Stroke Rehabilitation For Acupuncture Patients

Bindi Zhu, M.D. (China) Ph.D. and Ileana Bourland, MSOM, Lic.Ac.

Today I'm going to talk about stroke, or acute cerebrovascular accidents. First, I'll go over some material you're probably already familiar with. I'll talk about the different kinds of strokes, how they happen, and the results. Then, I'll talk about Chinese medicine. That includes acupuncture and Chinese herbal medicine. We'll talk about how they work and how they can help someone who's had a stroke.

Stroke ranks among the top three causes of death in the United States, along with cancer and heart. The most common results of stroke are hemiplagia and slurred speech. We want to think about improving the sequel to a stroke and how to prevent another stroke.

There are two types of stroke:
• An ischemic stroke result when the blood supply is cut off to the brain either from infection, inflammation, atherosclerosis or a blood thrombus has blocked a blood vessel. The lack of oxygen to the brain results in brain damage. Ischemic strokes are treated with anti-coagulants.
• Hemorrhage strokes occur when a blood vessel bursts in the brain due to aneurism or a blood clot preventing normal blood circulation. The event may occur in the brain, sub-arachnoid space, sub-dural space, or epidural space. As a result of a hemorrhagic stroke, blood can leak in to other parts of the brain, depriving it from oxygen, building up pressure, and/or damaging brain tissue. Symptoms depend on the affect area of the brain. A hemorrhagic stroke can.

In China, hospitals integrate conventional and traditional medicine to treat stroke patients. Emergency room care is identical to that found here in the United States, but once leaving the ER, treatment is quite different. In addition to intravenous drips of Chinese herbs, scalp acupuncture makes up an important part each patient's treatment.

Scalp acupuncture is considered a hybrid science because of the blend of modern-day knowledge of brain anatomy and the classical use of acupuncture. In brief, scalp acupuncture occurs over the area of the brain affected by the stroke. It was discovered in 1970 in China. Researchers found that when they needled the scalp, they stimulated the area of the brain found directly underneath. For example, if I put a needle in HERE [pointing at Broca's area] , over Broca's area, it will stimulate this area, the area responsible for speech. You can relate the concept to a shadow. When I insert a needle it makes a "shadow" on the part of the brain directly on the other side of the scalp.

Conversely, by inserting a needle in the BODY, for example, in the leg, a biochemical message is sent from the nerves in the leg to the brain, specifically to the area responsible for operating the leg. So, acupuncture works in two directions: by stimulating the brain itself to establish new wiring to communicate with the body and by stimulating the peripheral nervous system to send a message to the brain to further reestablish these connections.

I wanted to give you a brief explanation on how acupuncture works for stroke patients. When an acupuncture needle is inserted into the body, it affects the body in a number of different ways. With stroke patients, acupuncture effectively sets up a two-way flow of communication in the body where repeated signals from the peripheral nervous system (PNS) to the central nervous system (CNS) and vice verse help establish new neurological and vascular pathways.

There are three ways that acupuncture affects the body:
• Acupuncture increases the flow of blood at the local site of needle insertion and in the whole body, much like anticoagulant drugs.
• Scalp acupuncture encourages the formation of new neural and vascular pathways in the brain.
• Body acupuncture encourages the peripheral nervous system to send messages to the central nervous system, thereby encouraging the formation of new pathways.

These functions are similar to those of physical therapy, a very important component of stroke rehabilitation.

Frequently Asked Questions (FAQs)

What is a treatment like? Needles are inserted into the scalp, which may be accompanied with sensations of pulling, tightness, or pain. After insertion, some patients often feel a sensation of heat in the impaired body part. Other patients may experience cold, tingling, or numbness. However, the treatment is still effective even without these sensations.

How soon will improvements be seen? There is no set recovery pattern for stroke patients, but after the first treatment, patient and doctor will usually know if acupuncture will help the impairment. In some cases, the effects of the acupuncture treatment cannot be immediately measured and it could be days or weeks before the results are assessable. However, the Chinese experience over the past thirty years has demonstrated that acupuncture treatments re-establish motor and sensory abilities much faster than with physical therapy alone.

How many treatments? In China, the average stroke patient receives thirty treatments, although some continue to receive treatments as long as there is an improvement. In America, patients receive two or three treatments per week, although more aggressive approaches may consist of treatments every day. The number of treatments any patient needs depends on many factors. For best results, treatment should begin as soon as the patient has stabilized. However, substantial gains can be made at any stage of recovery.

Why are so many treatments necessary? Stoke patients are often in a weakened condition and cannot tolerate one massive stimulation. Post-stroke treatments must be carefully regulated to a level the patient can build upon. One analogy that can be made to this therapy is gardening: the doctor must carefully cultivate the new patterns of sensation in the patient. The treatment is the cumulative effect of many small awakenings.

Does post-stroke rehabilitation work? Acupuncture therapy after stroke helps thousands of stroke victims in China every day. Recent research led the National Institute of Health to conclude in 1997 that acupuncture benefits stroke recovery. In the 1950s, Chinese government researchers demonstrated that acupuncture treatments accelerate stroke rehabilitation and, today, the research has developed into well-established hospital treatment plans. The Chinese medical schools even have special programs to train doctors with a mix of western neuroscience and eastern acupuncture. In America, too, many health care providers now recognize the value of these treatments and include them with conventional therapy.

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