Effect of session frequency of radial extracorporeal shockwave therapy on gastrocnemius muscle spasticity in children with spastic cerebral palsy: A double-blinded, randomised clinical trial

Background/Aims Extracorporeal shockwave therapy has been effective in reducing spasticity in patients with spastic cerebral palsy, but there has yet to be a recommended guideline for the treatment of spasticity in children using extracorporeal shockwave therapy. The aim of this study was to evaluate the effect of session frequency of radial extracorporeal shockwave therapy on gastrocnemius muscle spasticity in children with spastic cerebral palsy. Methods This was a double-blinded, randomised controlled trial consisting of 14 patients with spastic cerebral palsy (8 boys and 6 girls), aged 5 to 12 years, who were divided into two groups. Group 1 received five true radial extracorporeal shockwave therapy sessions. Group 2 received three true radial extracorporeal shockwave therapy sessions and two sham extracorporeal shockwave therapy sessions. The Australian Spasticity Assessment Scale was measured at nine time points: 1) pre-extracorporeal shockwave therapy, 2-6) immediately after each radial extracorporeal shockwave therapy session, 7) 4 weeks after the fifth radial extracorporeal shockwave therapy session, 8) 8 weeks after the fifth radial extracorporeal shockwave therapy session, and 9) 12 weeks after the fifth radial extracorporeal shockwave therapy session. Results Both groups had a significant reduction in degree of resistance to passive movements of ankle plantar-flexor muscles measured using the Australian Spasticity Assessment Scale at all time points, relative to baseline. The mean ankle Australian Spasticity Assessment Scale in the two groups were not significantly different after the fifth extracorporeal shockwave therapy treatment (group 1: 1.13 ± 0.62; group 2: 1.50 ± 0.90, P=0.28), 4 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.12 ± 0.66; Group 2: 1.50 ± 0.90, P=0.40), 8 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.25 ± 0.68; group 2: 1.50 ± 0.90, P=0.54) and 12 weeks after the fifth radial extracorporeal shockwave therapy treatment (group 1: 1.19 ± 0.75; Group 2: 1.58 ± 0.90, P=0.28). Conclusions: The effect of radial extracorporeal shockwave therapy on spastic gastrocnemius in children with spastic cerebral palsy is not dependent on session frequency. There has yet to be a recommended guideline and research showing the factors that affect the efficacy of radial extracorporeal shockwave therapy on spastic gastrocnemius muscles in children with spastic cerebral palsy.