{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T05:27:59Z","timestamp":1786512479067,"version":"build-2736575974"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u202fdays, and 7\u202fdays 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1847848","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:41:12Z","timestamp":1786509672000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multimodal assessment of the effects of radial pressure wave therapy on spastic muscles in patients with traumatic brain injury"],"prefix":"10.3389","volume":"17","author":[{"given":"Mika","family":"Kobayashi","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo","place":["Tokyo, Japan"]},{"name":"Department of Rehabilitation Medicine, The University of Tokyo Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiko","family":"Iidaka","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The University of Tokyo Hospital","place":["Tokyo, Japan"]},{"name":"Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takemi","family":"Murayama","sequence":"additional","affiliation":[{"name":"Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims\u2019 Aid","place":["Chiba, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhi","family":"Inokuchi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, The University of Tokyo Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomohiro","family":"Yamaki","sequence":"additional","affiliation":[{"name":"Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims\u2019 Aid","place":["Chiba, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Ogata","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Graduate School of Medicine, The University of Tokyo","place":["Tokyo, Japan"]},{"name":"Department of Rehabilitation Medicine, The University of Tokyo Hospital","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1212\/WNL.30.12.1303","article-title":"The control of muscle tone, reflexes, and movement: Robert Wartenberg lecture","volume":"30","author":"Lance","year":"1980","journal-title":"Neurology"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1136\/practneurol-2011-000155","article-title":"Spasticity: pathophysiology, evaluation and management","volume":"12","author":"Kheder","year":"2012","journal-title":"Pract Neurol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1002\/mds.22995","article-title":"Spasticity treatment facilitates direct care delivery for adults with profound intellectual disability","volume":"25","author":"Charles","year":"2010","journal-title":"Mov Disord"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"449","DOI":"10.5603\/PJNNS.a2019.0067","article-title":"Prevalence and predictors of post-stroke spasticity and its impact on daily living and quality of life","volume":"53","author":"Schinwelski","year":"2019","journal-title":"Neurol Neurochir Pol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"E1","DOI":"10.1097\/HTR.0000000000000234","article-title":"Management of Spasticity in moderate and severe traumatic brain injury: evaluation of clinical practice guidelines","volume":"32","author":"Pattuwage","year":"2017","journal-title":"J Head Trauma Rehabil"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"S3","DOI":"10.4103\/2349-7904.347807","article-title":"Pathophysiology and assessment of spasticity; goal setting","volume":"5","author":"Escaldi","year":"2022","journal-title":"J Int Soc Phys Rehabil Med"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.rehab.2018.08.004","article-title":"Adjuvant treatments associated with botulinum toxin injection for managing spasticity: an overview of the literature","volume":"62","author":"Picelli","year":"2019","journal-title":"Ann Phys Rehabil Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1302\/2058-5241.5.190067","article-title":"Extracorporeal shock wave therapy: an update","volume":"5","author":"Auersperg","year":"2020","journal-title":"EFORT Open Rev"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"467","DOI":"10.26603\/001c.158527","article-title":"Radial pressure wave and focused shockwave therapy for proximal hamstring tendinopathy: the role of patient positioning, a narrative review and clinical commentary","volume":"21","author":"Arthurs","year":"2026","journal-title":"Int J Sports Phys Ther"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"26","DOI":"10.4081\/br.2020.11","article-title":"Effectiveness and tolerability of focal versus radial extracorporeal shock wave therapy in patients affected by plantar fascia enthesopathy","volume":"2","author":"Pisani","year":"2020","journal-title":"Beyond Rheumatol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"e3649","DOI":"10.1097\/MD.0000000000003649","article-title":"A prospective case-control study of radial extracorporeal shock wave therapy for spastic plantar flexor muscles in very young children with cerebral palsy","volume":"95","author":"Wang","year":"2016","journal-title":"Medicine"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1080\/09638280500404305","article-title":"A systematic review of the Tardieu scale for the measurement of spasticity","volume":"28","author":"Haugh","year":"2006","journal-title":"Disabil Rehabil"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"197","DOI":"10.3390\/toxins16040197","article-title":"Effectiveness of extracorporeal shock wave therapy after botulinum toxin injection for post-stroke upper extremity spasticity: a randomized controlled study","volume":"16","author":"Lee","year":"2024","journal-title":"Toxins"},{"key":"ref14","first-page":"423","article-title":"Rehabilitation procedures in the management of spasticity","volume":"46","author":"Smania","year":"2010","journal-title":"Eur J Phys Rehabil Med"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1016\/j.jmpt.2016.07.002","article-title":"Handheld tissue hardness meters for assessing the mechanical properties of skeletal muscle: a feasibility study","volume":"39","author":"Chino","year":"2016","journal-title":"J Manip Physiol Ther"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"2","DOI":"10.14366\/usg.18039","article-title":"Clinical utilization of shear wave elastography in the musculoskeletal system","volume":"38","author":"Davis","year":"2019","journal-title":"Ultrasonography"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"20062","DOI":"10.1038\/s41598-023-47468-z","article-title":"Detecting age-related changes in skeletal muscle mechanics using ultrasound shear wave elastography","volume":"13","author":"Ates","year":"2023","journal-title":"Sci Rep"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"8490","DOI":"10.3390\/s21248490","article-title":"Limitations of muscle ultrasound shear wave Elastography for clinical routine-positioning and muscle selection","volume":"21","author":"Romano","year":"2021","journal-title":"Sensors"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e3544","DOI":"10.1097\/MD.0000000000003544","article-title":"Effect of radial shock wave therapy on spasticity of the upper limb in patients with chronic stroke: a prospective, randomized, single blind, controlled trial","volume":"95","author":"Li","year":"2016","journal-title":"Medicine"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.1080\/02699050802530557","article-title":"The modified Tardieu scale for the measurement of elbow flexor spasticity in adult patients with hemiplegia","volume":"22","author":"Ansari","year":"2008","journal-title":"Brain Inj"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e050711","DOI":"10.1136\/bmjopen-2021-050711","article-title":"Validity and reliability of the modified Tardieu scale as a spasticity outcome measure of the upper limbs in adults with neurological conditions: a systematic review and narrative analysis","volume":"11","author":"Shu","year":"2021","journal-title":"BMJ Open"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e001394","DOI":"10.1136\/bmjopen-2012-001394","article-title":"Comparing the validity of the modified modified Ashworth scale (MMAS) and the modified Tardieu scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study","volume":"2","author":"Abolhasani","year":"2012","journal-title":"BMJ Open"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3390\/toxins15010014","article-title":"Shear wave velocity to evaluate the effect of botulinum toxin on post-stroke spasticity of the lower limb","volume":"15","author":"Hasegawa","year":"2022","journal-title":"Toxins"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3160","DOI":"10.3390\/jcm9103160","article-title":"Short-term exercise progression of cardiovascular patients throughout cardiac rehabilitation: an observational study","volume":"9","author":"De Canni\u00e8re","year":"2020","journal-title":"J Clin Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e34886","DOI":"10.1097\/MD.0000000000034886","article-title":"Electroencephalography-based parietofrontal connectivity modulated by electroacupuncture for predicting upper limb motor recovery in subacute stroke","volume":"102","author":"Li","year":"2023","journal-title":"Medicine"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1038\/sc.2015.230","article-title":"Modified Ashworth scale and spasm frequency score in spinal cord injury: reliability and correlation","volume":"54","author":"Baunsgaard","year":"2016","journal-title":"Spinal Cord"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1186\/1471-2474-9-44","article-title":"Reliability of Ashworth and modified Ashworth scales in children with spastic cerebral palsy","volume":"9","author":"Mutlu","year":"2008","journal-title":"BMC Musculoskelet Disord"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.3233\/NRE-161396","article-title":"Effect of shock wave therapy on ankle plantar flexors spasticity in stroke patients","volume":"40","author":"Sawan","year":"2017","journal-title":"NeuroRehabil"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"712512","DOI":"10.3389\/fneur.2021.712512","article-title":"Effects of radial extracorporeal shock wave therapy on flexor spasticity of the upper limb in post-stroke patients: study protocol for a randomized controlled trial","volume":"12","author":"Fan","year":"2021","journal-title":"Front Neurol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"108350","DOI":"10.1016\/j.toxicon.2025.108350","article-title":"Muscle physiology in spasticity and muscle stiffness","volume":"259","author":"Raghavan","year":"2025","journal-title":"Toxicon"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"52","DOI":"10.23736\/S1973-9087.24.08733-1","article-title":"Shear wave elastography in the assessment of gastrocnemius spastic muscle elasticity: influences of ankle position and muscle contraction","volume":"61","author":"Devis","year":"2025","journal-title":"Eur J Phys Rehabil Med"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"S90","DOI":"10.1097\/00003086-200210001-00011","article-title":"Cytoskeletal disruption after eccentric contraction-induced muscle injury","volume":"403","author":"Lieber","year":"2002","journal-title":"Clin Orthop Relat Res"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2014\/354906","article-title":"Pathophysiology of spasticity: implications for neurorehabilitation","volume":"2014","author":"Trompetto","year":"2014","journal-title":"Biomed Res Int"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"599","DOI":"10.5535\/arm.2011.35.5.599","article-title":"Spasticity and electrophysiologic changes after extracorporeal shock wave therapy on gastrocnemius","volume":"35","author":"Sohn","year":"2011","journal-title":"Ann Rehabil Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1177\/1352458514549566","article-title":"Effect of radial shock wave therapy on pain and muscle hypertonia: a double-blind study in patients with multiple sclerosis","volume":"21","author":"Marinelli","year":"2015","journal-title":"Mult Scler"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1002\/mus.25754","article-title":"Extracorporeal shock wave treatment can selectively destroy end plates in neuromuscular junctions","volume":"57","author":"Kenmoku","year":"2018","journal-title":"Muscle Nerve"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"1660","DOI":"10.1002\/jor.22111","article-title":"Degeneration and recovery of the neuromuscular junction after application of extracorporeal shock wave therapy","volume":"30","author":"Kenmoku","year":"2012","journal-title":"J Orthop Res"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1016\/j.jos.2020.07.009","article-title":"Influence of different energy patterns on efficacy of radial shock wave therapy","volume":"26","author":"Kenmoku","year":"2021","journal-title":"J Orthop Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1161\/01.STR.0000177880.06663.5c","article-title":"Long-term effect of shock wave therapy on upper limb hypertonia in patients affected by stroke","volume":"36","author":"Manganotti","year":"2005","journal-title":"Stroke"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1847848\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:41:17Z","timestamp":1786509677000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1847848\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,12]]},"references-count":39,"alternative-id":["10.3389\/fneur.2026.1847848"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1847848","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,12]]},"article-number":"1847848"}}