Exploration of Neuroprotective Therapy

Muscle tested	Right hamstring	Left hamstring	Combined hip abduction	Right gastrocnemius	Left gastrocnemius
Average degrees of increased PROM	6.55°	4.43°	11.92°	10.74°	8.02°

Declarations

Acknowledgments

The authors thank SM and her family for their unwavering cooperation.

Author contributions

TO: Conceptualization, Investigation, Methodology, Project Administration, Validation, Visualization, Writing—original draft, Writing—review & editing. JD: Resources, Writing—original draft, Writing—review & editing. Both authors read and approved the final manuscript that was submitted to Exploration of Neuroprotective Therapy.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The Human Research Protection Office of the University of Maryland, Baltimore Campus reviewed the study, Dry needling with electrical stimulation for the treatment of a pediatric patient with spastic cerebral palsy: a case report, and determined that the project met the definition of Not Human Subjects Research (NHSR). Institutional Review Board (IRB) oversight was therefore not required.

Consent to participate

Parent of under 16-year-old child signed the consent to participate-attached.

Consent to publication

The informed consent to publication was obtained from the parent of the patient.

Availability of data and materials

ROM data is available at the web address https://1drv.ms/w/s!AnsjmUSrka7QgYAE_WX-SyrxhK5xbA?e=PPaoWR

Funding

Not applicable.

Copyright

References

Shamsoddini A, Amirsalari S, Hollisaz MT, Rahimnia A, Khatibi-Aghda A. Management of spasticity in children with cerebral palsy. Iran J Pediatr. 2014;24:345–51. [PubMed] [PMC]

Mathewson MA, Lieber RL. Pathophysiology of muscle contractures in cerebral palsy. Phys Med Rehabil Clin N Am. 2015;26:57–67. [DOI] [PubMed] [PMC]

Núñez-Cortés R, Cruz-Montecinos C, Latorre-García R, Pérez-Alenda S, Torres-Castro R. Effectiveness of dry needling in the management of spasticity in patients post stroke. J Stroke Cerebrovasc Dis. 2020;29:105236. [DOI] [PubMed]

Davis JF, Khir AW, Barber L, Reeves ND, Khan T, DeLuca M, et al. The mechanisms of adaptation for muscle fascicle length changes with exercise: implications for spastic muscle. Med Hypotheses. 2020;144:110199. [DOI] [PubMed]

Dommerholt J. Dry needling - peripheral and central considerations. J Man Manip Ther. 2011;19:223–7. [DOI] [PubMed] [PMC]

Liu QG, Huang QM, Liu L, Nguyen TT. Structural and functional abnormalities of motor endplates in rat skeletal model of myofascial trigger spots. Neurosci Lett. 2019;711:134417. [DOI] [PubMed]

Theroux MC, Akins RE, Barone C, Boyce B, Miller F, Dabney KW. Neuromuscular junctions in cerebral palsy: presence of extrajunctional acetylcholine receptors. Anesthesiology. 2002;96:330–5. [DOI] [PubMed]

Bron C, Dommerholt JD. Etiology of myofascial trigger points. Curr Pain Headache Rep. 2012;16:439–44. [DOI] [PubMed] [PMC]

Shah JP, Gilliams EA. Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. J Bodyw Mov Ther. 2008;12:371–84. [DOI] [PubMed]

10.

Liu Z, Dong S, Zhong S, Huang F, Zhang C, Zhou Y, et al. The effect of combined transcranial pulsed current stimulation and transcutaneous electrical nerve stimulation on lower limb spasticity in children with spastic cerebral palsy: a randomized and controlled clinical study. BMC Pediatr. 2021;21:141. [DOI] [PubMed] [PMC]

11.

Schultz TJ. Review of cerebral palsy: the various intervention techniques. Honors Thesis. 2020;87.

12.

Ebel S, Langer K. The role of the physical therapist in hospice care. Am J Hosp Palliat Care. 1993;10:32–5. [DOI] [PubMed]

13.

Paulson A, Vargus-Adams J. Overview of four functional classification systems commonly used in cerebral palsy. Children (Basel). 2017;4:30. [DOI] [PubMed] [PMC]

14.

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]

15.

Liu Z, Heffernan C, Tan J. Caregiver burden: a concept analysis. Int J Nurs Sci. 2020;7:438–45. [DOI] [PubMed] [PMC]

16.

Khalifeloo M, Naghdi S, Ansari NN, Dommerholt J, Sahraian MA. Dry needling for the treatment of muscle spasticity in a patient with multiple sclerosis: a case report. Physiother Theory Pract. 2021;[Epub ahead of print]. [DOI] [PubMed]

17.

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]

18.

Valencia-Chulián R, Heredia-Rizo AM, Moral-Munoz JA, Lucena-Anton D, Luque-Moreno C. Dry needling for the management of spasticity, pain, and range of movement in adults after stroke: a systematic review. Complement Ther Med. 2020;52:102515. [DOI] [PubMed]

19.

Cruz-Montecinos C, Núñez-Cortés R, Bruna-Melo T, Tapia C, Becerra P, Pavez N, et al. Dry needling technique decreases spasticity and improves general functioning in incomplete spinal cord injury: a case report. J Spinal Cord Med. 2020;43:414–8. [PubMed] [PMC]

20.

Gallego PH, del Moral OM. A case study looking at the effectiveness of deep dry needling for the management of hypertonia. J Musculoskelet Pain. 2010;15:55–60. [DOI]

21.

Liu QG, Liu L, Huang QM, Nguyen TT, Ma YT, Zhao JM. Decreased spontaneous electrical activity and acetylcholine at myofascial trigger spots after dry needling treatment: a pilot study. Evid Based Complement Alternat Med. 2017;2017:3938191. [DOI] [PubMed] [PMC]

22.

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]

23.

Ghaffari MS, Shariat A, Honarpishe R, Hakakzadeh A, Cleland JA, Haghighi S, et al. Concurrent effects of dry needling and electrical stimulation in the management of upper extremity hemiparesis. J Acupunct Meridian Stud. 2019;12:90–4. [DOI] [PubMed]

24.

Logosu D, Tagoe TA, Adjei P. Transcutaneous electrical nerve stimulation in the management of calf muscle spasticity in cerebral palsy: a pilot study. IBRO Neurosci Rep. 2021;11:194–9. [DOI] [PubMed] [PMC]

25.

Tomasi FP, Chiappa G, Maldaner da Silva V, Lucena da Silva M, Lima AS, Arena R, et al. Transcutaneous electrical nerve stimulation improves exercise tolerance in healthy subjects. Int J Sports Med. 2015;36:661–5. [DOI] [PubMed]

26.

Rainey CE. The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report. Int J Sports Phys Ther. 2013;8:145–61. [PubMed] [PMC]

27.

Ansari NN, Naghdi S, Moammeri H, Jalaie S. Ashworth scales are unreliable for the assessment of muscle spasticity. Physiother Theory Pract. 2006;22:119–25. [DOI] [PubMed]

28.

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]

29.

Naghdi S, Ansari NN, Mansouri K, Asgari A, Olyaei GR, Kazemnejad A. Neurophysiological examination of the Modified Modified Ashworth Scale (MMAS) in patients with wrist flexor spasticity after stroke. Electromyogr Clin Neurophysiol. 2008;48:35–41. [PubMed]

30.

Naghdi S, Ansari NN, Azarnia S, Kazemnejad A. Interrater reliability of the Modified Modified Ashworth Scale (MMAS) for patients with wrist flexor muscle spasticity. Physiother Theory Pract. 2008;24:372–9. [DOI] [PubMed]

31.

Ghotbi N, Nakhostin Ansari N, Naghdi S, Hasson S. Measurement of lower-limb muscle spasticity: intrarater reliability of Modified Modified Ashworth Scale. J Rehabil Res Dev. 2011;48:83–8. [DOI] [PubMed]

32.

Ansari NN, Rahimi M, Naghdi S, Barzegar-Ganji Z, Hasson S, Moghimi E. Inter- and intra-rater reliability of the modified modified ashworth scale in the assessment of muscle spasticity in cerebral palsy: a preliminary study. J Pediatr Rehabil Med. 2022;15:151–8. [DOI] [PubMed]

33.

Haley SM, Coster WI, Kao YC, Dumas HM, Fragala-Pinkham MA, Kramer JM, et al. Lessons from use of the pediatric evaluation of disability inventory: where do we go from here? Pediatr Phys Ther. 2010;22:69–75. [DOI] [PubMed] [PMC]

34.

King G, McDougall J, Palisano R, Gritzan J, Tucker MA. Goal attainment scalingits use in evaluating pediatric therapy programs. Phys Occup Ther Pediatr. 2000;19:31–52. [DOI]

35.

Dommerholt J, Fernández-de-las-Peñas C, editor. Trigger point dry needling: an evidence and clinical-based approach. 2nd ed. Scotland: Elsevier; 2018. [PMC]

36.

Mendigutía-Gómez A, Quintana-García MT, Martín-Sevilla M, de Lorenzo-Barrientos D, Rodríguez-Jiménez J, Fernández-de-Las-Peñas C, et al. Post-needling soreness and trigger point dry needling for hemiplegic shoulder pain following stroke. Acupunct Med. 2020;38:150–7. [DOI] [PubMed]

37.

Perreault T, Dunning J, Butts R. The local twitch response during trigger point dry needling: is it necessary for successful outcomes? J Bodyw Mov Ther. 2017;21:940–7. [DOI] [PubMed]

38.

Almaee Nejad F, Dommerholt J, Attarbashi Moghadam B, Shadmehr A, Khazaei Pour Z. Impact of physical therapists’ instructions on function and the perception of post-dry needling soreness in mechanical cervical pain; a randomized clinical trial. J Bodyw Mov Ther. 2020;24:118–23. [DOI] [PubMed]

39.

Hakim IK, Ebrahimi I, Saffafzadeh J, Ezzati K. What is the acute effect of dry needling on the active trigger points of upper trapezius muscle? The effect of eliciting local twitch response on clinical outcomes. Phys Treat. 2017;7:49–57. [DOI] [PubMed]

40.

Baraja-Vegas L, Martín-Rodríguez S, Piqueras-Sanchiz F, Martín-Ruiz J, Yeste Fabregat M, Florencio LL, et al. Electromyographic activity evolution of local twitch responses during dry needling of latent trigger points in the gastrocnemius muscle: a cross-sectional study. Pain Med. 2020;21:1224–9. [DOI] [PubMed]

41.

Vargas Luna JL, Krenn M, Mayr W, Cortés Ramírez JA. Optimization of interphase intervals to enhance the evoked muscular responses of transcutaneous neuromuscular electrical stimulation. Artif Organs. 2017;41:1145–52. [DOI] [PubMed]

42.

Ahmed S, Haddad C, Subramaniam S, Khattab S, Kumbhare D. The effect of electric stimulation techniques on pain and tenderness at the myofascial trigger point: a systematic review. Pain Med. 2019;20:1774–88. [DOI] [PubMed]

43.

Hamann JJ, Kluess HA, Buckwalter JB, Clifford PS. Blood flow response to muscle contractions is more closely related to metabolic rate than contractile work. J Appl Physiol (1985). 2005;98:2096–100. [DOI] [PubMed]

44.

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]

45.

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]

46.

Multani I, Manji J, Hastings-Ison T, Khot A, Graham K. Botulinum toxin in the management of children with cerebral palsy. Paediatr Drugs. 2019;21:261–81. [DOI] [PubMed] [PMC]

47.

Romito JW, Turner ER, Rosener JA, Coldiron L, Udipi A, Nohrn L, et al. Baclofen therapeutics, toxicity, and withdrawal: a narrative review. SAGE Open Med. 2021;9. [DOI] [PubMed] [PMC]

48.

Sharan D. Orthopedic surgery in cerebral palsy: instructional course lecture. Indian J Orthop. 2017;51:240–55. [DOI] [PubMed] [PMC]

49.

Halle JS, Halle RJ. Pertinent dry needling considerations for minimizing adverse effects-part one. Int J Sports Phys Ther. 2016;11:651–62. [PubMed] [PMC]