Acupuncture for Stroke Rehab
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Acupuncture for Stroke Rehab

Scalp acupuncture can assists with recovery from cerebral vascular accident (CVA, stroke), by assisting MANY process that connect the central & peripheral nervous systems [i]. Scalp acupuncture, along with body acupuncture, herbs and physical therapies can improve quality of life by ameliorating such things as hemiplegia, aphasias, weakness, spasticity, and pain etc. The role of Acupuncture vs Western Medicine in stroke rehab is really a matter of semantics, and have the same ends in mind [ii]:

 WESTERN MEDICINE
 CHINESE MEDICINE
  
  • stop-bleeding & unblock circulation
  • neuro-humoral & endocrine balance
  • stimulate motor & sensory areas of the brain
  • reduce inhibitory mechanisms on nerve function
  • recover viable brain cells
  • reduce oxidative stress on impaired cells
  • antibiotics, analgesics, anti-inflammatory, immune enhancement

  • harmonize ying & wei 
  • balance ying & wei
  • unblock the channels & collateral
  • strengthen good Qi
  • expel bad Qi
  • antibiotic, analgesic, anti-inflammatory, immune-enhancement



EDUCATION, PREPARATION & COMMITMENT
There are many obstacles to using scalp acupuncture for stroke rehab. The first is that just the idea of needles in the scalp can dissuade someone who have never even had body acupuncture before. People may expect immediate results and be unprepared for the protracted course of treatment. And both the patient and the practitioner must together commit to follow-through on a treatment plan that includes physical and occupational therapists as well.

Goals must be agreed upon, because the benchmarks for success may not be the same for the patient vs. the practitioner at any given time during recovery. For example, the practitioner may view better sleep quality as the beginning of the healing process. Where-as the patient's main focus will always be "Will I be able to talk, walk, groom & feed myself again".  So, it must be made clear, to the best of the partitioners ability, what acupuncture can and can not do based on experience, and the research (see PROGNOSIS).

TREATMENT PROTOCOLS
Treatment protocols vary according to the style of acupuncture, and the severity of the condition:

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Results from Zhu's Scalp Acupuncture
For example, Dr. Zhu treats pateints every day for 1-2 weeks; then every other day for 1-2 weeks; followed by twice per week. Needles are stimulated manually or with electro-stimulation at regular short intervals. Then they are retained for 20" to 48 hours before removal. Patients may even be sent home with needles in place [i]. 




Other scalp acupuncture protocols are different than Dr. Zhu's, but the common threads across all styles are:

  • 1 course of treatment consists of 10 treatments.
  • 5 to 7 initial treatments per week, then tapering-down over several weeks for a total of 10 to 40 treatments (1 to 4 courses)
  • extended needle retention times.
  • manual, mechanical, or electrical stimulation of the needles until an improved functional response is achieved during each treatment.
  • adherence to standard contraindications to acupuncture & scalp acupuncture. 

PROGNOSIS
In the U.S., an unfamiliarity with acupuncture leads people to seek it out only as a last resort vs. a first effort [i]. This, coupled with an inability, or unwillingness to access acupuncture frequently enough, further reduces its efficacy for stroke rehab. In short, the earlier acupuncture is initiated the better; and the more frequent the treatments the better. 

The efficacy of scalp acupuncture for stroke rehab is also dependent on the location, number and extent of the cerebral lesions. In short, the less extensive the stoke the better; and the more focal to certain areas of the brain (e.g. the external cerebral cortex) the better.

The Location of the CVAWang et al concluded that subjects with multiple lesions, and lesions in the basal ganglia, brain stem, or cerebral ventricles received little benefit from scalp acupuncture. While subjects with multiple lesions in the external capsule, or cerebral lobes; and single lesions in the internal capsule or brain stem had better outcomes [i].

The Extent of the Lesions. Patients with lesions to less than ½ of the motor pathway areas of the brain had significantly increased range of motion (ROM) after receiving acupuncture for 2 to 3 months [iii] While patients with lesions extending more than ½ way along a motor pathway experienced less spasticity, they had little or no increase in ROM after receiving acupuncture. 

Level of Function and Other Therapies. Patients with arm paralysis experienced significant improvement in hand/ finger strength and dexterity if they already had some finger movement, even if acupuncture was initiated 6 to 8 years post CVA. Patients who received acupuncture in combination with physical therapy within 4 to 10 days post CVA experienced significantly better outcomes in walking, balance, activities of daily living, and quality of life at 1, 3 & 12 months [iv].

Consistency of Treatment. Two positive and measurable physiological responses during scalp acupuncture treatment are (1) decreased cholinesterase levels, and (2) improved microcirculation. These responses reverted back to pretreatment levels within 24 hours, validating the need for daily/consistent treatment [i]. Also demonstrated is improvement in markers for platelet aggregation, arterial vasospasm, and arterial atheroma (cell proliferation, blood stagnation).

Timing and Technique: A meta-synthesis of the research found that the positive outcomes after stroke were consistent across multiple studies using different styles of scalp acupuncture [v]. However, the main insight gained from the data was the importance of initiating scalp acupuncture as soon as possible after ischemic stroke, and after the bleeding from hemorrhagic stroke is controlled. The ideal for acute post-stroke hemiplegia was twice daily.

Needle retention in the scalp for several hours (to several days) was found to be an important technique. A "thrusting & withdrawing" (chou qi & jin qi) needling stimulation technique may be more effective than the "twirling" technique that is applied to body points [v]. Qi gong breathing, with moving/visualized movement (Dao-yin & Tu-na) of the affected body parts before, during, and after treatment were also found to be key techniques.



INTEGRATIVE MEDICINE TIP: Emergency acupuncture for a stroke in progress [any type]. Bilaterally in succession, and with strong stimulation: DU26 -> PC6-> LI11-> ST36-> SP6

Sources
Chen, Li & Zhongren Sun. (2014). Research on treating stroke by head acupuncture  therapy. Clinical Journal of Chinese Medicine 6(1).

Dharmananda, S. & Vickers, E. (2000). Synopsis of scalp acupuncture. In Institute for Traditional Chinese Medicine. Retrieved from www.itmonline.org/arts/newscalp.htm. 

Helms, J. (2012). Chinese scalp acupuncture. Medical Acupuncture 24(3).

Johansson, Lingren, Widner, Wiklund, Johansson (1993). 

Naeser et al. (1994). 

Naeser, m.  (1997). Neurological rehabilitation: Acupuncture and laser acupuncture to treat paralysis in stroke and other paralytic conditions and pain in carpal tunnel syndrome. In National Institute of Health Consensus Development Conference on Acupuncture; Office of Alternative Medicine and Office of Medical Applications of Research.

Zhu, M. & Sui, M. (2007).  Color atlas of Zhu's scalp acupuncture. In Zhu's Neuro Acupuncture Center.
























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