Hebei United University, Tangshan 063000, China

SPECIAL TOPIC STUDY

Reinforcing and Reducing Manipulation by Breathing on Yin and Yang Meridian Points for Motor Function of Knee Joints in Patients with Ischemic Stroke

Tian Fu-ling, Li Qi, Liu Guo-rong, Zheng De-song, Chen Jin-ming, Ma Shu-xiang, Cui Jian-mei, Wang Hong-bin, Li Xue-qing

Hebei United University, Tangshan 063000, China

Author:Tian Fu-ling, master of medicine, lecturer

Objective: To observe the effect of reinforcing and reducing manipulation by breathing on yin and yang meridian points for motor function of knee joints in patients with ischemic stroke.

Methods: A total of 60 ischemic stroke cases were randomly allocated into an observation group and a control group, 30 in each group. Other than basic and conventional rehabilitation therapies, cases in the observation group were treated with reinforcing and reducing manipulation on yin and yang meridians points for a period of 8 weeks; whereas cases in the control group only received the same basic and conventional rehabilitation therapy as that in the observation group. Then the knee joint energy, support moment and shaking moment were compared between the two groups before treatment, and after 4-week and 8-week treatment respectively.

Results: Before treatment, there were no between-group significant differences in knee joint energy, support moment and shaking moment (allP＞0.05). After treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved (P＜0.05). After 8 weeks of treatment, the knee joint energy, support moment and shaking moment in both groups were significantly improved than that of 4-week treatment (P＜0.05). In addition, there were between-group statistical significances in comparing knee joint energy, support moment and shaking moment after 4 and 8 weeks of treatment (P＜0.05).

Conclusion: Reinforcing and reducing manipulation by breathing on yin and yang meridian points can increase the knee joint support and shaking force and moment in stroke patients and improve their walking ability.

Acupuncture Therapy; Stroke; Brain Infarction; Cerebrovascular Disorders; Complications; Movement Disorders; Knee Joint

Stroke severely endangers human health and life. Because of its high incidence, disability rate and mortality rate, stroke is a life-threatening condition and can bring about social and economic burden to the family and society. Restricted movement due to motor dysfunction of the lower limbs following stroke can greatly affect the patients’ quality of life and confidence in rehabilitation. As a result, the primary rehabilitation goal for stroke patients is to improve the motor functions of the lower limbs and their walking ability[1-2]. Numerous clinical reports have proven that acupuncture can effectively improve the motor function of the affected limb. However, most literature reports used subjective rating scale insteadof quantifiable efficacy indexes, which resulted in subjectiveness and discrepancy. By using Lokomat automatic robot gait assessment system, this study evaluated the role of reinforcing and reducing manipulation by breathing on yin and yang meridian points in improving motor function of the knee joint in stroke patients. The report is now given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria in Western medicine

They are based on the diagnostic criteria of cerebral infarction[3]. Stroke onset in quiet or resting state, mostly without notable headache and vomiting; gradually progress, often related to arteriosclerosis and can also be seen in arteritis or blood disorders; clear consciousness or mild confusion 1-2 d after initial onset; signs and symptoms of internal carotid artery and/or vertebro-basilar artery system; CT scan or MRI examination showed no hemorrhagic focus.

1.1.2 Diagnostic criteria in Chinese medicine

They are based onStandard for Diagnosis and Therapeutic Effect Evaluation of Stroke(trial)[4]. Sudden collapse and unconsciousness coupled with deviation of the mouth corner, slurred speech and hemiplegia; alternatively, deviation of the mouth and hemiplegia without collapse. This condition is named wind stroke in Chinese medicine since its acute onset and variant symptoms are similar to the characteristics (mobile and changeable) of natural wind.

1.2 Inclusion criteria

Those who met the above diagnostic criteria in Chinese and Western medicine; cerebral infarction confirmed by cranial CT scan or MRI examination; aged between 50 and 70 years; between 2 weeks and 6 months after initial onset; initial onset involving one side of the internal carotid artery system; patients with clear consciousness and stable vital signs and could cooperate in treatment; patients presenting with spastic paralysis, increased muscle tension and hyperactive tendon reflex on one side of the body; signed the informed consent.

1.3 Exclusion criteria

Patients after craniotomy operation for cerebral hemorrhage; patients with subarachnoid hemorrhage; having complications of severe primary diseases involving heart, liver, lung, kidney, hematopoietic and endocrine systems; psychosis; dystonia or motor dysfunction due to other causative factors; difficulty walking due to total joint replacement of the lower limb and severe arthritis; and restricted movement due to other conditions.

1.4 Statistical method

The SPSS 17.0 version software was used for statistical analysis, independent samplet-test for measurement data (expressed byand Chi-square test for rate comparison. APvalue of less than 0.05 indicates a statistical significance.

1.5 General data

A total of 60 eligible outpatients and inpatients treated in the Affiliated Hospital of Hebei United University between January 2011 and January 2013 were randomly allocated into an observation group and a control group, 30 in each group. There were no between-group statistical differences in comparing age, gender, duration and ischemic focus (allP＞0.05), indicating that the two groups were comparable.

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Observation group

2.1.1 Basic treatment

In addition to controlling blood pressure, blood sugar and blood fat, patients were treated with vasodilation and neurotrophic drugs. These include intravenous dripping of 10-25 mL ginkgo leaf extract and Dipyridamole injection (manufactured by Guizhou Yibai Pharmaceutical Co., Ltd., China Food and Drug Administration approval number: H52020032) per day and intravenous dripping of 20 mg Vinpocetine injection (manufactured by Northeast General Pharmaceutical Factory, China Food and Drug Administration approval number: H10950217) per day. The treatment lasted for 28 d.

2.1.2 Rehabilitation therapy

Rehabilitation training includes bridge-style movement, sitting balance, limb activity, walking upand down the stairs, walking exercise, and activities of daily living (ADL) exercise, coupled with 3 treatments with ZM-C-VI intermediate frequency apparatus (a frequency of 2 000-8 000 Hz) a week, 1 h for each treatment. The treatment lasted for 8 weeks.

2.1.3 Reinforcing and reducing manipulation by breathing on yin and yang meridian points

Points: Biguan (ST 31), Zuwuli (LR 10), Xuehai (SP 10), Liangqiu (ST 34), Yinlingquan (SP 9), Yanglingquan (GB 34), Sanyinjiao (SP 6), Xuanzhong (GB 39), Kunlun (BL 60), Taixi (KI 3), Zhaohai (KI 6) and Shenmai (BL 62). All points are on the affected side.

Method: Upon arrival of qi, reducing manipulation by breathing was applied to points on yin meridians and reinforcing manipulation by breathing to points on yang meridians up to the patients’ tolerance. The needles were retained for 30 min. The treatment was done once a day, and lasted for 8 weeks.

2.2 Control group

3 Outcome Observation

3.1 Observation indexes

The knee joint energy, support moment and shaking moment were evaluated by using Lokomat full automatic robot gait assessment system before intervention, and after 4-week and 8-week treatments[5].

3.2 Results

Before treatment, there were no between-group statistical differences in comparing knee joint energy, support moment and shaking moment ( allP＞0.05). After treatment, the above indexes in both groups were significantly improved (allP＜0.05). There were intra-group statistical differences between 4 and 8 weeks of treatment (P＜0.05). There were also between-group statistical differences after 4 and 8 weeks of treatment (P＜0.05), indicating that patients in the observation group obtained better effect in knee joint function than those in the control group (Table 2).

Table 2. Between-group comparison in knee joint energy, support moment and shaking moment

Table 2. Between-group comparison in knee joint energy, support moment and shaking moment

Note: Compared with the same group before treatment, 1) P＜0.05; compared with the same group after 4-week treatment, 2) P＜0.05; compared with the concurrent control group, 3) P＜0.05

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4 Discussion

Walking involves rhythmic alternating movements of multiple joints and muscles. During walking, a full gait cycle starts from one foot touching the ground to the time the same foot touching the ground again. This cycle is divided into two phases: stance and swing. Stance is defined as the process from initial contact of the foot on to the ground to the point when the heel is lifted off the ground and the toe off position (approximately 60% of the gait cycle); a single support phase is defined as the process from the contralateral toe off the ground to the same heel striking the ground (approximately 40% of the gait cycle); and swing is defined as the interval in which the foot is not in contact with the ground (approximately 40% of the full gait cycle)[6-9]. Normal gait involves lateral pelvic tilt, pelvic rotation, flexion and extension of the hip, knee and ankle joints[10-11], especially the knee joints. The coupling mechanism analysis of flexion and extension of the knee joints have shown that during a normal gait cycle, the knee joints mainly control the forward shift of the body weight and reduce the impact of the ground reaction force on the body[12]. On the contrary, restricted flexion and extension and insufficient shaking and support of the knee joints can contribute to hemiplegic gait[10-11].

Acupuncture has been proven to be effective for stroke[13-15]. Numerous reports over the past decades have also confirmed the scientific foundation of its clinical efficacy. By interfering with the muscle tone and strength, needling manipulations can benefit balance of the stroke patients[16-18]. According to the pathological state in stroke patients (spasm of yin and flaccidity of yang), reinforcing and reducing manipulation by breathing on yin and yang meridian points aims to reduce yin meridian points to release spasm and reinforce yang meridian points to activateyang qi to balance yin and yang, thus restoring the motor functions of the hemiplegic limb[19].

By using the Lokomat full automatic robot gait assessment system, this study evaluated the effect of reinforcing and reducing manipulation by breathing on yin and yang meridian points for abnormal gait pattern of stroke patients. Research findings have shown that the knee joint energy, support moment and shaking moment of patients in the observation group were significantly better than that in the control group after 4 and 8 weeks of treatment. This indicates that this needling technique can increase the support and shaking force and moment of knee joints in stroke patients.

This study has shown that the Lokomat gait assessment system can analyze acupuncture effect on the lower limb movement in an accurate and objective way and thus enable acupuncturists to adjust the treatment protocol, better target the specific gait problem and improve the walking ability of patients with hemiplegic gait. This can further provide solid theoretical foundation for standardized acupuncture treatment for postapoplectic hemiplegic gait.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

This work was supported by National Nature Science Foundation of China (No. 81303046).

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

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Translator:Han Chou-ping

Received Date:April 8, 2014

Li Qi, master of medicine, lecturer.

E-mail: liqi19801211@163.com

R246.6

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in the control group only

the same (method and course of treatment) basic treatment and rehabilitation therapy as in the observation group.