Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients

Abstract

BACKGROUND:

The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain.

OBJECTIVE:

To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke.

METHODS:

Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment.

RESULTS:

A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point.

CONCLUSION:

The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Keywords

Stroke dry needling exercise therapy spasticity motor neuron excitability

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References

Abdullahi,

, Truijen,

, Saeys,

(2020) Neurobiology of recovery of motor function after stroke: the central nervous system biomarker effects of constraint-induced movement therapy, Neural Plasticity 2020, 9484298. https://doi.org/10.1155/2020/9484298

Adamson,

, Beswick,

, Ebrahim,

(2004) Is stroke the most common cause of disability? J Stroke and Cerebrovasc Dis 171–177. https://doi.org/10.1016/j.jstrokecerebrovasdis.2004.06.003

Ansari,

N. N.

, Naghdi,

(2007) The effect of Bobath approach on the excitability of the spinal alpha motor neurones in stroke patients with muscle spasticity, Electromyogr Clin Neurophysiol 47(1), 29–36.

Ansari,

N. N.

, Naghdi,

, Fakhari,

, Radinmehr,

, Hasson,

(2015) Dry needling for the treatment of poststroke muscle spasticity: a prospective case report, NeuroRehabilitation 36(1), 61–65. https://doi.org/10.3233/NRE-141192

Ansari,

N. N.

, Naghdi,

, Hasson,

, Fakhari,

, Mashayekhi,

, Herasi,

(2009) Assessing the reliability of the Modified Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia, NeuroRehabilitation 25(4), 235–240.

Ansari,

N. N.

, Naghdi,

, Moammeri,

, Jalaie,

(2006) Ashworth Scales are unreliable for the assessment of muscle spasticity, Physiother Theory Pract 22(3), 119–125. https://doi.org/10.1080/09593980600724188

Asadi,

, Fard,

K. R.

, Ansari,

N. N.

, Marco,

Á.

, Calvo,

, Herrero,

(2023) The effect of dry needling in chronic stroke with a complex network approach: a case study, Clin EEG Neuros 54(2), 179–188. https://doi.org/10.1177/15500594221120136

Babazadeh-Zavieh

S. S.

, Ansari

N. N.

, Ghotbi

, Naghdi

, Haeri

S. M. J.

, Khanmohammadi

, Mansoori

(2022) Combined effects of dry needling and exercise therapy on muscle spasticity and motor function in chronic stroke: A pretest-posttest pilot study, Explor Neuroprot Ther 2(3), 100–109. https://doi.org/10.37349/ent.2022.00021

Babazadeh-Zavieh

S. S.

, Ansari

N. N.

, Ghotbi

, Naghdi

, Haeri

S. M. J.

, Shaw

B. S.

, Shaw

(2022) Effects of dry needling and exercise therapy on post-stroke spasticity and motor function–protocol of randomized clinical trial, Contemp Clin Trials Commun 28, 100921. https://doi.org/10.1016/j.conctc.2022.100921

10.

Babazadeh-Zavieh

S. S.

, Ansari

N. N.

, Ghotbi

, Naghdi

, Mansouri

, Khanmohammadi

, Haeri

S. M. J.

(2022) Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: A case report, Complement Ther Clin Pract 46, 101520. https://doi.org/10.1016/j.ctc2021.101520

11.

Banky,

, Ryan,

H. K.

, Clark,

, Olver,

, Williams,

(2017) Do clinical tests of spasticity accurately reflect muscle function during walking: a systematic review, Brain Inj 31(4), 440–455. https://doi.org/10.1080/02699052.2016.1271455

12.

Calvo,

, Brandín-dela Cruz,

, Jimenez-Sánchez,

, Bravo-Esteban,

, Herrero,

(2022) Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial, Acupunct Med 40(4), 312–321. https://doi.org/10.1177/09645284211056347

13.

Chen,

C. L.

, Chen,

C. Y.

, Chen,

H. C.

, Wu,

C. Y.

, Lin,

K. C.

, Hsieh,

Y. W.

, Shen,

I. H.

(2019) Responsiveness and minimal clinically important difference of Modified Ashworth Scale in patients with stroke, Eur J Phys Rehabil med 55(6), 754–760. https://doi.org/10.23736/S1973-9087.19.05545-X

14.

Choy,

, Pourkazemi,

, Anderson,

, Bogaardt,

(2023) Dosages of swallowing exercises in stroke rehabilitation: a systematic review, Eur Arch Otorhinolaryngol 280(3), 1017–1045. https://doi.org/10.1007/s00405-022-07735-7

15.

De Jong,

L. D.

, Dijkstra,

P. U.

, Stewart,

R. E.

, Postema,

(2012) Repeated measurements of arm joint passive range of motion after stroke: interobserver reliability and sources of variation, Phys Ther 92(8), 1027–1035. https://doi.org/10.2522/ptj.20110280

16.

Dietz,

, Sinkjaer,

(2007) Spastic movement disorder: impaired reflex function and altered muscle mechanics, Lancet Neurol 6(8), 725–733. https://doi.org/10.1016/S1474-4422(07)70193-X

17.

Fakhari,

, Ansari,

N. N.

, Naghdi,

, Mansouri,

, Radinmehr,

(2017) A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke, NeuroRehabilitation 40(3), 325–336. https://doi.org/10.3233/NRE-161420

18.

Feigin,

V. L.

, Owolabi,

M. O.

, World Stroke Organization–Lancet Neurology Commission Stroke Collaboration Grou (2023) Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization–Lancet Neurology Commission, Lancet Neurol 22(12), 1160–1206. https://doi.org/10.1016/S1474-4422(23)00277-6

19.

Fernández-de-Las-Peñas,

, Pérez-Bellmunt,

, Llurda-Almuzara,

, Plaza-Manzano,

, De-la-Llave-Rincón,

A. I.

, Navarro-Santana,

M. J.

(2021) Is dry needling effective for the management of spasticity, pain, and motor function in post-stroke patients? A systematic review and meta-analysis, Pain Med 22(1), 131–141. https://doi.org/10.1093/pm/pnaa392

20.

Fernández,

, Pujol,

, Ruber,

, Calvo,

, Levin,

M. F.

, Herrero,

, Gómez-Trullén,

E. M.

(2022) Economics of dry needling and botulinum toxin type A for treatment of post-stroke spasticity: a review, Explor Neuroprot Ther 2(3), 131–140. https://doi.org/10.37349/ent.2022.00024

21.

Fleuren,

J. F. M.

, Voerman,

G. E.

, Erren-Wolters,

C. V.

, Snoek,

G. J.

, Rietman,

J. S.

, Hermens,

H. J.

, Nene,

A. V.

(2010) Stop using the Ashworth Scale for the assessment of spasticity, J Neurol Neurosurg Psychiatry 81(1), 46–52. https://doi.org/10.1136/jnn2009.177071

22.

Gallego,

P. H.

, del Moral,

O. M.

(2007) A case study looking at the effectiveness of deep dry needling for the management of hypertonia, J Musculoskelet pain 15(2), 55–60. https://doi.org/10.1300/J094v15n02_09

23.

Ghannadi,

, Shariat,

, Ansari,

N. N.

, Tavakol,

, Honarpishe,

, Dommerholt,

, Noormohammadpour,

, Ingle,

(2020) The effect of dry needling on lower limb dysfunction in poststroke survivors, J Stroke Cerebrovasc Dis 29(6), 104814. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104814

24.

Gladstone,

D. J.

, Danells,

C. J.

, Black,

S. E.

(2002) The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties, Neurorehabil Neural Repair 16(3), 232–240. https://doi.org/10.1177/154596802401105171

25.

Han,

, Zhang,

, Kang,

, Ma,

, Fu,

, Jia,

, Yu,

, Chen,

, Hou,

, Wang,

(2017) Clinical Evidence of Exercise Benefits for Stroke, Adv Exp Med Biol 1000, 131–151. https://doi.org/10.1007/978-981-10-4304-8_9

26.

Hernández-Ortíz,

A. R.

, Ponce-Luceno,

, Sáez-Sánchez,

, García-Sánchez,

, Fernández-de-Las-Peñas,

, de-la-Llave-Rincón,

A. I.

(2020) Changes in muscle tone, function, and pain in the chronic hemiparetic shoulder after dry needling within or outside trigger points in stroke patients: A crossover randomized clinical trial, Pain Med 21(11), 2939–2947. https://doi.org/10.1093/pm/pnaa132

27.

Lance,

J. W.

(1980) The control of muscle tone, reflexes, and movement: Robert Wartenbeg Lecture, Neurology 30(12), 1303–1313. https://doi.org/0.1212/wnl.30.12.1303

28.

Lee,

J. J.

, Shin,

J. H.

(2021) Predicting clinically significant improvement after robot-assisted upper limb rehabilitation in subacute and chronic stroke, Front Neurol 12, 668923. https://doi.org/10.3389/fneur.2021.668923

29.

Lieber,

R. L.

, Steinman,

, Barash,

I. A.

, Chambers,

(2004) Structural and functional changes in spastic skeletal muscle, Muscle Nerve 29(5), 615–627. https://doi.org/10.1002/mus.20059

30.

Lu,

, Briley,

, Zhou,

, Li,

(2020) Are there trigger points in the spastic muscles? Electromyographical evidence of dry needling effects on spastic finger flexors in chronic stroke, Front Neurol 11, 78. https://doi.org/10.3389/fneur.2020.00078

31.

Mangold,

, Schuster,

, Keller,

, Zimmermann-Schlatter,

, Ettlin,

(2009) Motor training of upper extremity with functional electrical stimulation in early stroke rehabilitation, Neurorehabil Neural Repair 23(2), 184–190. https://doi.org/10.1177/1545968308324548

32.

Middel,

, van Sonderen,

(2002) Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research.e, Int J Integr Care 2, 15. https://doi.org/10.5334/ijic.65

33.

Mohammadpour,

, Ali Oghabian,

, Nakhostin Ansari,

, Naghdi,

, Dommerholt,

(2021) Effects of dry needling on post-stroke brain activity and muscle spasticity of the upper limb: a case report, Acupunct Med 39(1), 69–71. https://doi.org/10.1177/0964528420920294

34.

Naghdi

, Ansari

N. N.

, Mansouri

(2008) Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity, Electromyogr Clin Neurophysiol 48(1), 35–41.

35.

Naghdi

, Ansari

N. N.

, Mansouri

, Olyaei

G. R.

, Asgari

, Kazemnejad

(2008) The correlation between Modified Ashworth Scale scores and the new index of alpha motoneurones excitability in post-stroke patients, Electromyogr Clin Neurophysiol 48(2), 109–115.

36.

Naghdi

, Ansari

N. N.

, Azarnia

, Kazemnejad

(2008) Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity, Physiother Theory Pract 24(5), 372–379. https://doi.org/10.1080/09593980802278959

37.

Nakhostin Ansari,

, Hasheminasab-Zavareh,

F. S.

, Naghdi,

, Dommerholt,

(2023). Effects of dry needling session frequency on wrist flexor spasticity and motor recovery after stroke: a single-blind randomized clinical trial. Physiother Theory Pract, 1-12. Online ahead of print. https://doi.org/0.1080/09593985.2023.2254827

38.

Nakhostin Ansari,

, Naghdi,

, Forogh,

Hasson,

, Atashband,

, Lashgari,

(2012) Development of the Persian version of the Modified Modified Ashworth Scale: translation, adaptation, and examination of interrater and intrarater reliability in patients with poststroke elbow flexor spasticity, Disabil Rehabil 34(21), 1843–1847. https://doi.org/10.3109/09638288.2012.665133

39.

Núñez-Cortés,

, Cruz-Montecinos,

, Latorre-García,

, Pérez-Alenda,

, Torres-Castro,

(2020) Effectiveness of dry needling in the management of spasticity in patients post stroke, J Stroke Cerebrovasc Dis 29(11), 105236. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105236

40.

Pollock,

, Farmer,

S. E.

, Brady,

M. C.

, Langhorne,

, Mead,

G. E.

, Mehrholz,

, van Wijck,

(2014) Interventions for improving upper limb function after stroke, Cochrane Database Sys Rev 2014(11), CD010820. https://doi.org/10.1002/14651858.CD010820.pub2

41.

Roger,

V. L.

, Go,

A. S.

, Lloyd-Jones,

D. M.

, Benjamin,

E. J.

, Berry,

J. D.

, Borden,

W. B.

, Bravata,

D. M.

, Dai

, Ford

E. S.

, Fox,

C. S.

, Fullerton,

H. J.

, Gillespie,

, Hailpern,

S. M.

, Heit,

J. A.

, Howard,

V. J.

, Kissela,

B. M.

, Kittner,

S. J.

, Lackland,

D. T.

, Lichtman,

J. H.

, Lisabeth,

L. D.

, Makuc,

D. M.

, Marcus,

G. M.

, Marelli,

, Matchar.

D. B.

, Moy,

C. S.

, Mozaffarian,

, Mussolino,

M. E.

, Nichol,

, Paynter,

N. P.

, Soliman,

E. Z.

, Sorlie,

P. D.

, Sotoodehnia,

, Turan,

T. N.

, Virani,

S. S.

, Wong,

N. D.

, Woo,

, Turner,

M. B.

, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. (2012) Heart disease and stroke statistics-2012 update: a report from the American Heart Association.e-e, Circulation 125(1), 220. https://doi.org/10.1161/CIR.0b013e31823ac046.

42.

Ryu,

, Cooney,

W. P.

, 3rd Askew,

L. J.

, An,

K. N.

, Chao,

E. Y.

(1991) Functional ranges of motion of the wrist joint, J Hand Surg Am 16(3), 409–419. https://doi.org/10.1016/0363-5023(91)90006-w

43.

Salom-Moreno,

, Sánchez-Mila,

, Ortega-Santiago,

, Palacios-Ceña,

, Truyol-Domínguez,

, Fernández-de-las-Peñas,

(2014) Changes in spasticity, widespread pressure pain sensitivity, and baropodometry after the application of dry needling in patients who have had a stroke: a randomized controlled trial, J manipulative Physiol Ther 37(8), 569–579. https://doi.org/10.1016/j.jmpt.2014.06.003

44.

Sánchez-Mila,

, Salom-Moreno,

, Fernández-de-Las-Peñas,

(2018) Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial, Acupunct Med 36(6), 358–366. https://doi.org/10.1136/acupmed-2017-011568

45.

Smania,

, Picelli,

, Munari,

, Geroin,

, Ianes,

, Waldner,

, Gandolfi,

(2010) Rehabilitation procedures in the management of spasticity, Eur J Phys Rehabil Med 46(3), 423–438.

46.

Taub,

, Uswatte,

, Mark,

V. W.

, Morris,

D. M.

(2006) The learned nonuse phenomenon: implications for rehabilitation, Eura Medicophys 42(3), 241–256.

47.

Tavakol,

, Shariat,

, Ansari,

N. N.

, Ghannadi,

, Honarpishe,

, Dommerholt,

, Noormohammadpour,

, Ingle,

(2020) A double-blind randomized controlled trial for the effects of dry needling on upper limb dysfunction in patients with stroke, Acupunct Electro-Ther Res45(2-3), 115–124. https://doi.org/10.3727/036012921X16112663844923

48.

Urban,

P. P.

, Wolf,

, Uebele,

, Marx,

J. J.

, Vogt,

, Stoeter,

, Bauermann,

, Weibrich,

, Vucurevic,

G. D.

, Schneider,

(2010) Occurence and clinical predictors of spasticity after ischemic stroke, Stroke 41(9), 2016–2020. https://doi.org/10.1161/STROKEAHA.110.581991

49.

Valencia-Chulian,

, Heredia-Rizo,

A. M.

, Moral-Munoz,

J. A.

, Lucena-Anton,

, Luque-Moreno,

(2020) Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review, Complement Ther Med 52, 102515. https://doi.org/10.1016/j.ctim.2020.102515

50.

Warren,

S. F.

, Fey,

M. E.

, Yoder,

P. J.

(2007) Differential treatment intensity research: A missing link to creating optimally effective communication interventions, Ment Retard Dev Disabil Res Rev 13(1), 70–77. https://doi.org/10.1002/mrdd.20139

51.

Xia,

, Dai,

, Xu,

, Huai,

, Bai,

, Zhang,

, Jin,

, Niu,

(2022) Cortical mapping of active and passive upper limb training in stroke patients and healthy people: A functional near-infrared spectroscopy study, Brain Res 1788, 147935. https://doi.org/10.1016/j.brainres.2022.147935

52.

Yozbatiran,

, Der-Yeghiaian,

, Cramer,

S. C.

(2008) A standardized approach to performing the action research arm test, Neurorehabil Neural Repair 22(1), 78–90. https://doi.org/10.1016/10.1177/1545968307305353

Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients – A randomized controlled trial

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

Get full access to this article

References