Department of Physical Medicine and Rehabilitation-"OORR Hospital,", University of Foggia, Foggia, Italy.
Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS), Istituto Superiore di Sanità (ISS), Roma, Italy.
Top Stroke Rehabil. 2014;21 Suppl 1:S17-24. doi: 10.1310/tsr21S1-S17.
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.
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.
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.
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.
评估体外冲击波疗法（ESWT）治疗脑卒中后马蹄足的效果，并将 ESWT 对痉挛性跖屈肌的影响与 Heckmatt 量表上的回声强度相关联。
这项前瞻性开放标签研究共纳入 23 例脑卒中后下肢痉挛患者。患有脑卒中后痉挛性马蹄足的成人接受一次高频跖屈肌 ESWT 治疗。评估痉挛程度、被动踝关节背屈程度和神经生理值的变化。在治疗前，对小腿肌肉进行超声评估，以确定 Heckmatt 量表上的回声强度。
治疗后即刻，ESWT 可显著降低肌肉张力，增加被动踝关节背屈运动。在 30 天的随访中，仅在 Heckmatt 量表上痉挛性跖屈肌回声强度分级为 I、II 或 III 的患者中，这种效果持续存在，且与脊髓兴奋性无关。治疗后有轻度不良反应报告，但在几天内得到缓解。
ESWT 治疗脑卒中后跖屈肌痉挛安全有效，可降低肌肉张力，改善被动踝关节背屈运动。在小腿肌肉回声强度分级为 I、II 或 III 的患者中，效果持久，但在 Heckmatt 量表上回声强度分级为 IV 的患者中，效果短暂。ESWT 的效果似乎与脊髓兴奋性无关。
