Publications

Background: Many non-pharmacological interventions have been proposed for spasticity modulation in spastic stroke subjects. Objective: To investigate the immediate effect of dry needling (DN), electrical stimulation (ES), and dry needling with intramuscular electrical stimulation (DN+IMES) on H-reflex in post-stroke spasticity. Methods: Spastic subjects with stroke (N = 90) (55–85 years) were evaluated after 1 month of stroke onset using Modified Ashworth Scale (MAS) score ≥1. Subjects were randomly allocated to receive one session of DN – Soleus (N = 30), ES – posterior lateral side of the leg with 100 Hz and 250 μs pulse width (N = 30), or DN+IMES – Soleus (N = 30). MAS, H-reflex, maximum latency, H-amplitude, M-amplitude and H/M ratio, were recorded before and after one session of intervention. Relationships for each variable within group or the difference among groups were calculated by effect size. Results: Significant decrease in H/M ratio in Gastrocnemius and Soleus at post-treatment within DN group (P = .024 and P = .029, respectively), large effect size (d = 0.07 and 0.62, respectively); and DN+IMES group (P = .042 and P = .001, respectively), large effect size (d = 0.69 and 0.71, respectively). No significant differences in all variables at pre-treatment and post-treatment was recorded among ES, DN, and DN+IMES groups. Significant decrease in MAS was recorded at posttreatment compared to pre-treatment within ES group (P = .002), DN group (P = .0001), and DN +IMES group (P = .0001), but not significant (P > .05) among three groups at pre treatment (P = .194) and post-treatment (P = .485). Conclusions: Single session of DN, ES, and the DN+IMES can significantly modulate post-stroke spasticity by possible bottom-up regulation mechanisms.