Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan.
Eur J Phys Rehabil Med. 2018 Aug;54(4):518-525. doi: 10.23736/S1973-9087.17.04801-8. Epub 2017 Oct 25.
Recent studies have suggested that either focused or radial shock wave therapy is an effect method for the treatment of spasticity in patients with stroke. However, no previous study compared these two types of extracorporeal shock wave on spasticity in patients with stroke. This study aimed to compare the effect of focused and radial shock wave therapy for the treatment of spastic equinus in patients with stroke.
Randomized control trial.
Outpatient rehabilitation center in a medical center.
Thirty-two stroke patients with spastic equinus (18 males and 14 women; mean age, 60.1±10.6 years).
Patients were randomly assigned to receive three sessions of either focused or radial shock wave therapy at 1-week intervals. The intensities that were used during focused shock wave therapy (0.12 mJ/mm2) and radial shock wave therapy (2.4 bar) were comparable. The patients were evaluated at baseline and at 1, 4, and 8 weeks after the final shockwave treatment. The primary outcome measure was change of modified Ashworth Scale Score of gastrocnemius muscle. The secondary outcome measures were Tardieu Scale, ankle passive range of motion, dynamic foot contact area and gait speed. A linear mixed model with repeated measures was used to compare each outcome measure between the two groups.
Both groups improved significantly in terms of modified Ashworth Scale Score and Tardieu Scale, and no differences were found between the two groups. In terms of ankle passive range of motion and plantar contact area during gait, the radial shock wave therapy yielded a significantly greater improvement than the focused shock wave therapy. No significant changes were observed in gait speed in either group.
Our study suggested that focused and radial shock wave therapy resulted in similar significant improvements in the modified Ashworth scale score and Tardieu scale, but those in the radial shock wave therapy group experienced greater improvements in the ankle passive range of motion and plantar contact area during gait.
Both focused and radial shock wave therapy yielded similar improve the spasticity of gastrocnemius muscle. Radial shock wave therapy is superior to focused shock wave therapy in terms of improving the ankle passive range of motion and plantar contact area during gait in patients with stroke.
最近的研究表明，聚焦式或径向冲击波治疗是治疗脑卒中后痉挛的有效方法。然而，以前没有研究比较这两种类型的体外冲击波治疗脑卒中后痉挛的效果。本研究旨在比较聚焦式和径向冲击波治疗脑卒中后痉挛性马蹄内翻的效果。
随机对照试验。
医疗中心的门诊康复中心。
32 名脑卒中后痉挛性马蹄内翻患者（18 名男性，14 名女性；平均年龄 60.1±10.6 岁）。
患者随机分为 1 周间隔接受 3 次聚焦式或径向冲击波治疗。聚焦式冲击波治疗（0.12mJ/mm2）和径向冲击波治疗（2.4 巴）的强度相当。患者在基线、最后一次冲击波治疗后 1、4 和 8 周进行评估。主要结局测量指标为改良 Ashworth 量表评分的变化。次要结局测量指标为 Tardieu 量表、踝关节被动活动范围、动态足接触面积和步行速度。采用重复测量线性混合模型比较两组间各结局测量指标。
两组患者改良 Ashworth 量表评分和 Tardieu 量表评分均显著改善，两组间无差异。在踝关节被动活动范围和步态时的足底接触面积方面，径向冲击波治疗组的改善明显大于聚焦式冲击波治疗组。两组患者的步行速度均无显著变化。
本研究表明，聚焦式和径向冲击波治疗均可显著改善改良 Ashworth 量表评分和 Tardieu 量表评分，但径向冲击波治疗组在步态时的踝关节被动活动范围和足底接触面积方面的改善更为显著。
聚焦式和径向冲击波治疗均可改善比目鱼肌痉挛。在脑卒中患者中，径向冲击波治疗在改善步态时的踝关节被动活动范围和足底接触面积方面优于聚焦式冲击波治疗。
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