Can Acupuncture Really Benefit Stroke Recovery?

Can Acupuncture Really Benefit Stroke Recovery?

Ming Qing Zhu, L.Ac., OMD (China)

Moyee Siu, L.Ac., MTCM

Zhu’s Neuro-Acupuncture Center, Inc.

1754 Technology Drive, Suite 225

San Jose, CA 95110

Tel: (408) 885-1288 Fax: (408) 885-0488

Email: moyee@scalpacupuncture.org

Key words: Stroke rehabilitation, acupuncture, scalp acupuncture, functional recovery

Subject Code: [74] Other stroke treatment – medical

Word count: 2462

Can Acupuncture Really Benefit Stroke Recovery? 2

Abstract

A number of studies and meta-analyses indicate that there is no clear evidence that

acupuncture has additional value to post-stroke rehabilitation. This article outlines key

issues underlining the failure of the acupuncture treatments in previous studies: delay in

intervention, incorrect procedures and inadequate treatments. The authors offer

suggestions, based on years of relevant practice, on how acupuncture should be done

to effectively foster stroke recovery.

Introduction

The World Health Organization estimates that 15 million individuals suffer from

stroke annually worldwide, most of whom in developed countries where hypertension,

hypercholesterolemia and cardiac diseases are prevalent. Stroke is the third leading

cause of fatality and ranks highest as a cause of disability.1

Western medicine has made some advances in the treatment of strokes,

including the use of Tissue Plasminogen Activator (tPA) and intracranial angioplasty.

However, these procedures are not indicated for or accessible to all stroke patients.

Despite receiving tPA in the recommended window, 58% of the patients still die or end

up with severe disabilities.2

Typical post-stroke care in the USA starts with seven days of hospital stay, then one

to two weeks of physical therapy, occupational therapy and speech therapy in a

rehabilitation facility. After three or more weeks of rehabilitation as an outpatient, the

treatment comes to an end, but the patient’s recovery is far from complete. In one
Can Acupuncture Really Benefit Stroke Recovery? 3

study3 on ischemic stroke survivors who were at least 65 years of age, the following

disabilities were observed six months after stroke:

• 50% had some hemiparesis.

• 30% were unable to walk without some assistance.

• 26% were dependent in activities of daily living.

• 19% had aphasia.

• 26% were institutionalized in a nursing home.

Obviously, there is a lot of room for improvement in standard stroke protocol.

Can acupuncture really benefit stroke patients?

Many people have asked this question. Our answer is a definite “yes”. However,

recent western research and meta-analyses make the claim that there is no clear

evidence that acupuncture has additional value for post-stroke rehabilitation.4,5 Why is

there a discrepancy? Whose statement is true, ours or the researchers’ ? Both are valid.

What is more accurate is: acupuncture can significantly benefit stroke patients if it is

done right; otherwise it is of little value. Our own experience with stroke patients over

the years demonstrates that when applied correctly, acupuncture can shorten recovery

time to as little as two weeks and restore function to over 95% in some patients.

Case Reports

(1) In December 2010, a man in his fifties suffered an ischemic stroke. Three days after

the stroke onset, he presented himself at our clinic with slurred speech, right

hemiparesis and wheelchair bound. After two hours of acupuncture treatment, he

Can Acupuncture Really Benefit Stroke Recovery? 4

was able to move his right upper extremity. The next day, less than 24 hours later,

he stood up and walked on his own. On his third day of treatment, he climbed the

stairs. He recovered all motor functions within two weeks.6

(2) One night in 1992, Mr. Shen, president of an acupuncturist association in California,

suddenly dropped on the floor and became stuporous. A CT scan of his brain

revealed a big lesion in the left cortex and basal ganglia, due to hemorrhage of the

middle cerebral artery. Within seven hours, we started Zhu’s Scalp Acupuncture

treatment on him, and continued for 20 consecutive days. Two weeks later, he

started to talk. After three months, he was able to return full-time to his acupuncture

practice and administrative work.

(3) In 1998, a 55 year-old man discharged himself from the Taipei Veterans General

Hospital of Taiwan despite his doctor’s advice. It was the 8th day after his stroke

when he arrived at our clinic in a wheelchair. His ischemic stroke left him paralyzed

on the right side. Twenty minutes after applying scalp acupuncture needles, he

stood up. An hour later, he took a few steps. After two weeks of daily acupuncture,

he started walking with a cane. He ultimately regained all his gross and fine

movements. Today he is living his life as a fully-recovered stroke patient and still

persists in his daily exercise routine to stay healthy .

(4) In 2007, an MD referred his 58 year-old male patient to us. This patient had an

ischemic stroke and was bed-ridden for 20 days. On the first visit, he came in a

wheelchair but left our clinic walking down two flights of stairs without assistance.

After 10 daily Zhu’s Scalp Acupuncture treatments of three hours each, he returned

to work.
Can Acupuncture Really Benefit Stroke Recovery? 5

These four case histories are a small representative sample of the large number of

stroke cases we have treated. What is common in these patients is that all were treated

very early and had nearly full functional recovery.

Discussion

How can we make acupuncture maximally beneficial for stroke patients? Below

are recommendations based on Zhu’s 50 years of clinical experience.

There are a few important factors to consider.

I. Time is crucial

There is a misconception that acupuncture is contraindicated in the acute

stage of stroke. Quite the contrary, acupuncture should intervene promptly, as early

as the first hour after onset. Every hour of delay can cause a difference in the

outcome. The best treatment windows are, in decreasing order of therapeutic value:

(1) the first three hours, (2) the first three days, (3) the first week, (4) the first month,

(5) the first three months, and (6) the first six months. Both ischemic and hemorrhagic

stroke can receive acupuncture treatment from the first day, but they differ in

operation details.

Acupuncture has exceptional value in the first 3 to 72 hours. As evidenced by our

own clinical cases, acupuncture seems to be able to salvage the penumbra

surrounding the core of the stroke. Usually about 72 hours after a stroke, cerebral

edema starts to form and it is very damaging. Although the mechanism is not well

understood, acupuncture triggers some changes in the brain that result in the

protection of brain cells from necrosis. Therefore it prevents or reduces edema and
Can Acupuncture Really Benefit Stroke Recovery? 6

consequently promises a better prognosis. The often dramatic results in our stroke

patients suggest that acupuncture could promote the reperfusion of the brain in a

very short time, perhaps through the activation of the collaterals or the dissolution of

fibrin around the clot. More research is needed to understand the mechanism.

Rehabilitation, like acupuncture, should also start as soon as vital signs are

stable. This is particularly important for aphasia and dysphagia. Our experience

shows that if speech therapy does not begin within the first month, speech recovery

will be almost impossible or very limited. Again, ischemic and hemorrhagic strokes

call for different types of rehabilitation exercises during the acute phase.

II. The treatment method

(1) Choose the right acupuncture style

Which acupuncture protocol is better for treating strokes? For many years Zhu

had used conventional body acupuncture to treat strokes but was not satisfied

with the results. So in the 1970’s he started to explore scalp acupuncture and

developed Zhu’s Scalp Acupuncture. Often people are amazed at the outcome.

For neurological conditions such as strokes, scalp acupuncture is by far the most

effective.

(2) Do the correct needle manipulation

Acupuncture is not just about inserting needles at certain points, it is about

regulating the qi flow. Hence manipulation of the needles is necessary to affect

the qi. The technique and amount of manipulation vary with the type of stroke,

stage of the disease and the patient’s condition. For example:

Can Acupuncture Really Benefit Stroke Recovery? 7

• If the patient is hypertensive or nervous or still hemorrhaging, very light

stimulation is desirable on the scalp treatment areas.

• It is not uncommon that the paralyzed side of the body feels colder to touch.

When this happens, the classical technique “Setting Mountain on FIre” often

brings miraculous change to the body temperature. “Unblocking the channels,

warming the Yang and promoting Qi”, as these are called in Chinese medicine,

certainly will benefit the patient’s recovery. It should be noted, however, that

this warming effect is not achievable by using electrical stimulation.

• During recovery stage, one can use stronger stimulation both on the scalp and

body.

• A comatose stroke patient whose vital signs are stable needs stronger

stimulation.

• Strong stimulation is contraindicated for spasms.

(3) Perform appropriate Daoyin

As mentioned before, acupuncture is not simply an act of inserting needles at

certain points. Acupuncture is a complete therapy that involves, besides

needling, psychological counseling, encouragement, building the patient’s

confidence to heal, helping the patient to relax, teaching the patient how to talk

and to move. All these things, which we call “Daoyin,”7 should be organically

integrated into every acupuncture session.

Daoyin has a much broader implication than conventional physical,

occupational or speech therapy. Since its content can vary so much, an

Can Acupuncture Really Benefit Stroke Recovery? 8

experienced acupuncturist customizes specific daoyin activities to suit the needs

of the patient at particular points in time. It requires that the acupuncturist is

knowledgeable of the nervous system, the musculoskeletal system, sports

medicine, rehabilitation science, and various traditional Chinese healing

modalities such as martial arts and taiqi.

The following are a few examples of Daoyin:

(a) A stroke patient with dysarthria or Broca’s aphasia is instructed to move

his/her tongue in different directions and make sounds during acupuncture.

(b) A stroke patient with facial palsy is instructed to open/close his/her affected

eye, and to exercise his/her face muscles during acupuncture.

(c) A stroke patient with paralytic lower limb is instructed to stand and walk with

support.

(d) A stroke patient with paralytic upper limb is instructed to push and pull on

his/her affected arm during needle manipulation.

Acupuncture with Daoyin is not a replacement but a great enhancement to

conventional rehabilitation therapies. However, there are several areas where

they differ.

(a) Our approach is proactive. We help a patient sit before he can sit on his own.

We make the first attempt to stand when the patient cannot even imagine or

believe it is possible. We provide whatever support the patient needs to

regain his lost function instead of waiting for the first sign of the function to

come back spontaneously. A proactive approach not only speeds up

recovery, it boosts the patient’s self-confidence.

Can Acupuncture Really Benefit Stroke Recovery? 9

(b) When doing Daoyin, we give the patient only minimal assistance while taking

adequate precaution and safety measures. The more active efforts from the

patient, the better the treatment results. By the same token, we discourage

the use of orthoses. Muscles, tendons and ligaments can be strengthened by

proper exercises. We have corrected countless foot inversion without using

ankle-foot orthoses (AFO) and not causing any harm to the patient. Orthoses

rob the patient’s opportunity to exert effort on his/her own, resulting in muscle

atrophy and permanent dependence on a brace.

(c) Unlike conventional therapy, we find that supporting a patient on his

paralyzed side instead of the good side brings better outcome in the end.

III. The right dose of treatment

Concentration and repetition are necessary to provoke and reinforce plastic

changes in the brain. Hence, to achieve speedy functional recovery after a stroke,

intensive treatments are paramount. The frequency and duration of acupuncture

treatments (needling and Daoyin combined) must be adequate especially in the first

three months. A daily three to six hours of focused and active Daoyin engagement

is the most desirable. We recommend multiple short sessions to avoid fatigue. The

average two to six hours a week that most stroke patients currently receive in out-

patient rehabilitation facilities is dismally insufficient.

IV.Management and prevention of complications following a stroke

Can Acupuncture Really Benefit Stroke Recovery? 10

(a) Seizures: Because anti-seizure medication is usually sedative, it hampers the

rehabilitation process. Scalp acupuncture is an effective substitute without

causing adverse side-effects.

(b) Blood thinning: Avoid overuse of warfarin or coumadin to prevent secondary

hemorrhage.

(c) Body postures: Spasticity does not set in immediately after a stroke and it can

be avoided if more attention is given to body postures in the first month.

Always keep the patient’s head, body, and limbs in normal physiological

positions, especially the joints - neck, elbow, wrist, fingers, ankle and feet.

(d) Dementia and Parkinsonism: These are common after-effects that manifest

after a long period of inactivity as the brain atrophies.8,9 Because they are not

always apparent immediately after a stroke, they are often neglected in the

rehabilitation process. Acupuncture is an excellent preventative treatment.

Conclusion

Acupuncture can be a major benefit to stroke rehabilitation when administered

correctly. Results are most remarkable in the acute stage. First, treatment must begin

promptly. Earlier intervention promises fewer deficits. Second, an effective acupuncture

system should be employed. Scalp acupuncture excels over body acupuncture in

treating neurological conditions such as strokes. After insertion, needles should be

manipulated to ensure qi flow. Third, appropriate Daoyin must be carried out

simultaneously. Finally, treatments have to be repeated frequently for reinforcement. In

this manner a stroke patient will achieve a faster and more complete recovery.
Can Acupuncture Really Benefit Stroke Recovery? 11

By sharing our experience, we hope that acupuncture treatments for stroke can

be optimized and that future research on this topic can yield more meaningful results.

Author Disclosure Statement

No competing financial interests exist.

References

1. Véronique R, Go A, Lloyd-Jones D, Adams R, Berry J, Brown T, et al. Heart Disease

and Stroke Statistics – 2011 Update: A Report from the American Heart Association.

Circulation Journal of the Americn Heart Association.

http://circ.ahajournals.org/content/123/4/e18.full.pdf. Accessed August 11, 2011.

2. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study

Group. Tissue plasminogen activator for acute ischemic stroke. E Engl J Med.

1995;333:1581-1587.

3. Kelly-Hayes M, Beiser A, Kase CS, Scaramucci A, D’Agostino RB, Wolf PA. The

influence of gender and age on disability following ischemic stroke: the Framingham

study. J Stroke Cerebrovasc Dis. 2003;12:119 –126.

4. Sze FK, Wong E, Or K, Lau J, Woo J. Does acupuncture improve motor recovery

after stroke?: A meta-analysis of randomized controlled trials. Stroke 2002; 33:2604-

2619.

5. Sze FK, Wong E, Yi X, Woo J. Does acupuncture have additional value to standard

poststroke motor rehabilitation? Stroke. 2002;33:186-194.

6. Siu M. A Speedy Stroke Recovery using Zhu’s Scalp Acupuncture. Available at:
Can Acupuncture Really Benefit Stroke Recovery? 12

http://www.youtube.com/watch?v=fuQ7hiYaj9s. Last accessed August 11, 2011.

7. The concept and practice of Daoyin were depicted in the Emperor’s Classic and

archaeological painting from the Han dynasty 200 BC.

8. Handley A, Medcalf P, Hellier K, Dutta D. Movement Disorders after Stroke. Age and

Ageing. 2009;38(3):260-266.

9. Tatemichi TK, Desmond DW, Mayeux R, Paik M, Stern Y, Sano M, et al. Dementia

After Stroke. Neurology. 1992 Jun;42(6):1185-1193.

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