Dry needling combined with exercise therapy: Effects on wrist flexors spasticity in post-stroke patients - A randomized controlled trial.

BACKGROUND: The positive contribution of dry needling (DN) in conjunction with exercise therapy for patients with stroke and spasticity remains uncertain. OBJECTIVE: To examine the effects of DN combined with exercise therapy on wrist flexor spasticity and motor function in patients with stroke. METHODS: Twenty-four participants with stroke were randomly assigned to either the DN and exercise therapy group or the DN alone group. Assessments were conducted at baseline, after the 4th treatment session, and 3 weeks post-treatment. RESULTS: A significant Group×Time interaction was observed for wrist active range of motion (ROM) (P = 0.046), favoring the DN with exercise therapy group (∼10° at baseline, ∼15° immediately after the 4th session, and 15.4° at follow-up). The improvements in spasticity, passive ROM, and H-reflex latency were sustained during follow-up. However, there were no significant between-group differences in any outcome at any measurement time point. CONCLUSION: The combined DN and exercise therapy did not exhibit superiority over DN alone concerning spasticity severity and motor function. However, it demonstrated additional advantages, particularly in improving motor neuron excitability and wrist passive extension.

Effects of Transcutaneous Electrical Nerve Stimulation on Chronic Pelvic Pain in Women: A Systematic Review and Meta-Analysis.

INTRODUCTION: The study aimed to identify the effects of transcutaneous electrical nerve stimulation (TENS) in women with chronic pelvic pain (CPP) by conducting a systematic review and meta-analysis of randomized controlled trials. METHODS: We used five international databases from 2000 to 2020 and selected the clinical trials that reported the effects of TENS on CPP. We excluded the case reports, acute pelvic pain reports, men-related, animal-related, and intravaginal and intrarectal electrical stimulation articles. The level of pain (based on the visual analog scale) was considered for pooling data through the meta-analysis. RESULTS: Ten studies met the inclusion criteria, and three articles were included in the meta-analysis. The results showed that TENS application mildly reduced pain in women with primary dysmenorrhea (mean difference = -1.29; 95% CI: -2.57 to -0.01; Z = 1.98, p = 0.05). Also, to reduce pain in patients with CPP, the TENS must be applied at least for 20 min, with a pulse duration of 50-400 µs, at a frequency of 2-120 Hz. The meta-analysis was followed by assessing the risk of bias, including publication bias. Based on the Cochrane risk of bias evaluation, the majority of the included trials were assessed with moderate methodological quality. CONCLUSION: TENS application can mildly improve the level of pain in patients with CPP caused by primary dysmenorrhea. Although no distinct agreement was observed among the effective parameters, the high-frequency mode with maximum tolerated intensity was more effective compared to the low-frequency mode.

Human thumb consists of three phalanges and lacks metacarpal? A morphometric study on the long bones of the hand.

PURPOSE: For many years, it was thought that the thumb consists of just two phalanges that differentiate it from the other four medial triphalangeal fingers. But there are some old reports that few former scientists believed the thumb has three phalanges and it lacked a metacarpal, and the thumb metacarpal is a phalanx. So this anthropometric study was carried out by investigating the morphology of the long bones of the hand and correlations between the thumb metacarpal and other miniature long bones of the hand. METHODS: We studied anterior-posterior X-ray images of the right hands of 80 individuals from 18 to 65 years old. The exploration targets were the length of all metacarpals (MC), proximal phalanges (PP), middle phalanges (MP), and distal phalanges (DP). Friedman Repeated Measures Analysis of Variance and Dunn's post hoc test were carried out to compare the means of all variables. The correlation between all quantitative factors was done by Spearman Rank Correlation (Spearman's Rho) coefficient. RESULTS: Our results showed that the length of the phalanges and the total length of the fingers are independent of the related metacarpal length (P < 0.001). Also, the thumb metacarpal length in comparison to all bones of the hand was significantly different from all long bones of the hand except the proximal phalanx of the middle finger (P = 1). CONCLUSION: Based on the morphology of the long bones of the hand and the high similarity between the thumb metacarpal and phalanges especially the proximal phalanx of the middle finger, it can be suggested that the current thumb metacarpal is a proximal phalanx of the thumb.

Validity and reliability of the movement assessment battery second edition test in children with and without motor impairment: A prospective cohort study.

Background: Examining the reliability and validity of the second edition movement assessment battery test (MABC-2) in children with and without motor impairment. Materials and methods: In this prospective cohort study, the MABC-2 test and developmental coordination disorder questionnaire 2007 (DCDQ'07) were completed by children and their parents. By using 95% confidence intervals, minimal detectable change (MDC95) was calculated, and concurrent validity was investigated. By applying the MABC-2 test as a reference standard (cut-off fifth centile), sensitivity and specificity were examined. Results: 273 children (mean age: 6.3 ± 2.3 years; 70% male) with and without motor impairment completed the investigation. For test-retest reliability, intra-class correlation coefficients (ICCs) was >0.89 for the MABC-2 test. The MDC95 value for the motor skill test was 5.76. There was a significant correlation between the MABC-2 test and DCDQ'07 (r = 0.60, P < 0.001) and the Go/No-Go test (r = 0.50, P < 0.001). Overall, the sensitivity was very high (90%), the specificity was low (46%), and positive and negative predictive values were high (69% and 81%, respectively). Conclusion: The MABC-2 test can be considered a valid and reliable motor skill assessment tool for children with and without motor impairment.

Effects of dry needling and exercise therapy on post-stroke spasticity and motor function- protocol of randomized clinical trial.

Background: Spasticity is one of the most common problems after the first stroke. Dry needling (DN) has been presented as a new therapeutic approach used by physiotherapists for the management of post-stroke spasticity. This study aimed to determine whether the addition of exercise therapy to the DN results in better outcomes in wrist flexors spasticity, motor neuron excitability, motor function and range of motion (ROM) in patients with chronic stroke. Methods: We will use a single-blind randomized controlled trial (RCT) in accordance with the CONSORT guidelines. A total of 24 patients with stroke will be included from the University Rehabilitation Clinics. The outcome measures will include Modified Modified Ashworth Scale, Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test, Fugl-Meyer Assessment, and wrist extension active and passive range of motion. Patients in the DN and exercise therapy group will undergo 4 sessions of deep DN in flexor carpi radialis and flexor carpi ulnaris muscles on the affected upper limb and exercise therapy. Participants in the DN group will only receive DN for target muscles. Clinical and neurophysiological tests will be performed at baseline, after four therapy sessions, and at three weeks' follow-up. Discussion: This study will provide evidence for additional effects of exercise therapy to DN in comparison to DN alone on wrist flexors spasticity, motor neuron excitability, upper-limb motor function, and ROM in patients with chronic stroke.

Effects of dry needling plus exercise therapy on post-stroke spasticity and motor function: A case report.

BACKGROUND AND PURPOSE: The use of dry needling (DN) with other treatments may be more beneficial in managing post-stroke spasticity. We report the effects of DN plus exercise therapy (ET) on wrist flexor spasticity. PATIENT PRESENTATION: The patient was a 45-year-old man with an 8-year history of stroke. The outcome measures included the Modified Modified Ashworth Scale (MMAS), Hmax/Mmax ratio, H-reflex latency, Action Research Arm Test (ARAT), Fugl-Meyer Assessment (FMA), and range of motion (ROM) which were assessed before (T1), after (T2), and after 3-week follow-up (T3). CONCLUSION: The MMAS was improved at T2 from "3" to "2". The Hmax/Mmax decreased from 0.77 to 0.53 at T3. The H-reflex latency increased from 15.4 ms to 18.5 ms at T3. The wrist active and passive ROM increased ∼30° and ∼20° at T2, respectively. A 4-session DN plus ET may improve spasticity and ROM. No meaningful improvement was observed in function.