Using Radial Shock Wave Therapy to Control Cerebral Palsy-Related Dysfunctions: A Randomized Controlled Trial

Hisham M Hussein,1,2 Ahmed M Gabr,1,3 Monira I Aldhahi,4 Amsha Alhumaidi Alshammari,5 Hand Zamel Alshammari,6 Khulood Khleiwi Altamimi,5 Abdulaziz Mohammed Alqahtani,7 Ibrahim M Dewir,8 Shamekh Mohamed El-Shamy,1,3 Ahmed Abdelmoniem Ibrahim1 1Department of Physical Therapy, College of Applied Medical Sciences, University of Ha’il, Ha’il, Saudi Arabia; 2Department of Basic Sciences for Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Egypt; 3Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt; 4Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, 11671, Saudi Arabia; 5Department of Physical Therapy, Maternity and Children Hospital in Ha’il, Ha’il, Saudi Arabia; 6Department of Physical Therapy, Hayati Center Day Care, Ha’il, Saudi Arabia; 7Department of Physical Therapy, King Salman Specialist Hospital, Ha’il, Saudi Arabia; 8Department of Physical Therapy, College of Applied Medical Sciences, Taif University, Taif, 21944, Saudi ArabiaCorrespondence: Ahmed Abdelmoniem Ibrahim, Department of Physical Therapy, College of Applied Medical Sciences, University of Hail, Ha’il, 2440, Saudi Arabia, Email [email protected]: Radial Shock wave Therapy (rSWT) is one of the recent promising modalities that can effectively improve muscle tone, ROM, and enhance functional capacity. It can be used to augment the rehabilitation effectiveness in spastic CP children. So, enhance their engagement in community and participation in social activities and decrease economic burden of rehabilitation.Purpose: To investigate the effect of adding rSWT to standard physical therapy on muscular spasticity, ROM, gross motor function, and planter surface in spastic CP patients.Methods: A total of 70 children (48 girls and 22 boys) with spastic CP were randomly assigned into the control group (n= 35 and average age 8.82± 0.91) which received standard physical therapy and the rSWT group (n=35 and average age 9.0± 1.81) which received the standard physical therapy plus 1500 rSWT shocks with 2 bar pressure and Hz frequency applied over acupuncture points. Passive ankle ROM, calf muscle tone, gross motor function (D and E categories), plantar surface area (PSA), and peak pressure values at midfoot (PPMF), and hindfoot (PPHF) were assessed at baseline, post-treatment, and three-month follow-up.Results: Between-group comparisons demonstrated post-treatment statistically significant differences in ankle plantar flexion (APF), walking category of the GMFM (GMFM-E), PPHF, and PPMF with medium to high effect size values favoring the rSWTG (p=0.011, d=0.858; p=0.003, d=1.02; p=0.035, d=0.577; p=0.049, d= 0.216, respectively). At follow-up, all outcomes were statistically significantly different (p< 0.05).Conclusion: rSWT is an effective addition to the standard physical therapy care for spastic CP children in favor of spasticity, ROM, and function.Keywords: cerebral palsy, diplegia, hypertonia, shockwave, spasticity