Acupuncture treatment of motor dysfunction post-stroke?

[Guest guest]

Hi All, & Steve,

 

I have left instructions with my family that, should I be unable to

communicate my wishes in the the aftermath of a serious CVA, stroke

or coma, I am to receive intensive acupuncture therapy in addition to

conventional therapy.

 

Steve wrote:

> ... several studies ... indicated that acupuncture has some efficacy in

> post-stroke recovery. I saw one study that indicated acupuncture is

> only helpful for dysphagia, but others that seemed to show improved

> motor function. I'd suggest you google " post stroke recovery

> acupuncture " . You'll get a lot of hits on that search. Steve

 

Google threw up the following:

 

Stroke Rehabilitation Forum: Questions answered by Stuart A. Rubin,

M.D., Board Certified in Pain Management and Physical Medicine and

Rehabilitation: post stroke recovery and acupuncture Forum: The Stroke

Rehabilitation Forum Topic: Stroke Treatment post stroke

recovery and acupuncture:

 

Q: Has anyone had any experience using acupuncture in addition to

rehabilitation? My mother's physical therapists see nothing adverse in

trying this to help my mother's impaired right arm.

 

A: Acupuncture has not been shown to be helpful to improve motor

function. It has been shown to be helpful for dysphagia. It can also

reduce pain which secondarily can improve function. Good Luck, SR

MD "

 

Dr. Rubin is correct that evidence for the value of AP in motor DysFx

after stroke is conflicting; some RTCs and most meta-analyses found

little or no effect. However, other studies found positive effects.

 

For example, Dr Rubin wrote on April 11, 2005 but the following

reference will not be published until August 2005:

 

Lo YL, Cui SL, Fook-Chong S. Neurosci Lett. 2005 Aug 12;384(1-

2):145-9. The effect of acupuncture on motor cortex excitability and

plasticity. National Neuroscience Institute, Singapore General Hospital,

Department of NeurologyOutram Road, Singapore 169608, Singapore.

Acupuncture has been used extensively in facilitating motor recovery

after stroke. Its mechanism of action remains uncertain. In this sham-

controlled study, we demonstrate for the first time that acupuncture HAS

A REAL AND ENDURING EFFECT on motor cortex functional changes,

in terms of cortical excitability and output mapping using transcranial

magnetic stimulation. PMID: 15913891 [PubMed - in process]

 

Dr. Rubin also may have missed this one:

 

Alexander DN, Cen S, Sullivan KJ, Bhavnani G, Ma X, Azen SP. Effects

of acupuncture treatment on poststroke motor recovery and physical

function: a pilot study. Neurorehabil Neural Repair. 2004

Dec;18(4):259-67. ASAP study group. Daniel Freeman Memorial

Hospital, Inglewood, CA, USA. This pilot study obtained preliminary

data on the effects of acupuncture treatment combined with a standard

inpatient stroke rehabilitation program on poststroke motor recovery and

physical function. Thirty-two patients with acute stroke were recruited

and randomized to 1 of 2 treatment arms: standard rehabilitation

(control group) or a combination of acupuncture and standard

rehabilitation (acupuncture group). Baseline and discharge

assessments were obtained on motor recovery as measured by the

Fugl-Meyer (FM) Assessment and on physical function as measured by

the Functional Independence Measure (FIM). Comparisons were made

between the acupuncture and control group in total FM and FIM as well

as for each subscale of the FM and FIM. No differences between

treatment groups were found in the total FM or the total FIM. However,

statistically significant benefit due to acupuncture was observed for the

FM lower extremity motor function subscale (P = 0.01) and the

tub/shower transfer mobility subscale of the FIM (P = 0.03). Marginally

significant benefit due to acupuncture was noted for the toilet transfer

mobility subscale of the FIM (P = 0.09). The effectiveness of

acupuncture as an adjunct to standard poststroke rehabilitation

programs may be demonstrated when more specific measures of stroke

motor recovery and physical function are used. Publication Types:

Clinical Trial Randomized Controlled Trial PMID: 15537996 [PubMed -

indexed for MEDLINE]

 

See also:

 

Moon SK, Whang YK, Park SU, Ko CN, Kim YS, Bae HS, Cho KH.

Antispastic effect of electroacupuncture and moxibustion in stroke

patients. Am J Chin Med. 2003;31(3):467-74. Department of

Cardiovascular and Neurologic Diseases, College of Oriental Medicine,

Kyung-Hee University, Seoul, Korea. m919k523 Spasticity

is a frequently observed motor impairment that develops after stroke.

The objective of this study was to evaluate the efficacy of

electroacupuncture (EA) and moxibustion (Mox) on spasticity due to

stroke. The subjects consisted of 35 stroke patients with elbow

spasticity whose mean duration of stroke was 2.97 months. Fifteen

patients were randomized to the EA group, ten to Mox, and ten to

control. Every other day, 30 minutes of electrical stimulation with a

frequency of 50 Hz was given through four needles on the Ch'u-Ch'ih-

San-Li (LI-11-LI-10) and Wai-Kuan-Ho-Ku (TB-5-LI-4) points of the

paretic side. Direct Mox was applied to Ch'u-Ch'ih (LI-11), San-Li (LI-

10), Wai-Kuan (TB-5) and Ho-Ku (LI-4) points 3 times/day every other

day. The control group was given only the routine acupuncture therapy

for stroke and range of motion (ROM) exercise, which were also applied

to the EA and Mox groups. The efficacy of treatment was measured

before, immediately, 1 hour, 3 hours, 1 day, 5 days, 10 days and 15

days after the start of treatment using a modified Ashworth scale (MAS).

In the EA group, spasticity was significantly reduced immediately, 1 hour

and 3 hours after treatment (p < 0.05). Reductions were significant on

the 5th day and thereafter (p < 0.05). In the Mox group, there was no

significant change in the MAS scores after the first treatment. In the Mox

and control group, there was no significant change in MAS scores. This

study suggests that EA can temporarily reduce spasticity due to stroke,

and if applied repeatedly it can maintain reduced spasticity. Publication

Types: Clinical Trial Randomized Controlled Trial PMID: 12943177

[PubMed - indexed for MEDLINE]

 

 

Wang SJ, Omori N, Li F, Jin G, Hamakawa Y, Sato K, Nagano I, Shoji

M, Abe K. Functional improvement by electro-acupuncture after

transient middle cerebral artery occlusion in rats. Neurol Res. 2003

Jul;25(5):516-21. Department of Neurology, Graduate School of

Medicine and Dentistry, Okayama University, 2-5-1 Shikatacho,

Okayama 700-8558, Japan. Functional recovery by the application of

electro-acupuncture (EA) on different acupoints was investigated using

a transient middle cerebral artery occlusion (MCAO) model in rat.

Acupoints were Baihui (D20) plus Renzhong (D26) (MCAO + D group),

and Hanyan (G4), Xuanlu (G5), Xuanli (G6), plus Qubin (G7) (MCAP +

G group). Animals with EA treatment showed significant functional

improvements from 12 days after the reperfusion against those without

EA treatment. Among EA treated groups, MCAO + G showed a more

significant recovery than MCAO + D. Infarct volume revealed the

significant reduction in the EA treated groups especially in MCAO + G at

30 days. Immunohistochemical study showed a remarkable induction of

vascular endothelial growth factor (VEGF) in astrocytes of the peri-

infarct area at 30 days, more in EA treated groups than in groups

treated with MCAO alone. These results suggest that the acupoints

applied in this study are effective for the functional recovery, and an

enhanced expression of VEGF may play a certain role in recovery

process after stroke. PMID: 12866201 [PubMed - indexed for

MEDLINE]

 

Sze FK, Wong E, Or KK, Lau J, Woo J. Does acupuncture improve

motor recovery after stroke? A meta-analysis of randomized controlled

trials. Stroke. 2002 Nov;33(11):2604-19. Department of Medicine and

Geriatrics, Shatin Hospital, N.T. Hong Kong. fkhsze

BACKGROUND AND PURPOSE: Acupuncture may be a promising

treatment for poststroke paralysis. We conducted a meta-analysis,

assessing the efficacy of acupuncture with and without stroke

rehabilitation. METHODS: We identified randomized trials comparing

acupuncture with no acupuncture within 6 months of stroke by searching

MEDLINE, CINAHL, EMBASE, Cochrane Library, and Chinese medical

literature databases. Two reviewers independently extracted data on

study characteristics, patient characteristics, and impairment and

disability outcomes. The outcome measures were internationally

recognized or nationally approved. The fixed- and random-effects

models were used to combine effect size and odds ratio across studies.

RESULTS: Fourteen trials with 1213 patients met all the inclusion

criteria. For the comparison of acupuncture with no acupuncture in

addition to stroke rehabilitation, the pooled random-effects estimates of

the change in motor impairment and disability were 0.06 (95% CI, -0.12

to 0.24) and 0.49 (95% CI, 0.03 to 0.96), respectively, with heterogeneity

in disability measures (P=0.05, chi(2) test). For the comparison of real

with sham acupuncture, the pooled random-effects estimate of the

change in disability was 0.07 (95% CI, -0.34 to 0.48). For the

comparison of acupuncture with no acupuncture without stroke

rehabilitation, the pooled random-effects estimate of the change in

motor impairment was 0.46 (95% CI, -0.20 to 1.12), and the pooled

random-effects odds ratio for disability was 12.5 (95% CI, 4.3 to 36.2),

with no statistically significant heterogeneity (P=0.97 and P=0.12,

respectively, chi(2) test), but the study quality was poor.

CONCLUSIONS: This meta-analysis suggests that with stroke

rehabilitation, acupuncture has no additional effect on motor recovery

but has a small positive effect on disability, which may be due to a true

placebo effect and varied study quality. The efficacy of acupuncture

without stroke rehabilitation remains uncertain, mainly because of the

poor quality of such studies. Publication Types: Meta-Analysis PMID:

12411650 [PubMed - indexed for MEDLINE]

 

Hopwood V & Lewith GT. Does Acupuncture Help Stroke Patients

Become More Independent? Journal of Alternative and Complementary

Medicine Feb 2005, Vol. 11, No. 1: 175-177 Val Hopwood, F.C.S.P.,

Ph.D. Complementary Medicine Research Unit, Aldermoor Health

Centre, Southampton, UK. George T. Lewith, D.M., F.R.C.P.

Complementary Medicine Research Unit, Aldermoor Health Centre,

Southampton, UK. This short speculative report describes the outcome

of three studies looking at the effect of acupuncture on stroke recovery

and the subsequent place of residence of the subjects entered. It is not

a systematic review and does not endeavor to provide comprehensive

data on the effect of acupuncture on poststroke recovery. Our

observations demonstrate that patients may be more likely to remain

independent and in their own homes one year post stroke if they receive

acupuncture. This conclusion is supported by our study and two

previous trials. It may be that acupuncture improves poststroke

perception, thereby enhancing independence.

 

Pei J, Sun L, Chen R, Zhu T, Qian Y, Yuan D. The effect of electro-

acupuncture on motor function recovery in patients with acute cerebral

infarction: a randomly controlled trial. J Tradit Chin Med. 2001

Dec;21(4):270-2. Longhua Hospital, Shanghai University of Traditional

, Shanghai 200032. The aim of this study is to

investigate the effect of electro-acupuncture treatment in acute phase of

cerebral infarction on the motor functions. In this randomly controlled

trial, 86 patients were allocated to two groups, the experimental group

given clinical and electro-acupuncture treatments for a period of 4

weeks, and the control group given clinical treatment plus active and/or

passive functional exercise. The result showed that the level of

impairment and disability in both groups were improvement according to

the Chinese Stroke Scale, Brunnstrom-Fugl-Meyer score, and Barthel

Index throughout the study and 3 months after. The motor functions and

the activities of daily living (ADL) were improved significantly in the

electro-acupuncture group as compared with the control group (P <

0.05). Also, the results showed greater reduction of neurological deficit

in the electro-acupuncture group than in the control group.

CONCLUSION: Early acupuncture treatment for acute stroke patients

may improve motor functions, and consequently the activities of daily

living. Publication Types: ClinicaTrial Randomized Controlled Trial

PMID: 12014128 [PubMed - indexed for MEDLINE]

 

Best regards,

 

 

Tel: (H): +353-(0) or (M): +353-(0)

 

 

 

 

Ireland.

Tel: (W): +353-(0) or (M): +353-(0)

 

 

 

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