| ObjectiveHypermyotonia of flexors is a common complication in patients with hemiplegia after stroke and severely affects patients'recovery of neural and muscular functiona and reduces their quality of lives. The effects of musculature puncture therapy (MPT), needle warming therapy (NWT) and penetration needling therapy (PNT) on neurologic impairment, spasticity, motor function, activities of daily living (ADL) of spastic hemiplegia patients after stroke were observed. The research helps to evaluate the therapeutic effect of the three methods on spastic hemiplegia after stroke and provides the best treatment to patients with hemiplegia spasticity after stroke. It has good value of clinical application to effectively, directly and positively prevent the occurrence and aggravation of spasm. Moreover, the effective clinical therapy is a scientific proof for spastic hemiplegia after stroke.Methods1. Selection of subjects: ninety cases subjecting to diagnostic criteria and inclusion criteria of spastic hemiplegia after stroke were enrolled into the study. During the experiment, the patients were randomized into MPT group (N=30), NWT group (N=30) and PNT group (N=30). 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, and aspermin for preventing platelet aggregation. 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 in2005. If necessary, symptomatic treatment, and prevention and cure of complications were also carried out.3. Therapies:In MPT group, the main acupoints consisted of the pain points near patients'shoulder, elbow, wrist, hip, knee, metacarpophalangeal joint, ankle. In NWT group, there were four points in upper limbs, including qianyu, chize, shousanli,hegu and there were four points in lower limbs, including fengshi, zusanli, yanglingquan, sanyinjiao;In PNTgroup, we adopted penetrating from the point to point, including from jianyu to binao, from quchi to shaohai, from waiguan to neiguan, from hegu to houxi, from futu to yinmen, from yinlingquan to yanglingquan, from sanyinjiao to xuanzhong, from kunlun to taixi. The manipulation of all the acupoints was carried out subjecting to the specified requirement.4. Period of treatment:The period of treatment in the three groups lasted21days. Every group was performed5times a week, and continued after2-day break for3weeks. The basic drug treatment lasted21days in the three groups.5. Evaluation of therapeutic effect:Before treatment and after treatment, The changes of the five indexes were observed for the evaluation of the therapeutic effect, including Acute stroke diagnosis and curative effect evaluation criteria of State Administration of traditional Chinese medicine clinical neurologic impairment degree scale (NDS), modified Ashworth scale, clinical spasticity index(CSI), and activities of daily living (ADL) with Barthel's index.Results1. Acute stroke diagnosis and curative effect evaluation criteria of State Administration of traditional Chinese medicine(1) Comparison of total score:Within every group, P<0.01, there was statistical significance and it showed that every group had good effect on treatment. Between groups, The differences of scores in the three groups were insignificant before treatment (P>0.05). The results of difference comparison after treatment showed that P was less than0.05between PNT group and NWT group, between MPT group and NWT group, moreover, P was less than0.01between PNT group and MPT group. It showed that every group reduced the total score on acute stroke diagnosis and curative effect evaluation criteria of State Administration of traditional Chinese medicine, and the therapeutic effect was best in the MPT group, and then came NWT group and PNT group. (2) Comparison of degree:After treatment, the light ratio increased from73.3%to83.3%in PNT group, from53.3%to100%in MPT group and from53.3%to76.7%in NWT group. It showed it help to improve the degree of disease for every group and the MPT group was the best among groups.(3) Comparison of curative effect:the total effects were70%,96.7%and86.7%in PNT group, MPT group and NWT group respectively. The differences in the three groups were significant (P<0.05) after treatment and the therapeutic effect was best in the MPT group, and then came NWT group and PNT group.2.Scores of neurologic impairment (NDS)(1) Comparison of total score:Within every group,(P<0.01) there was statistical significance and it showed that every group had good effect on treatment. Between groups, The results of difference comparison showed that P was less than0.05between PNT group and NWT group, between MPT group and NWT group, moreover, P was less than0.01between PNT group and MPT group. It showed that every group reduced the total score of NDS and the therapeutic effect was best in the MPT group, and then came NWT group and PNT group.(2) Comparison of different symptoms:For comparison of speech within every group and between groups, P was larger than0.05and it meant that there was no statistical significance. It showed that every group had not significance difference on treatment.For comparison of facial paralysis within every group,(P<0.05) there was statistical significance in MPT and NWT groups. Between groups, The differences of scores in the three groups were insignificant (P>0.05). The results shows that there is no significance difference among three groups.For comparison of muscle strengths of shoulder and hand within every group, P was less than0.01in the muscle strengths of shoulder in every group and in the muscle strengths of hand in NWT and MPT groups. Between groups, The results of difference comparison showed that P was less than0.05between PNT group and NWT group, between MPT group and NWT group, moreover, and P was less than0.01between PNT group and MPT group. It showed that every group improved the muscle strengths of shoulder and MPT and NWT groups improved the muscle strengths of hand too. The therapeutic effect was best in the MPT group, and then came NWT group and PNT group.For comparison of muscle strengths of lower limbs and walking ability within every group, P was less than0.01in the muscle strengths of lower limbs and walking ability in every group. Between groups, The results of difference comparison showed that P was less than0.05between PNT group and NWT group, between MPT group and NWT group, moreover, P was less than0.01between PNT group and MPT group. It showed that every group improved the muscle strengths of lower limbs and walking ability. The therapeutic effect was best in the MPT group, and there is no significant difference between NWT group and PNT group.3. Activities of daily living (ADL) with Barthel's index.(1) Comparison of total score:Within every group,(P<0.05) there was statistical significance and it showed that every group had good effect on treatment. Between groups, The differences of scores in the three groups were insignificant (P>0.05) after treatment and and it shows that there has no significant difference on three groups.(2) Comparison of degree:Before treatment,(P>0.05) there was no statistical significance on three groups. After treatment, The differences of degree in the three groups were insignificant (P>0.05) and it showed that there had no significant difference in three groups.4. modified Ashworth scale.Within every group:P were less than0.01in MPT and NWT groups. Additionally, P were larger than0.05in PNT group.It showed that MPT and NWT groups had good effect on improvement spasticity of the upper limbsBetween groups, The results of difference comparison showed that P was less than0.05between PNT group and MPT group, between MPT group and NWT group, moreover, P was less than0.01between PNT group and NWT group. It showed that every group improved the spasticity of the upper limbs. The therapeutic effect was best in the NWT group, and then came MPT group and PNT group.5. clinical spasticity index(CSI)(1) Comparison of total score:Within every group:P were less than0.01in three groups. It showed that every group had good effect on improvement spasticity of the lower limbsBetween groups:The differences of scores in the three groups were statistical significant (P<0.05). The results of difference comparison showed that P was less than0.01between PNT group and MPT group, between MPT group and NWT group and between PNT group and NWT group. It showed that every group improved the spasticity of the lower limbs. The therapeutic effect was best in the NWT group, and then came MPT group and PNT group.(2)Comparison of different symptoms:Within every group:P were less than0.05in three groups for the tendon reflex and muscle tone of the lower limbs, and P were less than0.05in NWT group for clonus of the lower limbs. It showed that every group had good effect on the tendon reflex and muscle tone of the lower limbs and NWT group had good effect on clonus of the lower limbs.Between groups:For comparison of the tendon reflex, P was larger than0.05between PNT and MPT group, moreover P was less than0.01between MPT and NWT group and between PNT and NWT group.It showed that every group improved the tendon reflex of the lower limbs. The therapeutic effect was best in the NWT group, and there was no significance difference between PNT and MPT groupFor comparison of the muscle tone, P was less than0.01among three groups. It showed that every group improves the muscle tone of the lower limbs. The therapeutic effect was best in the NWT group, and there was no significance difference between PNT and MPT group. The therapeutic effect was best in the NWT group, and then came MPT group and PNT group.For comparison of the clonus, between groups, the differences of scores in the three groups were insignificant (P>0.05) after treatment and it showed that there had no significant difference in three groups for the clonus of the lower limbs.ConclusionThe effects of musculature puncture therapy (MPT), needle warming therapy (NWT), penetration needling therapy(PNT) on acute stroke diagnosis and curative effect evaluation criteria of State Administration of traditional Chinese medicine and clinical neurologic impairment degree scale (NDS) were remarkable, especially for muscle strengths of shoulder, muscle strengths of lower limbs and walking ability. Additionally, musculature puncture therapy was the best on these ways.The research adopted the modified Ashworth scale to observe the spasticity of the upper limbs and adopted the clinical spasticity index (CSI) to observe the spasticity of the lower limbs. The MPT and NWT groups improved obviously the spasticity of the upper limbs and every group improved obviously the spasticity of the lower limbs, especially the tendon reflex and the muscle tone. Additionally, needle warming therapy was the best on these ways.
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