Effect of total number of pulses of radial extracorporeal shock wave therapy (rESWT) on hamstring muscle spasticity in children with spastic type cerebral palsy: A randomized clinical trial

Purpose To evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) according to total number of pulses on hamstring muscle spasticity in children with spastic type cerebral palsy (CP).Methods This study is a randomized controlled trial consisting of thirteen patients with spastic CP, 9 males and 4 females, aged 5 to 14 years (mean age 9.2). Twenty-five spastic hamstring muscles were divided in four groups. Group I: 500 pulses, Group II: 1, 000 pulses, Group III: 1, 500 pulses, and Group IV: 2, 000 pulses. Australian Spasticity Assessment Scale (ASAS) was measured at four different time points (pre-ESWT, post-ESWT, 2 weeks post-ESWT, and 4 weeks post-ESWT).Results All four groups showed improvement in ASAS relative to pre-treatment, although only significant in Group III (1, 500 pulses). There were no statistically significant differences in ASAS between all four groups in pre-ESWT [|2(2)=3.907,P=0.272], immediately post-ESWT [|2(2)=1.250,P=0.741], 2 weeks post-ESWT vs pre-ESWT [|2(2)=3.367,P=0.338], and 4 weeks post-ESWT vs pre-ESWT [|2(2)=1.566,P=0.667].Conclusion The effect of rESWT on spastic hamstring in children with spastic CP is not dependent on the number of pulses.