February 12, 2019 at 4:11 pm #21337kathryn.showers1Participant
Has anyone tried needling spasticity secondary to CVA? I would like try, but since there’s a lack of clinical trials out there to back it up, I haven’t tried it. The neuro doc is dead set against it without evidence to back it up (she gives Botox injections).
February 12, 2019 at 5:06 pm #21338NickParticipant
I don’t have any personal experience and hopefully we hear from someone who has used it directly but we are starting to see some literature using dry needling in patients post CVA for spasticity.
Here are the links to a few I was able to find. I would probably start with basic needling, with in/out techniques (in case the muscle grabs or spasms you won’t have needles in situ) until you learn how the patient is going to do with the treatment. Let us know how it goes!
February 15, 2019 at 11:45 am #21403mgibeault.vsmcMember
I have used Dry Needling for Spasticity on a 43 YO women with Cerebral Palsy. She was referred by her primary care, as patient was told her only option was Botox injections, and she did not want to do that. I was somewhat reserved myself in terms of positive outcome due to Central Nervous System nature of etiology over peripheral trauma, and I did not have much previous experience with needling for this purpose. However, due to fact her primary concern was the pain she experienced with spasm, vs reducing the spasm itself, and her strong objection to Botox with little or no other options, the mom and patient wanted to move forward with the needling. I began with .25 x 15 needle use to evaluate reaction of spasm, and lesson my concern over needle in situ in case spasm increased. This was not the case in any instance for this particular patient, so I became more comfortable and used needle lengths no greater than recommended for anatomical area, but never used more than .30 x 40. Dosing , I stayed with 6- 10 needles per session, and listened to patients symptoms in terms of treatment area. I typically would do paravertebral for that area of innervation, homeostatic for area, but also symptomatic. Patient reported relief within 24 hours, initially lasting up to 7 days. so I saw her weekly. it has been reduced to every 3 to 4 weeks with her reporting symptomatic relief. Objectively post treatment I did not always see immediate reduction in tone, but Mom reported changes within 24 hours both in pain and tone . Functionally, mom reports ease of transfers , reduced spasms waking her at night, ( less tone) ease of dressing upper extremities, sustained gains in shoulder ROM, gains in right hand grasp ( holding a cup).( which I did see objectively over time) There has been no other medical intervention during this time or change in medications. Her occasional reaction to needling is a sensation of nausea which passes quickly, and does not happen each time. Originally I used point touch with EMS using Pointer Excell II, but then purchased 6 lead ES-130 for longer periods of EMS to insertion points ( 10 min) She got much more subjective relief with the ES – 130. Why is this helping? Not clear with limited research. But I find it interesting that a clinical approach for CP spasticity and pain is a dorsal route rhizotomy or radiofrequency ablation at site of dorsal route ganglion. Hseih 2012 noted Substance P changes with dry needling to change not only locally but also at the dorsal route ganglion. I think in her instance its a case of both the Central and Peripheral sensitization effect of dry needling.
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