Effect of rESWT Session Frequency on Spasticity and Function Assessed by Sonoelastography in Children With Cerebral Palsy

Inclusion Criteria: * Children aged 6-14 years diagnosed with cerebral palsy according to the Rosenbaum diagnostic criteria. * Gross Motor Function Classification System (GMFCS) level I, II, or III. * Modified Ashworth Scale (MAS) score \>1 and ≤3 in unilateral or bilateral ankle plantar flexor muscle groups. * Presence of a spastic gait pattern characterized by a dynamic component of ankle equinus. Exclusion Criteria: * Age younger than 6 years or older than 14 years. * Botulinum toxin type A injection or extracorporeal shock wave therapy (ESWT) within 6 months prior to enrollment. * Fixed contracture with passive joint range of motion (ROM) \<5° in the affected extremity, or significant bone or joint deformity. * History of orthopedic surgery (tendon release or transfer, tenotomy, muscle release surgery, arthrodesis) involving the affected extremity. * Cognitive or behavioral disorders that would prevent participation in the intervention or assessments. * Uncontrolled systemic disease or significant comorbid conditions. * History of neurosurgical intervention (e.g., selective dorsal rhizotomy, neurectomy). * Presence of significant dystonia or severe movement disorder in the extremity to be evaluated. * Presence of contraindications for ESWT application in the treatment area, including open skin lesions, skin infection, signs of active inflammation, or history of malignancy; bleeding diathesis, use of anticoagulant therapy, or circulatory problems due to vascular pathology.