title: Dry needling for the treatment of poststroke muscle spasticity: a prospective case report.
abstract: BACKGROUND
  Spasticity is a common symptom that can be detrimental to the quality of life and daily function of patients with stroke.
  
  
  OBJECTIVE
  To introduce the use of dry needling (DN) as a novel method for the treatment of affected upper limb spasticity in a patient with chronic ischemic stroke who was admitted at the Stroke Physiotherapy Clinic.
  
  
  METHODS
  The pronator teres (PT), flexor carpi radialis (FCR), and flexor carpi ulnaris (FCU) on the affected side were needled. The patient received deep DN for 1 session, and the duration of needling for each muscle was 1 minute. The main outcomes were the Modified Modified Ashworth Scale (MMAS) muscle spasticity score, and the Hmax/Mmax ratio which were measured before (T0), immediately after (T1), and 15 minutes after the end of needling (T2).
  
  
  RESULTS
  The case was a 53-year-old man with a 13-year history of right hemiparesis poststroke. After DN, the spasticity scores improved and maintained as indicated in the MMAS grades (PT 3 to 2, finger flexors 1 to 0) and the Hmax/Mmax ratio (0.39, 0. 29, and 0.32 at T0, T1, and T2, respectively). The patient was able to voluntarily extend the wrist and fingers slightly after DN. The upper limb Brunnstrom recovery stage (3 to 4) and hand function (2 to 3) improved and maintained. The passive supination increased at T1 (75°) and T2 (50°) compared to T0 (38°).
  
  
  CONCLUSIONS
  This prospective case report presents dry needling as a novel method in neurorehabilitation for the treatment of poststroke spasticity. Further research is recommended.
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Noureddin Nakhostin
authors.initials: NN
authors.lastname: Ansari
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Soofia
authors.initials: S
authors.lastname: Naghdi
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Zahra
authors.initials: Z
authors.lastname: Fakhari
authors.affiliation: Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hojjat
authors.initials: H
authors.lastname: Radinmehr
authors.affiliation: Department of Physical Therapy, Georgia Regents University, Augusta, GA, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Hasson
mesh_terms: D026881:Acupuncture / Q000379:methods*; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy*; D018482:Muscle, Skeletal / Q000503:physiopathology*; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000503:physiopathology*
keywords: H-reflex; Stroke; dry needling; spasticity