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Acupuncture Therapy in the Rehabilitation of Stroke-induced Paralysis

Acupuncture therapy has been extensively applied in the rehabilitation treatment of motor functions for patients suffering from stroke-induced paralysis. In China, a significant number of stroke paralysis patients rely on acupuncture as a primary rehabilitation method. According to statistics from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, over 85% of the 71,893 stroke cases treated with the "Brain-Awakening and Orifice-Opening" acupuncture method achieved basic self-care abilities. It is generally believed that early acupuncture treatment can lead to the near-complete recovery of motor functions in mild paralysis cases, while significantly improving symptoms in severe cases.

Early initiation of acupuncture treatment in the acute phase of stroke is crucial. During all phases of treatment (acute, recovery, and post-stroke), five coordination principles are followed: coordination of acupuncture points on the paralyzed and healthy sides of the body, coordination between distal points on limbs and points on the head and neck, coordination between points on the Yang meridians (areas with low muscle tone) and Yin meridians (areas with high muscle tension), coordination of acupuncture techniques with electrostimulation, and a combination of acupuncture, massage, and exercise.

The selection of acupuncture points for paralysis treatment encompasses all commonly used points on the limbs, head, and neck. Points are selected based on the paralyzed area or muscle, consciously stimulating areas with reduced muscle tone (such as the posterior outer side of the upper limbs and anterior outer side of the lower limbs) and areas with increased muscle tension (such as the anterior inner side of the upper limbs and posterior inner side of the lower limbs). It's essential to press the points with a finger to locate the most sensitive reflex points before acupuncture. Strict adherence to traditional point locations is not necessary.

During treatment, the intensity of stimulation and needle retention time should be flexibly managed. Lighter techniques are preferable in the acute phase, gradually intensifying later to achieve strong needle sensation and conduction. From the recovery phase onwards, active or passive movement of the paralyzed limbs should be intensified. If the paralyzed limb cannot move actively, the patient should be assisted with passive movement while actively exercising the healthy limb. Once the paralyzed side shows slight movement, the patient is encouraged to engage in active exercises.

Predicting the Rehabilitation Outcome for Paralysis Patients

Assessing the best possible rehabilitation outcome or the maximum efficacy of acupuncture for a stroke paralysis patient is crucial for patients, their families, and physicians. Current consensus indicates that the effectiveness of body or scalp acupuncture depends on the nature, location, and duration of the brain lesion. Generally, the more severe the brain damage, the poorer the functional recovery after the critical period. Conversely, earlier acupuncture intervention can reduce brain damage, leading to quicker and better functional recovery.

The extent of brain injury can be assessed through the following clinical signs:

1. Whether the patient experienced coma at stroke onset and the duration of the coma. Stroke patients with coma indicate more severe brain damage. The longer the coma, the more severe the condition, leading to slower recovery and poorer outcomes post-danger period.

2. The timing of recovery from brain injury or lower brain shock. This can indicate the extent of brain damage and serve as a reference for prognosis. Generally, a longer brain shock period suggests more severe brain damage, reducing the likelihood of motor recovery in the affected limbs. Early recovery in areas like the lower limbs predicts better rehabilitation, whereas slower recovery in the upper limbs indicates more difficulty.

3. The severity of distal limb paralysis symptoms. Typically, the more flexible parts of the body post-stroke are harder to recover in terms of motor function. Therefore, distal limb recovery is slower than proximal, and the upper limbs, especially hand movements, are the most challenging to regain. If voluntary movement in the wrist or fingers remains lost after the spinal shock period, it often signifies a severe condition with little chance of complete upper limb motor function recovery.

Testing for recovery from brain shock involves stimulating sensitive points on the feet (e.g., Yongquan, Quxu) to induce ankle flexion, which can extend to knee and hip flexion with increased stimulation intensity. This physiological response is known as the flexor reflex, indicating the end of the brain shock period.

For the upper limbs, testing with acupuncture at Hegu can reveal recovery from the brain shock period if local muscle twitching occurs; otherwise, the period is ongoing.

It's important to differentiate between soft paralysis during the brain shock period and recovery period. High-level central nervous system controls over spinal reflexes have both facilitating and inhibitory effects. The complete disappearance of spinal reflexes in paralyzed limbs during the brain shock period is due to the loss of facilitating effects from higher centers. Post-brain shock, if high-level central control (both facilitation and inhibition) over spinal reflexes is not restored, parts of the spinal reflex that previously required facilitation will exhibit low muscle tone or soft paralysis, often in extensors, while parts that required inhibition will show increased muscle tone or hard paralysis, typically in flexors. Thus, if some muscles or body parts on the paralyzed side develop increased muscle tone or hard paralysis, it often indicates the end of the brain shock period.

Strategies to Improve Acupuncture Treatment Efficacy for Paralysis

Early initiation of acupuncture treatment for stroke patients is a vital principle proven by numerous clinical practices. Modern medicine has found that timely diagnosis and anticoagulant therapy within 6 hours of ischemic stroke onset generally prevent severe sequelae. Clinical evidence suggests that the earlier the acupuncture treatment for either hemorrhagic or ischemic stroke, the better the outcome. Acupuncture during the acute phase of stroke has no adverse effects and plays a crucial role in promoting hematoma absorption, establishing collateral circulation, reducing reperfusion injury, and protecting brain cells.

Five coordination principles are essential in acupuncture treatment for this condition: Coordination between acupuncture points on the paralyzed and healthy sides, between distal points on limbs and points on the head and neck, between points on Yang and Yin meridians, between acupuncture techniques and electroacupuncture, and between acupuncture, massage, and exercise.

Stimulating both the paralyzed and healthy limbs is based on the concept that the body's left and right sides are closely connected. Acupuncture on one limb or side can affect the entire body, including the opposite side or other limbs. Current theories suggest that stimulating the healthy side can enhance the effects of acupuncture on the paralyzed side, including stimulating the corresponding healthy side of the brain to establish functional compensatory areas. Clinical and experimental studies have supported the effectiveness of stimulating the healthy side, especially in the acute phase of stroke or when the paralyzed limb has sensory loss or spastic paralysis. Stimulation of the healthy side during the acute phase can significantly improve brain blood supply, reduce brain damage, and decrease sequelae. When the paralyzed limb has sensory loss, obtaining a needle sensation is challenging; hence, stimulating the corresponding healthy side ensures input. For spastic paralysis, besides targeting the affected side, stimulating the healthy side is also beneficial.

The combination of stimulating distal limb points and head and neck points ensures that therapeutic information can always enter the body through one of these pathways. Moreover, acupuncture points on the head and neck have been proven to improve vertebral artery blood flow, which is crucial during acute phase treatment.

For paralysis patients, acupuncture primarily targets Yang meridian points, supplemented by Yin meridian points. The role of Yin meridian points should not be overlooked.

It is generally believed that moxibustion is less effective than acupuncture in promoting motor function recovery in paralysis patients. However, thermotherapy, including moxibustion, plays at least three roles: improving blood circulation in the paralyzed limbs to prevent disuse muscle atrophy, helping relieve limb pain in some paralysis patients, and providing immediate relief from muscle tension in spastic joints.

Incorporating acupressure with acupuncture in the treatment of hemiplegia can enhance the rehabilitative effects of acupuncture. Massaging acupoints prior to acupuncture is beneficial not only in accurately identifying the stimulation points but also in facilitating the generation and transmission of needle sensations. Applying firm pressure to each acupoint until a sensation of soreness and numbness is felt, before inserting the needle, is believed to increase the sensitivity of the acupoint. This is particularly important for patients with hemiplegia who experience reduced sensation on the paralyzed side.

Post-acupuncture or routine daily acupoint massage, as well as general massage, can also intensify stimulation to the paralyzed limbs, aiding in the restoration of motor functions and preventing or treating disuse muscle atrophy. Some sensitive acupoints or reflex points, such as Yongquan and Qiuxu on the sole of the foot, can induce significant dorsiflexion of the foot or even an antagonistic reflex of the entire lower limb muscles when pressed. For these acupoints that can trigger a twitch response, it's beneficial to stimulate them several times a day. Additionally, stimulation of the soles of the feet or daily standing training is very important for the rehabilitation of lower limb paralysis.

In the rehabilitation treatment of hemiplegia, physical exercise is indispensable. The exercise regimen for hemiplegic patients includes both active and passive movements. Active exercises are divided into exercises for the paralyzed limb and exercises for the healthy side. Active exercises for the paralyzed limb are beneficial in establishing functional compensatory areas near the healthy side of the brain or the injured brain region, or in aiding the transmission of blocked neural impulses. When the paralyzed limb is completely immobile, it is necessary to assist the patient with passive movements of the paralyzed limb, while also encouraging active exercises of the healthy limb. This is because motor commands from the brain are usually conveyed to both sides of the body or to both upper and lower limbs simultaneously.

Active movements of the healthy limb can play a role in promoting the recovery of motor functions in the paralyzed limb. As soon as the paralyzed side becomes slightly mobile, patients should be encouraged to engage in active exercises themselves. Passive movements of the paralyzed limb are beneficial in reducing muscle tension and preventing disuse muscle atrophy, but care must be taken to avoid overexertion.



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