| Objective：To investigate the effectiveness of combining extracorporeal shock wave therapy (ESWT) with neuromuscular electrical stimulation (NMES) for the treatment of triceps surae spasticity in stroke patients, and to analyze the surface electromyographic characteristics of this treatment. Methods：A total of 40 patients with hemiplegia who were hospitalized from January 2022 to June 2024 were randomly assigned to NMES group and the combined group, with 20 patients in each group. Both groups received basic medication and conventional rehabilitation training, with the NMES group additionally receiving NMES of the anterior tibial muscle and the combined group receiving both NMES of the anterior tibial muscle and ESWT of the triceps surae muscle for a period of 4 weeks. Before and after the treatment, the muscle tone and motor function of lower extremities were assessed using the modified Ashworth scale (MAS ) and the Fugl-Meyer assessment lower extremities scale (FMA-LE). Besides, the active range of motion (AROM) of the ankle joint was measured. Additionally, the integrated electromyography (iEMG) and co-contraction ratio (CR) were used to analyze the electromyographic changes of the medial head of gastrocnemius and the tibialis anterior muscle. Results：There were no statistically significant differences in the MAS scores, the AROM of the ankle joint, the FMA-LE scores, the iEMG values of medial head of gastrocnemius and tibialis anterior muscle, and the CR values of ankle dorsiflexion between the two groups before treatment. After 4 weeks of treatment, the MAS score in the two groups was lower than that before treatment (P<0.05), and the MAS score in the combined group was significantly lower than that in the NMES group (P<0.01). The ankle AROM and FMA-LE scores in the two groups were higher than those before treatment (P<0.01), and those in the combined group were significantly higher than those in the NMES group (P<0.01). The iEMG of medial head of gastrocnemius in the two groups was significantly lower than that before treatment (P<0.01), the iEMG of the tibial anterior muscle was significantly higher than that before treatment (P<0.01), the iEMG of medial head of gastrocnemius in the combined group was significantly lower than that in the NMES group (P<0.05), and the iEMG of tibialis anterior muscle was significantly higher than that in the NMES group (P<0.01). Additionally, the CR values of ankle dorsiflexion were significantly decreased in both groups as compared with those before treatment (P<0.01), the CR value in the combined group was significantly lower than that in the NMES group (P<0.01). Conclusion: ESWT combined with NMES can effectively alleviate triceps surae spasticity, improve the muscle strength of tibialis anterior muscle and the AROM of the ankle joint, correct the abnormal spasticity pattern, and ultimately improve lower extremities motor function in stroke patients. |
