Pragmatic single center longitudinal study assessing radial extracorporeal shock wave therapy for patients with severe mental and physical disabilities.

Patients with severe motor and intellectual disability (SMID) experience persistent spastic pain and severe malpositioning of the limbs, exacerbated by the lack of effective treatment for severe spastic palsy. This study (UMIN-CTR, UMIN000048842) aimed to evaluate the efficacy and safety of radial extracorporeal shock wave therapy (rESWT) for spastic palsy in these patients. rESWT was applied to the biceps brachii of 15 elbow joints with flexion pattern spastic palsy of Modified Ashworth Scale (MAS) grade 1+ or greater in 11 patients with SMID. The MAS score, elbow range of motion (ROM) and adverse events were monitored for up to 10 weeks. Electromyography signals at rest were recorded on 8 elbow joints. Following a single rESWT session, the spasticity of the elbow joint immediately decreased, the MAS score significantly decreased from 2 (range, 2-3) to 1 (range, 1-2), and the elbow ROM significantly increased by 10° (range, 0°-15°). Moreover, muscle activity decreased by 24% (range, 11-37%), being clinically meaningful in SMID. rESWT resulted in an immediate and clear improvement in the MAS score for approximately 8 weeks and in the elbow ROM, continuing even at 10 weeks. Our findings highlight rESWT as a non-invasive therapy for spastic palsy in patients with SMID.