Abstracts of Scientific Papers and Posters Presented at the Annual Meeting of the Association of Academic Physiatrists: San Juan, Puerto Rico; February 19-23, 2019.

Abstract

s of Scientific Papers and Posters Presented at the Annual Meeting of the Association of Academic Physiatrists San Juan, Puerto Rico; February 19–23, 2019 BEST PAPER PRESENTATIONS Faculty Category Award Winner ARE THERE TRIGGER POINTS IN SPASTIC MUSCLES? EVIDENCE FROM DRY NEEDLING EFFECTS ON SPASTIC FINGER FLEXORS IN CHRONIC STROKE Zhiyuan Lu, PhD, AmyBriley, DPT, NCS, Ping Zhou, PhD, and Sheng Li, MD, PhD OBJECTIVES:Spasticity is a commondisablingmotor impairment after stroke. Though not fully understood, spasticity is a result of disinhibited descending excitatory inputs to spinal reflex circuitry, adaptive changes in intraspinal network and peripheral changes in spastic muscles. A wide spectrum of treatment options is available, including physical modality, stretching, oral medications to botulinum toxin injection and surgery to target different factors. Dry needling is largely known to be effective for management of myofascial pain through breakdown of taut bands of trigger points. Recently, there are clinical observational reports of dry needling for spasticity management after stroke. Unlikely commonly used botulinum toxin therapy, dry needling causes immediate spasticity reduction, increased active range of motion, and improved gait. It remains unclear whether dry needling-induced spasticity reduction is mediated through the same mechanisms as for trigger points. The purpose of this study was to examine the immediate effects of dry needling to spastic finger muscles in chronic stroke and to explore the potential underlying mechanisms with intramuscular needle EMG recordings and analysis. DESIGN: Ten chronic stroke patients with spasticity in finger flexors participated in this experiment (6 males and 4 females; average: 61.1±4.1 years of age; 5 right spastic hemiplegia, and 5 left spastic hemiplegia). Time since stroke ranged from 6months to 8 years, with an average of 4.6±0.7 years. Patients were scheduled to receive botulinum toxin injections, including to their finger flexors. Patients gave written consent prior to dry needling. Dry needling to the flexor digitorum superficiali (FDS) muscle was performed prior to botulinum toxin injections. A 27 gauge injection needle connected to the EMGmachinewas used. The needle tip position was visualized under ultrasound imaging, and was further verified by stretching of the fingers at the proximal interphalangeal (PIP) joints that induced increase in EMG amplitude and frequency. Continuous dry needling was performed by the injecting physician under ultrasound guidance for about one minute (about 100 times). Measurements of modified Ashworth scale (MAS), passive and active range of motion (PROM/AROM), and resting position of finger flexors were taken in the 3rd metacarpal phalangeal (MCP), PIP and distal interphalangeal (DIP) joints before and immediately (between 5 to 10 minutes) after dry needling. Firmness of taut band of FDSmuscles was assessed aswell. These clinical assessments were performed by an independent, experienced physical therapist. The body configuration, the wrist joint position in particular, was maintained the same before and after needling. Intramuscular needle EMG readingswere taken tomeasure spikes of spontaneousmotor unit action potentials (MUAPs). On intramuscular needle EMG analysis, any spontaneous dischargewith a magnitude above 100microvolt and a rise time below 4 microsecond is consider an MUAP. Frequency of spontaneous MUAP spikes per second was calculated. Paired t-tests were performed to analyze the dry