Effectiveness of shock waves in the local treatment of muscle hypertonia (spasticity and dystonia), in patients with cerebral palsy.

Pathological muscle hypertonia, which includes the better-known terms of spasticity and dystonia, is one of the biggest problems in people affected by Cerebral Palsy (CP). Radial shock wave treatment (rESWT), also called pressure waves, represents a relatively new alternative to conventional treatments for muscle hypertonia and has been established in recent years as a non-invasive option with few side effects for at your disposal

Executive Summary
This is a quasi-experimental study where the response to the shock wave intervention will be evaluated before and after the treatment. The treatment consists of 3 sessions of shock waves with a time interval of 1 week between each session in the selected muscles. The intervention will be carried out by two physiotherapists from the entity. Quantitative and qualitative aspects will be assessed.

Context and Justification
Pathological muscle hypertonia, which includes the better-known terms of spasticity and dystonia, is one of the biggest problems in people affected by Cerebral Palsy (CP). Radial shock wave treatment (rESWT), also called pressure waves, represents a relatively new alternative to conventional treatments for muscle hypertonia and has been established in recent years as a non-invasive option with few side effects for at your disposal

General Objective
The aim of the research is to assess the effectiveness of shock wave treatment in reducing local hypertension in patients with cerebral palsy in improving the person's clinical and functioning aspects.

Specific Objectives

• Check the relationship between the physiological improvement of spasticity and the person's functional improvement
• To evaluate the influence of the independent variables of sex, age, type of PC, GMFCS and CI on the treatment results.
• Assess the achievement of goals previously agreed upon by the patient or the family and the professional through standardized measures.
• Assess the effect of the treatment on subjective and/or emotional aspects (beliefs, expectations...) perceived by the patient/family in relation to the treatment with radial shock waves

The study will be carried out at the Centre Integral Montjuïc, located at C/ Tres Pins 31-35 in Barcelona. The Aspace Catalunya Foundation is a non-profit organization founded in 1961, declared a "social benefit" association in 1964 and considered of public utility in 1968. The objectives of this organization have always been to promote services for research, diagnosis, rehabilitation and education of people with cerebral palsy or other neurodevelopmental injuries, as well as their families. It was a pioneer in Spain in the treatment of patients with brain damage, mainly congenital, and especially in CP.

Once the candidates to participate are selected by the rehabilitation doctors, meet the eligibility criteria and sign the informed consent, basic data will be collected: age, sex, type of PC, description according to the guidelines of the European Registry of the PC using GMFCS, MACs, CFCS, and intelligence quotient (IQ).

The treatment consists of 3 sessions of shock waves with a time interval of 1 week between each session in the selected muscles. The intervention will be carried out by two physiotherapists from the entity

Our baseline values ​​will be taken just before the first shock wave session (V0); target values ​​will be taken just after the third shock wave treatment session (V1) is finished; subsequently, a reassessment will be carried out 3 months (V2) from the time when the base values ​​were taken and at 6 months (V3).

At the four times when the quantitative data is collected, a semi-structured survey will be given to the patient or family member in order to collect the subjective and emotional aspects associated with the treatment for their subsequent qualitative analysis.

Most people with CP have spasticity as the most common motor disorder, followed by mixed type and dystonic-athetotic. Spasticity, in association with the rest of the motor phenomena, can produce pain, contractures and bone deformities. The increase in tone makes difficult the tasks of the caregivers, the maintenance of the posture in the wheelchair, walking, the appropriate use of orthoses and involves a high energy expenditure during movement. In children, it hinders the longitudinal growth of the muscle, with the consequent risk of retraction. Occasionally, spasticity can be functionally useful, which must be taken into account when establishing therapeutic goals.

Extracorporeal shock waves (ESWT) have proven valuable for the treatment of various musculoskeletal and neurological pathologies. ESWTs involve a sequence of unique sonic pulses, with high peaks of maximum pressure, rapid pressure rise and short duration that converge through a generator and reach the designated area, producing an effective treatment. Several studies have shown the favorable effect of ESWT in the treatment of spasticity in patients affected by cerebral palsy, multiple sclerosis, traumatic brain injury and stroke.