Acupuncture Reverses Hand Paralysis And Spasticity

05 APRIL 2020

Acupuncture restores hand function in patients with hemiplegia. Foshan Jianxiang

Hospital (Guangdong, China) researchers conclude that active motion acupuncture
significantly improves outcomes for patients with hand dysfunction due to
hemiplegia. The researchers document improvements in motor function, reductions
in spasticity, and overall improvements in activities of daily living. [1]
Primary assessment instruments were the MAS (Modified Ashworth Scale), Fugl-
Meyer Assessment, and ADL (Activities of Daily Living Scale). Two groups were
compared. One group received physical rehabilitation training and another group
received identical physical rehabilitation training plus acupuncture. The integrative
medicine acupuncture group outperformed the physical rehabilitation monotherapy
group across all parameters.
The study included 70 patients with varying degrees of hand dysfunction due to
hemiplegia. The severity of the patients’ conditions was graded according to
Brunnstrom’s Stages of Motor Recovery. In brief, the scale is comprised of:

• Stage 1. Flaccid paralysis without reflexes

• Stage 2. Spasticity without voluntary movement
• Stage 3. Marked spasticity with synergistic movement elicited voluntarily
 • Stage 4. Decreasing spasticity with synergistic movement predominant
• Stage 5. Waning spasticity but present with rapid and extreme movement
• Stage 6. Near normal coordination and movement
• Stage 7. Normal coordination and movement

For inclusion in the study, patients were required to have hand dysfunction graded
1–5 on the above scale and provide informed consent to participate. Exclusion
criteria included serious organ dysfunction, hematopoietic disorders, and severe
kidney or primary liver dysfunction.
Patients were randomly assigned to the acupuncture integrative medicine group or
the rehabilitation training monotherapy control group. The acupuncture group was
comprised of 21 male and 14 female patients, ages 33–81 years (mean age 55.8
years). The control group was comprised of 19 male and 16 female patients, ages
37–83 years (mean age 56.5 years). There were no statistically significant
differences in baseline characteristics between the two groups (p>0.05).
Acupuncture and Rehabilitation Training
All patients received basic rehabilitation training according to the severity of their
condition. Those with stage 1–2 conditions were guided to perform limb positioning
exercises with bedside assistance and passive movement. Patients with stage 3–4
conditions performed activities of daily living and spasm reduction training. Patients
with stage 5 conditions performed upper limb strength and activities of daily living
training. Patients allocated to the acupuncture group also received exercise
acupuncture therapy depending on the severity of their condition. Patients in the
flaccid paralysis stage were treated using the following acupoints:

• Chongxian (T 22.02, Master Tung system)

• Chongzi (T 22.01, Master Tung system)
• Neiguan (PC6)
• Daling (PC7)

After eliciting deqi at Neiguan, the needle was stimulated using a lifting-thrusting,
twisting-rotating technique. Approximately 60 rotations were applied per minute for a
total of 3 minutes. Needles at the remaining acupoints were retained without further
stimulation after eliciting deqi. All needles were retained for 30 minutes. During this
time, the acupuncturist assisted the patient in passive flexion and extension of the
fingers of the affected hand. The patient was allowed to take the lead in this
movement if they were able to do so.
The point selection involved classic main channel acupoints PC6 and PC7 and two
Master Tung system acupoints. Chongzi (22.01) is located on the thenar eminence,
approximately 1 cun below the skin fold between the first and second metacarpal
bones. Chongxian (22.02) is located between the first and second metacarpal
bones, 2 cun below the skin fold, on the palmar surface of the hand. Chongxian
(22.02) is located on the ventral aspect of the hand and is directly opposite Linggu
(22.05), which is on the dorsal aspect of the hand. Patients in the spasticity stages
were treated using the following acupoints:

• Sifeng (MUE9)
• Baxie (MUE22)
• Waiguan (TB5)
• Zhongzhu (TB3)

The needles were stimulated using an intermittent lifting-thrusting, twisting-rotating

technique while guiding the patient in passive and active flexion and extension of
the affected hand.
Results
Outcome measures for the study included the MAS (Modified Ashworth Scale),
Fugl-Meyer Assessment, and ADL (Activities of Daily Living Scale). The MAS is a
scale used to assess spasticity in patients with central nervous system lesions. A
higher score is indicative of increased spasticity. Mean pre-treatment MAS scores
were 1.71 in the control group and 1.70 in the acupuncture group. Following
treatment, these scores fell to 0.62 and 0.42, respectively. Significantly greater
improvements were seen in the acupuncture group (p<0.05).
The Fugl-Meyer Assessment is designed to gauge recovery in hemiplegic patients.
A higher score is indicative of greater recovery. Mean pre-treatment Fugl-Meyer
scores were 21.55 in the control group and 22.06 in the acupuncture group.
Following treatment, these scores increased to 23.31 and 35.87, respectively.
Significantly greater improvements were seen in the acupuncture group (p<0.05).
ADL scores are used to assess a patient’s ability to perform tasks such as dressing,
toileting, and hygiene, independently. A higher score is indicative of greater
independence. Mean pre-treatment ADL scores were 37.8 in the control group and
38.1 in the acupuncture group. Following treatment, these scores increased to 52.4
and 74.1, respectively. Significantly greater improvements were seen in the
acupuncture group (p<0.05).
Review
The study focused on the application of local acupuncture points for the treatment of
hand dysfunction due to hemiplegia. The results indicate that this approach to
patient care improves outcomes for patients receiving physical rehabilitation
training.

Reference:
1. Fu Yanqian, Long Xiangyu, Wang Gang (2019) “Clinical study on exercise
acupuncture therapy in the recovery of hand dysfunction patients with hemiplegia”
Clinical Journal of Chinese Medicine Vol.11 (15) pp.95, 96.