Efficacy of Dry Needling in Enhancing Hand Function and Reducing Spasticity in MCA Stroke Patients: A Prospective Case Report

Saloni Ram Bachan; Ramana K; Vignesh Srinivasan; Prathap Suganthirababu

doi:10.52756/ijerr.2024.v42.014

Authors

Saloni Ram Bachan Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India-602105 https://orcid.org/0009-0000-8507-011X
Ramana K Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India-602105 https://orcid.org/0000-0003-2332-2187
Vignesh Srinivasan Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India-602105 https://orcid.org/0000-0003-3378-4334
Prathap Suganthirababu Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Science, Chennai, Tamil Nadu, India-602105 https://orcid.org/0000-0002-1419-266X

DOI:

https://doi.org/10.52756/ijerr.2024.v42.014

Keywords:

Dry needling, hand function, Middle cerebral artery stroke, Modified Ashworth Scale, spasticity, task-oriented training

Abstract

Stroke, particularly involving the middle cerebral artery (MCA), often leads to persistent disability, significantly impairing hand function and inducing severe spasticity in the forearm flexors due to complex motor pathway involvement. This case report evaluates the effectiveness of combining dry needling therapy (DNT) with task-oriented training (TOT) in reducing spasticity and improving hand function in a post-MCA stroke patient. A 61-year-old male with right-side hemiplegia following a left MCA stroke, compounded by a history of diabetes, hypertension, and recent kidney stone diagnosis, participated in this study. The patient experienced severe functional limitations due to spasticity (grade 3 on the Modified Ashworth Scale) and scored 31 on the CAHAI-13, indicating significant hand dysfunction. DNT was applied to key forearm muscles (flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, flexor digitorum profundus, and pronator teres), followed by TOT targeting daily tasks. Post-intervention, the patient demonstrated significant improvements: spasticity was reduced (Modified Ashworth Scale score decreased from grade 3 to grade 2), and muscle hypertonicity, as measured by EMG, was reduced in all targeted muscles. Functional hand use improved markedly, with the CAHAI-13 score increasing from 31 to 45. These improvements led to enhanced independence in daily activities. This case report highlights the clinical relevance of integrating DNT with TOT in stroke rehabilitation. The combined intervention not only reduced spasticity and improved neuromuscular function but also led to meaningful gains in hand function, enhancing the patient’s ability to perform daily activities independently. Given the promising results, this combined approach could serve as a practical and effective strategy for improving motor recovery and functional independence in post-stroke patients. Further studies with larger sample sizes are necessary to confirm these findings and explore the broader application of this approach in clinical practice.

References

Abdelaziz, W., Abdelmajeed, S., Elhabashy, H., & Abdelmegeed, M. (2023). Electromyographic Activity of Posterior Oblique Sling Muscles During Gait in Subjects with Chronic Non-Specific Low Back Pain versus Healthy Controls. Muscles, Ligaments & Tendons Journal (MLTJ), 13(1). https://doi.org/10.32098/mltj.01.2023.17

Akhtar, T., Amjad, A., Zafar, A., Khan, E., Azfar, H., & Humayoon, N. (2024). Effects of Task-Oriented and Strength Training on Upper Limb Recovery in Hemiplegic Stroke Patients: Task-Oriented Training and Strength Training on Upper Limb Recovery in Hemiplegic Stroke. Allied Medical Research Journal, 2(1), 26-35. https://doi.org/10.59564/amrj/02.01/005

Alashram, A.R., Padua, E., Romagnoli, C., & Annino, G. (2019). Effectiveness of focal muscle vibration on hemiplegic upper extremity spasticity in individuals with stroke: A systematic review. NeuroRehabilitation, 45(4), 471-481. https://doi.org/10.3233/NRE-192863.

Aliasgharpour, F., Honarpishe, R., Hosseini-Asl, S.H., Khonji, M.S., Abbaschian, F., Ansari, N.N., Naghdi, S., Gallego, P.H., & Nakhostin-Ansari, A. (2024). Effects of dry needling on spasticity and motor function in paralympic athletes: a study protocol for a randomised controlled trial. BMJ Open Sport & Exercise Medicine, 10(2). https://doi.org/10.1136/bmjsem-2024-002096.

Analan, P.D., & Ozdemir, H. (2020). Assessment of Post-Stroke Biceps Brachialis Muscle Stiffness by Shear-Wave Elastography: a Pilot Study. Muscles, Ligaments & Tendons Journal (MLTJ), 10(3). https://doi.org/10.32098/mltj.03.2020.26.

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. NeuroRehabilitation, 36(1), 61-5. https://doi.org/10.3233/NRE-141192.

Asgari, M.R., Dehvan, F., Samaei, A., Binesh, M., Rahaei, F., & Soleimani, M. (2024). Upper extremity motor function and hand muscular power in patients with stroke: A pilot study. Koomesh, 19(2), 438-47.

Babazadeh-Zavieh, S.S., Ansari, N.N., Ghotbi, N., Naghdi, S., Haeri, S.M., & Shaw, B.S. (2022). Effects of dry needling and exercise therapy on post-stroke spasticity and motor function–protocol of randomized clinical trial. Contemporary Clinical Trials Communications, 28, 100921. https://doi.org/10.1016/j.conctc.2022.100921.

Calvo, S., Brandín-de, la Cruz, N., Jiménez-Sánchez, C., Bravo-Esteban, E., & Herrero, P. Effects of dry needling on function, hypertonia and quality of life in chronic stroke: a randomized clinical trial. Acupuncture in Medicine, 40(4), 312-21. https://doi.org/10.1 177/09645284211056347.

Chacon-Barba, J.C., Moral-Munoz, J.A., De Miguel-Rubio, A., & Lucena-Anton, D. (2024). Effects of Resistance Training on Spasticity in People with Stroke: A Systematic Review. Brain Sciences, 14(1), 57. https://doi.org/10.3390/brainsci14010057.

Choobsaz, H., Ghotbi, N., & Ansari, N.N. (2024). Effects of dry needling on spasticity, cortical excitability, and range of motion in a patient with multiple sclerosis: a case report. Journal of Medical Case Reports, 18(1), 125. https://doi.org/10.1186/s13256-024-04452-z.

Cuenca, Z.J.N., Calvo, S., Bravo-Esteban, E., Oliva, R.P., Santi-Cano, M.J., & Herrero, P. (2021). Effectiveness of dry needling for upper extremity spasticity, quality of life and function in subacute phase stroke patients. Acupuncture in Medicine, 39(4), 299-308. https://doi.org/10.1177/0964528420947426.

Feigin, V.L., Stark, B.A., Johnson, C.O., Roth, G.A., Bisignano, C., & Abady, G.G. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet Neurology, 20(10), 795-820. https://doi.org/10.1016/S1474-4422(21)00252-0.

Johnson, D., Harris, J., Stratford, P., & Richardson, J. (2017). Inter-rater reliability of the Chedoke arm and hand activity inventory. NeuroRehabilitation, 40(2), 201-9. https://doi.org/10.3233/NRE-161405.

Liao, L.Y., Xu, P.D., Fang, X.Q., Wang, Q.H., Tao, Y., Cheng, H., & Gao, C.Y. (2023). Prevalence and clinical predictors of spasticity after intracerebral hemorrhage. Brain and Behavior, 13(3). https://doi.org/10.1002/brb3.2906.

Luque-Moreno, C., Granja-Domínguez, A., Moral-Munoz, J.A., Izquierdo-Ayuso, G., Lucena-Anton, D., & Heredia-Rizo, A.M. (2020). Effectiveness of dry needling versus placebo on gait performance, spasticity, electromyographic activity, pain, range-of-movement and quality of life in patients with multiple sclerosis: a randomized controlled trial protocol. Brain Sciences, 10(12), 997. https://doi.org/10.3390/brainsci10120997.

Naghdi, S., Ansari, N.N., Mansouri, K., Asgari, A., Olyaei, G.R., & Kazemnejad, A. (2008). Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity after stroke. Electromyography and Clinical Neurophysiology, 48, 35-41.

Nogles, T.E., & Galuska, M.A. (2023). Middle cerebral artery stroke. InStatPearls [Internet]. StatPearls Publishing.

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. Journal of Stroke and Cerebrovascular Diseases, 29(11), 105236. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105236.

Ramanathan, K., & Alhalaiqa, F. (2024). Assessing the Impact of Real-Time Visual Feedback during Treadmill Training on Walking Improvement in Stroke Patients. Int. J. Exp. Res. Rev., 39, 180-189. https://doi.org/10.52756/ijerr.2024.v39spl.014.

Rodríguez-Fernández, A., Lobo-Prat, J., Font-Llagunes, J.M. (2021). Systematic review on wearable lower-limb exoskeletons for gait training in neuromuscular impairments. J. Neuroeng. Rehabil., 18, 22. https://doi.org/10.1186/s12984-021-00815-5

Srilakshmi, A.S., PG, M.K., PV, H.H., Sundaram, S., Subramanian, T.A., Alkhob, S.A., & Gaowgzeh, R.A. (2024). Comparison between Task-Oriented Training and Proprioceptive Neuromuscular Facilitation Exercise on Upper Extremity Function in Spastic Cerebral Palsy. Int. J. Exp. Res. Rev., 39, 109-117. https://doi.org/10.52756/ijerr.2024.v39spl.008.

Suputtitada, A., Chatromyen, S., Chen, C.P., & Simpson, D.M. (2024). Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review. Toxins, 16(2), 98. https://doi.org/10.3390/toxins16020098.

Tedeschi, R. (2023). Unveiling the Potential of Trigger Point Therapy: Exploring its Efficacy in Managing Muscular Spasticity–A Scoping Review. MLTJ Muscles, Ligaments and Tendons Journal, 13(4), 564-573. https://doi.org/10.32098/mltj.04.2023.07.

Thant, A.A., Wanpen, S., Nualnetr, N., Puntumetakul, R., Chatchawan, U., & Hla, K.M. (2019). Effects of task-oriented training on upper extremity functional performance in patients with sub-acute stroke: a randomized controlled trial. Journal of Physical Therapy Science, 31(1), 82-87. https://doi.org/10.1589/jpts.31.82.

Tilborg, N.A., de Groot, V., & Meskers, C.G. (2024). The effectiveness of early interventions for post-stroke spasticity: a systematic review. Disability and Rehabilitation, 21, 1-2. https://doi.org/10.1080/09638288.2024.2363963.

Wang, H., Wang, L., Xiang, Y., Zhao, N., Li, X., Chen, S., Lin, C., & Li, G. (2017). Assessment of elbow spasticity with surface electromyography and mechanomyography based on support vector machine. IEEE, In 2017, 39th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), pp. 3860-3863. https://doi.org/10.1109/EMBC.2017.8037699.