Rehabilitation: Wide-Focus ESWT for Plantarflexor Spasticity

Wide-Focus ESWT for Stroke Rehabilitation: Clinical Insights. Plantarflexor spasticity remains a major contributor to gait impairment in chronic stroke, often leading to restricted ankle dorsiflexion, inefficient push-off, and reduced walking speed. A recent study explored the effects of wide-focus Extracorporeal Shock Wave Therapy (ESWT) combined with stretching to modulate spasticity and improve muscle quality. Clinical Methodology & Application. The study evaluated individuals with chronic stroke (Brunnstrom stage 4-5) using the Likawave® wide-focus ESWT system. Protocol: Participants underwent wide-focus ESWT once weekly for a duration of four weeks. *, Treatment Parameters: Therapy was delivered at an intensity level of 4 and a frequency of 4 Hz, with 1000 pulses applied per muscle., Targeted Muscles: The intervention targeted the gastrocnemius medialis, gastrocnemius lateralis, and soleus muscles, and was combined with standardized plantarflexor stretching. Observed Clinical Outcomes. All participants completed the intervention safely without any adverse events. The clinical assessments yielded the following results:. Spasticity Modulation: Improvements in velocity-dependent plantarflexor spasticity were observed, with the soleus muscle showing statistically significant improvements on the Modified Tardieu Scale (R2: p=0.04, R1: p=0.025)., Walking Performance: Walking speed increased in all participants, accompanied by meaningful clinical gains in walking-related goals (recording a mean Goal Attainment Scaling score of 1.2)., Muscle Quality Enhancement: A significant overall reduction in muscle echogenicity was observed across the targeted plantarflexor muscles (p<0.05). Conclusion. The application of wide-focus ESWT combined with stretching is a feasible and clinically applicable method for managing plantarflexor spasticity in chronic stroke. The findings suggest that improved walking performance may reflect enhanced muscle quality, despite modest changes in spasticity.