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Stroke Rehabilitation

 Stroke is one of the leading causes of death and disability in US. While modern Western medicine is excellent in providing effective emergency treatment for sufferers, it has little to offer stroke victims in terms of long-term recuperative treatment. Much research in China has proven that acupuncture and Traditional Chinese Medicine can effectively treat  many sequelae of stroke, and have been built into the standard stroke treatment protocols.

 

The understanding of stroke in China is dated as early as 2,500 years ago.  A definition of stroke can be found in the classic medical book named Huangdi Neijing, also known as Yellow Emperor’s Inner Canon, one of the earliest medical texts in the world and the foundation of the theory of Chinese Medicine and acupuncture. This ancient medical text had already recorded its etiology, symptoms and treatment. It described stroke related symptoms such as hemiplegia (paralysis of one side of the body), difficulty with speech, and facial distortion.

In ancient China, stroke was referred to as “Zhong Feng,” which literally translated means “wind stroke”. It is characterized by abrupt onset with pathological changes varying quickly like the wind, from which the term “wind stroke” comes.

 

The term Wind-stroke in Chinese medicine corresponds to four possible Western medical conditions:
•    Cerebral hemorrhage
•    Cerebral thrombosis
•    Cerebral embolism
•    Spasm of a cerebral vessel

 

Acupuncture is an ancient healing art that has been practiced for thousands of years, and throughout the history of Chinese medicine, many experienced physicians have recorded their valuable clinical experiences regarding stroke. Numerous texts recorded treatments, from immediate relief of acute symptoms of stroke to resuscitation due to acupuncture treatment of stroke and its sequelae.

 

Today, in contemporary hospitals in China, acupuncture is one of the first options for post-stroke rehabilitation patients once they are stable.

With the emergence of functional MRI, we are learning more about acupuncture’s ability to increase neural activity within different locations in the brain using different acupuncture points and can now direct our treatments to the areas of the brain that were damaged by a cerebral vascular accident and areas of the brain that are thought to be impaired based on clinical findings.The best example of the popularity of acupuncture treatment for post-stroke patients can be seen at Tianjin University of Traditional Chinese Medicine. There, hundreds of post-stroke patients are treated daily with great success.

 

Many studies involving thousands of stroke patients have been published in China demonstrating that acupuncture can help by promoting vessel dilation[1], cerebral collateral circulation reestablishment[2], fibrinolytic activity[3], dissolving blood clots and blood reabsorption[4].

 

Acupuncture therapy for stroke-caused conditions such as paralysis, difficulty with speech and swallow, and facial distortion is commonly used in China.  Many symptoms seen among stroke survivors that can be helped by acupuncture treatment, proved by clinical research, are listed below:

•    Post-stroke Depression[5]
•    Dysphagia[6]
•    Aphasia[7]
•    Ataxia[8]
•    Muscular tension[9]
•    Insomnia[10]
•    Hypertension[11]
•    Urinary incontinence[12]
•    Constipation[13]
•    Pain management[14]

 

In China and Japan, an acupuncturist is likely to start therapy as soon as possible after a stroke. For ischemic stroke, treatment 3 hours after anticoagulation therapy is recommended as a standard protocol in China. Research found that early involvement of acupuncture treatment produces the best results. For ischemic type, results are best if acupuncture treatment  start within 15 days. [15]  For cerebral hemorrhage type, treatment 2 weeks after the stroke is recommended if intracerebral hemorrhage (ICH) volume is <30mL. If hemorrhage is >30mL, acupuncture is used after the surgery is stabilized.[15]

 

Acupuncture is done on a daily basis in China. The majority of acupuncturists with experience in treating stroke believe treatment 2-3 times a week is optimal.

 

A course of treatment is usually 3 months. Severe cases may require multiple courses, up to 10 courses in some extreme cases. [15]

 

Acupuncture can certainly help in the prevention of subsequent strokes by controlling hypertension, help managing diabetes and lowering high cholesterol.

 

Sure. In China, physical therapy and herbal medicine are used as part of the treatment protocol accompanying acupuncture. In the acute stage, acupuncture is usually the modality used to prevent joint adhesions in the major joints. During rehabilitation stage, other treatment modalities are added into the treatment protocol.[15] Many stroke survivors experience some type of pain, ranging from mildly uncomfortable to so severe that it hinders recovery. Acupuncture is well-known in pain management.

 

Scalp needling is a special acupuncture technique which was develop from a combination of Chinese Medicine theory and neuro-anatomical physiology.  This technique is especially good for the treatment of brain diseases of symptoms related to cerebral cortex.  Scalp acupuncture can improve the circulation of blood in the damaged portions of the cerebral cortex and, in China, it is the most used and effective technique, combined with traditional body acupuncture, for stroke rehabilitation. Research has shown that scalp acupuncture accompanied by body needling is better than using just traditional body needling technique for rapid recovery from apoplectic hemiplegia.[16]

 

REFERENCES:


[1] Zhong Qi, Wa Rei Lin, Acupuncture in patients with ischemic cerebrovascular effects of cerebral blood flow. Liaoning Journal of Traditional Chinese Medicine,1991 , (8) :11.
[2] LI Gui-ping,SHI Lei,DU Yuan-hao,et al. Effect of electro-acupuncture and collateral circulation re-establish in early stage of cerebral infarction, Journal of Tianjin University of Traditional Chinese Medicine, 2011,02
[3] Ding Jun, Effect of Electro-acupuncture on coagulation and fibrinolysis activity in rats with acute cerebral infarction, Journal of Hunan University of Traditional Chinese Medicine,2007
[4] Zhao Yao Dong, Zheng JunJiang Zheng Kui Shan, RECENT PROGRESSES OF ACUPUNCTURE TREATMENT OF CEREBRAL HEMORRHAGE,  World Journal of Acupunture-Maxibustion 2003(02)
[5] Sun Jian Hua, Zhu Shan Shan et al. Clinical studies of applying Jian Nao Tiao Shen Acupuncture  technique for treating post –stroke depression. JIANGSU JOURNAL OF TRADITIONAL CHINESE MEDICINE,2009, 41(11)
[6] XIE Yue,WANG Li-ping,HE Jing-hua,et al. Acupuncture for dysphasia in acute stroke. Cochrane Database Syst Rev,2008(3): CD006076.
[7] LIU Zhi-dan,LI Hai-yan,SONG Yi,et al.Review of acupuncture for motor dysfunction after stroke, Shanghai J Acu&Mox,2008,27(11):38-42.
[8] Zhang Yulian, Wang Lian Shun,et al, Clinical studies of head and neck acupuncture to treat stroke ataxia, Shanghai Journal of Acupuncture and Moxibustion, 2003, 22(8)
[9] LU Yin-ming,FU Li-xin,MU Jiao,et al. Acupuncture for Post Stroke Shoulder Hand Syndrome :A Systematic Review. Chin J Evid-based Med,2009,9(9):976-978.
[10] Wang yan, Zhao Zhi Fu et al. Clinical therapeutic effect of acupuncture on post-stroke depression with insomnia, Chinese Acupuncture&Moxibustrion,2004,24(9)
[11] Zhao Hong Da, Clinical therapeutic effect of acupuncture for hypertension during recovery stage of the stroke, AEROSPACE MEDICINE  2008, 19(4)
[12] LIU Zhi-shun,DU Yi. Evaluation of the Curative Effect of Electro-acupuncture on Post apoplectic Incontinence of Urine. Shanghai J Acu&Mox,2007,20(26):13-14.
[13]Wang Dong Shen, Wang Shun,et al, Clinical observation on abdominal electro-acupuncture for treatment of post-stroke constipation, CHINESE ACUPUNCTURE & MOXIBUSTION , 2008, 28(1)
[14]Zhang Tong,et al, Clinical Research of Acupuncture treatment for pain caused by stroke hemiplegia , JOURNAL OF TRADITIONAL CHINESE MEDICINE ,2001, 42(1)

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[15] SHI Xue-min. Acupuncture & Moxibustion. Beijing: China Press of Traditional Chinese Medicine,2002:220-223
[16] SUN Hua ,BAO Fei ,WANG Dao-hai ,ZHANG Yun-xiang, WANG Feng-qin, Observation on clinical therapeutic effect of scalp acupuncture combined with body acupuncture on apoplectic hemiplegia, CHINESE ACUPUNCTURE & MOXIBUSTION, 2006, 26(6)

 

 

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