Acupuncture and Transcutaneous Nerve Stimulation in Stroke Rehabilitation

Johansson, Barbro; Haker, Eva; Arbin, Magnus von; Britton, M; Långström, Goran; Terént, Andreas; Ursing, Dag; Asplund, Kjell

doi:10.1161/01.str.32.3.707

Cited by 139 publications

(109 citation statements)

References 30 publications

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“…33,34 Larger randomized trials of the use of acupuncture to improve functional use of the hand have shown little or no benefit when sham puncture (i.e., insertion of the needle outside a traditional zone or without stimulation) served as a control. 35 Spasticity is often blamed for poor hand function in patients with minimal wrist and finger extension but some preservation of flexion. Contracture and change in the morphologic features of muscle 36 contribute to a flexed posture, but poor motor control with weakness, not hypertonia, is the primary cause of disability.…”

Section: Targeted Therapymentioning

confidence: 99%

Rehabilitation after Stroke

2005

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A 66-year-old man was suddenly unable to speak, follow directions, or move his right arm and leg. He received tissue plasminogen activator within 90 minutes. Four days later, his speech was limited to effortful answers of yes or no. He could not walk or use his right arm, and self-care tasks required maximal assistance. What advice would you offer him and his family regarding rehabilitation for his disabilities? THE CLINICAL PROBLEMApproximately 400 persons per 100,000 population over the age of 45 years have a first stroke each year in the United States, Europe, and Australia. Stroke is the most frequent cause of adult-onset disability among people in the United States, and the cost of related care is among the fastest-growing expenses for Medicare. 1 The likelihood of improvement after stroke varies with the nature and severity of the initial deficit. Approximately 35 percent of survivors with initial paralysis of the leg do not regain useful function, and 20 to 25 percent of all survivors are unable to walk without full physical assistance. 2 Six months after stroke, about 65 percent of patients cannot incorporate the affected hand into their usual activities. Poor upper-extremity outcomes are probable after a hemispheric infarction when the leg cannot move by two weeks and the hand has no movement or only slight finger flexion with no opening by four weeks, consistent with considerable damage to the corticospinal tract. 3 Patients who survive a stroke almost always have less physical disability by the end of the first three months. Functional scales, such as the Barthel Index and the Functional Independence Measure (which measure the physical assistance or supervision needed for self-care, including using the toilet, dressing, bathing, eating, and mobility), tend to show a plateau of gains by three to four months after stroke, partly owing to insensitivity of the scale to further improvements. Patients who no longer require assistance at that point may still be unable to use the affected hand, walk at speeds and distances that permit activities outside the home, or live alone. Only 25 percent of patients return to the level of everyday participation and physical functioning of community-matched persons who have not had a

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Section: Targeted Therapymentioning

confidence: 99%

Rehabilitation after Stroke

2005

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“…[11][12][13] In the earlier trials conducted outside China, 2 studies showed that acupuncture can improve motor function and independence in activities of daily living (ADL), 14,15 whereas 2 trials using sham treatment as control did not find evidence of benefit. 16,17 Although, by contrast, many Chinese trials reported positive results, the conclusions were not regarded as robust, as a result of small sample size and methodological weaknesses as follows: the use of outcome measures that were not internationally recognized; unclear methods of randomization and allocation concealment; the lack of long-term follow-up; and publication bias.…”

mentioning

confidence: 99%

Acupuncture Efficacy on Ischemic Stroke Recovery

Zhang

Liu

et al. 2015

Stroke

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Therefore, we designed this randomized controlled trials with a larger sample, and scales to Background and Purpose-Acupuncture is a frequently used complementary treatment for ischemic stroke in China but the evidence available from previous randomized trials is inconclusive. The objective of this study was to assess the efficacy and safety of acupuncture in a more robustly designed larger scale trial. Methods-This is a multicenter, single-blinded, randomized controlled trial. Eight hundred sixty-two hospitalized patients with limb paralysis between 3 to 10 days after ischemic stroke onset were allocated acupuncture plus standard care or standard care alone. The acupuncture was applied 5 times per week for 3 to 4 weeks. The primary outcomes were defined as follows: (1) death/disability according to Barthel index and (2) death/institutional care at 6 months. Results-There was a tendency of fewer patients being dead or dependent in acupuncture group (80/385, 20.7%) than in control group (102/396, 25.8%) at 6 months (odds ratio, 0.75; 95% confidence interval, 0.54-1.05). The benefit was noted in subgroup receiving ≥10 sessions of acupuncture (odds ratio, 0.68; 95% confidence interval, 0.47-0.98). There was no statistical difference in death or institutional care between the 2 groups (odds ratio, 1.06; 95% confidence interval, 0.63-1.79). Severe adverse events occurred in 7.6% and 8.3% of patients in the 2 groups, respectively. Conclusions-Acupuncture seemed to be safe in the subacute phase of ischemic stroke. If the potential benefits observed are confirmed in future larger study, the health gain from wider use of the treatment could be substantial. Clinical Trial Registration-URL: http://www.chictr.org/en/. Unique identifier: ChiCTR-TRC-11001353.

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“…Several previous studies have shown the benefit of acupuncture for motor improvement in stroke rehabilitation [1][2][3][4][5][6][7]. However, the effectiveness of acupuncture on motor functional recovery has been seriously challenged by the results reported in recent clinical trials [8][9][10][11]. In the current study, we targeted stroke survivors with moderate to severe muscle spasticity in the affected wrist joint.…”

Section: Discussionmentioning

confidence: 99%

“…Some past studies have demonstrated the effectiveness of acupuncture treatment in stroke rehabilitation [1][2][3][4][5][6][7]. Other studies reported different findings [8][9][10][11]. For instance, a recent metaanalysis of past clinical trials in the literature concluded that acupuncture had no additional effect on motor recovery but did have a positive effect on disability [12].…”

Section: Introductionmentioning

confidence: 99%

Electroacupuncture may help motor recovery in chronic stroke survivors: A pilot study

Li¹

2008

JRRD

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Abstract-Past studies have suggested that acupuncture may reduce spasticity in stroke survivors. We do not know, however, whether acupuncture may enhance the effect of strength training on motor function. This study compared upper-limb motor functional improvement in chronic stroke survivors who received a combination of acupuncture and strength training with that of subjects who received strength training alone. A total of 10 chronic stroke patients with moderate or severe wrist muscle spasticity were recruited for this study. The study used a crossover design with a random order of either combined electroacupuncture and strength training or strength training alone. Each subject received one of the two types of treatment twice a week for the first 6 weeks and switched to the other for another 6 weeks. Quantitative measurements of wrist spasticity, active wrist extension range of motion, isometric wrist strength, and clinical evaluation with Fugl-Meyer (FM) upper-limb motor scores were conducted before and after either treatment. After the combined treatment, the quantitative spasticity level, active wrist extension range of motion (increased by a mean of 16.3 degrees), and FM upper-limb motor score (increased by a mean of 4.9 points) changed significantly (p < 0.01) but no significant changes were noted in isometric wrist strength. The strength training alone resulted in no significant changes to any measured variable. The results of the current study indicate that the combined acupuncture and strength training treatment reduced muscle spasticity and may have improved motor function for chronic stroke survivors with moderate or severe muscle spasticity.

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Acupuncture and Transcutaneous Nerve Stimulation in Stroke Rehabilitation

Cited by 139 publications

References 30 publications

Rehabilitation after Stroke

Rehabilitation after Stroke

Acupuncture Efficacy on Ischemic Stroke Recovery

Electroacupuncture may help motor recovery in chronic stroke survivors: A pilot study

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