Frequency (percentage) of MMAS scores before and after treatment (n = 10)
MMAS
T1
T2
T3
0
0 (0)
1 (10)
2 (20)
1
3 (30)
2 (20)
1 (10)
2
2 (20)
5 (50)
4 (40)
3
4 (40)
2 (20)
3 (30)
4
1 (10)
0 (0)
0 (0)
Declarations
Acknowledgments
We would like to thank the patients who took part in this study and Dr. Minoo Kalantary (Shahid Beheshti University of Medical Sciences) for providing the ARAT.
Author contributions
SSBZ, NNA, NG, and SN contributed to the conception and design of the study. MK and KM contributed to data collection. SSBZ and NNA performed the statistical analyses. SSBZ and SMJH wrote the first draft of the manuscript that was revised by NNA and NG for important intellectual content. All authors read and approved the final submitted version.
Conflicts of interest
The authors declare that there are no conflicts of interest.
Ethical approval
This study was approved by the ethical committee of the Tehran University of Medical Sciences (IR.TUMS. FNM.REC.1399.008).
Consent to participate
The informed consent to participate in the study was obtained from all participants.
Brainin M, Norrving B, Sunnerhagen KS, Goldstein LB, Cramer SC, Donnan GA, et al.;International PSS Disability Study Group. Poststroke chronic disease management: towards improved identification and interventions for poststroke spasticity-related complications. Int J Stroke. 2011;6:42–6. [DOI] [PubMed]
Lance JW.The control of muscle tone, reflexes, and movement: Robert Wartenberg lecture. Neurology. 1980;30:1303–13. [DOI] [PubMed]
Doussoulin A, Rivas C, Bacco J, Sepúlveda P, Carvallo G, Gajardo C, et al. Prevalence of spasticity and postural patterns in the upper extremity post stroke. J Stroke Cerebrovasc Dis. 2020;29:105253. [DOI] [PubMed]
Bhakta BB.Management of spasticity in stroke. Br Med Bull. 2000;56:476–85. [DOI] [PubMed]
Ansari NN, Naghdi S, Fakhari Z, Radinmehr H, Hasson S.Dry needling for the treatment of poststroke muscle spasticity: a prospective case report. NeuroRehabilitation. 2015;36:61–5. [DOI] [PubMed]
Cuenca Zaldívar JN, Calvo S, Bravo-Esteban E, Oliva Ruiz P, Santi-Cano MJ, Herrero P.Effectiveness of dry needling for upper extremity spasticity, quality of life and function in subacute phase stroke patients. Acupunct Med. 2021;39:299–308. [DOI] [PubMed]
Fernández Sanchis D, Cuenca Zaldívar JN, Calvo S, Herrero P, Gómez Barrera M.Cost-effectiveness of upper extremity dry needling in the rehabilitation of patients with stroke. Acupunct Med. 2022;40:160–8. [DOI] [PubMed]
Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, et al. Interventions for improving upper limb function after stroke. Cochrane Database Syst Rev. 2014;2014:CD010820. [DOI] [PubMed] [PMC]
Han P, Zhang W, Kang L, Ma Y, Fu L, Jia L, et al. Clinical evidence of exercise benefits for stroke. Adv Exp Med Biol. 2017;1000:131–51. [DOI] [PubMed]
Babazadeh-Zavieh SS, Ansari NN, Ghotbi N, Naghdi S, Mansouri K, Khanmohammadi M, et al. Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: a case report. Complement Ther Clin Pract. 2022;46:101520. [DOI] [PubMed]
Abolhasani H, Ansari NN, Naghdi S, Mansouri K, Ghotbi N, Hasson S.Comparing the validity of the Modified Modified Ashworth Scale (MMAS) and the Modified Tardieu Scale (MTS) in the assessment of wrist flexor spasticity in patients with stroke: protocol for a neurophysiological study. BMJ Open.2012;2:e001394. [DOI] [PubMed] [PMC]
Ansari NN, Naghdi S, Hasson S, Fakhari Z, Mashayekhi M, Herasi M.Assessing the reliability of the Modified Modified Ashworth Scale between two physiotherapists in adult patients with hemiplegia. NeuroRehabilitation. 2009;25:235–40. [DOI] [PubMed]
Naghdi S, Ansari NN, Abolhasani H, Mansouri K, Ghotbi N, Hasson S.Electrophysiological evaluation of the Modified Tardieu Scale (MTS) in assessing poststroke wrist flexor spasticity. NeuroRehabilitation. 2014;34:177–84. [DOI] [PubMed]
Fakhari Z, Ansari NN, Naghdi S, Mansouri K, Radinmehr H.A single group, pretest-posttest clinical trial for the effects of dry needling on wrist flexors spasticity after stroke. NeuroRehabilitation. 2017;40:325–36. [DOI] [PubMed]
Elham K, Minoo K, Zahra S, Mehdi T.Inter-rater reliability of the Action Research Arm Test and the upper-limb section of Fugl-Meyer Test in adults with Cva who were resident in Qazvin, Iran. J Res Rehabil Sci. 2014;10:67–76.
McDonnell M.Action research arm test. Aust J Physiother.2008;54:220. [DOI] [PubMed]
Hsieh YW, Hsueh IP, Chou YT, Sheu CF, Hsieh CL, Kwakkel G.Development and validation of a short form of the Fugl-Meyer motor scale in patients with stroke. Stroke. 2007;38:3052–4. [DOI] [PubMed]
Jiménez Buñuales MT, González Diego P, Martín Moreno JM.International classification of functioning, disability and health (ICF) 2001. Rev Esp Salud Publica. 2002;76:271–9. Spanish. [DOI] [PubMed]
Richardson JT.Eta squared and partial eta squared as measures of effect size in educational research. Educ Res Rev. 2011;6:135–47. [DOI]
Chen CL, Chen CY, Chen HC, Wu CY, Lin KC, Hsieh YW, et al. Responsiveness and minimal clinically important difference of Modified Ashworth Scale in patients with stroke. Eur J Phys Rehabil Med. 2019;55:754–60. [DOI] [PubMed]
Chou LW, Kao MJ, Lin JG.Probable mechanisms of needling therapies for myofascial pain control. Evid Based Complement Alternat Med.2012;2012:705327. [DOI] [PubMed] [PMC]
Lu Z, Briley A, Zhou P, Li S.Are there trigger points in the spastic muscles? Electromyographical evidence of dry needling effects on spastic finger flexors in chronic stroke. Front Neurol. 2020;11:78. [DOI] [PubMed] [PMC]
Domingo A, Mayoral O, Monterde S, Santafé MM.Neuromuscular damage and repair after dry needling in mice. Evid Based Complement Alternat Med.2013;2013:260806. [DOI] [PubMed] [PMC]
Cagnie B, Barbe T, De Ridder E, Van Oosterwijck J, Cools A, Danneels L.The influence of dry needling of the trapezius muscle on muscle blood flow and oxygenation. J Manipulative Physiol Ther. 2012;35:685–91. [DOI] [PubMed]
Jafri MS.Mechanisms of myofascial pain. Int Sch Res Notices.2014;2014:523924. [DOI] [PubMed] [PMC]
Sánchez-Mila Z, Salom-Moreno J, Fernández-de-Las-Peñas C.Effects of dry needling on post- stroke spasticity, motor function and stability limits: a randomised clinical trial. Acupunct Med. 2018;36:358–66. [DOI] [PubMed]
Ghannadi S, Shariat A, Ansari NN, Tavakol Z, Honarpishe R, Dommerholt J, et al. The effect of dry needling on lower limb dysfunction in poststroke survivors. J Stroke Cerebrovasc Dis. 2020;29:104814. [DOI] [PubMed]
Mendigutia-Gómez A, Martín-Hernández C, Salom-Moreno J, Fernández-de-Las-Peñas C.Effect of dry needling on spasticity, shoulder range of motion, and pressure pain sensitivity in patients with stroke: a crossover study. J Manipulative Physiol Ther. 2016;39:348–58. [DOI] [PubMed]
Mohammadpour F, Ali Oghabian M, Nakhostin Ansari N, Naghdi S, Dommerholt J.Effects of dry needling on post-stroke brain activity and muscle spasticity of the upper limb: a case report. Acupunct Med. 2021;39:69–71. [DOI] [PubMed]
Bakheit AM, Zakine B, Maisonobe P, Aymard C, Fhedoroff K, Hefter H, et al. The profile of patients and current practice of treatment of upper limb muscle spasticity with botulinum toxin type A: an international survey. Int J Rehabil Res. 2010;33:199–204. [DOI] [PubMed]
Lim YH, Choi EH, Lim JY.Comparison of effects of botulinum toxin injection between subacute and chronic stroke patients: a pilot study. Medicine (Baltimore). 2016;95:e2851. [DOI] [PubMed] [PMC]
Formisano R, Pantano P, Buzzi MG, Vinicola V, Penta F, Barbanti P, et al. Late motor recovery is influenced by muscle tone changes after stroke. Arch Phys Med Rehabil. 2005;86:308–11. [DOI] [PubMed]
Young JL, Mayer RF.Physiological alterations of motor units in hemiplegia. J Neurol Sci. 1982;54:401–12. [DOI] [PubMed]
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. Acupunct Med. 2021;[Epub ahead of print]. [DOI] [PubMed]
Van der Lee JH, De Groot V, Beckerman H, Wagenaar RC, Lankhorst GJ, Bouter LM.The intra- and interrater reliability of the action research arm test: a practical test of upper extremity function in patients with stroke. Arch Phys Med Rehabil. 2001;82:14–9. [DOI] [PubMed]
Hiragami S, Inoue Y, Harada K.Minimal clinically important difference for the Fugl-Meyer assessment of the upper extremity in convalescent stroke patients with moderate to severe hemiparesis. J Phys Ther Sci. 2019;31:917–21. [DOI] [PubMed] [PMC]
Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C.Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther. 1993;73:447–54. [DOI] [PubMed]
Yozbatiran N, Der-Yeghiaian L, Cramer SC.A standardized approach to performing the action research arm test. Neurorehabil Neural Repair. 2008;22:78–90. [DOI] [PubMed]
