Treatment of finger spasm after stroke with wheat grain moxibustion at Shixuan (EX-UE 11) combined with rehabilitation training: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical effect of wheat grain moxibustion combined with rehabilitation training and simple rehabilitation training on finger spasm after stroke.@*METHODS@#A total of 80 patients with finger spasm after stroke were randomly divided into an observation group and a control group, 40 cases in each group. The control group was given routine rehabilitation training, once a day, 30 min each time. The observation group was given wheat grain moxibustion at Shixuan (EX-UE 11) on the basis of the control group, 8~10 moxibustion cones at each point, once a day. Both groups were treated for 6 days as one course of treatment for 4 courses. The motor function of the affected hand (Fugl-Meyer assessment [FMA] score) and muscle tension (modified Ashworth scale [MAS] grading), surface EMG indexes (wrist dorsiflexor muscle and flexor carpal metacarpal muscle mean square [RMS] value), hand muscle strength (neurological deficit score [NDS]) and daily living ability (modified Barthel index [MBI] score) were compared between the two groups before and after treatment, and clinical efficacy was evaluated.@*RESULTS@#After treatment, FMA and MBI scores in the 2 groups were increased compared with before treatment (P<0.05), and those in the observation group were higher than the control group (P<0.05). The RMS value of wrist dorsiflexor muscle and flexor carpal metacarpal muscle in relaxation and passive function testsand and NDS in the 2 groups were lower than those before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). MAS grading in the 2 groups was improved compared with before treatment (P<0.05), and that in the observation group was better than the control group (P<0.05). The total effective rate of the observation group was 92.5% (37/40), which was higher than that of the control group (80.0%, 32/40, P<0.05).@*CONCLUSION@#Wheat grain moxibustion at Shixuan (EX-UE 11) combined with rehabilitation training can improve the hand motor function and daily living ability of patients with finger spasm after stroke, improve the degree of spasm and the function of wrist dorsiflexor muscle and flexor carpal metacarpal muscle, the clinical effect is better than simple rehabilitation training.

Therapeutic effect on post-stroke spastic paralysis of upper extremity treated with combination of kinematic-acupuncture therapy and rehabilitation training / 中国针灸

OBJECTIVE@#To compare the clinical therapeutic effect on post-stroke spastic paralysis of the upper extremity between the combination of kinematic-acupuncture therapy and rehabilitation training and the combined treatment of the conventional acupuncture with rehabilitation training.@*METHODS@#A total of 60 patients of post-stroke spastic paralysis of the upper extremity at the non-acute stage were randomized into an observation group (30 cases) and a control group (30 cases, 1 case dropped off). On the base of the routine western medication and rehabilitation treatment, the kinematic-acupuncture therapy was added in the observation group and the conventional acupuncture was used in the control group. Baihui (GV 20), Dazhui (GV 14), Jiaji (EX-B 2) from T to T, Tianzong (SI 11), Jianzhen (SI 9), Jianyu (LI 15) and Quyuan (SI 13) were selected in both groups. The treatment was given once daily and the treatment for 14 days was as one course. The one course of treatment was required in this research. Separately, before treatment and in 7 and 14 days of treatment, the score of simplified Fugl-Meyer scale of the upper extremity (FMA-UE), the grade of the modified Ashworth scale (MAS) and the score of the modified Barthel index scale (MBI) were compared between the two groups.@*RESULTS@#Compared before treatment, in 7 and 14 days of treatment, FMA-UE score was increased obviously in either group (<0.01). In 14 days of treatment, FMA-UE score in the observation group was higher than that in the control group (<0.05). In 7 and 14 days of treatment, MAS grades of shoulder joint, elbow joint, wrist joint and metacarpophalangeal joint were all improved markedly in the two groups (<0.05). Compared with the grades in 7 days of treatment, MAS grades of elbow joint and metacarpophalangeal joint were improved markedly in 14 days of treatment in the two groups (<0.05). Compared with the control group, MAS grades of elbow joint and metacarpophalangeal joint were improved more markedly in the observation group in 14 days of treatment (<0.05). Compared with the score before treatment, MBI score was increased in 7 and 14 days of treatment respectively in the observation group (<0.05, <0.01). In 14 days of treatment, MBI score was increased in the control group (<0.01).@*CONCLUSION@#For the patients with post-stroke spastic paralysis of the upper extremity at the non-acute stage, the combined treatment with kinematic-acupuncture therapy and rehabilitation training obviously improves the motor function of the upper extremity and the muscle tone of elbow joint and metacarpophalangeal joint. The therapeutic effect of this combination is better than that of the combined treatment of the conventional acupuncture with rehabilitation training. Additionally, this combined therapy improves the ability of daily life activity.

Observation on the curative effect of articular needling at Sifeng (EX-UE 10) on finger spastic paralysis after stroke / 中国针灸

OBJECTIVE@#To observe the improved effects of articular needling at Sifeng (EX-UE 10) on finger spastic paralysis after stroke on the basis of conventional treatment.@*METHODS@#Sixty-four patients were randomly divided into an observation group and a control group, 32 cases in each group. Both groups were treated with conventional drugs, and in the control group, conventional acupuncture was treated. On the basis of the treatment in the control group, articular needling at Sifeng (EX-UE 10) was applied in the observation group. The treatment was given once everyday for 6 days with one day interval, and a total of two weeks were needed. The finger scores in the Fugl-Meyer evaluation scale (FMA), the Brunnstrom motor function rating, and the modified Ashworth spasm rating were observed before and after treatment.@*RESULTS@#After treatment, the Fugl-Meyer scores in the two groups were higher than those before treatment (<0.01). The Fugl-Meyer score in the observation group was higher than that in the control group (<0.01). The results of Brunnstrom motor function rating and the modified Ashworth spasm rating were improved in the two groups (<0.01, <0.05), and the observation group was superior to the control group (<0.01).@*CONCLUSION@#The articular needling at Sifeng (EX-UE 10) can effectively improve the condition of finger spastic paralysis.

Fire-needle acupuncture for upper limb spastic paralysis after stroke: Study protocol for a randomized controlled trial / 中西医结合学报

BACKGROUND@#Fire-needle acupuncture, an important kind of acupuncture therapy, has been clinically used to treat upper limb spastic paralysis (ULSP) after stroke. Clinical experience has indicated that fire-needle acupuncture treatment takes less time, requires fewer visits, and has more rapid results and fewer side effects compared to chemical medicine alternatives. This study will evaluate the effects of fire-needle acupuncture for ULSP in the context of standardized clinical research and provide high-quality data to inform clinical procedures and future study design.@*METHODS/DESIGN@#A randomized controlled trial will be carried out to evaluate the effects of fire-needle acupuncture therapy in patients with ULSP from stroke. ULSP patients (n = 120) will be recruited at Changhai Hospital in Shanghai, China. Patients will be randomly divided into three groups, including fire-needle acupuncture group (FAG), filiform-needle acupuncture group (FFAG) and rehabilitation treatment group (RTG). During the 3-week treatment, the FAG will be treated every two days, while FFAG and RTG will be treated 5 d in a row and then rest for 2 d. The Simplified Fugl-Meyer Motor Function Scale and Modified Ashworth Scale will be used as the primary outcome measures. Statistical analysis will be conducted by an independent statistician.@*DISCUSSION@#Through this study, the utility of fire-needle acupuncture in treating ULSP after stroke will be tested, and some specific claims of fire-needle acupuncture therapy will be evaluated, such as relieving spasm and muscular tension, improving activities of daily living, rapidity of response and less frequency of treatment compared with other treatments.@*TRIAL REGISTRATION@#Chinese Clinical Trial Registry (identifier: ChiCTR-IOR-17013875; registration date: 28 December 2016).

Progresses in Objective Assessment Tools to Assess the Subjects' Function and Spasticity of Upper Extremity after Stroke / 世界科学技术-中医药现代化

Spastic-paralysis impacts the function of upper extremity in most apoplexy patients.Assessing spasticity condition precisely,timely and effectively plays an important role in guiding rehabilitation treatment,therapeutic evaluation and prognosis of functional outcome.Owing to the limitations of subjective scales,the issue of quantifing the spasticity objectively has become a new research direction in recent years.By reviewing the literatures,we summed up the application of objective assessment tools,which were based on rehabilitation engineering,electrophysiology or biomechanics,in assessing the function of upper extremity with spastic paralysis,as well as put forward the research directions of prospects,in order to give a reference to the systematic integration of assessment tools in the near future.

Clinical Study on Huoxue Rongluo Particles Combined with Acupuncture at Eight Confluent Acupoints in Treatment of Spastic Cerebral Infarction Paralysis / 中国中医药信息杂志

Objective To observe the clinical efficacy of Huoxue Rongluo Particles combined with acupuncture in the eight confluent points of spastic cerebral infarction paralysis and its effects on Glu and Asp levels of serum. Methods Totally 60 patients were divided into two groups: the experimental group and the control group. Both groups received basic Western medicine treatment, and the experimental group received Huoxue Rongluo Particles additionally, one dose a day for two times orally taken; Acupuncture was on eight confluent acupoint, every two days. 15 d is a treatment course, with 6 courses in total. Clinical spasticity index (CSI) and TCM symptom scores before treatment and the treatment of half month, 1 month, 3 months were observed. The levels of Glu and ASP in serum were detected, and TCM clinical efficacy was observed. Results The CSI score, levels of Glu and Asp in serum and TCM symptom scores of the patients after half-month, one-month, and three-month treatment were lower than those before treatment (P0.05). The TCM symptom scores in experimental group was lower than the control group after half-month, one-month and three-month treatment (P<0.05). The total TCM effective rate was 86.67% (26/30) in experimental group, and 80.00% (24/30) in the control group, with the experimental group better than the control group (P<0.05). Conclusion Huoxue Rongluo Particles combined with acupuncture eight confluence acupoints in the treatment of spastic cerebral infarction paralyzed patients can relieve spasm degree, improve TCM clinical symptoms, which mechanism may be related to reducing serum excitatory neurotransmitters.

DNA Methylation and Muscle Fiber Configuration on Skeletal Muscle in Spastic Paralysis Rats / 中国康复理论与实践

@#Objective To investigate the DNA methylation of skeletal muscle in spastic paralysis rats and correlation with the muscle fiber configuration. Methods 100 5-day old Wistar rats were randomly divided into model group and control group. The former was established the spastic paralysis modle and reared for 30 days. Then, tissues from the gastrocnemius of all the rats were observed with triplicate DNA methylation, myosin heavy chain-I (MHC-I) mRNA with RT-PCR and transmission electron microscopy. Results The DNA methylation was (4.95±0.83)×10% in the model group, significantly less than (6.59±0.75)×10% in the control group (P<0.001); while the MHC-I mRNA was (1.23±0.31), significantly more than (0.44±0.29) in the control group (P<0.001). The Z-line was disordered, and the mitochondria near the Z-line increased, with edema and partially broken in cristae. The balance between the thick and thin filaments was broken, and myofibrils envelope fused. Conclusion Hypomethylation and hyperexpression of MHC-I mRNA have been found in skeletal muscle of spastic paralysis rats, which may result in type I fibers increase. However, there was no sufficient evidence to support the correlation between the DNA methylation and the secondary pathological changes.

Selection of Meridians and Acupoints of Tuina for Spastic Paralysis post Stroke: A Bibliometric Analysis / 中国康复理论与实践

@#Objective To investigate the meridians and acupoints selection in the treatment of post-stroke spastic paralysis with Tuina (Chinese massage). Methods The literatures about Tuina therapy for post-stroke spastic paralysis were retrieved. The frequency of meridians and acupoints used was counted and analyzed. Results 99 papers were collected, which involved in 226 acupoints and 1602 times of application. The selected acupoints were distributed in all the fourteen meridians and 64.5% (1033/1602, 606 on upper limb, 427 on lower limb) of them were on the limbs. The acupoints of the Yang meridians was 75.0% (1200/1602) and the specific acupoints was 71.7% (1148/ 1602). Conclusion The acupoint selected was basically focused on the local areas in Tuina for post-stroke spastic paralysis, assisted with the involved meridians and distal acupoints. The acupoints of the Yang meridians were the first option, mainly on the extremities. The specific acupoints were the major components of the prescription, especially the Five-shu acupoints and the He acupoints.

Anesthesia Selection for Modeling Spastic Paralysis in Rats / 中国康复理论与实践

@#Objective To explore the optimal dose and ways of anesthesia for creating a rat model of spastic paralysis with intermittent bilateral common carotid artery ligation. Methods 60 Wistar rats were randomly divided into groups A, B, C, D, E and F. Group A was anaesthetized with 10% chloral hydrate 5 ml/kg injected subcutaneously, while group B with 4 ml/kg subcutaneously, group C with 4 ml/kg intraperitoneally, group D with 3 ml/kg subcutaneously, group E with 3 ml/kg intraperitoneally, group F with 2 ml/kg subcutaneously. The onset and duration of anesthesia, and intraoperative and postoperative mortality were compared. Results All the rats in the group A died during anesthesia, while the group F did not achieve the depth of anesthesia, and abandoned. The onset time was (6.5±0.7) min, maintained (121.4± 3.9) min, mortality was 0 in the group B, and it was (5.5±1.1) min, (122.0±3.6) min, 30% in the group C; (9.6±0.8) min, (106.7±3.7) min, 0 in the group D, (7.4±1.2) min, (105.3±3.5) min, 20% in the group E. The overall mortality rate was 0 in the groups accepted subcutaneous injected and 25% of intraperitoneal injection. Conclusion Anesthesia with 10% chloral hydrate 4 ml/kg subcutaneous injection is optimal of lower mortality, faster onset and longer maintaining in rats for spastic paralysis model with intermittent bilateral common carotid artery ligation.

DNA Methylation and Muscle Fiber Configuration on Skeletal Muscle in Spastic Paralysis Rats / 中国康复理论与实践

Objective To investigate the DNA methylation of skeletal muscle in spastic paralysis rats and correlation with the muscle fi-ber configuration. Methods 100 5-day old Wistar rats were randomly divided into model group and control group. The former was estab-lished the spastic paralysis modle and reared for 30 days. Then, tissues from the gastrocnemius of all the rats were observed with triplicate DNA methylation, myosin heavy chain-I (MHC-I) mRNA with RT-PCR and transmission electron microscopy. Results The DNA methyla-tion was (4.95 ± 0.83) × 10%in the model group, significantly less than (6.59 ± 0.75) × 10%in the control group (P<0.001);while the MHC-I mRNA was (1.23±0.31), significantly more than (0.44±0.29) in the control group (P<0.001). The Z-line was disordered, and the mitochon-dria near the Z-line increased, with edema and partially broken in cristae. The balance between the thick and thin filaments was broken, and myofibrils envelope fused. Conclusion Hypomethylation and hyperexpression of MHC-I mRNA have been found in skeletal muscle of spas-tic paralysis rats, which may result in type I fibers increase. However, there was no sufficient evidence to support the correlation between the DNA methylation and the secondary pathological changes.

Anesthesia Selection for Modeling Spastic Paralysis in Rats / 中国康复理论与实践

Objective To explore the optimal dose and ways of anesthesia for creating a rat model of spastic paralysis with intermittent bilateral common carotid artery ligation. Methods 60 Wistar rats were randomly divided into groups A, B, C, D, E and F. Group A was an-aesthetized with 10%chloral hydrate 5 ml/kg injected subcutaneously, while group B with 4 ml/kg subcutaneously, group C with 4 ml/kg in-traperitoneally, group D with 3 ml/kg subcutaneously, group E with 3 ml/kg intraperitoneally, group F with 2 ml/kg subcutaneously. The on-set and duration of anesthesia, and intraoperative and postoperative mortality were compared. Results All the rats in the group A died during anesthesia, while the group F did not achieve the depth of anesthesia, and abandoned. The onset time was (6.5±0.7) min, maintained (121.4± 3.9) min, mortality was 0 in the group B, and it was (5.5±1.1) min, (122.0±3.6) min, 30%in the group C;(9.6±0.8) min, (106.7±3.7) min, 0 in the group D, (7.4±1.2) min, (105.3±3.5) min, 20%in the group E. The overall mortality rate was 0 in the groups accepted subcutaneous in-jected and 25%of intraperitoneal injection. Conclusion Anesthesia with 10%chloral hydrate 4 ml/kg subcutaneous injection is optimal of lower mortality, faster onset and longer maintaining in rats for spastic paralysis model with intermittent bilateral common carotid artery liga-tion.

Selection of Meridians and Acupoints of Tuina for Spastic Paralysis post Stroke:A Bibliometric Analysis / 中国康复理论与实践

Objective To investigate the meridians and acupoints selection in the treatment of post-stroke spastic paralysis with Tuina (Chinese massage). Methods The literatures about Tuina therapy for post-stroke spastic paralysis were retrieved. The frequency of meridi-ans and acupoints used was counted and analyzed. Results 99 papers were collected, which involved in 226 acupoints and 1602 times of ap-plication. The selected acupoints were distributed in all the fourteen meridians and 64.5% (1033/1602, 606 on upper limb, 427 on lower limb) of them were on the limbs. The acupoints of the Yang meridians was 75.0%(1200/1602) and the specific acupoints was 71.7%(1148/1602). Conclusion The acupoint selected was basically focused on the local areas in Tuina for post-stroke spastic paralysis, assisted with the involved meridians and distal acupoints. The acupoints of the Yang meridians were the first option, mainly on the extremities. The specific acupoints were the major components of the prescription, especially the Five-shu acupoints and the He acupoints.

Comparison of visual analogue scale and Likert scale in assessing the PROs for patient with spastic paralysis from the stroke / 中华行为医学与脑科学杂志

Objectives To assess if visual analogue scale(VAS) or Likert scale was relatively more suitable when measuring self-reported clinical outcomes for apoplexy spastic-paralysis patients.Methods Nineteen questions were made from the serf-evaluating instrument based on patient reported outcomes for apoplexy spasticparalysis patients developed previously in cross-sectional study.104 patients answered the questions by both continuous and discrete visual analogue scale(VAS),while other 110 patients by both five-point Likert scales and Likert-typo scales.Cronbach'sαfor internal consistency reliability,spearman for correlation,and exploratory factor analysis for construct validity were applied.Results Except for emotional domain,the α coefficients of physical domain,social domain and overall score with continuous and discrete VAS are higher than that with five-point Likert scales and Likert-type scales.Internal consistency reliability was stronger for VAS.lntraclass correlation coefficients were above 0.4 mostly for each item with its domain,and VAS may produce the higher correlation.For VAS,there were three factors in the exploratory factor analysis,which confirmed the domain hypotheses of physical,mental and social functions,but for the Likert scales,the result was undesiable.Conclusion The more accurate for the response options,the better for the performance.When the patient can complete the measurement without the help of others,VAS seems better suited.

Characteristics and Evaluation of Apoplexy Spastic-paralysis (review) / 中国康复理论与实践

@#Most of apoplexy patients have suffered limb spastic-paralysis for a long time,which impacts their activity and emotion seriously.However,the instruments of evaluating apoplexy spastic-paralysis used come from abroad mostly.These instruments are not special for apoplexy spastic-paralysis patients,and that there is a lack of patients' experience.Therefore,it is urgent to develop a Patient Reported Outcomes(PRO)instrument specially for apoplexy spastic-paralysis patients.

Advance in Acupuncture and Moxibustion in Spastic Paralysis After Stroke / 中国康复理论与实践

@# In the past, treatment of acupuncture and moxibustion always were emphasized on improving the strength of muscle. In fact, spasticity is the key point. This paper summarized recent studies on therapeutic effect of acupuncture and moxibustion on spastic paralysis after stroke.

Hereditary Spastic Paraplegia

Hereditary spastic paraplegia (HSP) is a rare hereditary disorder and becomes clinically apparent during adolescence or in childhood and progresses s1owly throughout the adult years with a variability in the severity of expression. We experienced 3 cases of hereditary spastic paraplegia. Cases 1 and 2, which were pure HSP, had only the signs and symptoms of corticospinal tract involvement with the positive family history, and case 3, which was a complicated case of HSP, had distal muscle wasting, dysarthria, signs and symptoms of the corticospinal tracts, and a positive family history. All are thought to be inherited in an autosomal dominant pattern.