Effects of dry needling plus static stretching on plantar flexors spasticity, alpha motor neuron excitability, and balance in patients with chronic stroke

If the use of dry needling plus static stretching causes a greater reduction in the spasticity of ankle plantarflexor muscles, this method can be suggested for use in clinics to achieve more effective physiotherapy intervention in chronic stroke patients.

Clinical trial with a control group, with parallel groups, double-blind, randomized, phase 3 on 26 patients.Randomization by cards or envelopes Shuffling

This study is conducted in the clinic of the rehabilitation faculty of Tehran University. In this study, the evaluation is done once before the treatment, once at the end of the treatment, and once a week after the treatment. In the intervention group, after dry needling for 60 seconds, 20 minutes of plantar flexor muscle stretching is applied using the designed orthosis. In the control group, in addition to Sham dry needling in the form of a 10-gram monofilament, static stretching is performed for 20 minutes using an orthosis. Static stretching is performed for 5 sessions with a frequency of once a day and 5 days a week, and dry needling is performed for 3 sessions with a frequency of once a day and 3 days a week.

Inclusion Criteria: 1) Men and women with chronic stroke 2) Age between 40 to 65 years Exclusion Criteria: 1) Passive ROM limitation of more than 10% in ankle dorsiflexion compared to the less involved leg. 2) Non-cooperation in carrying out treatment protocols

In the intervention group, dry needling plus static stretching will be applied to the plantar flexor muscles. Sham dry needling and static stretching will be applied in the control group.

Modified modified Ashworth scale (MMAS) • Passive and active range of motion • H reflex latency and the values of the Hmax/Mmax ratio • Timed up and go test • Euro Qol questionnaire (EQ-5D-5L)

In this study, the participants were divided into two groups by a simple random method with the help of shuffling the closed envelopes (Cards or Envelopes Shuffling) which were prepared according to their number and one of the names of the intervention or control was written on it. All patients have the same chance of being placed in any of the two groups. This study is a double-blind study. In this study, due to the use of sham dry needling, patients in the control group will be blinded of their placement in the intervention and control groups. Also, the assessor is blinded of the control and intervention groups and only knows them as groups A and B. Only the interventionist is aware of the research events.

The assessor is the researcher and during the evaluations, he is not aware of the grouping of the patients and only knows them into two groups A and B. The use of dry needling as a sham in the control group causes the patient to be blinded to being in the control or intervention group.