APPLICATION OF SHOCK WAVE THERAPY IN NEUROREHABILITATION (LITERATURE REVIEW)
Authors: Bakaliuk T. G. , Gordiychuk I. B. , Stelmakh H. O. , Makarchuk N. R. , Stoliarchuk V. M. 
Published: April 2022

The review presents current literature data on the use of shock wave therapy (SWT) in neurorehabilitation. In recent years, the development of this method is progressing. The uniqueness of the method lies in the wide and safe range of its capabilities used in various fields of medicine, including the rehabilitation of neurological diseases. It is indicated that SWT works by emitting acoustic waves (shock waves) that carry energy and can propagate through tissues, focus on a given area of the body, exerting a precisely directed therapeutic effect, without damaging other tissues of the body. It has been noted that shock waves can generate interstitial and extracellular responses, causing many beneficial effects such as pain relief, vascularization, protein biosynthesis, cell proliferation, neuro- and chondroprotection, and destruction of calcium deposits in musculoskeletal structures. The combination of these effects can lead to tissue regeneration and significant pain relief, improving functional outcomes in damaged structures. Given these facts, SWT demonstrates great potential as a useful method of regenerative medicine for the treatment of various pathologies. It is emphasized that the modern concept of tissue regeneration is closely related to neoangiogenesis. This is a new interpretation of the therapeutic effect and opens new horizons for the use of SWT, in addition to traditional orthopedic applications. In recent years, SWT has been shown to be a safe and effective method of reducing muscle spasticity. Possible mechanisms include nitric oxide formation, decreased excitability of motor neurons, induction of neuromuscular dysfunction, and direct effects on rheological properties. It has also been investigated that SWT can affect neuromuscular junctions, causing degeneration and a decrease in acetylcholine receptors, which in turn causes a significant reduction in maximal muscle action potential. A large number of clinical studies evaluating the effect of SWT on muscle spasticity in patients after stroke have shown that the use of SWT helps reduce pain, improve muscle strength, stimulate revascularization and neurogenesis. Also, the use of SWT improves motor function, reduces pain and restores functional independence in patients with post-stroke spasticity. Decreased muscle tone was also observed in children with cerebral palsy. Radial SWT reduces pain and muscle tone in patients with multiple sclerosis without side effects. SWT has been used also to treat carpal tunnel syndrome as a new and non-invasive method. It is noted that during the experimental study it was found that under the influence of SWT is the regeneration of neurons by accelerating the elimination of the damaged axon, increasing the proliferation of Schwann cells and increasing the regeneration of axons. It is emphasized that the mechanism of SWT in pinching neuropathy has not been fully studied, but two main effects, such as anti-inflammatory and neuronal regeneration effect, are potential recovery mechanisms in this pathology. SWT can be successfully used in neurological diseases to relieve pain, spastic and tunnel syndromes, inflammatory processes and to improve overall functional status. Potential new uses for SWT include spasticity, neuropathic changes, and other neurological disorders. Due to its non-invasive approach, lack of major side effects, recurrence, good tolerability and compliance with patients, SWT offers new rehabilitation perspectives in neurology.