Dry Needling of Forearm Pronators for Spasticity and Upper Limb Function in Chronic Stroke: A Sham-controlled Trial

Abstract

Background: Few studies have examined the spasticity of forearm pronators post-stroke. Objectives: To evaluate the effect of dry needling (DN) targeting forearm pronators on spasticity and upper limb function post-stroke. Methods: Twenty patients with chronic stroke participated in a single-group, sham-controlled trial (14 males, mean age 55.3 years, mean time since stroke 15.5 months). The intervention included two three-session phases: Sham DN and DN at pronator muscles. Assessments were conducted pre- and post-sham DN (T0, T1), pre- and post-DN (T2, T3), and at a one-week follow-up after DN (T4). Results: Spasticity scores for pronators reduced from 2 at T2 to 0 at T3 and 1 at T4 (P < 0.001). Wrist flexor spasticity improved by 1 point and remained reduced at T4 (P < 0.001). The DN significantly improved both active (Cohen’s d = 0.5 - 0.62) and passive range of motion (ROM) in forearm supination, as well as elbow and wrist extension (Cohen’s d > 0.8). Brunnstrom Recovery Stage improved from 3 to 4 at T3 (P < 0.001) and remained improved at T4 (P = 0.03). The effect size for upper limb function [Chedoke Arm and Hand Activity Inventory-13 (CAHAI-13) scores] was negligible (d = 0.09). Conclusions: The DN of the forearm pronators reduced spasticity, increased active and passive upper limb ROM, and promoted motor recovery. Effects were widespread and exceeded those observed with sham DN.