Curative Effect Of Shock Wave Combined With Transcutaneous Electric Nerve Stimulation To Treat The Triceps Spasm Of The Calf After Stroke

ObjectiveSpasticity is a common complication after stroke.The triceps spasm of the calf often affects patients' ability to walk which makes recovery difficult.There are a lot of methods to treat the spasm such as conventional rehabilitation treatment,physiotherapy,oral medication,nerve block and surgical treatment.Spasticity is often difficult to be controlled by single treatment because its mechanism is complicated.So comprehensive treatment based on conventional rehabilitation is often used.Physiotherapy is widely used because it is easy to do and less traumatic.This research aims to explore the optimal combination for the treatment of post-stroke spasm and to evaluate the clinical effect of radial extracorporeal shock wave treatment combined with transcutaneous electric nerve stimulation to treat the triceps spasm of the calf after stroke.Methods42 patients with triceps spasm of the calf after stroke were divided into three groups by random table method: electrical stimulation group,shock wave group and combined treatment group.There were 14 cases in each group.Patients in three groups were all treated with conventional stroke rehabilitation training.Patients in electrical stimulation group was given the treatment of the transcutaneous electric nerve stimulation to the anterior tibial muscle.Patients in shockwave group was treated to triceps surae with the radial extracorporeal shock wave.Patients in combination treatment group was given both of them.A univariate analysis of variance was used to compare the positive range of motion of ankle,composite spasticity scale of triceps surae and ratio of H wave and M wave in H reflex of tibial nerve before treatment and compared them again after 4 weeks' treatment.The SNK method was used for comparison between groups.The paired t test was used to compare these parameters before and after treatment.Results4weeks later,the positive range of motion of ankle and composite spasticity scale of posterior crus muscle were all significantly improved(P <0.05)in three groups,and they were better in combined treatment group than in electrical stimulation and shock wave treatment group(P <0.05).The differences were statistically significant.But ratio of H wave and M wave in H reflex of tibial nerve(Hmax/Mmax)was reduced only in combined treatment group and electrical stimulation group(P <0.05)and there were no significant differences between two groups(P >0.05).Hmax/Mmax was not significantly changed in shock wave group(P >0.05).Ratio of H wave and M wave in H reflex of tibial nerve in combined treatment group was significantly less than in shock wave group(P <0.05).ConclusionsThree kinds of treatment were all effective for triceps spasm of the calf after stroke.Combined treatment was better than electrical stimulation and shock wave treatment.Combined treatment was better than shockwave in decreasing the excitability of spinal motor neurons but not better than electrical stimulation.