Background Extracorporeal shock wave therapy (ESWT) is reportedly effective in improving spasticity and motor function in children with cerebral palsy (CP). Because late-stage Rett syndrome has a similar presentation, this study aimed to investigate the effects of ESWT on these two diseases.

Methods Patients received 1500 impulses of ESWT at 4 Hz and 0.1mJ/mm2, on their spastic legs once weekly for 12 weeks. Outcomes were assessed before and 4 and 12 weeks after ESWT. Clinical assessments included the Modified Ashworth Scale (MAS), passive range of motion (PROM), and Gross Motor Function Measure 88 (GMFM-88). Ultrasonographic assessments included muscle thickness, acoustic radiation force impulse (ARFI), and strain elastography.

Results Fifteen patients with CP and six with Rett syndrome were enrolled in this study. After ESWT, patients with CP showed significant clinical improvement in the MAS, ankle PROM, walking/running/jumping function, and total function of the GMFM-88. The patients with Rett syndrome showed improved MAS scores and significantly improved total gross motor function. Under ARFI, patients with CP demonstrated decreased shear wave speed in the gastrocnemius medial head. Conversely, patients with Rett syndrome show increased shear-wave speeds after ESWT.

Conclusion Our study provides evidence that a weekly course of low-dose ESWT for 12 weeks is beneficial for children with both CP and Rett syndrome, with the clinical effects of reducing spasticity and improving the gross motor function of the lower limbs. The ARFI sonoelastography reveals improved muscle stiffness in patients with CP after ESWT, but persistent degeneration in those with Rett syndrome.

Ting-Yu Su
Kaohsiung Chang Gung Memorial Hospital
Taiwan

Tzu-Yun Hsieh
Kaohsiung Chang Gung Memorial Hospital
Taiwan

Pi-Lien Hung
Kaohsiung Chang Gung Memorial Hospital
Taiwan