Acupuncture alleviated gait disturbance in patients with Parkinson’s

Acupuncture stimulation at some specific acupoints relieved gait disturbance immediate after acupuncture in PD patients according to a report published in the Journal of American Geriatrics Society.

Gait disturbance is one of the most common symptoms of Parkinson’s. A typical parkinsonian gait is characterised as slower speed, shorter arm swings, shorter stride length, longer double support time and faster cadence than healthy individuals. Gait dysfunction is regarded as one of the important symptoms of Parkinson’s and affects the quality of life of patients with Parkinson’s.

Recently doctors in Japan conducted a small clinical study to assess the short-term effect of acupuncture on gait disturbance in Parkinson’s. Patients with Parkinson’s were given acupuncture at following acupoints: ST36, SP6, LV3, LI4 and LI11. Gait function in PD patients were measured using a portable gait rhythmogram, a small device that measures three dimensional accelerations affecting gait associated with voluntary limb and trunk movements before and after acupuncture.

It was found that after acupuncture stride length, walking acceleration and gait speed, indicators of gait function significantly increased compared the baseline.

Authors suggested that acupuncture was as good as or better than the conventional treatment with gait disturbance in Parkinson’s. However, clinical study with controlled and large sample size should be conducted to evaluate efficacy of acupuncture treatment.

Reference

S Fukuda et al., Acupuncture for Gait Disturbance in Parkinson's Disease: Immediate Effects of Acupuncture Treatment. J Am Geriatr Soc. 2015 Oct;63(10):2189-90.    http://onlinelibrary.wiley.com/doi/10.1111/jgs.13690/abstract

Acupuncture helped restore function of a patient with severe dramatic brain injury

A patient suffered severe dramatic brain injury from a high-speed snowboarding accident, being initially unable to walk, having difficulty with speech, and suffering from poor eyesight. Following acupuncture treatment over 4 years, he now regained significant motor function, speech and vision and has returned to snowboarding. A case study was reported in the journal of Global Advances in Health and Medicine. 

  

A male patient, 21-year old at the time of accident, was admitted to the hospital in Colorado, the United States, following a high-speed snowboarding accident. Brain MRI and CT scans indicated diffuse axonal injury. The neck CT scan showed a non-displaced C6 vertebral body fracture and a non-displaced fracture of the left occipital condyle. He was diagnosed with severe traumatic brain injury that resulted in paralysis and then spastic hemiplegia of the dominant side. His left side was stiff, and his right side was more flaccid with tremors.

Following comprehensive inpatient care the patient was released from hospital for ongoing rehab and long-term care. Prior to acupuncture the patient had been doing occupational and speech therapy and were involved in physical therapy.

The patient came for acupuncture treatment in Southwest College of Naturopathic Medicine, Tempe, Arizona, United States, 3.5 months after injury. After initial assessment by the experienced acupuncturist, the acupoints selected initially were chosen to regulate and move the Qi and Blood and clear Wind according TCM. As an ongoing adaption to the patient protocol, supplemental acupoints were added as needed to address the relevant concerns including acute respiratory infection, constipation, insomnia, diplopia and balance. His acupuncture covered two separate treatment periods of 57 weeks and 38 weeks.

Overall, his vision has improved, tremors had decreased, and fine motor skills had improved following acupuncture. He was subsequently able to snowboard a number of times during the final year of treatment.

Authors suggest that acupuncture should be considered as a viable treatment addition for patients with traumatic brain injury; in particular, a patient-specific treatment protocol focusing on individual’s deficits appears to provide long-term benefits.

Reference

J Wolf et al., Restoration of function with acupuncture following severe traumatic brain injury: A case report. Global Adv Health Med. 2015;4(6):52-57.   http://www.gahmj.com/doi/full/10.7453/gahmj.2014.069

How does repeated verum acupuncture improve chronic pain in knee osteoarthritis?

Acupuncture has been effectively used to treat chronic pain conditions. However, the lack of understanding of underlying mechanisms of acupuncture, and reported cases of failure to produce greater clinical improvement, compared with sham acupuncture, have slowed down the incorporation of this modality into the mainstream of healthcare practice.

Functional magnetic resonance image (fMRI) showed that acupuncture stimulation caused changes in neuronal activity in many brain areas, including medial frontal cortex (MFC), hippocampus and periaqueductal gray (PAG). PAG is a pain-learning brain region as it is able to form long-term pain behavioural and nociceptive memory. Brain regional connectivity of PAG-MFC and PAG-hippocampus are believed to be associated with long-term pain learning process and pain memory.

Recently Dr. Jian Kong and colleagues in Harvard Medical School, the United States conducted a clinical study to assess the effect of repeated acupuncture specifically on brain regions known to support functions dysregulated in chronic pain conditions, such as knee osteoarthritis. Forty-nine patients with knee osteoarthritis were recruited and randomly divided into verum acupuncture and sham acupuncture groups. Patients in verum group were given acupuncture at ST35 and Xiyan points for the low-dose verum groups and additionally at GB34, SP9, GB39 and SP6 for the high-dose group, six times within one month. Treatments 1, 3, and 6 were conducted with the patient lying in a 3 Tesla MRI scanner. Treatments 2, 4 and 5 took place in a behavioural testing room. Sham acupuncture was performed with non-penetrating Streitberger needles at above acupoints.

It was shown at the end of study that verum acupuncture produced a significant decrease in knee pain and improved function in sport, and modulated connectivity of PAG-MFC and PAG-hippocampus, compared with sham acupuncture group.

Results of study have showed that repeated verum acupuncture might act by restoring the balance in the connectivity of the key pain brain regions, altering pain-related attention and memory. It also has implications for the assessment of the efficacy of acupuncture treatment with regard to reversal of chronic pain disorders.

Reference:

N Egorova et al., Repeated verum but not placebo acupuncture normalizes connectivity in brain regions dysregulated in chronic pain. NeuroImage: Clinical 9 (2015) 430–435.    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0067485

How does acupuncture stimulation at GB34 help improve motor function in post-stroke hemiplegic patients?

Acupoint GB34 has been used to treat patients with stroke to help motor function recovery and is accompanied with the increased neuronal activities in motor-related brain regions according to a neuroimaging study published in journal of Brain Research.

Acupoint GB34 is one of the most common acupoints used in treating motor-related conditions in China for a very long time. However its underlying mechanism is not clear. Recently scientists in China explored the central mechanism of immediate effect of acupuncture stimulation at GB34 on the motor-related network of stroke patients with hemiplegic.

Functional magnetic resonance image (fMRI) was used to assess the changes in neuronal activities of different brain regions before and after acupuncture stimulation at GB34 and compare the changes between GB34 and sham acupoint. Function MRI data analysis showed that acupuncture at GB34 may increase motor-cognition connectivity, including visual-memory, motor task learning, and motor intention, meanwhile decrease compensation of unaffected motor cortex and ipsilateral synkinesis, which can definitely promote the rehabilitation of hemiplegia and spasm.

This study demonstrated the underlying mechanism of GB34 central action in post-stroke patient with hemiplegia.

Reference:

Chen X et al., A functional magnetic resonance imaging study on the effect of acupuncture at GB34 (Yanglingquan) on motor-related network in hemiplegic patients. Brain Res. 2015 Mar 19;1601:64-72.    http://www.ncbi.nlm.nih.gov/pubmed/25601007

What is the proper depth of acupoints in neck and shoulder region?

Although acupuncture therapy is safe with only minor side effect, some severe complications such as pneumothorax still happens. Such incidence could have been avoided if acupuncturists were equipped with a better understanding of the anatomical knowledge and appropriate depth of needle insertion, in particular in points scattered in the neck and shoulder regions where the risk of injuries of lung, heart, nerve and vessels are significantly high.

Recently, a group of scientists in Taiwan, China, conducted a clinical study, using magnetic resonance imaging (MRI) to (1) measure the mean depth of some frequently used acupoints around the neck and shoulder regions, and (2) understand that how variable factors such as body size (using body mass index-BMI) and gender would affect the measured depth of each acupoint. Three hundred and ninety-four participants were recruited in this study. Outcome measure included the measurement of distance of needle insertion tip (surface of skin) to any tissue that would cause possible or severe complications.

MRI analysis showed the mean depths of all participants, regardless of BMI and gender, are as follows, in centimetres: GB21=5.6, SI14=5.2, SI15=8.8, GV15=4.9, GV16=4.6, GB20=5.0, ST9=1.6, SI16=1.8, SI17=2.4, TE16=3.1, LI18=1.3. It was revealed that participants with higher BMI had greater depths and males tended to have greater depths in most of the points.

This is the first study to investigate the mean depth of acupoints around neck and shoulders. Acupuncturists should take information provided in consideration during the treatment to prevent complications.

Reference

Chou PC et al., Retrospective study using MRI to measure depths of acupuncture points in neck and shoulder region. BMJ Open 2015;5:e007819. doi:10.1136/bmjopen-2015-007819.  http://bmjopen.bmj.com/content/5/7/e007819.abstract