Acupuncture restores hand function in patients with hemiplegia. Foshan Jianxiang Hospital (Guangdong, China) researchers conclude that active motion acupuncture significantly improves outcomes for patients with hand dysfunction due to hemiplegia. The researchers document improvements in motor function, reductions in spasticity, and overall improvements in activities of daily living. [1]
Primary assessment instruments were the MAS (Modified Ashworth Scale), Fugl-Meyer Assessment, and ADL (Activities of Daily Living Scale). Two groups were compared. One group received physical rehabilitation training and another group received identical physical rehabilitation training plus acupuncture. The integrative medicine acupuncture group outperformed the physical rehabilitation monotherapy group across all parameters.
The study included 70 patients with varying degrees of hand dysfunction due to hemiplegia. The severity of the patients’ conditions was graded according to Brunnstrom’s Stages of Motor Recovery. In brief, the scale is comprised of:
Stage 1. Flaccid paralysis without reflexes
Stage 2. Spasticity without voluntary movement
Stage 3. Marked spasticity with synergistic movement elicited voluntarily
Stage 4. Decreasing spasticity with synergistic movement predominant
Stage 5. Waning spasticity but present with rapid and extreme movement
Stage 6. Near normal coordination and movement
Stage 7. Normal coordination and movement
For inclusion in the study, patients were required to have hand dysfunction graded 1–5 on the above scale and provide informed consent to participate. Exclusion criteria included serious organ dysfunction, hematopoietic disorders, and severe kidney or primary liver dysfunction.
Patients were randomly assigned to the acupuncture integrative medicine group or the rehabilitation training monotherapy control group. The acupuncture group was comprised of 21 male and 14 female patients, ages 33–81 years (mean age 55.8 years). The control group was comprised of 19 male and 16 female patients, ages 37–83 years (mean age 56.5 years). There were no statistically significant differences in baseline characteristics between the two groups (p>0.05).
Acupuncture and Rehabilitation Training All patients received basic rehabilitation training according to the severity of their condition. Those with stage 1–2 conditions were guided to perform limb positioning exercises with bedside assistance and passive movement. Patients with stage 3–4 conditions performed activities of daily living and spasm reduction training. Patients with stage 5 conditions performed upper limb strength and activities of daily living training. Patients allocated to the acupuncture group also received exercise acupuncture therapy depending on the severity of their condition. Patients in the flaccid paralysis stage were treated using the following acupoints:
Chongxian (T 22.02, Master Tung system)
Chongzi (T 22.01, Master Tung system)
Neiguan (PC6)
Daling (PC7)
After eliciting deqi at Neiguan, the needle was stimulated using a lifting-thrusting, twisting-rotating technique. Approximately 60 rotations were applied per minute for a total of 3 minutes. Needles at the remaining acupoints were retained without further stimulation after eliciting deqi. All needles were retained for 30 minutes. During this time, the acupuncturist assisted the patient in passive flexion and extension of the fingers of the affected hand. The patient was allowed to take the lead in this movement if they were able to do so.
The point selection involved classic main channel acupoints PC6 and PC7 and two Master Tung system acupoints. Chongzi (22.01) is located on the thenar eminence, approximately 1 cun below the skin fold between the first and second metacarpal bones. Chongxian (22.02) is located between the first and second metacarpal bones, 2 cun below the skin fold, on the palmar surface of the hand. Chongxian (22.02) is located on the ventral aspect of the hand and is directly opposite Linggu (22.05), which is on the dorsal aspect of the hand. Patients in the spasticity stages were treated using the following acupoints:
Sifeng (MUE9)
Baxie (MUE22)
Waiguan (TB5)
Zhongzhu (TB3)
The needles were stimulated using an intermittent lifting-thrusting, twisting-rotating technique while guiding the patient in passive and active flexion and extension of the affected hand.
Results Outcome measures for the study included the MAS (Modified Ashworth Scale), Fugl-Meyer Assessment, and ADL (Activities of Daily Living Scale). The MAS is a scale used to assess spasticity in patients with central nervous system lesions. A higher score is indicative of increased spasticity. Mean pre-treatment MAS scores were 1.71 in the control group and 1.70 in the acupuncture group. Following treatment, these scores fell to 0.62 and 0.42, respectively. Significantly greater improvements were seen in the acupuncture group (p<0.05).
The Fugl-Meyer Assessment is designed to gauge recovery in hemiplegic patients. A higher score is indicative of greater recovery. Mean pre-treatment Fugl-Meyer scores were 21.55 in the control group and 22.06 in the acupuncture group. Following treatment, these scores increased to 23.31 and 35.87, respectively. Significantly greater improvements were seen in the acupuncture group (p<0.05).
ADL scores are used to assess a patient’s ability to perform tasks such as dressing, toileting, and hygiene, independently. A higher score is indicative of greater independence. Mean pre-treatment ADL scores were 37.8 in the control group and 38.1 in the acupuncture group. Following treatment, these scores increased to 52.4 and 74.1, respectively. Significantly greater improvements were seen in the acupuncture group (p<0.05).
Review The study focused on the application of local acupuncture points for the treatment of hand dysfunction due to hemiplegia. The results indicate that this approach to patient care improves outcomes for patients receiving physical rehabilitation training.
Reference: 1. Fu Yanqian, Long Xiangyu, Wang Gang (2019) “Clinical study on exercise acupuncture therapy in the recovery of hand dysfunction patients with hemiplegia” Clinical Journal of Chinese Medicine Vol.11 (15) pp.95, 96.
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