Can acupuncture help patients with stroke?
Stroke is a serious condition which blood supply to the
brain is cut off. It is the second most common cause of death worldwide, and
the leading cause of adult disability. Patients with mild strokes or rapidly
improving symptoms usually have a good prognosis, while patients with major
strokes have a poor prognosis. Acupuncture help reduce brain damage and brain
recovery. The mechanisms are as follows: Acupuncture has anti-inflammatory
effects and increases cerebral blood flow which would protect the brain from
ischaemic injury; acupuncture reduces cerebral odema after cerebral ischaemia
and protect neuron damage; acupuncture also regulates biochemical changes
involved in post stroke condition. Acupuncture acts on brain region which
reduces sensitivity to pain and stress and promotes relaxation reducing
anxieties. There have been many researches published recently to support the
effectiveness of acupuncture on stroke recovery. In China, stroke is treated with acupuncture.
A survey of 1095 physicians from 247 hospitals in China between 1993 and 1994
has shown that 66% of Chinese doctors routinely used acupuncture to treat
patients with stroke and 63% of them believed its effectiveness. Another survey
in 2007 from patients with acute stroke has shown that 63% patients with stroke
would choose acupuncture as part of medical intervention. Many researches were
carried out to examine the effectiveness of acupuncture on stroke to support
the clinical application of the interventions. Some research has shown that
acupuncture can slightly help acute stroke by decreasing mortality rate and
dependency at the end of long term follow up and improving neurological deficit
scores. Acupuncture treatment for strokes has been listed as a proved effective
treatment for stroke in world health organisation (WHO) website http://apps.who.int/medicinedocs/en/d/Js4926e/5.html.
Post stroke rehabilitation is an important part of the
treatment of stroke to reduce disability and improve quality of life for
patients with stroke. Available evidence suggested that acupuncture may be
effective for treating poststroke neurological impairment and dysfunction
In Korea, integrative treatment is also used for patients
with stroke. For inpatients, integrative management is applied at the request
of the primary physician with consent of patients or their families. In the
acute stage, neurologists or neurosurgeons take charge as the primary
physicians. Korean medicine doctors cooperate as secondary physicians to the
neurologists and neurosurgeons. When patients passed the acute stage,
responsibilities are changed between primary and secondary doctors. The
rehabilitation program is conducted under the supervision of rehabilitation
medicine doctors. The most frequently used complementary and alternative
medicines are acupuncture including manualacupuncture, electroacupuncture, and
intradermal acupuncture, moxibustion, herbal prescriptions and acupuncture
point injection. From their experiences, they believe the integration of
complementary and alternative medicine and Western medicine have benefit for
patients with stroke.
Acupuncture improves spasticity in post stroke patients
Post stroke patients can be seriously affected by many
complications as handicaps, unclear consciousness, aphasia, dementia,
psychological abnormalities and incomplete bladder emptying. Spasticity is
very common in post stroke patients. Spasticity is a condition in which muscles
are constantly tight and stiff. It could cause reduced flexibility, posture and
functional mobility; it could also cause joint pain, muscle and joint
shortening etc. In post stroke patients, muscle spasm in one side of the body
are in constant contraction state is very common. The affected side of the body
is rigid, weak and has low functional abilities. Treatment includes antispastic
medication such as baclofen, diazepam etc. Physiotherapy including muscle stretching
and exercises could help preventing muscle shortening and atrophy. Acupuncture
is use to help stroke rehabilitation and it improves post stroke motor ability.
Some research study showed that acupuncture reduces spasticity by stroke and
maintain a reduced level of spasticity. A study showed that combining a 6 week
electroacupuncture and standard rehabilitation treatment reduced the spasticity
of the elbow for chronic post stroke patients. The effect depends on the
acupuncture points chosen for the treatment to improve spasticity.
Recently a study investigated the effect of acupuncture on
muscle spasm. In this study, 44 patients were allocated in acupuncture group in
which patients received acupuncture combined with rehabilitation treatment
while 42 patients were in control group in which patients received only
rehabilitation treatment. The key acupuncture points selected were from head,
face, chest, abdomen, shoulder, back, hands, feet and ankles. Routine limb
rehabilitation program was applied to both groups. One course included 10
treatments and two courses were performed in total. The effective rate of
antispasm was 90% in acupuncture group which was superior to control group
(73.8%). The improvement of motro function was significantly greater in acupuncture
group. This study showed that acupuncture combined with rehabilitation therapy
effectively relieves the muscle spams in post stroke patients, improves the
limb function and the life activity.
References
Tong S Zhongguo Zhen Jiu (2013) 33:399-402
Bi-huei Wang et al Clin Interv Aging (2014) 9:147-156
Zhang JH et al Neuroepidemiology (2014) 42:50-8
Park SU et al Complement Ther Clin Pract (2014) 20:37-41
Acupuncture helps hemiplegia in post stroke patients.
Hemiplegia which is severer than hemiparesis is paralysis of
one half of the body on the same side. Brain damage is one of the causes. The
paralysis occurs on the opposite side of the damaged brain. For example if one
has an injury to the right side of the brain, the hemiplegia will be on the
left side of the body. It is a common
post stroke complication. Acupuncture is used in hemiplegia treatment in China.
There was a study that investigated the immediate effects of acupuncture at
GB34 acupoint on passive movement in stroke patients with hemiplegia using
modern technique MRI to provide reference for clinical treatment. Six patients
with right brain stroke and left hemiplegia in recovery stage were selected and
scanned during passive fingers movement before and after acupuncture at
acupoint GB34. The activated areas of
the passive movement in all the patients were mainly motor sensory cortex on
the right side. Compared with sham control, acupuncture had better effect on
activating brain motor related network.
This study used advanced technique and demonstrated that acupuncture is
potential treatment method for hemiplegia in post stroke patients.
Treating upper limb hemiparesis with acupuncture and other
interventions
Hemiparesis is a common complication for stroke survivors.
The intervention for the conditions is aimed to improve quality of life for
these patients. Pulman and Buckley from University of Liverpool UK reviewed the
efficacy of different upper limb hemiparesis interventions on improving
health-related quality of life in stroke patients. This is their findings:
Of the 22 studies, 12 reported significant findings within
groups and between control groups. Interventions including BTX-A injections,
CIMT, exercise programs, baclofen pump, robotic-assisted therapy,
electrical stimulation, and acupuncture were reported to
significantly improve either overall health-related QOL or certain individual
QOL domains, such as strength, hand function, memory, mood, activities of daily
living, mobility, social participation, communication, energy, pain, and sleep.
Example of acupuncture improves limb function in post stroke
patients
Scalp acupuncture is that the needles are inserted in the
acupuncture points on the scalp, while body acupuncture is that the needles are
inserted in acupuncture points on the body. Both types of acupuncture are
combined to treat stroke in China. Recent research showed the effectiveness of
combined scalp and body acupuncture on limb function in stroke patients. Tang et al studied the effect of acupuncture
n limb function in subacute stroke patients using scalp and body
acupuncture. These patients were treated
by routine neurological therapies. After 20 days, the limb function was better
improved in acupuncture plus routine treatment group than that routine
treatment only group. There were no significant differences between two groups
in the ratios of mortality/disability and recurrence rates at the end of 3 and
6 months follow-up. He et al also studied the combined application of scal and
body acupuncture on limb function in stroke patients. They also found better
improvement in lower limb function in acupuncture group. After 8 weeks
treatment, the walking ability rate in acupuncture group wa higher than that in
the control group. The walking speed in the acupuncture group was faster than
that in the control group.
Acupuncture point injection of herbal extract and floating
acupuncture helps post stroke shoulder pain.
Shoulder pain is very common after stroke. It can be treated
with pain killers, steroid injections, positioning and handling, shoulder
strapping, electrical stimulation. Recently acupuncture point injection of
herbal extract on post stroke shoulder pain was studied. There were 24 patients
participated the study. Acupuncture points injection of herbal extract was
carried out three times a week for 2 weeks. The effects of treatment were
assessed with a numerical rating scale (NRS), painless passive range of motion
(PROM) of external shoulder rotation, and the motor function assessment (FMMA).
The acupuncture point injection group showed significant improvement on the NRS
compared with that for control group after 2 weeks of treatment. PROM decreased
significantly in both groups with greater pain reduction in treatment group.
This study showed that acupuncture point injection of herbal extract was an
option for patients with post stroke shoulder pain. Another study compared
acupuncture with medicine and herbs for shoulder pain in post stroke patients.
They found that shoulder pain was relived and the daily life activity was
improved in the patients with post stroke using floating acupuncture technique.
The pain relief was superior to the oral western medicine mobic and local
Chinese herbs fumigation.
Current situation of stroke with acupuncture treatment
There is an increase in interest in using acupuncture on
stroke and its effectiveness. Much of the recent research has been carried out
in the Scandinavian countries and the USA. In China many studies have compared
different techniques and point combinations which often involved in very large
numbers of patients. The studies carried out so far have developed a variety of
methods and are strongly indicative of therapeutic benefit, though the precise
details of acupuncture treatment given are not always clearly stated in the
studies. And there was lack of standardization in the treatments. Recently Wu
et al analysed recent existing data to investigate the spectrum of acupuncture
points in post stroke patients treated with acupuncture and moxibustion. They
collect 652 clinical research papers. They found 143 nonacupuncture points were
used and the application frequency were 737; 253 acupuncture points were used
and the application frequency were 5395. According to application frequency,
the acupuncture points were divided into often used points (23points); sometime
used points (100 points) and less used points (130 points). Apparently there
was lack of standardization in stroke treatment with acupuncture. The selected
acupuncture points were distributed in fourteen meridians and most common used
meridians were Yangming and Shaoyang.
References
Wu et al Zhonguo Zhen Jiu (2013) 33:547-52
Si WJ et al Zhongguo Zhen Jiu (2013) 33:131-6
Seo YR et al Evid Based Complement Alternat Med (2013)
2013:504686
Wang J Zhongguo Zhen Jiu (2013) 33:294-8
Pulman and Buckley Top Stroke Rehabil (2013) 20:171-88
Tang et al Zhen Ci Yan Jiu (2012) 37:488-92
He et al Zhongguo Zhen Jiu (2012) 32:887-90
Acupuncture is effective with post-stroke constipation
Acupuncture could help motor function, cognition, speech
problems, shoulder pain, urinary incontinence, constipation, depression,
fatigue and dysphagia etc.
Constipation can occur after a stroke. This is because you
are not drinking enough liquids and you are in bed most of the time; or you are
taking certain medicines as part of your treatment. If you have constipation,
drink extra water and set a regular time for using toilet. Acupuncture can help
post stroke constipation. There is a case report about treating post stroke
constipation using acupuncture. There were 39 patients with post-stroke
constipation received acupuncture treatment for 2 weeks and another 35 patients
with post-stroke constipation received Chinese herb medicine Shengrue Tongbian
Capsules for 2 weeks. After two weeks treatment, constipation symptoms were
improved in these patients received both acupuncture and Chinese medicine. The
improvement was greater in patients with acupuncture treatment. Acupuncture was
potential treatment option for patients with post-stroke constipation.
Acupuncture could help post-stroke urinary incontinence.
Urinary incontinence is the unintentional passing of urine.
This is a common problem in patients with stroke. In China, acupuncture is used
to treat this problem. Recent clinical research compared the effect of
acupuncture with that indwelling catheter. Acupuncture was received 5 times a
week. The points used included Qugu (CV2), Zhongji (CV3), Shuidao (ST28, Qihai
(CV6) and Guanyuan (CV4) etc. The effect was compared after 4 weeks of
treatment. The urinary diary (including the interval of urination, nocturia
frequency, urination difficulty, urinary incontinence severity), bladder
capacity, patients’s satisfaction were assessed before and after the treatments
and compared between the two groups. After treatments, the effects were
observed in both groups with better effect in acupuncture group especially in
total score, the patients’ satisfaction and bladder capacity. Acupuncture is
potential treatment option for post stroke urinary incontinence.
Acupuncture has potential benefit for stroke patients with
incomplete bladder emptying
Urinary retention and incomplete bladder emptying (IBE) are
not uncommon in patients with stroke rehabilitation. This significantly
increased the risk of urinary infection. Recently there was a study
investigating the effect of acupuncture on IBE. The patients selected were
diagnosed with infarction or hemorrhagic stroke for the first time; they did
not suffer from an active urinary tract infection. During the study period,
these patients continued to receive conventional therapy without major changes
of medication. These patients received acupuncture five times a week for two
weeks. Among the 49 patients in the study, nine (18%) had IBE, and seven of the
stroke patients with IBE were treated with electroacupuncture. Increased
spontaneous voiding volume and decreased PVR urine volume were noted after ten
sessions of acupuncutre. They suggested electroacupuncutre may have beneficial effects
on stroke survivors with IBE. Acupuncture is a potential intervention to
improve urinary function.
Acupuncture for ischemic stroke
Most stroke (87% cases) is ischemic stroke which caused by
blood clot blocking blood vessel in the brain. The blood clot can form in the
blood vessel in the brain or it formed elsewhere and travelled to the vessel in
the brain which cannot pass because the vessel is too narrow to pass. Loss of
blood supply damages brain function. The recovery of brain function such as speech
and walking was attributed to reduction of inflammation in the brain region of
damage and rewire of the area. Recently a randomised controlled trial from
China studied efficacy of integrated rehabilitation techniques of Chinese
Medicine for ischemic stroke. They used acupuncture combined with massage
techniques and compared this with conventional rehabilitation technique. They
compared the related parameters on day 0, day 21 and day 90. They found better
improvement in acupuncture and massage compared with baseline and conventional
technique. They suggested there is potential benefit from acupuncture and
massage for ischemic stroke rehabilitation.
Acupuncture is beneficial for cognitive function in post
stroke patients
Jing well points are very powerful points located at the end
of fingers and toes. These points are very often used to treat stroke. Temple
points on the side of the head are also used for stroke in China. Recently a
research showed that these points are beneficial for patients with early vascular
congnitive impairment in China. They compared acupuncture at Jing well points
and temple points and conventional treatment in patients with stroke. They
observed improvement with acupuncture treatment but not conventional treatment.
This indicates that acupuncture has potential to improve cognitive function in
post stroke patients with mild cognitive impairment.
Acupuncture for post stroke depression
Patients with stroke not only suffer from physical
disability but also emotional problems. Post stroke depression (PSD) is very
common in patients with stroke in different stages. PSD is linked to increased
disability, and poor functional and cognitive outcomes of stroke survivors.
Reducing PSD could improve quality of life in patients with stroke. Anti-depression
drugs could used to treat PSD. Because of their side effects, combination drugs
and non drug treatments were recommended. Acupuncture is one of therapies
without drugs, but its use in PSD is still in debate. Recently a pilot study
investigated whether acupuncture is an effective treatment for PSD and whether
the effect of acupuncture differs according to the degree of motor function
impairments of the stroke patients. In this study 28 PSD patients were assessed
and participated the study. They were treated with acupuncture every day for 16
weeks. Depression status was significantly improved during the treatment
sessions. The depression of the good motor function groups was significantly
more reduced than that of the poor motor function group. This study indicates
that acupuncture therapy can improve PSD and that the effects depend on the
degree of motor function impairment.
Another research from China studied the combination of herbs
and acupuncture for post stroke depression. They compared herbs plus
acupuncture with western medicine fluoxetine hydrochloride for treating post
stroke depression. The treatments were given for four weeks. On six month
followup, improvement was seen in herbs plus acupuncture and western medicine
treatment with greater improvement in herbs plus acupuncture.
There was also study combined acupuncture and moxibustion or
antidepression medication (using aroxetine hydrochloride tablets) on post
stroke patients with depression. They compared the efficacy of medication only,
acupuncture plus moxibustion and acupuncture plus medication. Daily acupuncture
except weekends was offered for 4 weeks. The improvement of depression was
superior in acupuncture plus medication group and acupuncture plus moxibustion
group to medication only group.
Acupuncture helps post stroke swallowing difficulty
Swallowing difficulty can be present in post stroke
patients. This problem is treated with acupuncture in China. Recently Zhou et
al studied the effect of acupuncture on post stroke swallowing problem using
modern research methods to provide evidence from conventional medicine point of
view. They combined acupuncture with rehabilitation training program. There
were 80 patients with post stroke swallowing difficulty. 40 patients were in
control group treated with conventional approach and other 40 patients in
acupuncture group treated with acupuncture. After treatment, assessment was
carried out. They found there were improvements after the treatments in
swallowing tests for both groups compared with those before the treatments. The
improvements in acupuncture group were significantly greater. This showed that
acupuncture is a potential effective treatment for swallowing difficulty in
post stroke patients.
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Zhou XM et al Zhongguo Zhen Jiu (2013) 33:587-90
