Multimodal assessment of the effects of radial pressure wave therapy on spastic muscles in patients with traumatic brain injury.

Objectives: Radial pressure wave therapy (rPWT) has shown promise in reducing spastic symptoms; however, its application in patients with spasticity following traumatic brain injury, particularly in those with prolonged disorders of consciousness (pDoC), remains underreported. The study aimed to investigate the immediate effects of rPWT on spastic muscles in patients with TBI-associated pDoC. Methods: Ten patients with pDoC and upper limb spasticity and ten healthy controls received a single session of rPWT (2.5 Bar, 2000 shots) to the biceps brachii. Assessments were conducted at four time points: pre-intervention (Pre), immediately after intervention (Post), 2 days, and 7 days after intervention. Evaluation included the Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), muscle hardness (via handheld hardness meter), and muscle elasticity (via ultrasound elastography). Changes over time and between-group differences were evaluated. For preliminary subgroup analysis, patients were divided into Good Responders and Poor Responders based on the change from Pre- to Post-intervention to determine factors affecting responsiveness. Results: MAS remained unchanged, while MTS (R1) scores improved immediately after rPWT in 9 of 10 patients. However, no sustained improvement was observed on Day 7. Patients in Good Responders tended to have higher baseline muscle hardness, higher muscle elasticity, and lower MTS (R1) values. Conclusion: rPWT resulted in an immediate, though transient changes in spastic muscle symptoms of patients with pDoC. Our preliminary analyses demonstrated the possibility that greater baseline muscle stiffness might influence responsiveness. These findings would be considered when designing protocols to evaluate the efficacy of rPWT for spasticity in patients with TBI-related pDoC.