Effect of extracorporeal shock wave therapy (ESWT) on gastrocnemius muscle spasticity among cerebral palsy children: A randomised controlled trial with sonographic evidence.

BACKGROUND

Cerebral palsy (CP) is a group of permanent central motor and postural development disorders caused by non-progressive damage to the developing brain. Spastic cerebral palsy, the most common type, often results in increased gastrocnemius muscle tone, limiting gait and activity. This study investigates the impact of extracorporeal shock wave therapy (ESWT) on gross motor capacity assessed by the Gross Motor Function Measure (GMFM), muscle tone, and muscle properties in children with spastic cerebral palsy.

METHODS

Thirty-six patients (mean age 3.58 ± 0.96) years with spastic cerebral palsy were recruited and randomly assigned to an ESWT group (N = 18) or a control group (N = 18). The ESWT group received ESWT three times per week in addition to standard daily physical and occupational therapy for 12 weeks, while the control group received only conventional treatment. Baseline and post-intervention measurements included Gross Motor Function Measure (GMFM), Modified Ashworth Scale (MAS), muscle thickness (MT), pinnate angle (PA), fascicle length (FL), and shear wave velocity (SWV).

RESULTS

The ESWT group showed significant improvements in GMFM scores, reduced MAS ratings, increased MT and FL, and decreased PA compared to the control group. SWV was significantly correlated with MAS ratings in both groups. However, no significant correlations were found between GMFM and other muscle parameters in the ESWT group.

CONCLUSIONS

ESWT, combined with conventional treatment, was associated with greater short-term post-intervention GMFM scores, reduced gastrocnemius muscle tone, and improved selected sonographic muscle properties in children with spastic cerebral palsy. These findings suggest that ESWT may be a useful adjunct therapy, but longer-term follow-up is required to determine whether these changes are sustained and translate into real-world mobility benefits.