| Objective:Using convalescent patients after ischaemic stroke as the research model and biological mechanics, kinematics technology, modern rehabilitation function evaluation system as the research analysis method,this study evaluated the therapeutic effect of unblocking meridians and governor vessel tuina on motor function of ischemic stroke patients and discussed the mechanism to improve the function.Methods:This study included a total of120convalescent patients after stroke from October2009to October2011, all of whom were recruited from Rehabilitation Department and Neurology of Nanjing JiangBei Hospital. The inclusion criteria were:diagnosis according with1995cerebrovascular disease classification and approved by CT or MRI. Subjects were randomly assigned into3groups:41subjects received unblocking meridians and governor vessel tuina therapy(the treatment group),40subjects received common massage therapy (the control group),while the rest of39subjects received rehabilitation therapy (the rehabilitation group).All subjects received drug treatment corresponding with its related disease.At the same time,10patients were chosen from each group to receive gait kinematical analysis test according to random arrangement data tables.The research time was8-weeks.At conclusion, assessments observed before therapy and8weeks post therapy were conducted with regard to clinical effects(Clinical curative effect score), neural function (neural function defect degree rating scale, NFDS),muscular tension (modified Ashworth scale, MAS),motor function(Fugl-Meyer assessment, FMA),balance (Berg balance scale, BBS), comprehensive function (functional comprehensive assessment, FCA), activities of daily living(modified Barthel index, MBI), the quality of life (SF-36scale), gait time-space parameters, lower limb joint Angle and walk efficiency indexes.Results:(1),General condition:There were no statistically significant differences in physical or demographic characteristics among three groups,such as gender,age, height, the course, the hand side, the hemiparalysis side. There were no statistically significant differences among NFDS,MT,FMA,BSS,FCA,MBI and SF-36before therapy. Also, There were no statistically significant differences among gait time-distance parameters, lower limb joint angle and walk efficiency indexes. So each group was comparable.(2),Compared with that before treatment, improved outcomes in the patients of the treatment and rehabilitation group have been shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc. There were significant differences between the total scores of the assessment items when compared with that before and after4weeks and8weeks treatment, and compared with that after4weeks and8weeks treatment respectively.(3),Compared with that before treatment, improved outcomes in the patients of the control group have shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc. There were significant differences between the total scores of the assessment items, such as the total scores of MT, FMA, and BSS, FCA, MBI, and SF-36when compared with that before and after4weeks and8weeks treatment, and compared with that after4weeks and8weeks treatment. But there was no significant difference on NFDS when compared with that before and after4weeks treatment.(4),Compared among groups:After4weeks treatment, compared between the treatment group and the control group, the difference had statistical significance on the items, such as NFDS and BSS. Compared between the treatment group and the rehabilitation group, the difference on BSS had statistical significance. Between the control group and the rehabilitation group, a statistical significance on NFDS was also shown. After8weeks treatment, compared between the treatment group and the control group, the difference had statistical significance on the items, such as NFDS,MT and BSS. Compared between the control group and the rehabilitation group, the difference on the assessment items, such as the total scores of NFDS, MT,BSS,FCA,SF-36had statistical significance. Compared between the treatment group and the rehabilitation group, the difference on the assessment items, such as the total scores of MT, BSS, FCA, and SF-36also had statistical significance.(5),Compared the Clinical effects before and after treatment:Compared with that before treatment, the score of the clinical curative effect of all groups increased. Treatment group raised significantly, rehabilitation group and control group also increased obviously. The difference were significant compared the treatment group and the rehabilitation group to the control group, but no difference was revealed between the treatment group and the rehabilitation group.(6),After the treatment in the three groups, improved outcomes in the patients have been shown respectively on the assessment items, such as the total scores of NFDS, MT, FMA, and BSS, FCA, MBI, and SF-36, etc., which showed active prevention therapy could significantly improve the functions of the ischemic stroke patients.(7),Compared with that before treatment, improved outcomes in the patients of the treatment and control group have been shown respectively on the assessment items, such as the total scores of MT, FCA, and SF-36, etc., which indicates that Tuina has a special curative effect on the patients'psychosomatic state and it can decrease the muscle tone. And during the treatment it is utilized for the overall therapy and doctors pay more attention to communicate with patients and respect patients' feeling, which in turn are willing to be accepted by patients and get higher adherence. It can significantly improve stoke patients' psychosomatic state and activities of daily life.(8),Gait time-space parameters:The stride length, distance, frequency and width of all groups did not change obviously, whereas, the speed, limb-support time and swing time changed significantly after therapy. Compared among groups, between the treatment group and the control group or between the treatment group and the rehabilitation group, the difference had statistical significance,but there was no difference between the control group and the rehabilitation group. It indicated rehabilitation had positive function on prompting the hemiplegia gait, and the unblocking meridians and governor vessel tuina work best among the three.(9),Lower limb joint Angle:The maximum stretch angle in support-phase and flexion angle in swing-phase of knee-joint all changed obviously, at the same time, the maximum stretch angle in support-phase and swing-phase and flexion angle in support-phase of ankle-joint also changed obviously. Compared among groups, between the treatment group and the control group, or between the treatment group and the rehabilitation group, or between the control group and the rehabilitation group,the difference had no statistical significance.(10),Walk efficiency:After therapy, the stride speed of three groups increased, whereas the oxygen consumption and oxygen valence decreased, so the walk efficiency improved obviously. Compared among groups, between the treatment group and the control group or between the treatment group and the rehabilitation group, the difference had statistical significance,but there was no difference between the control group and the rehabilitation group. The result showed unblocking meridians and governor vessel tuina can obviously improve the walk efficiency of hemiplegics.Discussion:(1) The etiology and pathogenesis of ischemic stroke are complicated. Stroke is marked by faint and hemiplegia caused by the obstruction of the brain vessels due to various kinds of factors, such as stagnation of blood stasis, internal accumulation of phlegm-heat, or yang turning into endogenous wind, blood flowing with adverse qi. Stroke can be treated by the method of dredging the governor meridian and massage. Through regulating the general qi flow and dredging the meridians and collaterals of the trunk, limbs and muscles, smooth qi movement of governor meridian, modified qi and blood circulation of the meridians and collaterals as well as the recovery of visceral function can be achieved. And thus, the purpose of nourishing yin and suppressing yang, unblocking the fu-organs and resolving the phlegm, activating blood circulation and dredging the collaterals, invigorating qi and nourishing blood can also be achieved.(2) The damage of upper-motor neuron and the excessive release of lower-motor neuron leads to the disorder of muscle function, which also expresses movement disability and the decline in the quality of life in ischemic stroke patients. The unblocking meridians and governor vessel tuina can improve the motor function of hemiplegics. The most likely mechanisms are that it can influence the rhythmic movement of peripheral neurons to reconstruct the muscle function by intervening muscle biological resonant frequency and, fix abnormal motor pattern to promote the balance and coordination among muscle groups and increase the muscle endurance and the accuracy of activity.(3) By intervening muscle biological resonant frequency and balancing and coordinating nerve muscle function, the unblocking meridians and governor vessel tuina can combine the coordination of the trunk and extremities with the participation of feeling function, which leads to the improvement of the motor function and walking ability and ADL and life quality in hemiplegics. It has good short-term curative effect.(4) The unblocking meridians and governor vessel tuina have a good therapeutic effect on hemiplegics, it is a confirmed and exercisable clinical therapy, which is proper to popularize and worthy of further discussion and study.
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