Effects of Radial Shockwave Therapy and Orthotics Applied with Physical Training on Motor Function of Children with Spastic Diplegia: A Randomized Trial

Abstract

Aims: To explore the effects of radial shockwave therapy (rSWT) combined with standard orthotic management (SOM) on spasticity, functional balance, and gait in children with spastic diplegia. Methods: Sixty children with diplegia were allocated to group I (rSWT, n = 20), group II (SOM, n = 20), or group III (rSWT + SOM, n = 20). All groups received a physical training program 3 times/week for 3 months. Assessments were completed before and immediately after the intervention and included the Hoffman reflex/Myogenic response ratio of the soleus muscle (H/M ratio), balance, and gait. Results: At a significance criterion adjusted to p ˂ .006, there were no between-group differences in balance or gait (p > .006). The rSWT + SOM group had a greater improvement of H/M ratio compared to rSWT alone (p = .001) but not to SOM alone (p = .04). Within-group analysis demonstrated significant improvement of all variables for rSWT + SOM (p ˂ .006). The H/M ratio and knee midstance angle exhibited clinically meaningful improvement for rSWT alone (p ˂ .006). No significant changes were observed in any variable for SOM alone (p > .006). Conclusions: Radial shockwave and orthotics together, or either of them along with physical training did not differ in improving balance or gait. Their combination was more effective than rSWT alone in reducing spasticity.

Keywords:

• Ankle foot orthosis
• balance control
• cerebral palsy
• gait function
• shockwave therapy
• spasticity

Acknowledgments

We would like to show our gratitude to all children and their families for participation in this work. We are also immensely grateful for the team of physical therapy laboratories at Prince Sattam bin Abdulaziz University for their continuous support during the course of this research.

Disclosure statement

No potential conflict of interest was reported by the authors.

About the authors

Ragab K. Elnaggar, PT, PhD, Assistant Professor of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.

Amira M. Abd-Elmonem, PT, PhD, Lecturer of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.