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Lim SM, Go E, Lee J, Lee GE, Kim EJ, Son C. Improving Upper Limb Spasticity in Patients with Stroke by Electroacupuncture Therapy: a Pre- and Post-Treatment Study. J Acupunct Meridian Stud 2023; 16:248-254. [PMID: 38115590 DOI: 10.51507/j.jams.2023.16.6.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/27/2023] [Accepted: 08/30/2023] [Indexed: 12/21/2023] Open
Abstract
Background : Post-stroke upper limb spasticity (PS-ULS) causes a decline in the quality of life of patients by reducing their ability to perform normal daily activities. Objectives : We performed pre- and post-treatment analyses of the changes in stroke patients with ULS following constant electroacupuncture therapy (EAT). Methods : Thirty patients with PS-ULS underwent 12 sessions of EAT over 4 weeks. After performing acupuncture therapy at four acupoints on the affected arm (LI11, LI10, LI4, and TE5), electrostimulation (60 Hz) was performed for 20 min. The modified Ashworth scale (MAS) and the Fugl-Meyer assessment of the upper extremity (FMA-UE) were measured as the outcome variables. Results : Following EAT, there was a significant decrease in the elbow MAS score (p < 0.001), a significant decrease in the wrist MAS score (p < 0.01), and a significant increase in the FMA-UE score (p < 0.001). Adverse events related to EAT were not reported. Conclusion : EAT decreased upper limb spasticity and improved functional recovery at the elbow and wrist. Large-scale and rigorous clinical trials are needed to verify the efficacy of EAT.
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Affiliation(s)
- Sung Min Lim
- Department of Clinical Rehabilitation Research, National Rehabilitation Research Institute, Seoul, Korea
| | - Eunji Go
- Department of Clinical Rehabilitation Research, National Rehabilitation Research Institute, Seoul, Korea
| | - Jungsup Lee
- Department of Korean Traditional Internal Medicine, National Rehabilitation Center, Seoul, Korea
| | - Go Eun Lee
- Department of Korean Traditional Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Eun Joo Kim
- Department of Neurorehabilitation, National Rehabilitation Center, Seoul, Korea
| | - Chihyoung Son
- Department of Korean Traditional Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
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Wang JX, Fidimanantsoa OL, Ma LX. New insights into acupuncture techniques for poststroke spasticity. Front Public Health 2023; 11:1155372. [PMID: 37089473 PMCID: PMC10117862 DOI: 10.3389/fpubh.2023.1155372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
With the trend of aging population getting more obvious, stroke has already been a major public health problem worldwide. As a main disabling motor impairment after stroke, spasticity has unexpected negative impacts on the quality of life and social participation in patients. Moreover, it brings heavy economic burden to the family and society. Previous researches indicated that abnormality of neural modulation and muscle property corelates with the pathogenesis of poststroke spasticity (PSS). So far, there still lacks golden standardized treatment regimen for PSS; furthermore, certain potential adverse-events of the mainstream therapy, for example, drug-induced generalized muscle weakness or high risk related surgery somehow decrease patient preference and compliance, which brings challenges to disease treatment and follow-up care. As an essential non-pharmacological therapy, acupuncture has long been used for PSS in China and shows favorable effects on improvements of spastic hypertonia and motor function. Notably, previous studies focused mainly on the research of antispastic acupoints. In comparison, few studies lay special stress on the other significant factor impacting on acupuncture efficacy, that is acupuncture technique. Based on current evidences from the clinic and laboratory, we will discuss certain new insights into acupuncture technique, in particular the antispastic needling technique, for PSS management in light of its potential effects on central modulations as well as peripheral adjustments, and attempt to provide some suggestions for future studies with respect to the intervention timing and course, application of acupuncture techniques, acupoint selection, predictive and aggravating factors of PSS, aiming at optimization of antispastic acupuncture regimen and improvement of quality of life in stroke patients. More innovations including rigorous study design, valid objective assessments for spasticity, and related experimental studies are worthy to be expected in the years ahead.
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Affiliation(s)
- Jun-Xiang Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- *Correspondence: Jun-Xiang Wang,
| | | | - Liang-Xiao Ma
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- The Key Unit of State Administration of Traditional Chinese Medicine, Evaluation of Characteristic Acupuncture Therapy, Beijing, China
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Javier-Ormazábal A, González-Platas M, González-Sierra E, González-Sierra M. Invasive Physiotherapy as a Treatment of Spasticity: A Systematic Review. Degener Neurol Neuromuscul Dis 2022; 12:23-29. [PMID: 35264894 PMCID: PMC8901191 DOI: 10.2147/dnnd.s350192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Nowadays, a set of novel physiotherapy techniques have emerged, in which the physical agent used to try to reduce spasticity is applied percutaneously, specifically, through the patient’s skin. The aim of this work is to encompass all the invasive techniques used in spasticity in a single article, updating the existing bibliography. Methodology A systematic review was carried out between December 2020 and April 2021 in the Web of Science, Scopus and PubMed databases, selecting the clinical trials that used acupuncture, electroacupuncture or dry needling as a treatment for spasticity. Sixteen clinical trials were included, summarizing all the study characteristics and the outcome measures, at last the evidence was described for their results. Results Most of the studies find a difference of significant decrease in spasticity between the subjects of the experimental groups. Only four studies found no significant changes in spasticity. All the studies are carried out together with the conventional physiotherapy treatment in spasticity. Conclusion Treatment with invasive physiotherapy, combined with conventional physiotherapy, seems to have positive effects in reducing spasticity, although more studies are needed to improve the heterogeneity of the interventions and to assess their long-term effectiveness.
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Affiliation(s)
- Alberto Javier-Ormazábal
- Rehabilitation Service, Hospital Universitario de Canarias, San Cristobal de la Laguna, Islas Canarias, Spain
- Correspondence: Alberto Javier-Ormazábal, Calle La Rosa no. 4, San Cristóbal de La Laguna, S/C de Tenerife38203, Spain, Email
| | - Montserrat González-Platas
- Neurology Service, Hospital Universitario de Canarias, San Cristóbal de La Laguna, Islas Canarias, Spain
| | | | - Marta González-Sierra
- Home Hospitalization, Service Hospital Universitario de Canarias, San Cristóbal de La Laguna, Islas Canarias, Spain
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M. Alwhaibi R, Mahmoud NF, M. Zakaria H, M. Ragab W, Al Awaji NN, Y. Elzanaty M, R. Elserougy H. Therapeutic Efficacy of Transcutaneous Electrical Nerve Stimulation Acupoints on Motor and Neural Recovery of the Affected Upper Extremity in Chronic Stroke: A Sham-Controlled Randomized Clinical Trial. Healthcare (Basel) 2021; 9:healthcare9050614. [PMID: 34065465 PMCID: PMC8160996 DOI: 10.3390/healthcare9050614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 11/16/2022] Open
Abstract
Inability to use the affected upper extremity (UE) in daily activities is a common complaint in stroke patients. The somatosensory system (central and peripheral) is essential for brain reorganization and plasticity. Neuromuscular electrical stimulation is considered an effective modality for improving UE function in stroke patients. The aim of the current study was to determine the therapeutic effects of transcutaneous electrical nerve stimulation (TENS) acupoints on cortical activity and the motor function of the affected UE in chronic stroke patients. Forty male and female patients diagnosed with stroke agreed to join the study. They were randomly assigned to group 1 (G1) and group 2 (G2). G1 received task-specific training (TST) and sham electrical stimulation while G2 received TST in addition to TENS acupoints. Session duration was 80 min. Both groups received 18 sessions for 6 successive weeks, 3 sessions per week. Evaluation was carried out before and after completion of the treatment program. Outcome measures used were the Fugl-Meyer Assessment of the upper extremity (FMA-UE) and the box and block test (BBT) as measures of the motor function of the affected UE. Brain activity of the motor area (C3) in the ipsilesional hemisphere was measured using a quantitative electroencephalogram (QEEG). The measured parameter was peak frequency. It was noted that the motor function of the affected UE improved significantly post-treatment in both groups, while no significant change was reported in the FMA-UE and BBT scores post-treatment in either G1 or G2. On the other hand, the activity of the motor area C3 improved significantly in G2 only, post-treatment, while G1 showed no significant improvement. There was also significant improvement in the activity of the motor area (C3) in G2 compared to G1 post-treatment. The results of the current study indicate that TST only or combined with TENS acupoints can be considered an effective method for improving motor function of the affected UE in chronic stroke patients, both being equally effective. However, TST combined with TENS acupoints proved better in improving brain plasticity in chronic stroke patients.
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Affiliation(s)
- Reem M. Alwhaibi
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (R.M.A.); (N.F.M.)
| | - Noha F. Mahmoud
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia; (R.M.A.); (N.F.M.)
| | - Hoda M. Zakaria
- Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 12613, Egypt; (H.M.Z.); (W.M.R.); (M.Y.E.)
| | - Walaa M. Ragab
- Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 12613, Egypt; (H.M.Z.); (W.M.R.); (M.Y.E.)
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, Taibah University, Medina 42353, Saudi Arabia
| | - Nisreen N. Al Awaji
- Health Communication Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh 11671, Saudi Arabia;
| | - Mahmoud Y. Elzanaty
- Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Cairo 12613, Egypt; (H.M.Z.); (W.M.R.); (M.Y.E.)
- Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Deraya University, New Menya 11159, Egypt
| | - Hager R. Elserougy
- Department of Neuromuscular Disorders and Its Surgery, Faculty of Physical Therapy, Misr University for Science and Technology, Giza 77, Egypt
- Correspondence:
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The Therapeutic Effect of Electroacupuncture Therapy for Ischemic Stroke. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:6415083. [PMID: 33293991 PMCID: PMC7718040 DOI: 10.1155/2020/6415083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/09/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022]
Abstract
Electroacupuncture (EA) stimulation is a supplementary therapy and commonly applied in treatment of ischemic stroke in clinic. Stroke is an important cause of long-term disability in individuals in both developing and developed countries. In our review, we show the application of EA stimulation for apoplectic pain, limbs spasticity, blood flow interruption, depression, swallowing dysfunction, aphasia, urinary incontinence, cognition and memory impairment, and constipation following stroke in patients and the related mechanisms in animals. The effectiveness of EA involves with acupoints, intensity, intervals, and duration of intervention for treatment of stroke. The combination of EA and common rehabilitation treatment may exert better effect compared with EA alone. In summary, EA might provide a potential treatment strategy for treating apoplectic patients in clinic.
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Ferrer-Peña R, Calvo-Lobo C, Gómez M, Muñoz-García D. Prediction Model for Choosing Needle Length to Minimize Risk of Median Nerve Puncture With Dry Needling of the Pronator Teres. J Manipulative Physiol Ther 2019; 42:366-371. [PMID: 31262581 DOI: 10.1016/j.jmpt.2018.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to relate forearm anthropometric measures to ultrasound pronator teres depth to determine the necessary needle length to prevent median nerve (MN) injury during pronator teres dry needling. METHODS We conducted a study employing a diagnostic accuracy prediction model (NCT03308279) at a Spanish university center. The study recruited 65 participants to predict the depth of the MN (measured with ultrasound) in the pronator teres using a decision tree algorithm to reduce the risk of MN puncture using 2 needle lengths (13 mm or 25 mm). The decision tree was developed by automatically selecting a cutoff for body mass index, forearm length and circumference, and pronator teres thickness. RESULTS For forearm circumferences ≤27.5 cm, the predictive value for the 13-mm needle was 92%. For forearm circumferences >27.5 cm and forearm lengths ≤26.75 cm, the predictive value for the 25-mm needle was 100%. CONCLUSION Based upon the findings of this study, we suggest that needle length should be selected according to forearm anthropometric measures to prevent MN injury during pronator teres dry needling.
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Affiliation(s)
- Raúl Ferrer-Peña
- Departamento de Fisioterapia and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Nursing and Physical Therapy Department, Faculty of Health Sciences, Universidad de León, Ponferrada, León, Spain.
| | - Miguel Gómez
- Departamento de Fisioterapia and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Daniel Muñoz-García
- Departamento de Fisioterapia and Motion in Brains Research Group, Instituto de Neurociencias y Ciencias del Movimiento, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
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Sham Electroacupuncture Methods in Randomized Controlled Trials. Sci Rep 2017; 7:40837. [PMID: 28106094 PMCID: PMC5247761 DOI: 10.1038/srep40837] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/13/2016] [Indexed: 01/04/2023] Open
Abstract
Sham electroacupuncture (EA) control is commonly used to evaluate the specific effects of EA in randomized-controlled trials (RCTs). However, establishing an inert and concealable sham EA control remains methodologically challenging. Here, we aimed to systematically investigate the sham EA methods. Eight electronic databases were searched from their inception to April 2015. Ten out of the 17 sham EA methods were identified from 94 RCTs involving 6134 participants according to three aspects: needle location, depth of needle insertion and electrical stimulation. The top three most frequently used types were sham EA type A, type L and type O ordinally. Only 24 out of the 94 trials reported credibility tests in six types of sham EA methods and the results were mainly as follows: sham EA type A (10/24), type B (5/24) and type Q (5/24). Compared with sham EA controls, EA therapy in 56.2% trials reported the specific effects, of which the highest positive rate was observed in type N (3/4), type F (5/7), type D (4/6) and type M (2/3). In conclusion, several sham EA types were identified as a promising candidate for further application in RCTs. Nonetheless, more evidence for inert and concealable sham EA control methods is needed.
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