{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T17:42:27Z","timestamp":1793727747441,"version":"4.6.1"},"reference-count":61,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:00:00Z","timestamp":1767744000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["NeuroRehabilitation"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post-stroke spasticity (PSS) arises from central neural hyperexcitability and maladaptive muscle architectural changes that impair motor function. Interventions targeting both mechanisms is essential to support adaptive neural reorganization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate the combined effects of extracorporeal shockwave therapy (ESWT) and a neuroplasticity-based training protocol (NBTP) on lower limb spasticity, muscle architecture, and motor function in stroke patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This was a sham-controlled, double-blind, randomized controlled trial. Fifty-four patients with post-stroke spasticity (PSS) were randomly assigned to receive either ESWT combined with a NBTP, or to sham ESWT with NBTP . Participants received six weekly sessions of ESWT (1,500 shocks at 5\u2005Hz, 0.10\u2005mJ\/mm\n                      <jats:sup>2<\/jats:sup>\n                      ) targeting the gastrocnemius muscle, alongside a 12-week NBTP comprising mirror therapy, resistance and aerobic training, motor imagery, and task-specific activities. Outcome assessments were conducted at baseline, 6\n                      <jats:sup>th<\/jats:sup>\n                      week, and 12\n                      <jats:sup>th<\/jats:sup>\n                      week using the Modified Ashworth Scale (MAS), passive range of motion (PROM), and the Fugl-Meyer Assessment\u2013Lower Extremity (FMA-LE). Ultrasonographic evaluations included measurements of muscle thickness (MT), muscle fascicle length (MFL), and pennation angle (PA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      At the 12th week, the experimental group showed significantly greater improvements than controls in MAS (MD\u2009=\u20090.88;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), PROM (MD\u2009=\u2009\u22126.72;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and FMA-LE (MD\u2009=\u2009\u22121.55;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). RMI also improved moderatly (MD\u2009=\u2009\u22121.04;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.03). Ultrasonographic parameters improved in both groups, with a significant difference observed only in PA and MT (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ESWT combined with NBTP yielded superior functional and structural outcomes compared with NBTP, supporting this integrative approach as a clinically relevant post-stroke intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      Trial was submitted on\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"http:\/\/clinicaltrials.gov\">http:\/\/clinicaltrials.gov<\/jats:ext-link>\n                      (registration no. NCT05405140).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10538135251403026","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T18:04:44Z","timestamp":1767809084000},"page":"154-172","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Effects of Extracorporeal Shockwave Therapy Combined with Neuroplasticity-Based Training Protocol on Lower Limb Spasticity in Stroke Patients: A Randomized Controlled Trial with Ultrasonography Evaluation"],"prefix":"10.1177","volume":"58","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0009-9624","authenticated-orcid":false,"given":"Binash","family":"Afzal","sequence":"first","affiliation":[{"name":"Faculty of Rehabilitation and Allied Health Sciences, Riphah internation university, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabiya","family":"Noor","sequence":"additional","affiliation":[{"name":"Faculty of Rehabilitation and Allied Health Sciences, Riphah internation university, Lahore, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alia A","family":"Alghwiri","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, The University of Jordan, Amman, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aqsa","family":"Umar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,7]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.639732"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/00207454.2023.2271164"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s42466-021-00108-1"},{"key":"e_1_3_3_5_1","doi-asserted-by":"publisher","DOI":"10.1159\/000460503"},{"key":"e_1_3_3_6_1","doi-asserted-by":"publisher","DOI":"10.1123\/japa.2023-0283"},{"key":"e_1_3_3_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006199-200503000-00007"},{"key":"e_1_3_3_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rehab.2020.03.005"},{"key":"e_1_3_3_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(20)30141-1"},{"key":"e_1_3_3_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/10749357.2019.1654242"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-158-3-201302050-00583"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/10749357.2017.1399527"},{"key":"e_1_3_3_13_1","doi-asserted-by":"publisher","DOI":"10.15406\/mojap.2018.05.00181"},{"issue":"6","key":"e_1_3_3_14_1","first-page":"754","article-title":"Responsiveness and minimal clinically important difference of Modified Ashworth Scale' in patients with stroke","volume":"55","author":"Chen C. 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