{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T14:34:09Z","timestamp":1781620449283,"version":"3.54.5"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Spasticity is a common complication in patients with neurological disorders, increasing disability and hampering quality of life. Combined treatment with focused shock waves (fESWT) and botulinum toxin (BoNT-A) has been shown to increase the effectiveness and duration of the effect of BoNT-A on spasticity in patients with brain injuries. We studied the effectiveness of the combination of unfocused shock waves (uESWT) and BoNT-A on spasticity. This prospective study with systematic randomization included 24 patients with brain injury, a small sample size due to clinical limitations, and spasticity was measured using the Ashworth scale (AS) for those with lower limb involvement; gait speed was assessed using the 10-m gait test (10MWT). To judge patient satisfaction with treatment, we used the Consumer Reports Effectiveness Scale-4 (CRES-4). Both uESWT and fESWT with BoNT-A resulted in a 3-point improvement in the median spasticity score, which was maintained from week 2 to week 26, and a statistically significant reduction in the 10MWT was observed. Furthermore, the proportion of patients who were very satisfied with the treatment was higher with uESWT (91%) than with fESWT (69.2%). To the authors\u2019 knowledge, this is the first study to evaluate the added benefit of concurrent and combined treatment with uESWT and BoNT-A injections to improve spasticity in patients with stroke or multiple sclerosis and show higher patient satisfaction with the treatment.<\/jats:p>","DOI":"10.3390\/toxins17050209","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T20:11:48Z","timestamp":1745352708000},"page":"209","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effectiveness of Unfocused vs. Focal Shock Waves Combined with Botulinum Toxin on Spasticity in Brain-Damaged Patients"],"prefix":"10.3390","volume":"17","author":[{"given":"Antonio","family":"D\u00e9niz","sequence":"first","affiliation":[{"name":"Neurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negr\u00edn, 35010 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1681-7165","authenticated-orcid":false,"given":"Pedro","family":"Saavedra","sequence":"additional","affiliation":[{"name":"Department of Mathematics, University of Las Palmas de Gran Canaria, 35017 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Marrero","sequence":"additional","affiliation":[{"name":"Physiology, Department of Biochemistry and Molecular Biology, University of Las Palmas de Gran Canaria, 35016 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Barrera","sequence":"additional","affiliation":[{"name":"Neurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negr\u00edn, 35010 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ra\u00fal","family":"Dom\u00ednguez","sequence":"additional","affiliation":[{"name":"Neurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negr\u00edn, 35010 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ra\u00fal","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Neurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negr\u00edn, 35010 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Neurorehabilitation, Rehabilitation Service of the University Hospital of Gran Canaria Dr. Negr\u00edn, 35010 Las Palmas, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Yang, E., Lew, H.L., \u00d6z\u00e7akar, L., and Wu, C.H. 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