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.
Abdullahi,A., Truijen,S., Saeys,W. (2020) Neurobiology of recovery of motor function after stroke: the central nervous system biomarker effects of constraint-induced movement therapy, Neural Plasticity2020, 9484298. https://doi.org/10.1155/2020/9484298
Ansari,N. N., Naghdi,S. (2007) The effect of Bobath approach on the excitability of the spinal alpha motor neurones in stroke patients with muscle spasticity, Electromyogr Clin Neurophysiol47(1), 29–36.
4.
Ansari,N. N., Naghdi,S., Fakhari,Z., Radinmehr,H., Hasson,S. (2015) Dry needling for the treatment of poststroke muscle spasticity: a prospective case report, NeuroRehabilitation36(1), 61–65. https://doi.org/10.3233/NRE-141192
5.
Ansari,N. N., Naghdi,S., Hasson,S., Fakhari,Z., Mashayekhi,M., Herasi,M. (2009) Assessing the reliability of the Modified Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia, NeuroRehabilitation25(4), 235–240.
6.
Ansari,N. N., Naghdi,S., Moammeri,H., Jalaie,S. (2006) Ashworth Scales are unreliable for the assessment of muscle spasticity, Physiother Theory Pract22(3), 119–125. https://doi.org/10.1080/09593980600724188
7.
Asadi,B., Fard,K. R., Ansari,N. N., Marco,Á., Calvo,S., Herrero,P. (2023) The effect of dry needling in chronic stroke with a complex network approach: a case study, Clin EEG Neuros54(2), 179–188. https://doi.org/10.1177/15500594221120136
8.
Babazadeh-ZaviehS. S., AnsariN. N., GhotbiN., NaghdiS., HaeriS. M. J., KhanmohammadiM., MansooriK. (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 Ther2(3), 100–109. https://doi.org/10.37349/ent.2022.00021
9.
Babazadeh-ZaviehS. S., AnsariN. N., GhotbiN., NaghdiS., HaeriS. M. J., ShawB. S., ShawI. (2022) Effects of dry needling and exercise therapy on post-stroke spasticity and motor function–protocol of randomized clinical trial, Contemp Clin Trials Commun28, 100921. https://doi.org/10.1016/j.conctc.2022.100921
10.
Babazadeh-ZaviehS. S., AnsariN. N., GhotbiN., NaghdiS., MansouriK., KhanmohammadiM., HaeriS. M. J. (2022) Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: A case report, Complement Ther Clin Pract46, 101520. https://doi.org/10.1016/j.ctc2021.101520
11.
Banky,M., Ryan,H. K., Clark,R., Olver,J., Williams,G. (2017) Do clinical tests of spasticity accurately reflect muscle function during walking: a systematic review, Brain Inj31(4), 440–455. https://doi.org/10.1080/02699052.2016.1271455
12.
Calvo,S., Brandín-dela Cruz, N., Jimenez-Sánchez,C., Bravo-Esteban,E., Herrero,P. (2022) Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial, Acupunct Med40(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 med55(6), 754–760. https://doi.org/10.23736/S1973-9087.19.05545-X
14.
Choy,J., Pourkazemi,F., Anderson,C., Bogaardt,H. (2023) Dosages of swallowing exercises in stroke rehabilitation: a systematic review, Eur Arch Otorhinolaryngol280(3), 1017–1045. https://doi.org/10.1007/s00405-022-07735-7
15.
De Jong,L. D., Dijkstra,P. U., Stewart,R. E., Postema,K. (2012) Repeated measurements of arm joint passive range of motion after stroke: interobserver reliability and sources of variation, Phys Ther92(8), 1027–1035. https://doi.org/10.2522/ptj.20110280
16.
Dietz,V., Sinkjaer,T. (2007) Spastic movement disorder: impaired reflex function and altered muscle mechanics, Lancet Neurol6(8), 725–733. https://doi.org/10.1016/S1474-4422(07)70193-X
17.
Fakhari,Z., Ansari,N. N., Naghdi,S., Mansouri,K., Radinmehr,H. (2017) A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke, NeuroRehabilitation40(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 Neurol22(12), 1160–1206. https://doi.org/10.1016/S1474-4422(23)00277-6
19.
Fernández-de-Las-Peñas,C., Pérez-Bellmunt,A., Llurda-Almuzara,L., Plaza-Manzano,G., 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 Med22(1), 131–141. https://doi.org/10.1093/pm/pnaa392
20.
Fernández,D., Pujol,C., Ruber,C., Calvo,S., Levin,M. F., Herrero,P., Gómez-Trullén,E. M. (2022) Economics of dry needling and botulinum toxin type A for treatment of post-stroke spasticity: a review, Explor Neuroprot Ther2(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 Psychiatry81(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 pain15(2), 55–60. https://doi.org/10.1300/J094v15n02_09
23.
Ghannadi,S., Shariat,A., Ansari,N. N., Tavakol,Z., Honarpishe,R., Dommerholt,J., Noormohammadpour,P., Ingle,L. (2020) The effect of dry needling on lower limb dysfunction in poststroke survivors, J Stroke Cerebrovasc Dis29(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 Repair16(3), 232–240. https://doi.org/10.1177/154596802401105171
25.
Han,P., Zhang,W., Kang,L., Ma,Y., Fu,L., Jia,L., Yu,H., Chen,X., Hou,L., Wang,L. (2017) Clinical Evidence of Exercise Benefits for Stroke, Adv Exp Med Biol1000, 131–151. https://doi.org/10.1007/978-981-10-4304-8_9
26.
Hernández-Ortíz,A. R., Ponce-Luceno,R., Sáez-Sánchez,C., García-Sánchez,O., Fernández-de-Las-Peñas,C., 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 Med21(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, Neurology30(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 Neurol12, 668923. https://doi.org/10.3389/fneur.2021.668923
29.
Lieber,R. L., Steinman,S., Barash,I. A., Chambers,H. (2004) Structural and functional changes in spastic skeletal muscle, Muscle Nerve29(5), 615–627. https://doi.org/10.1002/mus.20059
30.
Lu,Z., Briley,A., Zhou,P., Li,S. (2020) Are there trigger points in the spastic muscles? Electromyographical evidence of dry needling effects on spastic finger flexors in chronic stroke, Front Neurol11, 78. https://doi.org/10.3389/fneur.2020.00078
31.
Mangold,S., Schuster,C., Keller,T., Zimmermann-Schlatter,A., Ettlin,T. (2009) Motor training of upper extremity with functional electrical stimulation in early stroke rehabilitation, Neurorehabil Neural Repair23(2), 184–190. https://doi.org/10.1177/1545968308324548
32.
Middel,B., van Sonderen,E. (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 Care2, 15. https://doi.org/10.5334/ijic.65
33.
Mohammadpour,F., Ali Oghabian,M., Nakhostin Ansari,N., Naghdi,S., Dommerholt,J. (2021) Effects of dry needling on post-stroke brain activity and muscle spasticity of the upper limb: a case report, Acupunct Med39(1), 69–71. https://doi.org/10.1177/0964528420920294
34.
NaghdiS., AnsariN. N., MansouriK. (2008) Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity, Electromyogr Clin Neurophysiol48(1), 35–41.
35.
NaghdiS., AnsariN. N., MansouriK., OlyaeiG. R., AsgariA., KazemnejadA. (2008) The correlation between Modified Ashworth Scale scores and the new index of alpha motoneurones excitability in post-stroke patients, Electromyogr Clin Neurophysiol48(2), 109–115.
36.
NaghdiS., AnsariN. N., AzarniaS., KazemnejadA. (2008) Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity, Physiother Theory Pract24(5), 372–379. https://doi.org/10.1080/09593980802278959
37.
Nakhostin Ansari,N., Hasheminasab-Zavareh,F. S., Naghdi,S., Dommerholt,J.(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,N., Naghdi,S., Forogh,B.Hasson,S., Atashband,M., Lashgari,E. (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 Rehabil34(21), 1843–1847. https://doi.org/10.3109/09638288.2012.665133
39.
Núñez-Cortés,R., Cruz-Montecinos,C., Latorre-García,R., Pérez-Alenda,S., Torres-Castro,R. (2020) Effectiveness of dry needling in the management of spasticity in patients post stroke, J Stroke Cerebrovasc Dis29(11), 105236. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105236
40.
Pollock,A., Farmer,S. E., Brady,M. C., Langhorne,P., Mead,G. E., Mehrholz,J., van Wijck,F. (2014) Interventions for improving upper limb function after stroke, Cochrane Database Sys Rev2014(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., DaiS., FordE. S., Fox, C. S., Fullerton,H. J., Gillespie,C., 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,A., Matchar.D. B., Moy,C. S., Mozaffarian,D., Mussolino,M. E., Nichol,G., Paynter,N. P., Soliman,E. Z., Sorlie,P. D., Sotoodehnia,N., Turan,T. N., Virani,S. S., Wong,N. D., Woo,D., 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, Circulation125(1), 220. https://doi.org/10.1161/CIR.0b013e31823ac046.
42.
Ryu,J., Cooney,W. P.,
3rdAskew,L. J., An,K. N., Chao,E. Y. (1991) Functional ranges of motion of the wrist joint, J Hand Surg Am16(3), 409–419. https://doi.org/10.1016/0363-5023(91)90006-w
43.
Salom-Moreno,J., Sánchez-Mila,Z., Ortega-Santiago,R., Palacios-Ceña,M., Truyol-Domínguez,S., Fernández-de-las-Peñas,C. (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 Ther37(8), 569–579. https://doi.org/10.1016/j.jmpt.2014.06.003
44.
Sánchez-Mila,Z., Salom-Moreno,J., Fernández-de-Las-Peñas,C. (2018) Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial, Acupunct Med36(6), 358–366. https://doi.org/10.1136/acupmed-2017-011568
45.
Smania,N., Picelli,A., Munari,D., Geroin,C., Ianes,P., Waldner,A., Gandolfi,M. (2010) Rehabilitation procedures in the management of spasticity, Eur J Phys Rehabil Med46(3), 423–438.
46.
Taub,E., Uswatte,G., Mark,V. W., Morris,D. M. (2006) The learned nonuse phenomenon: implications for rehabilitation, Eura Medicophys42(3), 241–256.
47.
Tavakol,Z., Shariat,A., Ansari,N. N., Ghannadi,S., Honarpishe,R., Dommerholt,J., Noormohammadpour,P., Ingle,L. (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,T., Uebele,M., Marx,J. J., Vogt,T., Stoeter,P., Bauermann,T., Weibrich,C., Vucurevic,G. D., Schneider,A. (2010) Occurence and clinical predictors of spasticity after ischemic stroke, Stroke41(9), 2016–2020. https://doi.org/10.1161/STROKEAHA.110.581991
49.
Valencia-Chulian,R., Heredia-Rizo,A. M., Moral-Munoz,J. A., Lucena-Anton,D., Luque-Moreno,C. (2020) Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: A systematic review, Complement Ther Med52, 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 Rev13(1), 70–77. https://doi.org/10.1002/mrdd.20139
51.
Xia,W., Dai,R., Xu,X., Huai,B., Bai,Z., Zhang,J., Jin,M., Niu,W. (2022) Cortical mapping of active and passive upper limb training in stroke patients and healthy people: A functional near-infrared spectroscopy study, Brain Res1788, 147935. https://doi.org/10.1016/j.brainres.2022.147935
52.
Yozbatiran,N., Der-Yeghiaian,L., Cramer,S. C. (2008) A standardized approach to performing the action research arm test, Neurorehabil Neural Repair22(1), 78–90. https://doi.org/10.1016/10.1177/1545968307305353
