Superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia of stroke in early stage / 中国针灸

OBJECTIVE@#To verify the superiority of motor imagery acupuncture in improving muscle tension for patients with upper limb hemiplegia in early stroke.@*METHODS@#A total of 64 patients of stroke hemiplegia with upper limb flaccid paralysis were randomly divided into an observation group (32 cases, 1 case dropped off ) and a control group (32 cases, 4 cases dropped off ). The observation group was treated with motor imagery acupuncture (both acupuncture and motor imagery therapy at affected upper limb were performed).The control group was treated with acupuncture plus motor imagery therapy at affected lower limb, 2 h later after acupuncture, motor imagery therapy was applied to upper limb. Baihui (GV 20) to Taiyang (EX-HN 5) of healthy side, Fengchi (GB 20) and Jianyu (LI 15), Jianjing (GB 21), Quchi (LI 11), Waiguan (TE 5) on the affected side, ect. were selected in both groups, once a day, 5 times a week for 4 weeks. Before and after treatment, 4, 8 weeks after treatment, the modified Ashworth scale (MAS) grade and Brunnstrom stage were compared in the two groups.@*RESULTS@#Compared before treatment, the muscle tension of shoulder, elbow and wrist each time point after treatment was increased in the two groups (@*CONCLUSION@#Motor imagery acupuncture could promote hemiplegia upper limb muscle tension recovery in patients of stroke hemiplegia with upper limb flaccid paralysis, make the patients gradually shift to the separate fine movement mode, inhibit and relieve the appearance and development of spasm.

Tapping at acupoints along meridian combined with thunder-fire moxibustion for upper-limb hemiplegia after stroke / 中国针灸

OBJECTIVE@#To observe the effect of tapping at acupoints along meridian combined with thunder-fire moxibustion on upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke.@*METHODS@#A total of 140 patients with upper-limb hemiplegia after stroke were randomly divided into a combination group (35 cases, 2 cases dropped off), an acupoint-tapping group (35 cases), a moxibustion group (35 cases, 2 cases dropped off) and a routine group (35 cases). The patients in the routine group were only treated with routine treatment and nursing. On the basis of the treatment in the routine group, the patients in the acupoint-tapping group were treated with tapping along the large intestine meridian of hand @*RESULTS@#Compared before treatment, body mass indexs of shoulder abduction, elbow extension, wrist flexion as well as BI scores in the four groups were significantly increased after treatment (@*CONCLUSION@#Tapping at acupoints along meridian combined with thunder-fire moxibustion could effectively improve the upper-limb muscle strength and activities of daily living in patients with upper-limb hemiplegia after stroke, and its effect is superior to simple tapping at acupoints along meridian or thunder-fire moxibustion.

Improvement in Paralyzed Upper Limb Function following Two Courses of Low-frequency Repetitive Transcranial Magnetic Stimalation (rTMS) Combined with Intensive Occupational Therapy / The Japanese Journal of Rehabilitation Medicine

Background : Both low-frequency repetitive transcranial magnetic stimulation (rTMS) and intensive occupational therapy (OT) have been recently reported to be clinically beneficial for post-stroke patients with upper limb hemiparesis. We have already reported that the function of the paralyzed upper limb in the post-stroke hemiplegic patients was improved after a 15-day hospitalization protocol, named NEURO-15. In this present study, we investigated whether two courses (2X) of NEURO-15 were superior to a single one in therapeutic efficacy. Methods: During NEURO-15, each patient was scheduled to receive 21 treatment sessions of 20-min low-frequency rTMS followed by 120-min intensive OT daily. Low-frequency pulses of 1 Hz were applied to the motor cortex of the nonlesional hemisphere. Fugl-Meyer Assessment (FMA), log performance time of the Wolf Motor Function Test (WMFT) and modified Ashworth Scale (MAS) were evaluated on the days of admission and discharge. The first NEURO-15 was given to 16 apoplectic hemiplegic patients whose Brunnstrom Recovery Stage in their fingers ranged from IV to V. After an average of 13.6 months, the second NEURO-15 was administered to all 16 patients. Results : The 2X protocol was completed by all patients without any adverse effects. After the first course of NEURO-15, all patients showed improvement in their paralyzed upper limb function ; improvements which remained until the second NEURO-15 course. The second NEURO-15 course yielded even further improvement in the paralyzed upper limb function. Conclusions : Our proposed combination treatment is a safe, feasible, and clinically useful neurorehabilitative intervention for post-stroke patients with upper limb hemiparesis when administered as both a single application or as a 2X protocol. The effectiveness of the 2X protocol or even more frequent application of NEURO-15 courses needs to be further explored.

Regional Cerebral Blood Flow (rCBF) after Low-frequency Repetitive Transcranial Magnetic Stimulation (rTMS) Combined with Intensive Occupational Therapy for Upper Limb Hemiplegia after Stroke : A Study using Single Photon Emission Computed Tomography / The Japanese Journal of Rehabilitation Medicine

We performed a 15 day protocol of low-frequency repetitive transcranial magnetic stimulation (rTMS) combined with intensive occupational therapy in hemiplegic upper limbs in poststroke and investigated the effect of cerebral blood flow using single photon emission computed tomography (SPECT). Seventeen chronic stroke patients were studied with SPECT at rest before and 4 weeks after undergoing the 15 day protocol. Before and after the treatment, Fugl-Meyer Assessment (FMA) score and Wolf Motor Function Test (WMFT) -Log performance time showed a significant improvement. The specific areas with a significant increase in perfusion in the affected hemisphere were the insula (BA 13), the precentral gyrus (BA 44) and the cerebellum. In the nonaffected hemisphere, perfusion was significantly increased in the lingual gyrus and cerebellum. On the other hand, perfusion was significantly decreased in the middle frontal gyrus (BA 6), precentral gyrus (BA 4) and postcentral gyrus (BA 3) in the nonaffected hemisphere. It was suggested that low-frequency rTMS combined with intensive occupational therapy effects the cerebral blood flow and contributes to improving upper limb hemiplegia after stroke.