To evaluate the effects and safety of electro-acupuncture (EA) for stroke patients with spasticity.
Explore the relationship between acupuncture and cognitive therapy with change in cognitive domains following traumatic brain injury. The secondary objective was to evaluate the potential relationship between acupuncture and cognitive therapy with volume activation in select brain areas as shown by functional MRI (fMRI).
BACKGROUND: Stroke is the second most common cause of death in the world and in China it has now become the main cause of death. It is also a main cause of adult disability and dependency. Acupuncture for stroke has been used in China for hundreds of years and is increasingly practiced in some Western countries. This is an update of the Cochrane review originally published in 2006 .
OBJECTIVES: To determine the efficacy and safety of acupuncture therapy in people with subacute and chronic stroke. We intended to test the following hypotheses: 1) acupuncture can reduce the risk of death or dependency in people with subacute and chronic stroke at the end of treatment and at follow-up; 2) acupuncture can improve neurological deficit and quality of life after treatment and at the end of follow-up; 3) acupuncture can reduce the number of people requiring institutional care; and 4) acupuncture is not associated with any intolerable adverse effects.
SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (June 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library 2015, Issue 7), MEDLINE (1966 to July 2015, Ovid), EMBASE (1980 to July 2015, Ovid), CINAHL (1982 to July 2015, EBSCO), and AMED (1985 to July 2015, Ovid). We also searched the following four Chinese medical databases: China Biological Medicine Database (July 2015); Chinese Science and Technique Journals Database (July 2015); China National Infrastructure (July 2015), and Wan Fang database (July 2015).
SELECTION CRITERIA: Truly randomised unconfounded clinical trials among people with ischaemic or haemorrhagic stroke, in the subacute or chronic stage, comparing acupuncture involving needling with placebo acupuncture, sham acupuncture, or no acupuncture.
DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials for inclusion, assessed quality, extracted and cross-checked the data.
MAIN RESULTS: We included 31 trials with a total of 2257 participants in the subacute or chronic stages of stroke. The methodological quality of most of the included trials was not high. The quality of evidence for the main outcomes was low or very low based on the assessment by the system of Grades of Recommendation, Assessment, Development and Evaluation (GRADE).Two trials compared real acupuncture plus baseline treatment with sham acupuncture plus baseline treatment. There was no evidence of differences in the changes of motor function and quality of life between real acupuncture and sham acupuncture for people with stroke in the convalescent stage.Twenty-nine trials compared acupuncture plus baseline treatment versus baseline treatment alone. Compared with no acupuncture, for people with stroke in the convalescent phase, acupuncture had beneficial effects on the improvement of dependency (activity of daily living) measured by Barthel Index (nine trials, 616 participants; mean difference (MD) 9.19, 95% confidence interval (CI) 4.34 to 14.05; GRADE very low), global neurological deficiency (seven trials, 543 participants; odds ratio (OR) 3.89, 95% CI 1.78 to 8.49; GRADE low), and specific neurological impairments including motor function measured by Fugl-Meyer Assessment (four trials, 245 participants; MD 6.16, 95% CI 4.20 to 8.11; GRADE low), cognitive function measured by the Mini-Mental State Examination (five trials, 278 participants; MD 2.54, 95% CI 0.03 to 5.05; GRADE very low), depression measured by the Hamilton Depression Scale (six trials, 552 participants; MD -2.58, 95% CI -3.28 to -1.87; GRADE very low), swallowing function measured by drinking test (two trials, 200 participants; MD -1.11, 95% CI -2.08 to -0.14; GRADE very low), and pain measured by the Visual Analogue Scale (two trials, 118 participants; MD -2.88, 95% CI -3.68 to -2.09; GRADE low). Sickness caused by acupuncture and intolerance of pain at acupoints were reported in a few participants with stroke in the acupuncture groups. No data on death, the proportion of people requiring institutional care or requiring extensive family support, and all-cause mortality were available in all included trials.
AUTHORS’ CONCLUSIONS: From the available evidence, acupuncture may have beneficial effects on improving dependency, global neurological deficiency, and some specific neurological impairments for people with stroke in the convalescent stage, with no obvious serious adverse events. However, most included trials were of inadequate quality and size. There is, therefore, inadequate evidence to draw any conclusions about its routine use. Rigorously designed, randomised, multi-centre, large sample trials of acupuncture for stroke are needed to further assess its effects.
Update of Acupuncture for stroke rehabilitation. [Cochrane Database Syst Rev. 2006]
This study illustrates that direct electrical stimulation (ES) improve functional recovery and time of return to work evaluated by prognostic scoring system after ulnar nerve injury.
The Rosén and Lundborg (R&L) protocol, Disabilities of the Arm, shoulder and Hand (DASH) scores, and electromyography were applied for measuring improvements after direct ES intervention.
A 32-year-old male with deep cutting wound and total rupture of right proximal forearm ulnar nerve was treated using direct ES and daily rehabilitation activities.
Direct ES, transmitted using 2 acupuncture needles inserted in the cubital tunnel, was applied along the site of the injured ulnar nerve. Other needles were placed according to muscle origins and insertions. All needles were connected to electrical stimulators. We executed these procedures once per week and conducted rehabilitating activities daily.
The R&L protocol, DASH scores, and electromyography were used to measure the intervention outcomes.
The total score in the R&L protocol was 0.703 of the initial state; the sensory domain contributed the least amount. Among the improved numerical factors, pain/discomfort domain was the first to reach a stable ameliorative state in the first month. The sensory and motor domains reached stable growth in fourth and third months, respectively. The patient returned to the previous job in third month; his time off work was 75 days.
Directly applying ES to the proximal site of an injured nerve can augment nerve regeneration through three suspected mechanisms. Although direct ES on the injured nerve contributed to an effective recovery of this patient with minimal adverse effects, additional investigation of treatment protocols is warranted and the actual mechanism must be identified.
The medical management of stroke is often a dynamic process. While treatment regimens have been established, practitioners and patients are constantly searching for new techniques to improve patient outcomes. The use of treatments not traditionally taught in medical schools has begun to gain popularity. Reports suggest that up to 40% of adults living in the United States and elsewhere have used some form of Complimentary and Alternative Medicine to treat a health problem (Astin et al. 2000). Physicians and researchers are also using standard interventions in new ways to treat difficult medical complications. New applications for medications and technologies are regularly being evaluated. In this review, we examine the use of miscellaneous treatments as they relate to patients who have suffered a stroke. Evidence regarding complimentary and alternative medicine, medications used for the treatment of motor and language recovery, and new technological therapies are evaluated. Alternative therapies include acupuncture, traditional Chinese patent medicine, Reiki, and massage therapy. Medications include those specifically used to aid in motor and language recovery. New technological therapies assessed are hyperbaric oxygen therapy, repetitive transcranial magnetic stimulation, and motor cortex stimulation.
Introduction: Many patients with stroke receive integrative medicine in China, which includes the basic treatment of Western medicine and routine rehabilitation, in conjunction with acupuncture and Chinese medicine. The question of whether integrative medicine is efficacious for stroke rehabilitation is still controversial and very little research currently exists on the integrated approach for this condition. Consequently, we will conduct a multicentre, randomised, controlled, assessor-blinded clinical trial to assess the effectiveness of integrative medicine on stroke rehabilitation.
Methods and analysis: 360 participants recruited from three large Chinese medical hospitals in Zhejiang Province will be randomly divided into the integrative medicine rehabilitation (IMR) group and the conventional rehabilitation (CR) group in a 1:1 ratio. Participants in the IMR group will receive acupuncture and Chinese herbs in addition to basic Western medicine and rehabilitation treatment. The CR group will not receive acupuncture and Chinese herbal medicine. The assessment data will be collected at baseline, 4 and 8 weeks postrandomisation, and then at 12 weeks’ follow-up. The primary outcome is measured by the Modified Barthel Index. The secondary outcomes are the National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment, the mini-mental state examination and Montreal Cognitive, Hamilton’s Depression Scale and Self-Rating Depression Scale, and the incidence of adverse events.
Ethics and dissemination: Ethical approval was obtained from ethics committees of three hospitals. The results will be disseminated in a peer-reviewed journal and presented at international congresses. The results will also be disseminated to patients by telephone, during follow-up calls inquiring on patient’s post-study health status.
Trial registration number: Chinese Clinical Trial Register: ChiCTR-TRC-12001972, http://www.chictr.org/en/proj/show.aspx?proj=2561
Acupuncture is widely accepted by Chinese people and it is increasingly requested by patients and their relatives in Western countries. Stroke is one of the most common diseases for which acupuncture treatment is recommended, according to the World Health Organization . However, Cochrane reviews have shown that although acupuncture appeared to be safe, there is no clear evidence of benefit. The number of patients in existing trials is too small to be certain whether acupuncture is effective for the treatment of acute ischemic stroke. Larger, methodologically sound trials are required [16,28].
For clinical trials blinding is difficult for acupuncture so real randomized placebo-controlled trials seem impossible. In Western medical hospitals in China, acupuncture is used less for stroke compared with Chinese medical hospitals, so setting up a no acupuncture control is feasible. We will conduct our trial in three Western medicine hospitals to ensure a sufficient source of subjects and compliance of the control group. Because many stroke patients will ask for traditional Chinese medicine and acupuncture treatment during the recovery period, we have set the follow-up period as only four weeks.
Under strict quality control, this study could potentially confirm whether or not acupuncture (including scalp acupuncture and electroacupuncture) is an effective adjunct to the standard rehabilitation therapy for acute stroke. Our study may also confirm if acupuncture can be effective in promoting the recovery of motor function and is beneficial to swallowing disorder and cognitive impairment.
…A recent, rather flattering, article on acupuncture on this website holds a mirror to a broader problem in the world of acupuncture research. A problem that goes to the heart of the most fundamental scientific principles.
There’s no doubt that acupuncture is gaining traction on the grounds that it holds up under scientific interrogation. But does it really?…
Acupuncture is an ancient Chinese therapy involving the stimulation of specific trigger points along the body’s 18 meridian lines to help regulate the flow of Qi (energy). The meridian lines represent the normal flow of Qi through the body. It is believed that when this energy is disrupted, disease ensues. The use of thin metal needles or other acupuncture techniques is proposed to conduct Qi through its correct paths. The trigger points used are areas of the skin where Qi flows close to the surface and thus can be reached by the various acupuncture therapies…
…Based on ITT analyses, we conclude that acupuncture does not improve UE function or QOL in patients with chronic stroke symptoms. However, gains in UE function observed in protocol-compliant subjects suggest traditional Chinese acupuncture may help patients with chronic stroke symptoms…