Acupuncture n Stroke (1)

7/29/2019 Acupuncture n Stroke (1)

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ACUPUNCTURE

& STROKE

Prepared by: Tilda Teo


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Does Acupuncture

really work to help

stroke victims improve?


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Control of Pain

Improve motor functions

Increase sensation

Improve neurological functions in stroke

Respiratory disorders

Strengthening immune system

Emotional and psychological disorders

Musculoskeletal disorders (ie: frozen shoulder, OA)

ETC

Benefits of Acupuncture


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insertion of solid filiform acupuncture needles into the skin at specific

points on the body to achieve a therapeutic effect

encourage natural healing, improve mood and energy, reduce or relieve

pain and improve function of affected areas of the body

dull, heavy, or aching feeling often occurs when the needle is inserted

needles are left in place for 15-30 minutes

What is Acupuncture?


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Terminologies

Qi : Vital energy flows through the channels of Meridiens and regulatesbodily functions

Meridiens : Transmission lines of communication among the organs and the

body

Acupoints : Locations on the body along meridiens

Manual-Acupuncture : Acupuncture performed at acupointsMechanical

Stimulation

Electro-Acupuncture : Needles which are electrically stimulated by various

frequencies and voltages Electrical Stimulation


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Effect of acupuncture on

motor recovery in acutestroke patients


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Effect of EA and MA on motor recovery in stroke

patients-- Acute

A Cochrane review

review of 14 trials

insufficient evidence to determine the benefits of

acupuncture

due to the small sample size

(Zhang et al 2005)


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Johansson et al (2001)Acupuncture and

Transcutaneous Nerve Stimulation in Stroke Rehabilitation. A RCT.Hypotheses :

1) Sensory stimulation by

acupuncture (including EA)

improves motor function and/or

ADL after stroke

2) Sensory stimulation by high-

intensity low-frequency TENS,

that induces muscle contractions

comparable to those induced byEA, improves motor function

and/or ADL after stroke

Outcome Measures :

1) Barthel Index

2) Rivermead Mobility Index

3) Nine Hole Peg Test

4) 10m Walk test

5) Nottinghan Health Profile


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Transcutaneous Nerve Stimulation in Stroke Rehabilitation. A RCT.


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Transcutaneous Nerve Stimulation in Stroke Rehabilitation. A RCT.


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Transcutaneous Nerve Stimulation in Stroke Rehabilitation. A RCT.Results :

No clinically important or statistically

significant differences were

observed between groups for

any outcome variables.

Discussion :

Although stimulation in the control

group was subliminal, theremight be some degree of

sensory input .

Placement of electrodes on the skin

are likely to stimulate

mechanosensitive nerve fibers.


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Sze et al (2002)Does Acupuncture have additional

value to standard poststroke motor rehabilitation?Aims:

1) Examine whether acupuncture

has additional value to standard

poststroke motor rehabilitation.

Outcome Measures :

1) Fugl-Meyer Assessment of

Physical Performance2) Barthel Index

3) Functional Independence

Measure

4) Abbreviated Mental Test

5) NIH Stroke Scale


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value to standard poststroke motor rehabilitation?


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value to standard poststroke motor rehabilitation?


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value to standard poststroke motor rehabilitation?Results :

1) No statistically significant

differences were observed

between the 2 arms for any

outcome measures at week 10.

Discussion :

1) Comparability assessment

between the 2 groups was basedon admission BI, and not on the

TCM classification of stroke and

its characteristics.

2) Flexibility of selecting acupoints

leading to poor standardization

or protocol


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Effect of EA and MA on motor recovery

in stroke patients-- Acute

Study Subject Rx Outcome

measures

Finding

Sze et al

(2002)

106 acute

stroke

moderate to

severe motordisabilities

MA

Flexible acupoints

30min

35X 8 week

BI

FIM

FMA

No further improvement

Compare with patients

solely involved in motor

rehabilitation programme

Johanss

on et al

(2001)

150 acute

stroke

moderate to

severe

functionalimpairment

EA and MA

Fixed acupoints

30 min

2 X /week

10 weeks

BI

RMI

9 holes Peg

test

time tocomplete a

10m walk

No further improvement

No additional benefit to

conventional stroke rehab


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Effect of acupuncture on

motor recovery in chronicstroke patients


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Wayne et al (2005)Acupuncture for Upper-Extremity Rehabilitation in chronic stroke: A randomized sham-

controlled studyAims:

1) Examine whether active

acupuncture improves UE ROM,

spasticity and motor function.

2) Assess whether active

acupuncture improves ADLs,

QOL and mood

Outcome Measures :

1) Fugl-Meyer Assessment

2) Modified Ashworth Scale

3) UE ROM

4) Grip Strength

5) Barthel Index

6) Nottingham Health Profile


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controlled study


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controlled study


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controlled studyResults :

1) Intention-to-treat analyses found

no statistically significant

differences in outcomes between

active and sham acupuncture

groups.

2) Analyses of protocol-compliant

subjects showed significant

improvements in wrist spasticity,both wrist and shoulder ROM

and improvement trends in UE

motor function.

Discussion :

1) Use of sham blunt-tipped needle

that did not penetrate the skinwas a effective concealable

control.


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Schaechter et al (2007)Correlated change inUpper Limb Function and motor cortex activation after verum and

sham acupuncture in patients with chronic stroke.Aims:

1) Examine whether changes in

brain activation differs in stroke

patients treated with verum or

sham acupuncture.

Outcome Measures :

1) MR image acquisition


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sham acupuncture in patients with chronic stroke.


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sham acupuncture in patients with chronic stroke.Results:

1) There is a significant positive

correlation between changes in

function of the affected UL

(spasticity and ROM) and

activation of ipsilesional motor

cotex.

Discussion :

1) Acupuncture helps restore activity

along spared descending motorpathways, thereby improving

cortical modulation of lower

motor neuron excitability

involved in spasticity and ROM.


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in stroke patients-- ChronicStudy Subject Rx Outcome

measures

Finding

Wayne et al

(2005)

33 chronic

stroke

severe to

moderate

upper limbfunctional

disabilities

EA + MA

Flexible yet

standard

Acupoint

20-30 minutes 2X/ week

a mean period

of 10.5week

UE motor

function

FMA

Spasticity

MASGrip strength

ROM

ADL

QOL

Mood

Active acupuncture:

A significant improvement:

Ashworth wrist score (p


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in stroke patients-- summary

Acute:

Do not support additional benefit for patients

receiving conventional stroke rehabilitation Chronic:

May have a role in improving upper limb function

Small sample size


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So does Acupuncture

really work to help

stroke victims improve?


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Clinical Implication

The safety

Only 1 study noticed a harmful effect of EA (Sui, Lo, Leung 2004b)

inappropriate acupoint used

Acupoint:

animal studies a few fixed acupoints were used

Human highly recommendable that a different set of acupuncture points

to be used for individual patients based on their presentation instead of using

fixed prescription acupoint for all patients.

(Sze et al 2002)


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Conclusion

Effects of MA and EA on motor recovery

No strong evidence in further enhancing motor recovery in

chronic and acute stroke patients.

Further studies if MA or EA treatment able to improve

functional status


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Acupuncture n Stroke (1)

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