Acupuncture Continuing Education

Acupuncture Benefits Stroke Patients Finding

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Acupuncture benefits patients suffering from hemiplegia (unilateral paralysis) after a stroke. Traditional Chinese Medicine Hospital of Baoji researchers compared daily exercise monotherapy with acupuncture plus daily exercises. Patient outcomes were consistently superior in the combined therapy group, demonstrating that the addition of acupuncture to the daily exercise treatment regimen improves clinical outcomes. The researchers conclude that acupuncture plus rehabilitation exercises improves motor function and cerebral blood flow, making it an effective intervention for post-stroke hemiplegia. [1]

Objective and subjective data were the basis for the conclusions. Blood flow changes in the brain were measured with a transcranial Doppler device, a specialized ultrasound unit utilized for measuring blood flow velocity through cerebral blood vessels. This was used to monitor the movement of blood in the anterior, middle, and posterior cerebral arteries. Both groups showed marked improvements in blood flow following treatment, but improvements in the combined therapy group were significantly greater (p<0.05). The measurements demonstrate that the addition of acupuncture to the treatment protocol enhances recuperation within the human brain.

Subjective clinical observations for both groups were made using the Neurological Deficit Scale and the Fugl-Meyer Assessment. The Neurological Deficit Scale (NDS) is designed to measure neurological function following a stroke. The Fugl-Meyer Assessment (FMA) is a scale specifically designed to measure post-stroke impairment based on categories including motor function, balance, sensation, and joint function. The results were divided into four categories:

  • Cured (>90% improvement)
  • Marked progress (46–90% improvement)
  • Progress (18–45% improvement)
  • No progress (<18% improvement)

Both groups showed improvements following treatment, but improvements in the combined therapy group were significantly greater (p<0.05). In the combined therapy group, 65.71% of patients fell within the cured category, compared with just 42.86% in the control group.

 

Design
A total of 70 patients with hemiplegia were recruited and a definitive diagnosis of cerebrovascular accident (stroke) was confirmed by means of CT and MRI scans. Patients were randomly assigned to two groups. Both groups received standard physical rehabilitation exercises and one group received acupuncture. Acupuncture was performed on the side of the body affected by hemiplegia. Points on the upper limb included LI11 (Quchi), LI4 (Hegu), LI10 (Shousanli), and SI3 (Houxi). Points on the lower limb included ST36 (Zusanli), GB30 (Huantiao), SP6 (Sanyinjiao), and LV3 (Taichong). Filiform needles 40–75mm in length were used to needle the points and were manually manipulated to obtain deqi. The needles were retained for 20 minutes per acupuncture session. Treatment was administered once daily, with 10 treatments comprising one course. A total of 10 courses of treatment were administered consecutively.

Rehabilitation therapeutic exercises mainly consisted of daily exercises to strengthen the muscles of the trunk and limbs. These included passive or assisted stretches and exercises for patients that were confined to their beds or had limited mobility. Ambulatory patients were also encouraged to walk and climb stairs, aided by a walking stick if necessary. Exercises were administered for 30 minutes daily, with 10 days comprising one course. A total of 10 courses of exercises were administered consecutively.

Limitations of the study include a relatively small sample size and the lack of an acupuncture monotherapy arm. A strength of the study design is the use of both subjective and objective instruments to measure outcomes. Based on the data, acupuncture benefits patients with post-stroke hemiplegia and is a reasonable treatment option.

 

Chengdu University of Traditional Chinese Medicine
The aforementioned research is not isolated. Chengdu University of Traditional Chinese Medicine researchers conclude that acupuncture benefits brain activity in areas responsible for motor function, sensory perception, and emotions after an acute ischemic stroke. [2] Patients underwent fMRI scans before and after treatment to assess brain activity.

Brain activity was measured using regional homogeneity (ReHo) to show changes in activity in different areas of the brain. ReHo is a multimodal neuroimaging marker of the human connectome (a map of brain neural connections detailing neural interactions). The connectome is often described as the wiring map of the brain. The ReHo approach to functional magnetic resonance imaging (fMRI) methods used in this study measures brain connectomics, measuring the brain’s intrinsic dynamics. [3]

Two groups were compared using fMRIs. Group 1 received drug therapy. Group 2 received drug therapy plus acupuncture. Patients in the drug monotherapy group showed increased activity in the frontal lobe and parietal lobes. Patients in the acupuncture group showed increased activity in the frontal lobe, parietal lobe, middle temporal gyrus, cerebellum, and insula, which are areas responsible for motor function, sensory perception, and emotions.

Subjective instruments measured improved outcomes for patients receiving acupuncture. Results were based on three parameters: NDS, FMA, and the Modified Barthel index (MBI), a scale used to assess quality of daily life in stroke survivors. Both groups showed statistically significant (p<0.05) improvements in NDS, FMA, and MBI. However, improvement was greater in the acupuncture group in all three areas.

A total of 21 patients were selected and randomly assigned to receive either acupuncture plus conventional drug treatment (n=11) or conventional drug treatment alone (n=10). The two groups were demographically similar in terms of gender, sex, weight, and height. They also had similar disease characteristics including duration and severity of symptoms.

In the combined acupuncture and conventional medication group, treatments utilized the points GV20 (Baihui), GB20 (Fengchi), LI11 (Quchi), LI4 (Hegu), ST36 (Zusanli), GB34 (Yanglingquan), GB39 (Xuanzhong), and SP6 (Sanyinjiao). Needles were retained for 30 minutes and treatments were administered daily. Five treatments comprised one course and a total of four courses were administered, with a two day break between each one.

Both groups were treated with conventional medications including antiplatelet medication (aspirin, 100mg daily, for patients with abnormal platelet counts) and citicoline 500mg daily. Citicoline is a drug commonly used in the treatment of various neurological disorders, including stroke. Other symptomatic related treatments were also administered as needed.

The differences in brain activity demonstrated by the two groups in this study indicates that acupuncture increases brain activity following an ischemic stroke, significantly more so than conventional drug treatment alone. These findings indicate that acupuncture is a reasonable treatment option for stroke recovery and rehabilitation. To learn more, contact your local licensed acupuncturist for more information.

 

Notes
1. Hou Qiang, Li Jin-tao “Clinical value of acupuncture combined with rehabilitation therapy in patients with hemiplegia after cerebrovascular accident” Clinical Medical Research and Practice (2018) Issue 11.

2. Wu Ping et al. “Effect of acupuncture plus conventional treatment on brain activity in ischemic stroke patients: a regional homogeneity analysis” Journal of Traditional Chinese Medicine (2017) October 15; 37 (5).

3. Jiang, Lili, and Xi-Nian Zuo. "Regional homogeneity: a multimodal, multiscale neuroimaging marker of the human connectome." The Neuroscientist 22, no. 5 (2016): 486-505.

 

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