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Updated: Jun 27, 2025

The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb
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Effectiveness of Extracorporeal Shock Wave Therapy after Botulinum Toxin Injection for Post-Stroke Upper Extremity

Junhee Lee1,2, Seung Nam Yang2

  • 1Department of Physical Medicine and Rehabilitation, Ewha Womans University Mokdong Hospital, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea.

Toxins
|April 26, 2024
PubMed
Summary

Extracorporeal shock wave therapy (ESWT) combined with botulinum toxin (BTx) shows promise for improving post-stroke upper limb spasticity. This combination therapy demonstrated specific benefits for finger flexor spasticity not seen with BTx alone.

Keywords:
botulinum toxinsextracorporeal shock wave therapymuscle spasticitystroke

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Area of Science:

  • Neurology
  • Rehabilitation Medicine
  • Physical Therapy

Background:

  • Post-stroke spasticity is a frequent complication impacting patient function.
  • Botulinum toxin (BTx) is a recognized treatment for spasticity.
  • Extracorporeal shock wave therapy (ESWT) has shown positive outcomes for post-stroke spasticity.

Purpose of the Study:

  • To investigate the additional benefits of ESWT when used with BTx therapy for post-stroke spasticity.
  • To evaluate the efficacy of combined BTx and ESWT versus BTx alone in upper extremity spasticity.

Main Methods:

  • A randomized study involving 16 patients with post-stroke upper extremity spasticity.
  • Participants were assigned to either botulinum toxin (BTx) with focused extracorporeal shock wave therapy (ESWT) or BTx alone.
  • Spasticity was assessed using the modified Ashworth scale (MAS) and modified Tardieu scale (MTS).

Main Results:

  • Both treatment groups showed significant improvements in elbow and wrist flexor spasticity.
  • The BTx + ESWT group exhibited a significant decrease in finger flexor MAS at follow-up.
  • The BTx + ESWT group demonstrated increased R1 (MTS) for finger flexors at 3 weeks, unlike the BTx alone group.

Conclusions:

  • This study is the first to suggest an add-on effect of ESWT to BTx injections for post-stroke upper limb spasticity.
  • Combined BTx and ESWT may offer specific advantages for managing finger flexor spasticity.
  • Further research is warranted to confirm these findings and optimize treatment protocols.