Early Radial Shock Waves Treatment on Spasticity in Patients With Stroke in Sub-acute Phase
Early Radial Shock Waves Treatment on Spasticity in Patients With Stroke in Sub-acute Phase
Hands and wrist spasticity are a common post stroke complication and often lead to
 restrictions in daily living activities. Spasticity causes changes in muscle composition such
 as accumulation of collagenous connective tissue and progressive loss of skeletal muscle
 fibres and these changes start almost immediately after a vascular event. Radial Shock Wave
 Therapy (rSWT) is a valid alternative rehabilitating tool in managing chronic spasticity but
 no study has so far investigated the effect in a recently onset hemiparesis. The aim of this
 study is to evaluate the efficacy of an early radial shock wave therapy in improving
 spasticity of the upper limb in patients with a recent onset stroke. The secondary outcome is
 to investigate the improvement of upper limb motor functionality, passive range of motion and
 joint pain and to determine if it can lead to a better performance in daily living
 activities. This study is a randomized controlled trial double arm single blind. The
 investigators plan to enrol 40 hemiplegic patients with sub-acute stroke and randomly assign
 them to an experimental or control group. The experimental group (EG) will perform one radial
 shock wave therapy session a week for 8 weeks administered during the daily morning 40
 minutes of conventional rehabilitation treatment. The control group (CG) 40-minutes of
 conventional rehabilitation treatment for 5 days per week in the morning for 8 weeks. All
 patients performed in the afternoon a second daily session of 40 minutes of conventional
 rehabilitation therapy 5 days per week. The Modified Ashworth Scale (MAS), Fugl-Meyer
 Assessment Upper Extremity (FMA-UE) (with motricity, Passive Range of Motion (PROM) and pain
 sub-scores of upper extremity part of the scale), Modified Barthel Index and Visual Analogue
 Scale (VAS) for patient's benefit perceived, will be evaluated before and a week after the
 last intervention. MAS will be administered once a week, before rSWT treatment. The
 investigators plan to have a 1 month follow up during which every outcome measure will be
 administered. The investigators hypothesize that radial shock waves therapy, started early
 and associated with traditional physiotherapy, may be more effective in promoting the
 reduction of spasticity and pain of the upper limb, improve its functionality and therefore a
 reduction in disability, compared to conventional rehabilitation treatment. A reduction in
 the use of analgesic and muscle relaxants drugs is also conceivable
Inclusion Criteria:

 -  Diagnosis of hemiparesis after an ischemic or hemorrhagic stroke

 -  Onset of spasticity within 3 months from acute stroke

 -  First-stroke survivors with confirmed brain lesions by tomography or magnetic
 resonance imaging

 -  Adults (age between 18 and 80 years)

 -  Post-stroke upper limb spasticity ranging 1-4 according to the Modified Ashworth Scale

 Exclusion Criteria:

 -  No treatment of the limb spasticity with botulinum toxin, phenol, alcohol, or surgery
 in the last 6 months

 -  Presence of an unstable medical condition

 -  Contraindications to shock waves treatment (pregnancy, cancer, coagulopathies,
 pacemakers, skin pathologies)

 -  Global aphasia

 -  All subjects who scored above 25 on the Mini-Mental State Examination