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Evaluation of radial Extracorporeal Shock Wave Therapy (rESWT) as a treatment option in chronic post-stroke upper limb management

Background: Stroke leaves almost fifty percent (50%) of its survivors disabled with respect to arm–hand performance, and after six months, 25-53% of people are dependent at least one ADL task. Shock wave therapy used in treating post-stroke upper limb for many years; therefore this current review discusses the literature on the effects of shock wave therapy on chronic poststroke upper limb management. Materials and Methods: A literature survey was conducted through MEDLINE PubMed, PEDro, Science Direct and Google Scholar. ‘Chronic stroke, spasticity, upper limb and shock wave therapy’ were used as the key words independently and/ or combination and included articles only written in English. Results: Two application sites for rESWT treatment were identified as muscle belly and musculotendinous junction. Due to its elcetrophysiogical and thermal effects, rESWT treatment should be considered as a possible anti-spastic effect to regulate vasculature. On its long lasting effect with a single treatment session, there were conflicting results as 12 weeks (2005), 5 weeks (2015) and 8 weeks (2016). With two sessions of rESWT, improvements were maintained up to 6 months and with three sessions, persistent effects were observed up to 16 weeks. All the studies used Modified Ashwath scale (MAS) as the primary outcome measure for spasticity. Conclusion: All the studies conclude that the rESWT is an effective treatment method for treating post-stroke upper limb. There were conflicts of the long-lasting effects with single session, two and three sessions, therefore further investigations are needed to clarify those with larger sample size.