Shota Itoh

BACKGROUND: Radial extracorporeal shock wave therapy (rESWT) improves lower-limb spasticity after stroke. However, the efficacy of rESWT in individuals with hemiparetic stroke in the subacute phase, in whom neural components of spasticity are thought to predominate, has not been sufficiently investigated. In addition, the effects of different numbers of stimulations on the magnitude and duration of spasticity improvement remain unclear. OBJECTIVE: We aim to explore the effects of different numbers of stimulations during a single rESWT session on lower-limb spasticity in individuals with subacute stroke and assess the feasibility and safety of the evaluation and treatment procedures for future large-scale trials. METHODS: This single-center, open-label pilot randomized controlled trial will enroll 24 individuals with subacute stroke and spasticity who will be randomly assigned to either the rESWT 3000- or 6000-stimulation group for 1 treatment at the triceps surae muscle, with stimulation applied at 3 locations: the medial and lateral heads of the gastrocnemius muscle and the triceps surae muscle-Achilles tendon junction. The stimulation intensity will be the maximum intensity tolerated by the individual (≤3.0 bar), with a 10-Hz fixed frequency. Evaluations will be performed the day before treatment; immediately before and after completion of treatment; at 1 and 8 hours after treatment; and at 1, 2, 3, 5, 7, and 14 days after treatment. The primary clinical outcome is the intergroup difference in the Modified Ashworth Scale score of the triceps surae immediately after completion of treatment. Secondary clinical outcomes include intergroup differences in Modified Ashworth Scale scores at 1 and 8 hours and on days 1, 2, 3, 5, 7, and 14 after treatment, as well as intragroup differences from baseline to each evaluation point. Additional measures include the range of motion, angle of catch, tendon reflexes, and clonus scores. Feasibility will be assessed using the recruitment, enrollment, adherence, and retention rates. Safety will be assessed by recording the occurrence of serious and treatment-related adverse events. RESULTS: This study was approved by the Fujita Health University Institutional Review Board on September 26, 2024 (CR24-033). Participant enrollment commenced on November 19, 2024. By November 25, 2025, a total of 14 participants had been enrolled. Data analysis has not commenced, and the results will be reported in a separate article in 2026. CONCLUSIONS: This exploratory dose comparison pilot study is designed to explore whether the number of stimulations delivered during a single rESWT session influences the extent of short-term improvement in spasticity following subacute hemiparetic stroke and obtain preliminary clinical outcomes and feasibility and safety data for future large-scale trials. TRIAL REGISTRATION: Japan Registry of Clinical Trials jRCTs042240098; https://jrct.mhlw.go.jp/en-latest-detail/jRCTs042240098. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/88443.

Abstract We aimed to evaluate the applicability of a newly developed joint angle measurement system comprising six-axis inertial measurement unit sensors and tablet-based application for estimating joint angles from angular velocity and acceleration data. The application calculated orientation angles from single sensor data, with relative angles calculated using multiple sensors. In experiment 1, validity and reliability were examined using a test device. In experiment 2, static angles of five joints were calculated in four healthy participants using attached sensors and compared with universal goniometer values. In experiment 3, usability and satisfaction were evaluated using the System Usability Scale (SUS) and Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)-like scale. In experiment 1, mean difference and root mean squared error (RMSE) between the developed system and test device were < 0.2° and < 1.0°, respectively, across all axes. In experiment 2, when data from all joints were pooled, mean difference and RMSE were 0.2° and 3.8°, respectively. Mean difference and RMSE across each joint were < 5°, indicating the system is comparable to universal goniometer. In experiment 3, median SUS and QUEST-like scores were 73.8 and 4.0, respectively, indicating good usability and satisfaction. The developed system has high accuracy and sufficient validity for human joint angles, with good usability and satisfaction.

Objective To determine the effects of repetitive peripheral magnetic stimulation in a patient with chronic stroke. Design Case report. Patients A man in his 70s presented with left hemiplegia secondary to cerebral hemorrhage. Methods An AB design was used: phase A (sham stimulation) and phase B (active stimulation). Magnetic stimulation was applied using a peripheral magnetic stimulator (Pathleader™, IFG, Sendai, Japan). Outcomes were assessed at four points: before the intervention, after phase A, after phase B, and at follow-up (3 weeks after phase B) using the Modified Ashworth Scale, range of motion, Fugl-Meyer Assessment, Simple Test for Evaluating Hand Function, and Canadian Occupational Performance Measures. Results The Modified Ashworth Scale score for the wrist extensor remained unchanged in phase A but improved after phase B and was sustained at follow-up. The range of motion showed no change. The Fugl-Meyer Assessment scores were 40, 41, 44, and 45, respectively, and the Simple Test for Evaluating Hand Function scores were 1, 4, 3, and 5, respectively, at the four time points. One Canadian Occupational Performance Measure item improved after phase B and remained stable. Conclusion In patients with chronic stroke and severe hemiplegia, repetitive peripheral magnetic stimulation may be effective in reducing spasticity and improving motor function.