Ayurvedic Treatment of Acute Ischemic Stroke: A Prospective Observational Study

Ayurvedic Treatment in the Rehabilitation of Ischemic Stroke Patients in India: A Randomized Controlled Trial Study Protocol

In patients with ischemic stroke, motor and sensory impairments are common and are associated with functional disability. Conventional physiotherapy (CP) is the primary modality of rehabilitation for post-stroke sensorimotor dysfunction. Ayurveda is a commonly practiced alternative system of medicine that offers unique rehabilitative measures for post-stroke recovery. We hypothesize that Ayurvedic rehabilitative treatment (ART) is superior to similar duration CP in improving the sensorimotor recovery of patients with ischemic stroke at 90 days after enrollment. AyuRvedic TrEatment in the Rehabilitation of Ischemic STrOke Patients in India: A Randomized controllEd trial (RESTORE) is an investigator-initiated, multicenter, prospective, randomized, controlled, parallel-arm, blinded outcome assessment trial being conducted under the Indian Stroke Clinical Trial (INSTRuCT) Network across the four comprehensive stroke centers in India. Consecutive hemodynamically stable adult patients with their first acute ischemic stroke between 1 and 3 months from stroke onset are being randomized (1:1) into two treatment groups to receive either 1 month of ART or 1 month of CP. The primary outcome measure is the Fugl Meyer Assessment-upper extremity for physical performance at 90 days. The secondary outcomes are the modified Rankin Scale, Barthel Index, Berg Balance, and SF-36 at 90 days. The safety outcomes include a composite of irreversible morbidity and mortality. A sample size of 140 (70 in each group) patients with ischemic stroke will allow us to detect a minimal clinical important difference of 9.4 (standard deviation) with superiority margin of 5, an attrition rate of 10%, alpha of 5%, and power of 80%. This randomized trial will systematically assess the efficacy and safety of traditional ART compared to CP. The trial has been registered in the Clinical Trial Registry India (CTRI/2018/04/013379).

Report: Council for Ayurveda Research - Industry Roundtable and Global Consortium for Collaborative Research in Ayurveda, 2021

The Council for Ayurveda Research (CAR) organized a three-day international event titled 'Global Consortium for Collaborative Research in Ayurveda (GCCRA) from September 17 to 19, 2021. The Consortium event was preceded by a pre-conference Industry Round Table (IRT), on September 16, 2021. The IRT and GCCRA events hosted industry heads, Ayurveda and integrative scholars and subject matter experts from several countries. The event's main objective was to initiate, facilitate, and conduct classical and cutting-edge research in Ayurveda and identify current gaps in research and research methodologies. The idea was also to develop consensus on key research areas. It was decided to form a Council for Ayurveda Research-Industrial Conclave (CAR-IC) to foster and support research on the industry side, with regular periodic meetings to enable dialogs and exchange of information and thoughts. Similarly, a Council for Ayurveda Research-Global Consortium for Collaborative Research in Ayurveda (CAR-GCCRA) was incepted to lead the initiative for providing clear, contemporary, and futuristic directions to research in the practice side of Ayurveda.

Vegetarian Diets, Ayurveda, and the Case for an Integrative Nutrition Science

Two recent studies of the health effects of vegetarian diets reported conflicting results: the EPIC-Oxford study reported a significant increase in strokes among vegetarians compared to meat-eaters among a predominantly Caucasian cohort, while another, performed on Taiwanese Buddhists, reported significantly lower incidence of strokes among vegetarians. This was doubly puzzling given the pronounced decrease in cardiovascular events among the EPIC-Oxford group. In this article, we make a detailed comparison of the actual dietary intake of various food groups by the cohorts in these studies. We then use the nutritional principles of Ayurveda—traditional Indian medicine—to show how these apparently contradictory results may be explained. Systems of traditional medicine such as Ayurveda possess profound knowledge of the effects of food on physiology. Ayurveda takes into account not just the type of food, but also multiple other factors such as taste, temperature, and time of consumption. Traditional cuisines have evolved hand in hand with such systems of medicine to optimize nutrition in the context of local climate and food availability. Harnessing the experiential wisdom of these traditional systems to create an integrative nutrition science would help fight the ongoing epidemic of chronic lifestyle diseases, and improve health and wellness.

Complementary and alternative interventions for stroke recovery - a narrative overview of the published evidence

OBJECTIVES

Stroke survivors dissatisfied with their progress often seek complementary and alternative interventions (CAI). This paper reviews the evidence for CAIs in stroke recovery.

METHODS

A literature search was performed for publications until December 2019 of CAI for stroke in Pubmed, Cochrane Library, EMBASE, CINAHL, AMED. Evidence was assessed according to Oxford Centre for Evidence-based Medicine criteria.

RESULTS

In a meta-analysis, acupuncture reduced death or dependency compared to control at the end of follow-up and over the long term (≥3 months), OR 0.61(95%CI 0.46-0.79) and OR 0.67(95%CI 0.53-0.85) respectively, but was neutral against sham acupuncture. A Cochrane review of acupuncture vs. sham acupuncture in subacute or chronic stroke vs. showed no differences in motor function and quality of life. Three trials found favourable effects of moxibustion on motor function (SMD=0.72, 95%CI 0.37-1.08, p<0.0001). Two trials showed cupping compared to acupuncture reduced hemiplegic shoulder pain and upper-limb 'myodynamia'. A meta-analysis of traditional Chinese medicines for ischaemic stroke showed marked improvement in neurological deficit on stroke scales. There was no evidence for Ayurveda, homoeopathy or reiki. Tui-na reduced the Modified Ashworth Scale in some muscle groups. Marma massage improved Motricity Index and trunk control. Thai massage and herbal treatments improved the Barthel Index. On meta-analysis, Yoga improved memory and anxiety, while tai-chi improved activities of daily living, balance and walking ability. Studies were generally of poor quality.

CONCLUSIONS

The evidence for benefit of CAIs for stroke recovery is weak. More research is needed to justify these treatments for stroke, by well-conducted, adequately-sized, double-blinded, randomized controlled trials.

Stroke rehabilitation in low-income and middle-income countries: a call to action

The WHO Rehabilitation 2030 agenda recognises the importance of rehabilitation in the value chain of quality health care. Developing and delivering cost-effective, equitable-access rehabilitation services to the right people at the right time is a challenge for health services globally. These challenges are amplified in low-income and middle-income countries (LMICs), in which the unmet need for rehabilitation and recovery treatments is high. In this Series paper, we outline what is happening more broadly as part of the WHO Rehabilitation 2030 agenda, then focus on the specific challenges to development and implementation of effective stroke rehabilitation services in LMICs. We use stroke rehabilitation clinical practice guidelines from both high-income countries and LMICs to highlight opportunities for rapid uptake of evidence-based practice. Finally, we call on educators and the stroke rehabilitation clinical, research, and not-for-profit communities to work in partnership for greater effect and to accelerate progress.