Introduction: Shock wave therapy (SWT) has a potential interest to treat spasticity. However, the pathophysiology of this treatment remains unknown. Some authors assert that it is effective on spasticity itself, while others suggest that it acts more on fibrosis. Method: this study will assess the effectiveness of radial SWT to treat wrist and finger flexors stiffness in stroke patients, comparing subacute spastic patients (\< 12 months) with chronic patients presenting muscle contractures (\> 12 months). Forty-eight stroke patients (24 in the subacute phase and 24 in the chronic phase) will be included. One real and one sham sessions of SWT will be performed with a 2-week interval. The order of the sessions will be randomized. Motor control, stiffness and spasticity will be assessed with clinical and objective measures, just after and just before each session, by a blind assessor. The targeted muscles will be flexor carpi radialis, flexor carpi ulnaris and flexor digitorum profundus, and will be the same for the two session.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
48
Shockwave therapy is a non-invasive treatment creating a series of low energy acoustic wave pulsations that are directly applied through the skin via a gel medium
Cliniques universitaires Saint-Luc
Brussels, Belgium
RECRUITINGModified Ashworth Scale
Clinical assessment of spasticity for wrist and fingers flexors, score from 0 to 4 (a higher score representing a greater spasticity)
Time frame: Before (baseline) and 5 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Tardieu scale
Clinical assessment of spasticity for wrist and fingers flexors; score from 0 to 4 (a higher score representing a greater spasticity)
Time frame: Before (baseline) and 5 minutes (post-treatment) after each of the two sessions (sham or real SWT)
objective measure of elastic and viscous stiffness of the wrist, expressed in N.m.rad
electronic oscillatory device for stiffness measurement
Time frame: Before (baseline) and 5 minutes (post-treatment) after each of the two sessions (sham or real SWT)
objective measure of muscle stiffness
Myoton measurement device
Time frame: Before (baseline) and 10 minutes (post-treatment) after each of the two sessions (sham or real SWT)
manual goniometer
Passive measure of joint range of motion
Time frame: Before (baseline) and 10 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Medical Research Council muscle testing
strength assessment; score from 0 to 5 (a higher score representing a greater strength)
Time frame: Before (baseline) and 25 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Isokinetic dynamometer
objective measure of muscle stiffness at the wrist
Time frame: Before (baseline) and 15 minutes (post-treatment) after each of the two sessions (sham or real SWT)
H reflex
electrophysiological assessment of the H reflex (motoneuronal excitability)
Time frame: Before (baseline) and 5 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Box and block test
measure of manual ability
Time frame: Before (baseline) and 30 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Fugl Meyer Assessment - computerized adaptive testing
neurological impairment
Time frame: Before (baseline) and 25 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Abilhand scale
PROMS on bimanual activities; a higher score represents a better manual ability
Time frame: Before (baseline) and 45 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Wolff Motor Function Test
manual activities
Time frame: Before (baseline) and 35 minutes (post-treatment) after each of the two sessions (sham or real SWT)
Visual Analog Scale
patient self-assessment of overall effectiveness of SWT; score from 0 to 4 (a higher score representing a greater improvement)
Time frame: Before (baseline) and 45 minutes (post-treatment) after each of the two sessions (sham or real SWT)
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