Extracorporeal Shockwave Therapy for Spasticity in Children With Cerebral Palsy: A Literature Review of Treatment Protocols and Outcome Measurement Parameters.

This literature review investigates the therapeutic potential of radial extracorporeal shockwave therapy (rESWT) for managing spasticity in children with cerebral palsy (CP), with a focus on its clinical efficacy, safety profile, and implications for functional rehabilitation. Synthesizing findings from six randomized controlled trials, the review reveals that rESWT consistently produces statistically significant reductions in spasticity, as measured by the Modified Ashworth Scale (MAS), along with notable improvements in gross motor function, joint range of motion, gait symmetry, plantar contact area, and manual dexterity. These benefits were maintained for varying durations, with some studies demonstrating sustained effects for up to 12 weeks post-treatment. Importantly, rESWT was well-tolerated, with no serious adverse events reported across all included studies, highlighting its safety and feasibility in pediatric populations. Despite the consistent reporting of positive outcomes, considerable heterogeneity exists in treatment protocols, target muscle groups, outcome measurement timing, and reporting of participant characteristics, which complicates direct comparisons and limits the generalizability of findings. The review also emphasizes the need for incorporating multidimensional outcome domains, including those related to posture, balance, and gross motor performance, in future studies to better reflect real-world functional gains. Although promising, the current evidence base remains constrained by methodological inconsistencies and limited use of objective assessment tools. To optimize clinical application, future research should aim to standardize rESWT protocols, extend follow-up periods, and incorporate validated biomechanical and functional performance assessments. Collectively, these findings support rESWT as a non-invasive, clinically effective, and safe adjunct to conventional therapies in pediatric neurorehabilitation, with the potential to enhance both motor and functional outcomes in children with CP.