| ObjectiveIn this study, we used a randomized controlled trial, acupuncture commonly observed shoulder-hand syndrome, ie EA, temperature differences in the clinical efficacy of acupuncture, acupuncture fire shoulder-hand syndrome after stroke, and to explore the mechanism of acupuncture treatment for stroke after different shoulder-hand syndrome principles and Problems, acupuncture treatment for post-stroke shoulder-hand syndrome systematic, standardized to provide clinical reference.MethodsCase patients in this study was collected from Taiwan Charity Hospital stroke shoulder-hand syndrome after treatment, the treatment observation period was from February 2013 to March 2014,96 patients were collected, according to a completely randomized into three groups:EA group, warm acupuncture group, fire needle group,32 cases in each group.Stroke Western diagnostic criterion-referenced the Chinese Medical Association in 2006 compiled the diagnostic criteria for "Clinical Practice Guidelines · Neurology Volume" in the formulation of related stroke, stroke TCM diagnostic criteria are referring to the use of the State Administration of Traditional acute encephalopathy Research Group developed "stroke diagnosis and evaluation standard" (Trial), shoulder-hand syndrome diagnostic criteria according to the China Rehabilitation Research Center in 1996 to develop a "stroke rehabilitation assessment and treatment" on the shoulder-hand syndrome diagnostic criteria. Shoulder-hand syndrome after stroke in a 1:1:1 ratio were randomly assigned to acupuncture group, warm acupuncture group, fire acupuncture group,32 cases in each group. Select reference points higher education "fifteen" national planning textbook "acupuncture" (Shi Xuemin editor of China Pharmaceutical Press) combined with rehabilitation exercises on the basis of acupuncture. Treatment for 28 days, treatment three times a week for 4 weeks. Efficacy of specific projects, including a visual than pain (VAS) assessment form, shoulder-hand syndrome swelling assessed Simple Fugl-Meyer motor function score (upper extremity), functional activities of daily living scale (ADL), shoulder-hand syndrome According efficacy standards "for stroke rehabilitation assessment and treatment" Combining shoulder-hand syndrome develop the actual situation.ResultsEA group before treatment, warm acupuncture group, gender fire needle group, age, duration, shoulder-hand syndrome stage, TCM syndromes, shoulder-hand syndrome, pain score, swelling score, ADL activities of daily living the analysis of the total score was not statistically significant, indicating that general information among the three groups have balance.The results of the clinical studies show that:1. shoulder-hand syndrome pain scores showed:EA group after two weeks of treatment, warm acupuncture group after stroke shoulder-hand syndrome, compared with pre-treatment pain score, the score has decreased, but it was not statistically significant (P> 0.05). Fire needle group, the patients with pain scores were significantly different (P<0.05) compared with before treatment. Three groups of patients with pain scores compared with before treatment were statistically significant, in which warm acupuncture group, fire needle group before and after treatment were significantly different (P <0.01). Comparisons between the two groups, after two weeks of treatment, acupuncture group, warm acupuncture group, set fire needle pain score pairwise comparison, the difference was not statistically significant (P> 0.05). After 4 weeks, pain scores and fire needle acupuncture group were significantly reduced compared (P<0.01). Pain symptoms in patients with shoulder-hand syndrome after stroke improvement after two weeks of treatment to achieve better fire needle clinical efficacy; after four weeks of treatment, all three acupuncture can alleviate to some extent, shoulder-hand syndrome Pain patients; in contrast therapy, it can be clear that fire needle pain compared to patients treated with more obvious shoulder-hand syndrome after stroke in EA.2. The shoulder-hand syndrome swelling scores showed:swelling after two weeks of treatment in patients with shoulder-hand syndrome warm acupuncture group scored better than before treatment decreased significantly (P<0.05); EA group and set fire needle swelling scores before treatment ratings contrast, no significant difference (P> 0.05). After four weeks of treatment, acupuncture group, warm acupuncture group, fire needle group than shoulder-hand syndrome score before treatment to reduce swelling, the group was statistically significant (P<0.05). Comparisons between the two groups, after two weeks of treatment whether it is, or after 4 weeks of treatment, the three groups in contrast aspects shoulder-hand swelling scores of patients were not statistically significant (P> 0.05) syndrome. Swelling score on three aspects of the patient’s post-stroke shoulder-hand syndrome, after two weeks of warm acupuncture treatment group was significantly swelling scores than before treatment, visible, warm acupuncture treatment is better for improving the efficacy of shoulder-hand syndrome swelling; after four weeks of treatment after three acupuncture can relieve swelling in patients, but the difference was not significant treatment effect of the three groups.3. Fugl-Meyer motor function scale (upper) display:Three groups of stroke patients before treatment Fugl-Meyer motor function score (upper) compared with the scores before treatment, no significant differences were comparable. After treatment, patients flexor synergy EA sports, extensor aspects of cooperative movement, with activities coordinated movement of shoulder and elbow, wrist stability and wrist movements with coordination activities compared with before treatment, significantly (P <0.05); warm acupuncture group, the flexor synergy movement, shoulder and elbow movements with coordination of activities, from sports activities coordinated, cooperative movement from the activities of the movement of the wrist, wrist movement coordination activities with scores than before treatment reduced the difference was statistically significant (P<0.05); fire needle group in the coordination of activities with shoulder and elbow movement, wrist movement, coordination and speed improvement is obvious (P<0.05). For the improvement of the patient’s shoulder-hand reflexes, hyperreflexia, the three treatment groups were significant effect (P> 0.05) syndrome. Three groups of stroke patients before treatment Fugl-Meyer motor function score (upper) compared with the scores before treatment, no significant differences were comparable. After treatment, patients flexor synergy EA sports, extensor aspects of cooperative movement, with activities coordinated movement of shoulder and elbow, wrist stability and wrist movements with coordination activities compared with before treatment, significantly (P<0.05); warm acupuncture group, the flexor synergy movement, shoulder and elbow movements with coordination of activities, from sports activities coordinated, cooperative movement from the activities of the movement of the wrist, wrist movement coordination activities with scores than before treatment reduced the difference was statistically significant (P<0.05); fire needle group in the coordination of activities with shoulder and elbow movement, wrist movement, coordination and speed improvement is obvious (P<0.05). For the improvement of the patient’s shoulder-hand reflexes, hyperreflexia, the three treatment groups were significant effect (P> 0.05) syndrome.Fugl-Meyer motor function before and after the total score (upper) treatment, after two weeks of treatment Fugl-Meyer motor function acupuncture group than before the treatment the total score was less (P<0.05). After four weeks of treatment, the three groups of Fugl-Meyer motor function improvement than the total score (P<0.05) before treatment. Between the two groups:After two weeks of treatment, the EA group of motor function score better than fire needle group; after four weeks of treatment, acupuncture group, significantly reduced Fugl-Meyer motor function warm acupuncture group total score than fire needle group, (P<0.05). Acupuncture treatment in patients with upper limb motor function after stroke may be better in the short term to improve the shoulder-hand syndrome, such as sports flexor synergy, synergy extensor exercise, shoulder and elbow movement with coordinated activities, wrist stability, coordination with wrist movement and so on. After four weeks of treatment, the three therapy can improve arm movement in patients with shoulder-hand syndrome, but acupuncture, acupuncture was significantly better than warm fire needle therapy.4. ADL total score display function in daily life:After two weeks of treatment three groups of daily living ADL total score compared with before treatment, there was no significant difference (P> 0.05). After four weeks of treatment, the EA group of daily living ADL total score was significantly improved compared with before treatment there was statistically significant (P<0.01); warm acupuncture group, fire needle group also improved than before treatment (P<0.05). Comparisons between the two groups, after two weeks of treatment, the three groups of daily living ADL total score was no significant difference (P>0.05), after 4 weeks of treatment, acupuncture group ADL total score of daily living than fire needle, group between statistically significant (P<0.05). After four weeks of treatment, all three therapies can improve the daily lives of stroke patients function, such as the transfer of (bed-chair), bathing conditions, eating, personal hygiene, in which the efficacy of acupuncture for the best, followed by warm acupuncture, fire needle the efficacy of acupuncture therapy is better.ADL function in daily life before and after comparison of the total score after treatment three weeks of daily living ADL total score compared with before treatment, there was no significant difference (P> 0.05). After four weeks of treatment, the EA group of daily living ADL total score was significantly improved compared with before treatment there was statistically significant (P<0.01); warm acupuncture group, fire needle group also improved than before treatment (P<0.05). Comparisons between the two groups, after two weeks of treatment, the three groups of daily living ADL total score was no significant difference (P> 0.05), after 4 weeks of treatment, acupuncture group ADL total score of daily living than fire needle, group between statistically significant (P<0.05). After four weeks of treatment, all three therapies can improve the daily lives of stroke patients function, such as the transfer of (bed-chair), bathing conditions, eating, personal hygiene, in which the efficacy of acupuncture for the best, followed by warm acupuncture, fire needle the efficacy of acupuncture therapy is better.5. Comparison of the three groups after treatment of shoulder-hand syndrome clinical efficacy results show (see Table 10):The clinical efficacy of three shoulder-hand syndrome after treatment by Kruskal-Wallis H rank sum test, H=1.27, P> 0.05, prompted three The clinical efficacy of group difference was not statistically significant. Among them, the effective rate of 74.19% EA group, markedly effective rate was 38.71%; warm acupuncture group effective rate 71.88%, markedly effective rate was 34.38%; fire needle group of effective rate 67.74%, markedly effective rate was 41.94%. The results show that:EA, warm acupuncture, acupuncture efficacy differences fire shoulder-hand syndrome after stroke is not obvious.ConelusionElectro-acupuncture, warm-needle acupuncture, fire acupuncture in shoulder-hand syndrome after stroke have a certain effect, can relieve pain symptoms, eliminate swelling, improve upper extremity movement of shoulder-hand syndrome patients, such as shoulder and elbow movement with coordinated activities for, wrist movement, etc., and to improve the daily lives of stroke patients function, such as the transfer of (bed-chair), bathing conditions, eating, personal hygiene. In contrast to the three different aspects of acupuncture, fire needle pain relief is better than acupuncture therapy; aspects of improving the shoulder-hand syndrome in patients with upper limb movement, acupuncture, acupuncture was significantly better than warm fire needle therapy; on improving stroke patients the functional aspects of daily life, to the efficacy of acupuncture was the best, followed by warm acupuncture, fire needle acupuncture therapy efficacy is better. The three treatments for patients to alleviate swelling, no significant difference in efficacy. |
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