Clinical Research Directory

Underwater exercise was conducted five times per week for 12 weeks. Each session took place for 60 minutes in a therapy pool with water temperatures between 33-35°С. The water depth ranged from chest deep to waist deep, depending on the functional level and progress of each participant. Sessions were structured into five parts. Each session began with 10 minutes of warm-up consisting of water walking with support, slow water marching, and body awareness exercises using aquatic foam noodles. After the warm-up, patients spent 15 minutes practicing neuromotor control in buoyancy. The goals of this portion were to reduce co-contraction of muscles and increase ability to have selective motor control.

Group B received a Targeted Neuromodulatory Shockwave Protocol (TNMSP). The protocol involves the combined application of extracorporeal shockwave therapy (ESWT) and the targeted immediate functional activation. The rationale behind the treatment is the concept that spasticity reduction achieved through the use of ESWT would facilitate enhanced motor learning and promote the emergence of normal motor patterns. The intervention was lasted for 12 weeks and involved 1 ESWT and 2 functional activation sessions weekly. The ESWT component of the protocol was selected to maximize the neuromodulatory potential by promoting plasticity within the central nervous system and to consolidate the motor patterns introduced during the functional activation