| ObjectiveTo observe the clinical effect of meridian massage therapy on the spastic hemiplegia after stroke. By comparing the effect of traditional acupuncture, rehabilitation training, meridian massage therapy on the spastic hemiplegia after stroke, comparing the change of Modified Ashworth Scale(MAS), Clinical Spasticity Index (CSI) and Activities of Daily Living (ADL),to analysis the advantages and disadvantages of three kinds of treatment methods. To explore the mechanism and clinical efficacy of different therapeutic methods, inquiry of massage therapy in the treatment of post-stroke spasm of the operation of the program, so as to provide clinical evidences for the further study and popularization of massage therapy.Methods1. case selection:90 patients were divided into, acupuncture treatment group, rehabilitation group and meridian massage group,30 cases in each.90 patients were in line with Western diagnostic criteria of stroke, duration of in 2 weeks and 6 months; 40 to 80 years of age, sex is not limited, the number of strokes is less than or equal to 2 times. The patients had limb hemiplegia, increased muscle tone, and Modified Ashworth scale in the 1-3 class.2. basic treatment:Three groups of patients were all receiving basic medical treatment.3. treatment method:(1) acupuncture treatmentAcupuncture treatment according to Xuemin Shi editor for<Acupuncture and moxibustion science), Scalp needle positioning reference< scalp acupuncture point standardization international program> Scalp needle:The temporal slash, the top side and 1 line,2 line near the top, body acupuncture acupoint: Affected side Shuigou Neiguan Sanyinjiao Jiquan Chize Weizhong, Combined with dialectical points and with the disease with points.Scalp acupuncture stabed slowly advance the needle of 0.8 to 1 inch line quickly, twist turn technique 2 to 3 minutes, Neiguan with reducing method of lifting and thrusting, Jiquan stab 1 to 1.5 inch into the needle, lifting and thrusting, Weizhong stab 0.5 to 1 inch into the needle, lifting and thrusting, Sanyinjiao used interpolation method provided, Chize stab into 1 inch, lifting and thrusting. The needle for 30 minutes, needle for the first 10 minutes,20 minutes each twisting switch pin a, the total needle for 30 minutes.Acupuncture treatment for 30 minutes, for tenth minutes, Twentieth minutes each time is a twist manipulating needle, Twist the needles every 10 minutes, Twist two times, the needle for 30 minutes.(2) Rehabilitation therapyRehabilitation treatment with physical therapy (PT), combined with occupational therapy (OT). Physical therapy includes: In the supine and sitting right limb placement, the body was placed in the anti spastic position, the passive movement of the affected limb joints, turning over exercise, sitting on the bed, The bed sitting balance training, sitting and standing training, Standing balance training, gait training. Occupational therapy includes:Patients were instructed to eat, Grooming, dressing, bed chair conversion activities of daily living, as well as carpentry textile hand simulation operation and ring puzzles, such as entertainment and sports training.(3) Meridian massageHead and face massage includes pressing the acupuncture points, pressing the five channels and collaterals on the head, massage the temporal, use the thenar to knead the face. Arm massage includes Rolling method on medial arm, with shoulder, elbow passive activities, The outer arm with the friction, so that the skin temperature of warm feeling, Holding and rubbing method on the inside and outside of the arm. The legs massage includes:roll ing method on lateral leg, medial leg with the friction, so that the skin temperature of warm feeling, holding and rubbing method on the inside and outside of the legs, kneading manipulation should be gentle and slow, from light to heavy, massage for 3 minutes. Back operation:with the palm of the hand to massage the back of the bladder 2 minutes, focus on Ganshu and Shenshu 1 minute; then plucked method acting on vertical spinal muscle 2 minutes, on the hemiplegic side mainly.4. course of treatmentEach treatment was 30 minutes,1 times a day treatment, Weekend break, after 2 days to continue the next week of treatment, a total of 4 weeks of treatment,28 days of treatment.5. curative effect observationAll enrolled patients fill out " Clinical observation table of Spastic paralysis after stroke", Modified Ashworth Scale, Clinical Spasticity Index scale, and Activities of Daily Living (ADL) were measured before and after treatment. The Modified Ashworth table was used to evaluate the grade of the spasm as the standard of curative effect evaluation.Results1. Modified Ashworth Scale(MAS)There was no significant difference in the three groups before treatment, MAS rating was comparable, (P>0.05). After treatment, the three groups were statistically significant differences between the MAS rating and before treatment, After treatment, the MAS scores of the three groups were better than before, Before and after treatment, the differences were statistically significant. After treatment, the difference between the three groups was statistically significant (P<0.05). After two two comparison between the three groups, there were significant differences between the acupuncture group and the rehabilitation group(P<0.05), there were significant differences between the acupuncture group and the moxibustion group(P<0.05), there were significant differences between the rehabilitation group and the massage group (P<0.05), Indicating that after treatment, the degree of spasm in the massage group was lighter than that in the rehabilitation group, the degree of spasm in the rehabilitation group was lighter than that in the acupuncture group.According to MAS to evaluate the efficacy of the three groups of treatment. After treatment,1 cases markedly effective in acupuncture group, effective in 4 cases,16 cases were improved,9 cases ineffective, the effective rate was 70.00%; in the rehabilitation group,2 cases markedly effective, effective in 3 cases,15 cases were improved,10 cases ineffective, the effective rate was 66.67%; in the massage group,5 cases markedly effective, effective in 11 cases,10 cases were improved and 4 cases were ineffective, the effective rate was 86.67%.Results suggest that massage treatment, the total efficiency of massage treatment was higher than that of acupuncture group and massage group, the effective rate of rehabilitation group was slightly larger than the acupuncture group, the efficacy of the three groups between groups is statistically significant, the group between pairwise comparisons, there was no significant difference between acupuncture group and rehabilitation group(P>0.05), there was no significant difference between massage group and rehabilitation group (P<0.001), there was significant difference between acupuncture group and massage group (P<0.05).The results showed that after treatment of three different treatment methods, patients with spastic state were improved to varying degrees, the acupuncture group and rehabilitation group were equivalent, the effect of massage group was better than that of acupuncture group and rehabilitation group.Before the treatment, acupuncture group CSI score was 12.97±2.01, the rehabilitation group CSI score was 2.77±1.91, massage group CSI score was 13.03±1.69. There was no significant difference in CSI scores between the three groups before treatment. After treatment, the three groups of patients with CSI scores were decreased, the CSI score of the acupuncture group was 11.20=1=1.90, the rehabilitation group was 11.07±1.78, the massage group was 10.17±1.53, there were statistically significant differences in scores before and after treatment(P<0.05).The three groups after treatment were compared between groups by analysis of variance(P<0.05), the difference was statistically significant. There were significant difference in CSI scores after treatment among the three groups. The difference was not statistically significant compared with acupuncture group and rehabilitation group(P>0.05), acupuncture group and massage group after treatment score difference was statistically significant (P<0.05), massage group and rehabilitation treatment group score difference was statistically significant (P<0.05), suggesting that the acupuncture and rehabilitation group in the clinical effect of improving the spasticity,the massage treatment group is better than the other two groups.2. Clinie Spastieity Index(CSI)Based on CSI score to grade the degree of spastic before and after the treatment, three groups of patients before treatment CSI severity of comparability, the spasticity difference of the three groups after treatment has statistical significance (P<0.05).The difference between acupuncture and rehabilitation group was not statistically significant, the spastic degree of the massage group and acupuncture group have statistical significance, the spastic degree of the massage group and rehabilitation group have statistical significance. It suggested that acupuncture group and rehabilitation group had a significant effect on the improvement of limb spasm. Compared with other two groups, the therapeutic effect of massage group was better.3. Activitise of Daily Living(ADL, Barthel index)Barthel index was evaluated in the daily life of the 10 basic items of the degree of independence, the scale of the total score fluctuations in the 0～100 score, the higher the score, the daily living ability of the poor. Before treatment, the total score of the acupuncture group was 49.67±5.86, the rehabilitation group was 49.50±6.07, the massage group was 48.83±5.83, the ADL score difference of the three groups was not statistically significant, After treatment, the acupuncture group ADL scores was 61.83±5.17, rehabilitation group was 67.33±4.87 and massage group was 66.67±4.87, after treatment, three kinds of treatment can improve the patient’s ADL. three groups in the clinical effect of improving the ability in patients with activities of daily living differences.After treatment, the difference beteewn Massage group and rehabilitation group score was not statistically significant(P>0.05). massage group and acupuncture group, was statistically significant(P<0.001), score(P<0.001). The difference beteewn acupuncture group and rehabilitation group is statistically significant.Results suggested that massage group and rehabilitation group had a considerable effect in improving the ability of life of patients. Massage group and rehabilitation group curative effect were better than the acupuncture group. Tips activities of daily living in patients with energy, massage group and rehabilitation group has more advantages on improving the ADL.GonclusionIn the treatment of limb spasm after stroke, traditional acupuncture treatment and rehabilitation training is not much difference, meridian massage therapy is better than acupuncture and rehabilitation therapy effect. In improving the ability of activities of daily living, meridian massage and rehabilitation treatment is better than the traditional acupuncture therapy. |
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