| Objective The effects of Jin's three-needle therapy (JTNT), rehabilitation therapy (RT), Jin's three-needle therapy combined with rehabilitation therapy on neurologic impairment, comprehensive function, activities of daily living (ADL) of spastic hemiplegia patients after ischemic stroke were observed for the evaluation of the therapeutic effect of Jin's three-needle therapy. Thereby, the standardization of effective therapy for spastic hemiplegia after ischemic stroke is explored.Methods1 Selection of subjects:One hundred and fifteen cases subjecting to diagnostic criteria and inclusion criteria of spastic hemiplegia after ischemic stroke were enrolled into the study. The patients had a course of disease from 2 weeks to 6 months. During the experiment, the patients were randomized into JTNT group (N=36), RT group (N=42) and combination group (N=37). The baseline was similar in the three groups (P>0.05).2 Basic treatment:The drug treatment included drugs for controlling blood pressure and blood sugar, drugs for regulating blood lipid, aspermin for preventing platelet aggregation, and citicoline for nourishing nerves. The drug treatment followed China Guideline for Prevention and Cure of Cerebrovascular Disease issued by Disease Control Department of Ministry of Public Health, and Chinese Medical Association Neurology Association in 2005. If necessary, symptomatic treatment, and prevention and cure of complications were also carried out.3 Therapies:In JTNT group, the main acupoints for Jin's three-needle therapy consisted of Niesanzhen (temporal three needles), Sishenzhen (four needles around Baihui), Luansanzhen (spasm three needles) in the upper limbs, (?)ans(?)zhen in the lower limbs, and coordination of acupoints included Shesanzhen (tongue three needles) for aphasia, Kousanzhen (mouth three needles) for distortion of commissure, Wansanzhen (wrist three needles) for severe spasm in wrist joint, Huaisanzhen (ankle three needles) for ankle joint inversion, Kaisanzhen (extension three needles) for extremities spasm, Baxie and Bafen for edema in digits. On the basis of syndrome differentiation, the following acupoints were selected when necessary:Taichong for sudden hyperactivity of liver yang, Fenglong for wind-phlegm blocking collaterals, Zusanli in the uninjured side for Qi deficiency and blood stasis, and Taixi for wind stirring due to yin deficiency. The manipulation of all the acupoints was carried out subjecting to the specified requirement. In RT group, the patients received rehabilitation therapy based on the method described in the third edition of Rehabilitation Medicine published by People's Health Publishing House. The rehabilitation training included relief of muscular tension, balance of sitting position, transition of sitting position and standing position, balance of erect position, walking training, and control of upper extremity. In the combination group, treatment included JTNT and RT.4 Period of treatment:The period of treatment in the three groups lasted 28 days. Acupuncture and rehabilitation were performed 5 times a week, and continued after 2-day break for 4 weeks. The basic drug treatment lasted 28 days in the three groups.5 Evaluation of therapeutic effect:Before treatment,14 and 28 days after treatment, neurologic impairment was evaluated with clinical neurologic impairment degree scale (NDS), comprehensive function with Functional Capacity Assessments (FCA), motor function of four limbs with simplified Fugl-Meyer Motor Scale, and activities of daily living (ADL) with Barthel's index. The changes of the four indexes were observed for the evaluation of the therapeutic effect.Results1 Scores of neurologic impairmentThe differences of NDS scores in the three groups were insignificant (P>0.05) before treatment. After treatment for 14 days, NDS scores were improved in the three groups (P<0.001 compared with those before treatment). The improvement of NDS scores in the combination group was the best, the difference of NDS scores being 3.5,3.5 and 4.9 in JTNT group, RT group and the combination group, respectively. However, the difference of NDS scores was insignificant between the three groups (P=0.077)After treatment for 28 days, NDS scores were improved in the three groups (P<0.001 compared with those before treatment). The difference of NDS scores was 7.1,6.7 and 9.1 in JTNT group, RT group and the combination group, respectively, and the difference of NDS scores was significant between the three groups (P=0.026). The results of differences between groups compared with SNK method showed that the improvement of NDS score in the combination group differed from that in JTNT group and RT group (P<0.05), but the difference between JTNT group and RT group was insignificant.After treatment for 14 days, the therapeutic effect on NDS was best in the combination group, and then came JTNT group and RT group, the difference being insignificant (P>0.05). So did the remarkable rate on NDS in the three groups (P>0.05)After treatment for 28 days, the therapeutic effect on NDS was best in the combination group, and then came JTNT group and RT group. The result of rank sum test showed statistical differences. The results of difference between groups showed that the combination group had better effect than that in RT group (P<0.05). However, the difference between the combination group and JTNT group was insignificant (P>0.05), so did the difference between JTNT group and RT group (P>0.05). The remarkable effective rate was the best in the combination group, better in JTNT group and good in RT group, the difference being significant (P=0.02). The remarkable effective rate in the combination group differed from that in RT group (P<0.05) while did not differ from JTNT group (P> 0.05). The difference between JTNT group and RT group was insignificant (P>0.05)2 Functional comprehensive assessment (FCA)The differences of FCA scores in the three groups were insignificant before treatment (P>0.05). After treatment for 14 days, FCA scores were improved (P<0.001), and the improvement value was 8.2,7.7 and 12.78 in JTNT group, RT group and combination group, respectively (P=0.007). The results of difference comparison between groups showed that FCA scores in the combination group differed from those in JTNT group and RT group (P<0.05), but the difference between JTNT group and RT group was insignificant. After treatment for 28 days, FCA scores were improved in the three groups (P<0.001), and the improvement value was 14.6,15.3,23.4 in JTNT group, RT group and combination group, respectively (P=0.002). The results of difference comparison between groups showed that FCA scores in the combination group differed from those in JTNT group and RT group (P<0.05), but the difference of the improvement of FCA scores between JTNT group and RT group was insignificant.3 Scores of simplified Fugl-Meyer assessment (FMA)(1) Upper limbsFMA scores in upper limbs of the three group were insignificant before treatment (P>0.05).After treatment for 14 days, FMA scores in upper limbs of the three group were improved (P<0.001), and the improvement value was 8.8,9.1,12.5 in JTNT group, RT group and combination group, respectively, the difference between the three groups being insignificant (P=0.139).After treatment for 28 days, FMA scores in upper limbs were improved in the three groups (P<0.001 compared with those before treatment), and the improvement value was 17.6,18.8,25.4 in JTNT group, RT group and combination group, respectively (P=0.011). The results of difference comparison between groups showed that FMA scores in upper limbs in the combination group differed from those in JTNT group and RT group (P<0.05), but the difference between JTNT group and RT group was insignificant.(2) Lower limbsFMA scores in lower limbs of the three group were insignificant before treatment (P>0.05).After treatment for 14 days, FMA scores in lower limbs of the three group were improved (P<0.001), and the improvement value was 4.9,4.0,5.8 in JTNT group, RT group and combination group, respectively, the difference between the three groups being insignificant (P=0.17).After treatment for 28 days, FMA scores in lower limbs of the three group were improved (P<0.001 compared with those before treatment), and the improvement value was 8.8,8.0,10.7 in JTNT group, RT group and combination group, respectively, the difference between the three groups being insignificant (P=0.10).4 Scores of ADLScores of ADL in the three groups were insignificant before treatment (P>0.05).
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