Effect Of Musculature Puncture On The Degree Of The Spasticity Of Limbs Of Stroke Patients

Spasticity in hemiplegia is one of the most fundamental functional impairment in stroke,whose incidence rate is up to 80%in stroke,and is often occurred several days or weeks after stroke.The principle clinical manifestations are hypermyotonia of flexors(in charge of adduction of shoulder joint and flexion of elbow,wrist and hand joints)of upper limbs and extensors(extension of hip and knee joint and plantar flexion of ankle joint)of lower limbs,and often accompanied by tendon hyperreflexia,clonus, concomitant contraction of synergic and antagonistic muscles,pathologic signs,lack of power and fatigue,etc.The appearance of spasticity limited affected limbs' ability of re-learning voluntary motion,and even "misuse syndrome" will occur,which may cause contracture of joints and traumas, hindering the patient' s recovery of neural and muscular function.So,it is an important problem in current medical science to relieve spasticity of hemiplegic limbs effectively,and is a focal point in department of neurology and rehabilitation,which is laid store by medical institutions all over the world.Spasticity in hemiplegia belongs to the category of "tendon bi" in traditional Chinese medicine.In the era of "Emperor' s Canon of Medicine", there is similar records such as "stroke" or "tendon bi" etc.,and is considered that it is caused by imbalance of yin and yang and lack of smoothing of tendons.It is said in "Classic on Medical Problems——29^thQuestion": "When there is disease in yinqiao vessel,yang is relaxed and yin is urgent; when there is diseasein yangqiao vessel,yin is relaxed while yang is urgent." The musculature puncture is directed by the theory "musculature of 12 meridians",and formed in "Spiritual Pivot" by "close to the point thrusted perpendicularly" of Lateral Puncture and "thrusting left and right till up to the tendon" of Joint Punture.When it is practised in clinic,the therapeutic effect is fairly well,which can achieve the effect of relaxing tendons and activating collaterals to ease up tendon spasm,i.e.,"recover the muscular contracture."This research adopted musculature puncture method,observing the degree of improvement of the spasticity of limbs of stroke patients before and after treatment,and compare it with the group which selects points of traditional acupuncture group,exploring the therapeutic effects on hemiplegic spasm patients from spasticity degree[modified Ashworth scale(MAS)and clinical spasticity index(CSI)],assessment of motor function(using Brunnstrom stages of motor recovery)and simplified Fugl-Meyer assessment(FMA)and activity of daily living(using Barthel' s ADL index and simplified neurological functional defects score).It has good value of clinical application and socially economy to effectively prevent the occurrence and aggravation of spasm.(1)Utilizing the method of block random control trial,dividing 60 hemiplegic spasm patients into musculature group(therapy group)and traditional acupuncture group(control group),treating for 3 weeks,and evaluate therapeutic effect by modified Ashworth scale.Make elbow joint in upper limbs,and knee joint in lower limbs as observing object,and assessing in four scales from excellence,efficiency,amelioration and unavailability. The result shows that the total effect of therapy group is 80%,while that of the control group is 56.67%,after Ridit test(Z=2.15,P＜0.05),it shows that there is statistical significance in the difference of total effective rate between two groups,which prompts that the degree of improvement of spasticity in therapy group is better than control group.(2)as to the influence on therapeutic effect by patient' s general state, it is found that there is no statistical significance of age,gender,state of illness,nature of disease and TCM type of syndrome(P＞0.1).,but the course of disease and the frequency of incidence has statistical significance on therapeutic effect(P＜0.05),which indicates that the shorter the course of disease,the fewer the incidence times,the better the therapeutic effect.(3)as to the degree of spasticity:comparing the total score of clinical spasticity index(CSI)between two groups and the total score before and after treatment,there is significant improvement in the therapeutic effect(P_{therapy group}＜0.001,P_{control group}＜0.01),there shows statistical significance in the difference of value after treatment between two groups,t_{difference,value}=2.36,P＜0.05,and the therapeutic effect of therapy group is better than control group.And comparing each score in clinical spasticity index(CSI)before and after treatment,there is significant improvement of therapy group in tendon reflex,muscular tension and clonus:while there is also significant improvement in muscular tension and clonus in control group,but no significant improvement after treatment in tendon reflex.The score difference after treatment has no apparent significance between two groups in tendon reflex, muscular tension and clonus.(4)Evaluation of the motor function:Brunnstrom stages of motor recovery is an earliest clinically applied semi-quantitative measuring method for limbs' motor function,including contents of trunk,four limbs and walking etc.,and is fallen into 5 functional grades for each item.The advantage of this evaluation method is all-around and detailed,for it not only evaluates the ill side but also the uninjured side,which is easy to compare.We found that there is an improvement in the scores of Brunnstrom stages in upper and lower limbs after treatment in therapy group;and amendment in the scores of Brunnstrom stages in lower limbs in control group,but there is no obvious amelioration of Brunnstrom stages in upper limbs in control group.And in the improvement in Brunnstrom stages in lower limbs,the therapy group is better than control group.In the aspect of simplified Fugl-Meyer assessment(FMA)of hemiplegic spasm patients,there is significant improvement in upper and lower limbs in both therapy group and control group after treatment.And the therapeutic effect of lower limbs in the scores of simplified Fugl-Meyer assessment in therapy group is better than that in control group.There is significant therapeutic effect in the grading scores of upper and lower limb' s motor function after treatment in therapy group and control group,but there is no statistical significance of the difference in the grading of motor function scores of upper and lower limbs after treatment between two groups,P＞0.5.(5)Activity of daily living:Using Barthel's ADL index and simplified neurological functional defects score.First of all,in the aspect of Barthel's ADL evaluation,there is significant improvement in the ADL's grading and score after treatment in therapy group,and the degree of improvement in therapy group is better than that in control group;and there is apparent therapeutic effect in simplified functional defects score after treatment in both group,while the effect is better in therapy group than that in control group.In a further control study on each items of simplified functional defects score respectively,it is found that after treatment,there is significant improvement in muscle force of upper limb,hand and lower limb and walking ability in therapy group,and significant improvement in muscle force of upper limb,hand and lower limb in control group,but no significant improvement in walking ability.After treatment,there is significant difference of scores after treatment in upper limb's muscle force,lower limb's muscle force and walking ability between two groups,and the therapeutic effect of therapy group is better than that of control group.And in the improvement degree of hand's muscle force,the therapeutic effect of two groups are similar.