Evaluation of the efficacy of extracorporeal shock wave therapy following botulinum toxin type a injection on post-stroke ankle plantar flexor spasticity.

BACKGROUND AND PURPOSE: This study aimed to compare the efficacy of Botulinum Toxin Type A (BoNT-A) injection and BoNT-A injection in combination with ESWT for post-stroke lower extremity ankle plantar flexor spasticity in this prospective, randomized cohort study.

METHODS

Patients with post-stroke ankle plantar flexor spasticity of 1+ or more on the Modified Ashworth Scale (MAS) were randomized into two groups. Group 1 (n:20): BoNT-A was injected into the gastrocnemius muscle, and conventional physical therapy exercises were performed. Group 2 (n:20): ESWT was applied to the gastrocnemius muscle in addition to the treatments in group 1. MAS, Brunnstrom Motor Recovery Stage (BMRS), ankle range of motion (ROM) measurement, clonus score (CS), Barthel Index (BI), Heckmatt measurements with ultrasonography, and visual analog scale (VAS) evaluations were performed on the patients.

RESULTS

No statistically significant differences were observed between the groups in any of the measured parameters at baseline or at any other time (p > 0.05). In both groups, there was a statistically significant improvement in all scores, except for the Heckmatt scores, after treatment compared to before treatment (p < 0.05).

CONCLUSION

ESWT treatment added to BoNT-A was not statistically significantly superior to BoNT-A in terms of MAS, BME, ROM, BI, Heckmatt grade, VAS, and CS. Our study did not observe the additional antispastic contribution of ESWT on spasticity.