Shock Waves in the Treatment of Muscle Hypertonia and Dystonia

Table 1

Reference	Participants	Treatment	Treated muscles	Outcome measures	Placebo	Other treatments	Results	Side effects
Lohse-Busch et al.; 1997 [14]	35 children and young adults with CP	FSWT: 1 session; 0.06 mJ/mm^2; 500 shots for each treated muscle	Hamstrings, Triceps surae and Ileopsoas	ROM	No	Physiotherapy	↑ ROM lasting ≥3 weeks	No
Amelio and; Manganotti,; 2010 [13]	12 children with CP	FSWT: 1 session; 0.03 mJ/mm^2; 4500 shots in total	Triceps surae	ROM, MAS, baropodometry	1 session of placebo followed 6 weeks later by FSWT	No	↑ ROM, ↓ MAS scores, and ↑ plantar surface area lasting ≥4 weeks and <12 weeks after FSWT. No effects after placebo	No
Vidal et al.; 2011 [24]	15 children and adults with CP	RSWT: 3 sessions (1/week); 2 Bars; in each session, 2000 shots for each treated muscle	Forearm and wrist flexors; hip adductors; soleus and hamstrings	AS for upper limb muscles; ROM for lower limb muscles	Placebo was applied to 13 muscles (patients’ number not specified)	Not specified	↓ AS scores and ↑ ROM lasting ≥8 weeks and <12 weeks after FSWT. No effects after placebo	Petechiae and light pain during RSWT in 3 patients
Gonkova et al.; 2013 [22]	25 children with CP	RSWT: 1 session; 1.5 Bars; 4500 shots in total	Triceps surae	ROM, MAS, and baropodometry	1 placebo session, then RSWT after 1 month	No	↓ MAS scores and ↑ ROM lasting ≥4 weeks after RSWT. No effects after placebo	No
Manganotti; and Amelio,; 2005 [15]	20 adults with poststroke spasticity	FSWT: 1 session; 0.03 mJ/mm^2; 4700 shots in total	Wrist flexors; interosseus muscles of the hand	ROM, AS, MCV, and F-waves from ADM; EMG (FDI)	1 placebo session followed by FSWT after 1 week	Not specified	↑ ROM lasting 4–12 weeks after FSWT. ↓ AS scores lasting 4–12 weeks in wrist flexors and lasting ≥12 weeks in fingers flexors after FSWT. No changes of MCV, F-waves, and EMG after FSWT. No effects after placebo	No
Troncati et al.; 2013 [20]	12 adults with poststroke spasticity	FSWT: 2 sessions (1 session per week); 0.08/0.105 mJ/mm^2; 800/1600 shots for each treated muscle	Flexor muscles in the forearm; interosseus muscles of the hand	MAS, subscores of the upper limb FM scale for motricity, ROM and pain; perceived benefit (VAS)	No	Not specified	↑ ROM and motricity subscores and ↓ MAS scores lasting ≥6 months. ↓ Pain lasting 1–12 weeks. No changes in perceived benefit (VAS)	No
Santamato et al.; 2013 [18]	16 adults with poststroke spasticity	FSWT: 5 sessions (1 session every day starting from BoNT-A injection); 0.03 mJ/mm^2; 2000 shots in total	Flexor digitorum superficialis muscle	MAS; VAS for pain and frequency of muscle spasms	No	BoNT-A	↓ MAS scores and ↓ pain lasting 1–3 months. ↓ Frequency of muscle spasms lasting ≥3 months.; In 16 patients treated with BoNT-A and electrical stimulation, the results were shorter in duration and smaller in size	No
Moon et al.; 2013 [16]	30 adults with poststroke spasticity	FSWT: 3 sessions (1 session per week); 0.089 mJ/mm^2; 1500 shots in total	Medial and lateral gastrocnemius	ROM, clonus score, FM assessment of the lower limb, MAS, biomechanical assessment (PET and TTA)	1 placebo session followed by FSWT	Physiotherapy	↓ MAS scores and PET values lasting 1–4 weeks. No effects after placebo	No
Santamato et al.; 2014 [17]	23 adults with poststroke spasticity	FSWT: 1 session; 0.10 mJ/mm^2; 4500 shots in total	Triceps surae	ROM, MAS, MCV, and F-waves from AH	No	No	↓ MAS scores and ↑ ROM lasting ≥1 month after FSWT in the patients with baseline HS <4. No long-lasting effects in patients with HS = 4. No MCV and F-waves changes after FSWT	Pain in 5 subjects and local weakness in 2 subjects
Kim et al.; 2013 [23]	57 adults with poststroke spasticity	RSWT: 5 sessions (1 session every 2 or 3 days); 1.6 Bars; in each session, 3000 shots in total	Subscapularis muscle	ROM, MAS, VAS for pain	No	Physiotherapy	↓ MAS scores, ↓ pain, and ↑ ROM lasting 4 weeks	Petechiae in 1 patient and light pain during RSWT in some patients
Trompetto et al.; 2009 [21]	3 adults with secondary dystonia and 3 with writer’s cramp	FSWT: 4 sessions (1 session per week); 0.03 mJ/mm^2; up to 8000 shots	Forearm and hand muscles	UDRS, ADDS, 4-point pain intensity scale, median nerve SEPs, F-waves from ADM	1 placebo session followed by FSWT after 2 weeks	No	In patients with secondary dystonia, clinical benefit on dystonia and pain lasting 1-2 months. Less consistent effects on writer’s cramp patients. No changes of SEPs and F-waves after FSWT. No effects after placebo	No
Sohn et al.; 2011 [19]	10 adults with poststroke spasticity	FSWT: 1 session; 0.10 mJ/mm^2; 1500 shots in total	Medial gastrocnemius muscle	MAS, F-waves from AH and H-reflex from soleus	No	No	↓ MAS scores just after FSWT (no follow-up). No changes of F-waves and H-reflex	Mild pain during FSWT
Manganotti, et al.; 2012 [25]	10 healthy subjects	FSWT: 1 session; 0.03 mJ/mm^2; 1600 shots in total	Right ADM	MCV, F-waves, and MEPs from right ADM; SAP from 5° finger by ulnar nerve stimulation	No	No	No changes in any of the investigated parameters	No

ADDS: arm dystonia disability scale; ADM: abductor digiti minimi; AH: abductor hallucis; AS: Ashworth scale; BoNT-A: botulinum toxin type A; CP: cerebral palsy; EMG: electromyography; FDI: first dorsal interosseus; FM: Fugl-Meyer; FSWT: focused shock waves therapy; HS: Heckmatt scale; MAS: modified Ashworth scale; MCV: motor conduction velocity; MEPs: motor evoked potentials; PET: peak eccentric torque; ROM: passive range of movement; RSWT: radial shock waves therapy; SAP: sensory afferent potential; SEPs: sensory evoked potentials; TTA: torque threshold angle; UDRS: unified dystonia rating scale; VAS: visual analogue scale.