We are going to change it up this week and take a quick departure from our "No Mess Up Monday" series and write about something different. It seems that in almost every class I teach, someone will ask about dry needling for spasticity associated with stroke. My short answer has always been that you may see a temporary change, but because the spasticity is centrally mediated, it will likely return. I’ve seen some decent short-term success over the years with stroke, but it has mostly been temporary. I'm pretty sure the image below is not what happens when we needle someone with stroke. But...low level laser??
As part of the PhD program I’m enrolled in, I recently had to write a short research article synthesis, and I chose this topic.
Tip:
Did you know William Carey University has a DPT to PhD program? You can find out more about that here.
As we say in the military: Bottom Line Up Front (BLUF)
"The implications of this study's findings could provide another tool in the physical therapist’s toolbelt in treating stroke patients with spasticity, which provides generalizability across the physical therapy profession. Even with the small sample size and lack of randomization, the authors were able to offer promising results on the benefits of performing dry needling to muscles with spasticity or increased tone in the post-stroke population."
If you feel froggy, you can read my whole synthesis below and you can click on the references to check out the articles.
Research Article Synthesis
Dry needling is a treatment typically performed by a physical therapist, and the procedure consistently rose in popularity over the past ten years (Dunning et al., 2014). The most common indication to perform dry needling is musculoskeletal pain (Dunning et al., 2014). However, multiple neurological conditions create musculoskeletal pathologies such as muscular spasticity or increased muscular tone. According to Fakhari et al. (2017), spasticity is often a result of upper motor neuron pathologies like a cerebral vascular accident or stroke. In the field of physical therapy, there are various treatment techniques to address spasticity associated with stroke, and there are multiple procedures to treat musculoskeletal pain, such as dry needling. The purpose of this study was to analyze the effects of a dry needling treatment on post-stroke spasticity of hemiparetic wrist flexor musculature (Fakhari et al., 2017).
The theoretical framework the authors utilize to base their study proposes that dry needling reduces spasticity in hemiparetic wrist flexors (Fakhari et al., 2017). The population sample recruited for participation in this study included 29 patients in total with a mean age of 54 years old and a mean time post-stroke of 36.8 months (Fakhari et al., 2017). The instrumentation used to determine primary and secondary outcomes included the Modified Modified Ashworth Scale (MMAS), passive resistance force (PRF), wrist extension active range of motion (AROM), wrist extension passive range of motion (PROM), Box and Block Test (BBT), and EMG analysis of H-reflex, H-max, and M-max (Fakhari et al., 2017). The authors report that the MMAS, PRF, and the BBT are reliable and valid measures to assess wrist flexor spasticity following a stroke, wrist flexor resistance following a stroke, and hand dexterity following a stroke, respectively (Fakhari et al., 2017). The research design implemented by the authors is a “single group, pretest/posttest clinical trial with repeated measurements to evaluate the effects of deep DN on post-stroke wrist flexor spasticity” (Fakhari et al., 2017, p.326). Fakhari et al. state that statistical analysis via SPSS Statistics for Windows is the software utilized for calculation (2017). Specific statistical analyses performed include: mean and median calculation of patient characteristics and outcome variables, a Kolmogorov-Smirnov test to ensure normal distribution of quantitative data, an ANOVA to test treatment effect on outcome measures with time, a Bonferroni Adjustment Test to assess multiple comparisons, a non-parametric Friedman’s Test for variables that deviated from normality, a Wilcoxon Signed Ranks Test for comparison of multiple variables at different times, effect size calculation using Cohen’s d statistic, and Pearson’s correlation coefficient assessed outcome variable relationships (Fakhari et al., 2017).
The authors were able to demonstrate one session of dry needling to wrist flexor muscles improved spasticity and excitability of alpha motor neurons in patients with stroke (Fakhari et al., 2017). Possible limitations to this study include a lack of long-term follow-up and a lack of a control group or placebo treatment such as sham dry needling (Fakhari et al., 2017). Through the results of the study, the authors were able to recommend a single session of dry needling to improve wrist flexor spasticity and improve the excitability of alpha motor neurons along with demonstrating these improvements lasted one-hour after the intervention. (Fakhari et al., 2017). The authors did not report any bias or state any conflicts of interest.
Conclusion
The implications of this study's findings could provide another tool in the physical therapist’s toolbelt in treating stroke patients with spasticity, which provides generalizability across the physical therapy profession. Even with the small sample size and lack of randomization, the authors were able to offer promising results on the benefits of performing dry needling to muscles with spasticity or increased tone in the post-stroke population.
References
Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S., & Perreault, T. (2014). Dry needling: A literature review with implications for clinical practice guidelines. Physical Therapy Reviews, 19(4), 252–265. https://doi.org/10.1179/108331913x13844245102034
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. NeuroRehabilitation, 40(3), 325–336. https://doi.org/10.3233/nre-161420