ACUPUNCTURE FOR STROKE
by London Acupuncture Practitioner Roisin Golding
Carved in stone above the heavy hospital doors are the words, "Home for the Incurables." The doors slam shut behind as you enter and your footsteps reverberate along the miles of polished corridor. Their echo takes on a haunting quality when you realise that you are among the few in the building who is not wheelchair-bound, for this isn't a hospice for the terminally ill but for those who have suffered severe head injuries.
The lucky ones are those you can see, dotted around the grand rooms-with-a-view, silently watching from within their shattered world. The worst rarely leave their rooms. To sepulchre such patients may now seem scandalous, but these dark Victorian buildings are a testament to a bygone kindness and the growing social conscience of their age.
Thankfully, it is not simply our attitudes to disability that have progressed. Present day diagnostic capabilities and treatments have made the possibility of recovery, for all but the most severely affected, plausible. Road accidents, assaults and drug overdose can all cause widespread neurological damage, but by far the most common cause of neurological disability in the Western world is cerebrovascular accident, commonly known as stroke.
While Western medical technology is of paramount importance in the acute stage and immediate aftermath of stroke, it is other treatments, particularly physiotherapy and acupuncture, which offer the greatest benefits in the long term rehabilitation of the stroke patient.
The exact mechanisms of how acupuncture works has intrigued the medical community for years. The favoured theories propose neurological pathways, especially the blocking of pain pathways to the brain. Others focus on the release of neurochemicals. Both theories limit the scope of acupuncture to treating pain. But as Dr. David St. George, Consultant and Senior lecturer in epidemiology and public health medicine at the Royal Free Hospital, London, explained, "Studies done so far into treating stroke with traditional acupuncture, makes one ask questions about mechanisms. You're talking about the regeneration of damaged nerves and reprogramming of the brain. How can the brain be reprogrammed to retake control of an arm just by stimulating endorphins?"
Among the studies St George referred to was one in Sweden. In a controlled study, a group of patients receiving acupuncture showed significant improvement in walking, balance, daily living activities and emotional state. This stabilising of the emotional state, as anyone who has had to care for a stroke patient at home will know, is of great significance.
A further study was carried out on the same group the following year and matched with the original control group to investigate patients' posture control. Again, it showed that acupuncture had enhanced the recovery of postural function and, furthermore, that this was still evident two years later.
There have been many other studies undertaken, in the United States, in Norway, and of course, China. A further study to test the validity of the Scandinavian trials is underway in Southampton, England.
Although there is evidence that acupuncture can be effective in treating paresis (extreme weakness of muscles, including paralysis) due to stroke even eight years after the event, it is generally stressed that better results are obtained if acupuncture is started as soon as possible, preferably within one to six months.
Treatment needs to be frequent. Some proponents suggest treating every day, seven days a week, during the first month or so, with a weeks break after several weeks. All acknowledge the minimum required is two treatments per week. Twenty to forty treatments per course are standard. A combination of normal acupuncture needling (referred to as dry needling by medics), low frequency electrical stimulation - just enough to produce sensation on the points and in the surrounding muscles, and the newly developed scalp acupuncture is used.
Scalp acupuncture developed in the late 1960s in China and is based on modern neurological mapping of the brain so that, for instance, in treating paralysis of the left arm, points on the right side of the scalp relating to motor function of the upper limbs are used.
Improvement in speech, regain of control over bladder and bowel functions, reduction of spasm and increased mobility in the limbs, are the great gains available through acupuncture. I should stress that these gains are made not in isolation but in conjunction with physiotherapy and any other medications that may be required.
Although studies have not yet been undertaken to test the traditional Chinese medical assertions that acupuncture can be used as a preventative medicine, a recent study in Norway with a one year follow-up showed that only the acupuncture group maintained and increased significant improvements on all scales tested - motor function, activities of daily living and quality of life.
After the initial focus on restoration of normal functioning, acupuncture turns its attention to correcting the underlying energetic imbalances that have led to stroke. High blood pressure, dizziness, headaches, as well as other more subtle imbalances which the Chinese attach importance to, but which may be discounted as irrelevant by Western medicine, are all taken into consideration.
Since many stroke victims are subject to subsequent attacks, the preventative aspects of acupuncture treatment may yet prove to be among the greatest advantages of this as a choice of treatment.
