Professional Documents
Culture Documents
Paraplegic Acupuncture
Paraplegic Acupuncture
Alice M. K. Wong, MD
Chau-Peng Leong, MD
Ting-Ya Su, MS Acupuncture
Shang-Won Yu, MD
Wen-Chung Tsai, MD
Carl P. C. Chen, MD
Affiliations:
Research Article
From the Departments of Physical
Medicine and Rehabilitation (AMKW,
TYS, WCT, CPCC) and Traumatic and
Emergent Surgery (SWY), Chang
Gung Memorial Hospital, Taipei,
Taiwan, Republic of China; the
Department of Physical Medicine and Clinical Trial of Acupuncture for
Rehabilitation, Chang Gung Memorial
Hospital, Kaohsing, Taiwan, Republic
Patients with Spinal Cord Injuries
of China (CPL); and the Department
of Physical Medicine and ABSTRACT
Rehabilitation, Chang Gung Wong AMK, Leong CP, Su TY, Yu SW, Tsai WC, Chen CPC: Clinical trial
University, Taipei, Taiwan, Republic
of China (CPL).
of acupuncture for patients with spinal cord injuries. Am J Phys Med
Rehabil 2003;82:21–27.
Disclosures: Objective: To examine whether electrical acupuncture therapy through
FIM™ is a trademark of the Uniform
adhesive surface electrodes and concomitant auricular acupuncture ther-
Data System for Medical apy could improve the neurologic or functional recovery in acute traumatic
Rehabilitation, a division of UB spinal cord injury patients.
Foundation Activities, Inc.
Design: A total of 100 acute traumatic spinal cord injury patients with
Correspondence: American Spinal Injury Association (ASIA) impairment grading of A and B
were recruited into this study. They were randomly divided into the acu-
All correspondence and requests for puncture and control groups. In the acupuncture group, electrical acu-
reprints should be addressed to Alice puncture therapy via the adhesive surface electrodes were applied to the
M. K. Wong, MD, Department of
Physical Medicine and Rehabilitation,
bilateral Hou Hsi (SI3) and Shen Mo (B62) acupoints. In auricular acu-
Chang Gung Memorial Hospital, 199, puncture, four acupoints related to the spinal cord were selected for
Tun-Hwa North Road, Taipei, 105, stimulation at the antihelix, helix, and lower portion of the ear-back areas.
Taiwan, ROC. Acupuncture therapy was initiated early in the emergency room setting or
soon after spinal surgical intervention. Rehabilitation therapy was also
0894-9115/03/8201-0021/0
provided to the patients during acupuncture therapy. In the control group,
American Journal of Physical
Medicine & Rehabilitation only rehabilitation therapy was provided to the patients. Neurologic and
Copyright © 2002 by Lippincott functional scores were assessed during the time of admission, hospital
Williams & Wilkins discharge, and 1-yr postinjury follow-up.
DOI: 10.1097/01.PHM.0000043517.06642.D0 Results: There were significant improvements in neurologic (sensory
and motor), functional, and FIM™ scores in the acupuncture group com-
pared with the initial admission period when assessed during the time of
hospital discharge and the 1-yr postinjury follow-up. A greater percentage
of patients in the acupuncture group recovered to a higher ASIA impair-
ment grading.
Conclusion: The use of concomitant auricular and electrical acupunc-
ture therapies, when implemented early in acute spinal cord injury, can
contribute to significant neurologic and functional recoveries.
Key Words: Spinal Cord Injury, American Spinal Injury Association, Re-
habilitation, Electrical Acupuncture, Auricular Acupuncture
ans, the internal organs are believed to peutic trials of acupuncture therapy for followed by slow manual twisting ac-
be interconnected with the superficial neurogenic bladder of SCI patients also tion of the acupuncturist. The needles,
parts of the body. Acupuncture therapy showed significantly shortened dura- once correctly inserted into the acu-
has been shown to be effective in im- tion for bladder training.8 points, can also be stimulated electri-
proving functional outcomes in hemi- Acupuncture therapy is usually cally. The de qi response is a prerequi-
plegic stroke patients and paraplegic done by the insertion of thin metal site for effective acupuncture therapy.
spinal cord–injured patients. Thera- needles to the acupoints, and this is It is often described as an uncomfort-
able sensation, causing a numb, sore, through adhesive surface electrodes through the twitching and contraction
or heavy feeling during needle twirling and auricular acupuncture therapy motions of the stimulated muscles.
at the acupoint.9,10 In our ASIA grade A were applied to the patients.7,11 Reha- However, in electrical acupuncture
and B SCI patients, sensory perception bilitation treatments were also per- therapy, stimulation is provided di-
is absent caudal to the injury level. The formed on these patients in addition to rectly to the acupoint areas, not to the
usual de qi response could not be per- the acupuncture therapies. muscles nor the neuromuscular junc-
ceived by these patients. The applica- The mechanism of action provided tion areas. As a result, the typical mus-
tion of needles might even be a noxious by electrical acupuncture therapy is be- cle contraction motions will not be ob-
stimulus causing autonomic hyperre- lieved to be different than that of tra- served during electrical acupuncture
flexia, especially in patients with higher ditional therapeutic electrical stimula- therapy.
cord level injury. As a result, the alter- tion. In electrical stimulation, muscles In this study, the Hou Hsi (SI3)
native electrical acupuncture therapy are stimulated. This can be observed and Shen Mo (B62) were selected as
TABLE 3
Comparison of neurologic and functional status in the two groups during different time
points
ASIA Scores FIMTM
Motor PP Sensory LT Sensory Total Score
Admission
Acupuncture group 41.0 ⫾ 21.5 60.8 ⫾ 22.7 63.0 ⫾ 23.2 48.7 ⫾ 13.1
Control group 41.0 ⫾ 17.7 59.1 ⫾ 24.9 60.8 ⫾ 24.4 47.7 ⫾ 12.3
P value 0.992 0.425 0.616 0.407
Discharge
Acupuncture group 58.8 ⫾ 21.4 80.0 ⫾ 20.8 81.7 ⫾ 20.3 75.8 ⫾ 19.2
Control group 45.3 ⫾ 20.4 63.2 ⫾ 27.4 64.1 ⫾ 27.7 64.5 ⫾ 19.7
P value 0.002a 0.001a 0.000a 0.004a
1-yr follow up
Acupuncture group 74.4 ⫾ 23.7 90.0 ⫾ 29.1 92.5 ⫾ 27.8 106.9 ⫾ 21.5
Control group 52.3 ⫾ 23.2 69.9 ⫾ 26.8 70.5 ⫾ 26.7 88.7 ⫾ 24.0
P value 0.000a 0.000a 0.000a 0.000a
ASIA, American Spinal Injury Association; PP, pinprick; LT, light touch.
a
P ⬍ 0.05.
the acupoints for acupuncture therapy. els of the spinal cord, which also in- compared with the control group. The
The Hou Hsi (SI3) and Shen Mo (B62) cluded the lumbar cord level.9 acupuncture group also had many pa-
acupoints belong to the Yang Ming me- As evident in our results, patients tients improved to an ASIA grade of C
ridian of the hands and feet, which are in the acupuncture group had signifi- or better. There can be numerous neu-
connected to the cervical spinal cord. cant motor, sensory, and FIM score im- rophysiologic factors contributing to
The four auricular acupoints selected provements during the time of dis- the aforementioned improvements
in this study were related to more lev- charge and 1-yr postinjury follow-up as that are difficult to be proved clinically
Figure 2: Changes in American Spinal Injury Association (ASIA) impairment scale of both groups during the three
different time points. SCI, spinal cord injury.