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Spasticity/ParesisPhase 3NCT06128616

Efficacy of Extracorporeal Shock Wave Therapy in Children With Cerebral Palsy

A Phase 3 study testing ESWT, Botulinum Toxin Type A and Serial Casting in people with Spasticity/Paresis and Cerebral Palsy, run by Kocaeli University.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Spastic plantar and palmar flexion deformities are very common in children with cerebral palsy (CP). These deformities usually involve spasticity of the plantar or palmar muscle complexes, weakness of the antagonist dorsiflexor muscles of the ankle or wrist, and also involve soft tissue/muscle contractures and require… Read more about this study

Who is it for?
Ages 3 to 17 years
Conditions the study is for
Spasticity/Paresis, Cerebral Palsy
What is being tested?
ESWT, Botulinum Toxin Type A and Serial Casting
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
No sites listed yet
Study dates
Nov 2023to Sep 2024
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 3 to 17 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Having a diagnosis of CP according to Rosenbaum criteria, presenting plantar or palmar flexion deformity, having a Modified Ashworth Scale score of 3 in plantar or palmar flexor muscle groups, being scheduled for BoNT-A treatment, intermittent serial casting and physical or occupational therapy

Who cannot join

  • Having cognitive dysfunction, having a history of orthopedic surgery, presenting significant dystonia, having vascular disease, fracture, or dislocation

Trial locations and contacts

No sites are listed yet.

Nigar Dursun, MD contact

90 5334322568

nigard@hotmail.com

Tugba Gokbel, MD contact

905442877390

tugbagokbelftr@gmail.com

About this study

Official title: Efficacy of Extracorporeal Shock Wave Therapy Integrated to Combined Treatment of Botulinum Toxin A and Serial Casting in Children With Cerebral Palsy

Spastic plantar and palmar flexion deformities are very common in children with cerebral palsy (CP). These deformities usually involve spasticity of the plantar or palmar muscle complexes, weakness of the antagonist dorsiflexor muscles of the ankle or wrist, and also involve soft tissue/muscle contractures and require a multimodal treatment approach. Physical therapy (PT), occupational therapy (OT), serial casting (SC), and botulinum toxin A (BoNT-A) injections had shown positive results in both of these deformities. Recent systematic reviews and meta-analyses showed that extracorporeal shock wave therapy (ESWT) is effective in reducing spasticity, pain intensity, and increasing range of motion and motor function when combined with PT or BoNT-A injections in neurological conditions like stroke, CP, multiple sclerosis. ESWT can be a complimentary therapy to obtain an earlier efficacy, better efficacy, a sustained effect for a longer period, and less adverse events. The objective of this study was to show the effects of ESWT when combined with intermittent SC, BoNT-A injections and PT or OT on spasticity, passive range of motion (pROM) of children with CP having spastic equinus foot deformity or wrist palmar flexion deformity.

Read the detailed description

Spasticity is one of the most common motor disorder which may slowly cause soft tissue contractures in children with CP. Spastic plantar and palmar flexion deformities are very common in children with CP. These deformities usually involve spasticity of the plantar or palmar muscle complexes, weakness of the antagonist dorsiflexor muscles of the ankle or wrist, and also involve soft tissue/muscle contractures. PT, OT, SC, and BoNT-A injections had shown positive results in both of these deformities. Skin irritation or breakdown, painful episodes, oedema, tendonitis, weakness, stiffness are some of the side effects reported after SC. Moreover casting especially when prolonged might complicate activities of daily living for instance by increasing the risk of falls or causing problems in bathing. Recent evidence from literature favors early, goal oriented, activity based, intensive, repetitive motor trainings in enriched environments to optimize neuroplasticity in children with CP. Prolonged SC might also interfere with these activity based, intensive rehabilitation options for upper extremity. In order to overcome the issues with patient compliance, side effects and combined treatment options an intermittent SC model was developed and used both for children with CP presenting equines foot deformity or palmar flexion deformity. Combined management of intermittent SC, and BoNT-A injections had shown better results compared to either treatment alone in both of these deformities. Recent systematic reviews and meta-analyses showed that ESWT is effective in reducing spasticity, pain intensity, and increasing range of motion and motor function when combined with PT or BoNT-A injections in neurological conditions like stroke, CP, multiple sclerosis. ESWT can be a complementary therapy to obtain an earlier efficacy, better efficacy, a sustained effect for a longer period, and less adverse events.

The objective of this study was to show the effects of ESWT when combined with intermittent SC, BoNT-A injections and PT or OT on spasticity, passive range of motion (pROM) of children with CP having spastic equinus foot deformity or wrist palmar flexion deformity.

Being tested
ESWT, Botulinum Toxin Type A, Serial Casting, Physical Therapy, Occupational Therapy
Keywords
Spasticity, Cerebral Palsy, Botulinum toxin A, Extracorporeal Shock Wave Therapy, Casting
Medical subject headings
Muscle Spasticity, Paresis, Cerebral Palsy

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • ESWTDevice

    Extracorporeal Shock Wave Therapy

  • Botulinum Toxin Type ADrug

    Also called Botox

    Botulinum Toxin Type A

  • Serial CastingOther

    Serial Casting

  • Physical TherapyBehavioural

    Physical Therapy

  • Occupational TherapyBehavioural

    Occupational Therapy

Study groups in NCT06128616
Study groupRoleWhat they receive
ESWT GroupExperimentalPatients treated by BoNT-A, intermittent SC and ESWT, whom received either PT or OT
Receives: Device: ESWT; Drug: Botulinum Toxin Type A; Other: Serial Casting; Behavioral: Physical Therapy; Behavioral: Occupational Therapy
Control GroupActive comparatorPatients treated by BoNT-A, and intermittent SC, whom received either PT or OT
Receives: Drug: Botulinum Toxin Type A; Other: Serial Casting; Behavioral: Physical Therapy; Behavioral: Occupational Therapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Mean change from baseline Tardieu XV3 angle

    Spasticity measurement

    Measured: Post-treatment weeks 4-6

  2. Mean change from baseline passive range of movement

    Soft tissue contracture measurement

    Measured: Post-treatment weeks 12-20

Secondary outcomes (2)
  1. Goal Attainment Scale-Light

    Attainment of treatment goals 5 point scale ranging from -2 to 2, higher score representing better outcome

    Measured: Post-treatment weeks 4-12-20

  2. Faces Pain Scale

    Assessment of pain by a visual 6 point scale ranging from 0 to 10, 0 representing no pain, 10 representing most excruciating pain

    Measured: Post-treatment weeks 4-12-20

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted13 Nov 2023
  2. Study startNov 2023 (estimated)
  3. Primary completionJun 2024 (estimated)
  4. Study completionSep 2024 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
40 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06128616
Sponsor's protocol ID
KAEK/16.bI.06
Status last verified
Nov 2023
First submitted
8 Nov 2023
Last updated
18 Nov 2023
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Carranza-Del Rio J, Dursun N, Cekmece C, Bonikowski M, Pyrzanowska W, Dabrowski E, Tilton A, Oleszek J, Volteau M, Page S, Shierk A, Delgado MR. Goal Attainment after Treatment with Abobotulinumtoxina and a Tailored Home Therapy Programme in Children with Upper Limb Spasticity: Descriptive, Exploratory Analysis of a Large Randomized, Controlled Study. J Rehabil Med. 2022 Dec 9;54:jrm00349. doi: 10.2340/jrm.v54.2540.

    PubMed 36306168
  • Dursun N, Gokbel T, Akarsu M, Bonikowski M, Pyrzanowska W, Dursun E. Intermittent serial casting for wrist flexion deformity in children with spastic cerebral palsy: a randomized controlled trial. Dev Med Child Neurol. 2021 Jun;63(6):743-747. doi: 10.1111/dmcn.14765. Epub 2021 Jan 22.

    PubMed 33483965
  • Delgado MR, Tilton A, Carranza-Del Rio J, Dursun N, Bonikowski M, Aydin R, Maciag-Tymecka I, Oleszek J, Dabrowski E, Grandoulier AS, Picaut P; Dysport in PUL study group. Efficacy and safety of abobotulinumtoxinA for upper limb spasticity in children with cerebral palsy: a randomized repeat-treatment study. Dev Med Child Neurol. 2021 May;63(5):592-600. doi: 10.1111/dmcn.14733. Epub 2020 Nov 18.

    PubMed 33206382
  • Dursun N, Gokbel T, Akarsu M, Dursun E. Randomized Controlled Trial on Effectiveness of Intermittent Serial Casting on Spastic Equinus Foot in Children with Cerebral Palsy After Botulinum Toxin-A Treatment. Am J Phys Med Rehabil. 2017 Apr;96(4):221-225. doi: 10.1097/PHM.0000000000000627.

    PubMed 27631386
  • Delgado MR, Tilton A, Russman B, Benavides O, Bonikowski M, Carranza J, Dabrowski E, Dursun N, Gormley M, Jozwiak M, Matthews D, Maciag-Tymecka I, Unlu E, Pham E, Tse A, Picaut P. AbobotulinumtoxinA for Equinus Foot Deformity in Cerebral Palsy: A Randomized Controlled Trial. Pediatrics. 2016 Feb;137(2):e20152830. doi: 10.1542/peds.2015-2830. Epub 2016 Jan 26.

    PubMed 26812925
  • Dursun N, Bonikowski M, Dabrowski E, Matthews D, Gormley M, Tilton A, Carranza J, Grandoulier AS, Picaut P, Delgado MR. Efficacy of Repeat AbobotulinumtoxinA (Dysport(R)) Injections in Improving Gait in Children with Spastic Cerebral Palsy. Dev Neurorehabil. 2020 Aug;23(6):368-374. doi: 10.1080/17518423.2019.1687602. Epub 2019 Nov 6.

    PubMed 31691605
  • Chang MC, Choo YJ, Kwak SG, Nam K, Kim SY, Lee HJ, Kwak S. Effectiveness of Extracorporeal Shockwave Therapy on Controlling Spasticity in Cerebral Palsy Patients: A Meta-Analysis of Timing of Outcome Measurement. Children (Basel). 2023 Feb 9;10(2):332. doi: 10.3390/children10020332.

    PubMed 36832460
  • Mihai EE, Popescu MN, Iliescu AN, Berteanu M. A systematic review on extracorporeal shock wave therapy and botulinum toxin for spasticity treatment: a comparison on efficacy. Eur J Phys Rehabil Med. 2022 Aug;58(4):565-574. doi: 10.23736/S1973-9087.22.07136-2. Epub 2022 Apr 12.

    PubMed 35412036
  • Kwon DR, Kwon DG. Botulinum Toxin a Injection Combined with Radial Extracorporeal Shock Wave Therapy in Children with Spastic Cerebral Palsy: Shear Wave Sonoelastographic Findings in the Medial Gastrocnemius Muscle, Preliminary Study. Children (Basel). 2021 Nov 17;8(11):1059. doi: 10.3390/children8111059.

    PubMed 34828772

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing ESWT, Botulinum Toxin Type A and Serial Casting in people with Spasticity/Paresis and Cerebral Palsy, run by Kocaeli University.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: status not confirmed, as of the sponsor's last update on 18 Nov 2023. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

How can a doctor refer a patient or contact the research team?

Contact Nigar Dursun, MD (90 5334322568, nigard@hotmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Mean change from baseline Tardieu XV3 angle (time frame: Post-treatment weeks 4-6). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06128616, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Nov 2023.

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