FlexWave Trial: Efficacy of Extracorporeal Shock Wave Therapy in Post-Stroke Upper Limb Spasticity

Inclusion Criteria: * Individuals aged 18 years or older with unilateral cerebral stroke. * Wrist and finger flexor muscle tone with a score greater than 1 on the Modified Ashworth Scale. * Stable medical condition and vital signs. * Conscious and able to comply with instructions. Exclusion Criteria: * History of more than one stroke, traumatic brain injury, or cerebral neoplasm. * Coexisting central nervous system disorders (e.g., spinal cord injury, Parkinson's disease) or other musculoskeletal diseases affecting muscle tone assessment. * Contraindications for shockwave intervention, such as malignancies, coagulopathies, local infections, or use of cardiac pacemakers. * Undergone shockwave therapy or botulinum toxin injections for post-stroke spasticity in the past three months. * Cognitive, consciousness, or language impairments preventing participation in the intervention or functional assessments.