completed the final review at 3 months and were included in the study. Subjects ranged in age from 12 to 60 months (mean age 27.0 ± 13.6 months; median age 22.0 months; 33.3% female). For the rESWT group (n = 34), mean MAS grades at BL, M1, and M3 were 2.6, 1.9, and 1.5 on the left side and 1.9, 1.7, and 1.2 on the right side. For the control group (n = 32), mean MAS grades at BL, M1, and M3 were 2.5, 2.4, and 2.1 on the left side and 1.8, 1.8, and 1.5 on the right side. The within-subject effects time × side and time × treatment were statistically significant (P < 0.01). Similar results were found for the improvement of mean pROM. GMFM-88 improved from BL to M3, but showed no statistically significant difference between the groups. There were no significant complications.This study demonstrates that the combination of rESWT and traditional conservative therapy is more effective than traditional conservative therapy alone in the treatment of spasticity in very young patients with CP.
authors.affiliation: From the Department of Pediatric Neurology and Neurorehabilitation (TW, LD, LS, HD, JF, FJ) ; the Institute of Pediatrics (FJ), First Hospital of Jilin University, Changchun, China; the Neurological Research Center (FJ), First Hospital of Jilin University, Changchun, China; and the Extracorporeal Shock Wave Research Unit (MCK, NBA, CS), Department of Neuroanatomy, Ludwig-Maximilians-University of Munich, Munich, Germany.
authors.forename: Tiantian
authors.initials: T
authors.lastname: Wang
authors.forename: Lin
authors.initials: L
authors.lastname: Du
authors.forename: Ling
authors.initials: L
authors.lastname: Shan
authors.forename: Hanyu
authors.initials: H
authors.lastname: Dong
authors.forename: Junyan
authors.initials: J
authors.lastname: Feng
authors.forename: Maren C
authors.initials: MC
authors.lastname: Kiessling
authors.forename: Nicholas B
authors.initials: NB
authors.lastname: Angstman
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.forename: Feiyong
authors.initials: F
authors.lastname: Jia
mesh_terms: D016022:Case-Control Studies; D002547:Cerebral Palsy / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002675:Child, Preschool; D002681:China; D005260:Female; D006801:Humans; D007223:Infant; D007866:Leg / Q000503:physiopathology; D008096:Lithotripsy / Q000379:methods*; D008297:Male; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D018482:Muscle, Skeletal / Q000503:physiopathology; D011446:Prospective Studies; D016059:Range of Motion, Articular; D016896:Treatment Outcome