Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2023; 11(1): 127-134
Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.127
Extracorporeal shock wave for plantar flexor spasticity in spinal cord injury: A case report and review of literature
Natalia Comino-Suárez, Julio Gómez-Soriano, Silvia Ceruelo-Abajo, Eduardo Vargas-Baquero, Ana Esclarín, Juan Avendaño-Coy
Natalia Comino-Suárez, Julio Gómez-Soriano, Juan Avendaño-Coy, Toledo Physiotherapy Research Group, Faculty of Physiotherapy and Nursery, Castilla La Mancha University, Toledo 45071, Toledo, Spain
Silvia Ceruelo-Abajo, Eduardo Vargas-Baquero, Ana Esclarín, Department of Physical and Rehabilitation Medicine, Hospital Nacional de Parapléjicos, Sescam, Toledo 45071, Toledo, Spain
Author contributions: Comino-Suárez N contributed to apply the therapy and data collection; Comino-Suárez N, Gómez-Soriano J and Avendaño-Coy J contributed to manuscript writing and editing, supervision, and data analysis; Ceruelo-Abajo S, Vargas-Baquero E, and Esclarín A contributed subject recruitment and data collection; and all the authors have read and approved the final manuscript.
Supported by BTL Industries Ltd. Prague, Czech Republic.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Julio Gómez-Soriano, MSc, PhD, Physiotherapist, Toledo Physiotherapy Research Group, Faculty of Physiotherapy and Nursery, Castilla La Mancha University, Avda Carlos III s/n 45071-Toledo, Toledo 45071, Toledo, Spain. julio.soriano@uclm.es
Received: July 21, 2022
Peer-review started: July 21, 2022
First decision: August 4, 2022
Revised: September 12, 2022
Accepted: November 28, 2022
Article in press: November 28, 2022
Published online: January 6, 2023
Processing time: 167 Days and 15.7 Hours
Abstract
BACKGROUND

Approximately 65%-78% of patients with a spinal cord injury (SCI) develop any symptom of spasticity. The aim of this study was to investigate the tolerability and short-term effects of radial extracorporeal shock wave therapy (rESWT) on plantar flexor spasticity in a patient with incomplete SCI.

CASE SUMMARY

An 18-year-old man with an incomplete SCI completed five sessions of rESWT. The primary outcomes were the changes in ankle-passive range of motion (A-PROM) and passive resistive force to ankle dorsiflexion. The outcomes were assessed at baseline (T0), immediately after treatment (T1) and 1 wk after the end of treatment (T2). The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0. The passive resistive force to ankle dorsiflexion at low velocity decreased by 33% at T1 and 55% at T2 in the gastrocnemius muscle and by 41% at T1 and 39% at T2 in the soleus muscle compared with T0. At high velocity, it also decreased by 44% at T1 and 30% at T2 in the gastrocnemius muscle compared with T0. However, in the soleus muscle, the change was minor, with a decrease of 12% at T1 and increased by 39% at T2 compared with T0.

CONCLUSION

In this patient, the findings showed that rESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term. Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.

Keywords: Spasticity; Spinal cord injury; Radial extracorporeal shock wave therapy; Rehabilitation; Case report

Core Tip: Spasticity is a major problem in the life of spinal cord injury (SCI), which can affect to their daily life activities. Extracorporeal shock wave therapy (ESWT) is defined as a sequence of mechanical pulses waves, characterized by a high peak pressure, fast pressure rises and short time duration. Previous studies have reported that ESWT is effective for pain relief and hypertonia in post-stroke, cerebral palsy, and multiple sclerosis patients. However, no clinical trials have investigated the effects of ESWT in the symptoms of spasticity in spinal cord injury patients. This is the first case report published which analysed the effects of ESWT in plantar flexor spasticity symptoms in a volunteer with incomplete SCI.