Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Sunday, 31 July 2022

Stroke rehabilitation, how can acupuncture help?

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.

References

Yu KW et al Clin Interv Aging (2012) 7:469-74

Song et al Zhongguo Zhen Jiu (2013) 33:769-73

Ren et al Zhongguo Zhen Jiu (2013) 33:893-6

Youn JI et al J Phys Ther Sci (2013) 25:725-8

Hu JF et al Zhongguo Zhong Yao Za Zhi (2013) 38:2403-5

Nie and Huang Zhongguo Zhen Jiu (2013) 33:490-4

Li F et al Zhongguo Zhen Jiu (2013) 33:784-8

Zhang et al Am J Chin Med (2013) 41:971-81

Zhou XM et al Zhongguo Zhen Jiu (2013) 33:587-90

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