The Effect of dry Needling in Chronic Stroke with a complex Network Approach: A Case Study

Abstract

Background: Dry Needling (DN) has been demonstrated to be effective in improving sensorimotor function and spasticity in patients with chronic stroke. Electroencephalogram (EEG) has been used to analyze if DN has effects on the central nervous system of patients with stroke. There are no studies on how DN works in patients with chronic stroke based on EEG analysis using complex networks. Objective: The aim of this study was to assess how DN works when it is applied in a patient with stroke, using the graph theory. Methods: One session of DN was applied to the spastic brachialis muscle of a 62-year-old man with right hemiplegia after stroke. EEG was used to analyze the effects of DN following metrics that measure the topological configuration: 1) network density, 2) clustering coefficient, 3) average shortest path length, 4) betweenness centrality, and 5) small-worldness. Measurements were taken before and during DN. Results: An improvement of the brain activity was observed in this patient with stroke after the application of DN, which led to variations of local parameters of the brain network in the delta, theta and alpha bands, and inclined towards those of the healthy control bands. Conclusions: This case study showed the positive effects of DN on brain network of a patient with chronic stroke.

Effects of Dry Needling on Spasticity in Multiple Sclerosis Evaluated Through the Rate-Dependent Depression of the H Reflex: A Case Report

“… 12 Despite these positive clinical findings, the mechanism of DN to decrease spasticity is not well known and needs further research. 32 Current research supports the hypothesis that DN could have neuromodulation effects at different levels in the central nervous system, 33 , 34 with recent EEG studies highlighting the existence of variations of local parameters of the brain network in the delta, theta and alpha bands. 32 Moreover, there is no agreement neither on how many DN sessions per week and for how long this therapy would show the best results, although a period of one week between DN sessions is recommended considering tissue repair.…”

Effects of dry needling on spasticity, cortical excitability, and range of motion in a patient with multiple sclerosis: a case report

“…Notably, the heightened cortical excitability persisted for 2 weeks following DN. These findings may be explained by the dual impact of DN, which excites the motor cortex through both peripheral sensory inputs and intracortical mechanisms [ 28 , 29 ]. The DN, offering somatosensory conditioning stimulus, can generate excitability in the motor cortex through direct impact or cutaneous input from the spastic plantar flexor muscles, manifesting at short latency [ 28 – 30 ].…”

Ultrasound-Guided Percutaneous Neuromodulation in Multiple Sclerosis: A Case Report

“…This could be because the DN treatment performed in the aforementioned cases has demonstrated to have a mechanical effect, working through the mechanical disruption of dysfunctional endplates, which are reinnervated after 3 days, 15 whereas PN acts at a central level, without mechanical effects. However, DN performed at Myofascial Trigger Points is also known to have indirect effects in the central nervous system, 5 , 6 which makes it difficult to formulate any hypothesis that may explain the differences found. Because of this, future studies should compare different invasive techniques such as DN and PN to better understand both the effects they have and how long they last.…”

“…In the case of rehabilitation treatments, on the one hand, different types of neuromodulation treatments such as intrathecal baclofen pump, functional electrical stimulation, deep brain stimulation, transcranial magnetic stimulation, bladder stimulation, spinal cord stimulation and brain–computer interface have been applied to treat MS-related symptoms. 4 On the other hand, minimally invasive techniques such as dry needling (DN) have shown to have neuromodulating effects at different levels in the CNS 5 , 6 and achieve positive changes in patients with MS, concretely in spasticity, quality of life, walking capacity and manual dexterity. 7 …”

“…In the case of functional electrical stimulation, this is applied transcutaneously to restore function and prevent muscle atrophy (e.g stimulation of the common peroneal nerve in patients with foot drop). Although the use of transcutaneous electrical stimulation has been widely used in MS patients, the effects of this stimulation performed percutaneously has been only researched in musculoskeletal conditions, 6 showing to be effective to treat chronic lateral epicondylalgia, 7 chronic low back pain 8 and to decrease postoperative pain following ambulatory rotator cuff repair. 9…”