Effect of Phased Whole AP Therapy on Ability of Daily Life in 63 Cases of Cerebral Infarction-induced Hemiplegia

[Guest guest]

Hi All, & Tom,

 

Tom Verhaeghe wrote:

> here's the article ( " Effect of " Phased Whole AP Therapy " on Ability of

> Daily Life in 63 Cases of Cerebral Infarction-induced Hemiplegia " ) for

> you to review, Phil.

 

Many thanks, Tom. My comments on my edited version of the paper are

below.

 

I invite discussion of my comments from those who may disagree with

them.

 

(1) This was a poorly randomised and analysed trial and its conclusions

are invalid.

 

(2) As Table 2 (below) shows, randomisation in this trial was poor,

because the DEFORMED RATE in the Basic Tx Group was 10.5%

higher than in the Phased Tx Group BEFORE Tx. Therefore, one would

expect a poorer outcome in the Basic Tx Group BEFORE the trial was

done!

 

(3) As Table 1 (below) shows, the CHANGE in BI scores between the

two treatments (28.51 units of improvement dt Phased Tx versus 26.64

units of improvement dt Basic Tx) were minimal and did NOT confirm

that the Phased Tx was significantly better than the Basic (Control) Tx.

 

(4) I conclude that the Basic Tx gave similar clinical outcomes to the

much more complicated " Phased Whole AP Tx " . Also, this paper gave

no proof that the Reinforcing and Reducing manoeuvres, used

respectively on the unaffected and affected side, are necessary to elicit

good clinical responses.

 

(5) For basic AP Tx of cerebral infarction-induced hemiplegia, one could

select 10-12 points/session from the points listed below, and alternate

points between sessions every 1-2 days. If there is sensory paralysis,

one can select Body Points/Extraordinary Points on the unaffected side.

 

(a) Contralateral Scalp Motor Area;

(b) Extraordinary Points: Bafeng (EX-UE10), Baxie (EX-UE9);

Xiashaohai [1 " below HT03)]

© Body Points: BL23, BL25, BL37, BL60; GB20, GB29, GB30, GB34,

GB40; GV14; LI04, LI11, LI15; LV08; SI12; SJ01, SJ05, SJ14; SP10;

ST31, ST36, ST41.

 

If indicated by symptoms (aphasia, thoracic limb paralysis, pelvic limb

paralysis, etc), points may be added from: BL40, BL57; CV23; GB31,

GB39; GV15; HT03, HT05; KI03; LI10; OT05 (local points); PC07; SI03;

SJ04, SJ17; SP06; ST04, ST06; Z_21 (Shanglianquan Above CV23

(Lianquan; Ridge Spring), on CV line, 1' above CV23), as in the

Cookbook selections from

http://homepage.eircom.net/~progers/ad2.htm below:

 

020300

brain, its

functions &

parts,

meninges,

polio,

convulsions

, memory,

tetanus,

CVA etc

53/477/.953

LI04

LI11

ST36

GB34

ST06

LI15

GB20

GB30

ST04

GV14

 

Citation

Score

 

0.800

0.741

0.703

0.663

0.634

0.610

0.608

0.604

0.594

0.578

 

020350 CVA,

polio,

paralysis,

hemiplegia

44/401/.964

LI04

LI11

ST36

GB34

ST06

GB30

ST04

LI15

TH05

GB39

 

Citation

Score

 

0.858

0.792

0.767

0.743

0.731

0.719

0.684

0.656

0.618

0.616

 

021200

tongue,

speech

38/179/.961

CV23

GV15

LI04

HT05

TH17

LI11

TH05

ST06

GB20

Z_21

 

Citation

Score

 

0.732

0.641

0.600

0.501

0.397

0.392

0.389

0.345

0.310

0.247

 

040000

thoracic

limb, its

organs &

functions

48/291/.983

LI11

LI15

TH05

LI04

SI03

TH04

HT03

PC07

LI10

OT05

 

Citation

Score

 

0.978

0.879

0.842

0.792

0.688

0.669

0.608

0.606

0.604

0.604

 

070000

pelvic limb,

its organs &

functions

52/330/.965

GB34

ST36

GB30

SP06

BL60

BL40

BL57

GB39

GB31

KI03

 

Citation

Score

 

0.940

0.884

0.841

0.809

0.793

0.773

0.751

0.735

0.691

0.687

 

 

(6) There is some evidence (elsewhere) that Electro-AP may be more

effective than manual AP in paralysis cases.

 

(7) AP therapy should be used to complement conventional treatment of

stroke / cerebral infarction, and expert Rehab / Physiotherapy.

 

Best regards,

 

 

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

>>>>>>

 

Effect of " Phased Whole AP Therapy " on Ability of Daily Life in 63

Cases of Cerebral Infarction-induced Hemiplegia

Guo Yuanqi , Chen Liyi 2, Zhou Lucjin , Li Hui

,Qu Xuanming 3 & Liu Dongsheng 3 Journal of

Traditional 88 2006;26(2):88-91.

1Dept of AP, 2nd Clinical Medical College, Guangzhou U of TCM,

Guangzhou 510120, China

2 4th Affiliated Hospital of Medical College, Jinan U, Guangzhou, China

3 Guangzhou U of TCM, Guangdong, China

 

Published in: Journal of Traditional 2006; 26(2):

88-91.

 

Objective: To observe the effect of " Phased Whole AP therapy " on the

ability of daily life (ADL) of patients with cerebral infarction-induced

hemiplegia. Methods: 113 patients were randomly divided into a Tx with

traditional Group (n=63) treated with Phased Whole AP and a control

Group (n=50) treated with traditional AP. After the Tx, the improvement

of ADL was compared between the two Groups. Results: Patients in the

Tx Group obtained satisfactory therapeutic results in ADL improvement

and in lowering of deformed rate, which were superior to those in the

control Group. Conclusion: The Phased Whole AP is an effective

therapy in treating cerebral infarction-induced hemiplegia, which can

better improve the life quality of the patients.

 

By adopting the internationally-acknowledged method for evaluating the

ability of daily life (ADL), authors had from Apri1 2001 to April 2004

observed the effect of Phased Whole AP on ADL in patients with

cerebral infarction-induced hemiplegia, and compared the findings with

those of traditional AP. It is reported as follows.

 

Clinical Data: 118 cases of cerebral infarction-induced hemiplegia

were inpatients from the Department of Neuronal Internal Medicine and

the Department of AP, The Second Clinical Medical College,

Guangzhou University of TCM. They were randomly divided into a Tx

Group (n=65) and a control Group (n=53). There were 5 cases (2 cases

in the Tx Group and 3 cases in the control Group) that failed to be

followed in the whole process.

 

 

Phased Tx Group

Basic Tx (Control) Group

 

Number of patients

63

50

 

Gender

31M 32F

28M 22F

 

Age (Years)

63.839.69

65.747.72

 

days in the course of disease

2.482.68

2.944.72

 

days to initiation of needling

4.974.22

4.023.96

 

scores in previous history

6.682.56

6.862.46

 

accumulated scores for

accompanying diseases

6.98 3.69

7.12 3.76

 

 

Chi2 test and t test showed that the two Groups were comparable in

gender, age, course of diseases initiation of needling, accumulated

scores for previous history and accompanying diseases (P>0.05).

 

1. Criteria for Dx: The Criteria for Evaluation of the Therapeutic Effects

for Apoplexy formulated by the Cooperation Group for Acute Cerebral

Diseases, State Administration of TCM in 1995 were used for TCM Dx,

and the criteria for " atherosclerotic thrombotic cerebral infarction " in the

Essentials for Dx of Various Kinds of Cerebrovascular Diseases revised

at the 4th National Conference on Cerebrovascular Diseases in 1995

were adopted for Dx in western medicine.

 

2. Criteria for recruitment: Included in the observations were those

who accorded with the above-mentioned TCM/western diagnostic

criteria, with cerebral infarction at the basal ganglia defined by cranial

CT/MRI, with ages <75 years, with the first attack within a week and

with consciousness and a stable disease condition.

 

3. Criteria for exclusion: Excluded in the observation were (1) those

whose disease was induced by cerebral tumour, cerebral trauma,

cerebral parasitosis, metabolism disorder, rheumatic cardiac disease,

coronary heart disease and other heart disease complicated with atrial

fibrillation; (2) those who had such severe complications as severe

psychiatric disorder, severe dementia, and those who were complicated

with severe primary diseases in the heart, liver, kidney, haemopoietic

and endocrine system; (3) those who had severe dysfunction in

language comprehension, and (4) those who had disorders severely

affecting the movement of the limbs like joint pathological changes.

 

Tx Methods

1) Basic AP Tx (Control) Group: According to AP Therapy compiled

by Prof. Yang Changsen, points selected were contralateral motor area

on the scalp, plus SJ14, LI11, LI04, GB30, GB34, ST36, ST41 and

BL60 on the affected side. For points on the scalp, the needles were

inserted horizontally with rotating manoeuvre. For body points, the

needles were inserted perpendicularly, and the lifting and thrusting

manoeuvre was applied with the reducing method being used during

acute stage and reinforcing manoeuvre during the convalescence

stage.

 

2) " Phased Whole AP " Tx Group: Based on Brunnstrom, point

selection was made at different stages in the following ways:

 

At the flaccid paralysis stage (stage 1 and 2), bilateral GB20, bilateral

BL23, bilateral BL25 and GV14 were added in addition to the general

points mentioned above. 10-12 points were alternatively taken each

time, and ST36, LI11 and LI04 on the unaffected side were added at the

same time. Reinforcing and reducing manoeuvres were used

respectively on the unaffected and affected side.

 

At the spasmodic stage (stage 3 and 4), points of the Hand-Shaoyang

Meridian in the upper limbs and those of the Foot-Yangming and Foot-

Jueyin Meridians in the lower limbs were used mainly. SI12, LI15, SJ01,

SJ05, Baxie (EX-UE9), ST31, GB29, ST36, GB40, LV08 and Bafeng

(EX-UE10) on the affected side were selected alternatively according to

the condition of the patients. A reinforcing manoeuvre with a strong

stimulating intensity was adopted. Also, Xiashaohai, [l“ below HT03)],

BL37 and SP10 were added with a reducing manoeuvre.

 

At the convalescence stage (stage 5 and 6), the same points as those

in the control Group were used. Uniform reinforcing and reducing

manoeuvre was used with a mild/moderate stimulating intensity.

Needles were retained for 30 minutes, during which manipulation was

performed once every 10 minutes. Tx was given once daily except

Sunday. The therapeutic effect was estimated after 4 weeks of Tx.

 

Apart from the basic Tx for patients in both Groups, functional Rehab

should be added. At the flaccid paralysis stage, strengthened medical

care was given to make the affected limbs in a right position and a

proper body posture in bed should be adopted and the body posture

shifted regularly to prevent spasm. Also, patients were encouraged to

do active exercises on bed, such as bridge-like exercise, leg splint

exercise, stretching/bending of the upper limb and the elbow. At the

spasmodic stage, training should be carried out to avoid spasm, and

massage was applied to relieve the spasm of joints and muscles. At the

convalescence stage, patients should be asked to do the selective

active and speedy exercises, such as 3-grade sitting positions,

balanced standing, walking up and down the stairs. Besides, the

training for controlling muscular spasm was also made continuously.

 

The ability of daily life (ADL) was scored and estimated by adopting

Barthel Index (BI). Clinical data were collected before Tx and 4 weeks

after Tx. The t-test was used for numerical analysis, and Chi2 test used

for comparison of rates. SPSS 11.0 software was used for statistical

analysis.

 

Criteria for Therapeutic Effects: Ability of daily life: According to BI

scoring method, the improvement of ADL was evaluated in both

Groups. 2) Evaluation of deformity: Based on BI scores, ADL was

classified into deformed (BL<75) and non-deformed (BL=/>75). And the

deformed rates were compared between the two Groups.

 

Therapeutic Results: Comparison of BI scores before and after Tx in

both Groups: As is shown in Table 1, there was no significant difference

in BI scores between the two Groups before Tx (P>.05). After Tx, the BI

scores were significantly elevated (P<.01) in both Groups, but the

elevation in the Tx Group was obviously higher than that in the control

Group with significant difference (P<.01), indicating that the " Phased

Whole AP " was superior to the traditional AP in elevating ADL.

 

Table 1. Comparison of BI scores between the two Groups before

and after Tx (X+/-s)

Group

n

Before Tx

After Tx

Mean BI

Change(**)

 

Phased Tx

63

53.57+/-29.07

82.08+/-19.31*$

28.51

 

Basic Tx

(Control)

50

43.34+/-29.58

69.98+/-27.53*

26.64

 

(*) P<.01, compared before v after Tx within Group

($) P<.01, compared between the 2 Groups

(**) comment: The CHANGE in BI scores between the two

treatments (28.51 units of improvement dt Phased Tx v 26.64 units of

improvement dt Basic Tx) were minimal and did NOT confirm that the

Phased Tx was significantly better than the Basic (Control) Tx.

 

Comparison of deformed rates before and after the Tx: As is shown in

Table 2, there was no significant difference in deformed rates before

the Tx between the two Groups (P>.05), but after the Tx significant

difference was found (P<.05), indicating that the " Phased Whole AP "

was superior to the traditional AP in lowering the deformed rate.

 

Table 2. Comparison of deformed rates between the two Groups

before and after Tx

 

Group

 

n

Before Tx

Deformed Non-Deformed

After Tx

Deformed Non-Deformed

 

Phased Tx

63

40 (63.5%) 23 (36.5%)

19 (30.2%) 44 (69.8%)

 

Basic Tx

(Control)*

50

37 (74.0%) 13 (26.0%)

25 (50.0%) 25 (50.0%)

 

 

(*) comment: Randomisation in this trial was poor, because

the DEFORMED RATE in the Basic Tx Group was higher than in the

Phased Tx Group before Tx. Therefore, one would expect a poorer

outcome in the Basic Tx Group BEFORE the trial was done!

 

Discussion

With improved level in Dx and Tx, apoplexy-induced mortality

decreased greatly, but a higher deformed rate still remained. This

deformity always resulted from the lowering/loss of ability of daily life

due to diskinesia of the limbs. Modern Rehab medicine holds that it is

more significant when estimation on motor is combined with estimation

on ADL. Clinically, the BI scoring is a method that is used most widely

and affectively to evaluate ADL.

 

" Phased Whole AP " is a therapy composed of various kinds of AP

methods, combined with modern Rehab training measures, in treating

apoplexy-induced hemiplegia. It is composed of scalp-AP, traditional

body AP, back-shu needling, opposing needling, and balanced needling

in yin and yang meridians as well as functional Rehab training. This

therapy should start at the early stage.

 

At the flaccid paralysis stage (stages 1 and 2), scalp-AP is used

together with body AP, with points selected both on the affected and the

unaffected sides, especially back-shu points, aiming at putting more

sensory and motor information to the brain and evoking active

movement of the limbs to induce combined reaction and synergic

movement to promote functional reformation of the brain, so as to

modulate the lower centres. This way of emphasizing the back-shu

points is beneficial to the restoration of trunk strength at the early

paralyzed stage, so that it sets up a basis for further functional training.

 

At the spasmodic stage (stages 3 and 4), AP Tx is mainly to inhibit

spasm by way of combined point selection from yin and yang meridians

with the points in antagonist muscles being selected to regulate balance

between yin and yang and to inhibit muscular spasm.

 

At the convalescence stage (stages 5 and 6), points are selected mainly

according to differentiation and the points of the Yangming Meridian on

the affected limb also are selected to dredge Qi & Xue in the affected

limbs and to facilitate the establishment of a normal motor model.

 

The combination of AP Tx and corresponding functional Rehab training

has become a Rehab therapeutic model of TCM in treating apoplexy-

induced hemiplegia, which is by means of integrated intervention, in

which AP is taken as the main therapy. This model is in accord with

natural pathological process of hemiplegia and conducive to restoration,

" The Phased Whole AP therapy " is superior to traditional AP in lowering

the deformed and handicapped rate, and in raising the ability of daily life

of the patients, indicating further that it is a safe and effective AP

therapy. Plasticity of the CNS may be involved in the mechanisms. By

means of considerable repeated benign stimulations, Phased Whole AP

may enhance the ability of structural and functional compensation and

functional reformation of the CNS, hence a remarkable therapeutic

effects.

 

References

1. .

..1996; 29 ( 6 ): 381-383.

2. . ,

1996;19(1): 55-56.

3. . .

1997;17( 5):312.

4. Duncan PW, Jorgensen HS, Wade DT. Outcome measures in acute

stroke trials. A systematic review and some recommendations to

improve practice. Stroke 2000; 31 (6):1429-1438.

 

(Translated by Chen Zhengqiu )

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

 

 

 

Best regards,

 

HOME + WORK: 1 Esker Lawns, Lucan, Dublin, Ireland

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

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