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Ask an expert - neuro and psycho logical - stroke

9 questions

Q:  My father suffered from brain stroke 5 yrs ago. He is getting physiotherapy but his left hand is still not working. Can he have acupuncture therapy for this? Does this procedure have any side effects?

A: We are sorry to hear of your father's continuing problems.

Let's deal with the easy answer first. There are very few side effects from acupuncture, and the vast majority are transient. We put together a safety website with the two leading medical acupuncture organisations (www.acupuncturesafety.org.uk)  which quotes a number of research studies. These show that acupuncture ranks as one of the safest therapies around. There are occasionally minor reactions to treatment, like headaches or tiredness, and very rarely an injury caused by the needles, but when you consider that there are over 4 million treatments being given each year the number of these is remarkably low.

The other side of your question is more difficult to answer. We have on the BAcC website a very thorough review paper

 http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

as well as a simpler factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/3894-stroke.html

which are both very encouraging about the use of acupuncture for the after effects of stroke. In China, however, it is common practice to start treatment on the day of the stroke itself and to treat daily or more to try to restore the 'lost' functions as quickly as possible. The received wisdom is that if the treatment is delayed it becomes progressively more difficult to achieve the same level of result and the final outcome may not be as good. This is paralleled by some treatments in the west, where drug intervention on the day may work when a gap means it won't. The fact that your father is now five years on from his stroke suggests that where he is now may not improve a great deal.

However, there's no point in being unduly pessimistic. All of us have taken on cases like this and managed to achieve a great deal more than we expected. The great strength of Chinese medicine is that it treats the individual, not the condition, and there is always a chance that if someone's baseline constitution is strong they may be able to achieve quite a great deal of improvement. Full restoration of function would be a stretch, but some gain may be possible.

The best advice, which we invariably give, is to visit a local BAcC member with your father to get a face to face assessment of what may be possible. Most of our colleagues are more than happy to give up a little time without charge to see whether acupuncture treatment may be of benefit.  

 

Q:  My sister aged 31 had brain haemorrhage and paralysis on 30th March, 2016 (9:00 AM). She was 7 weeks pregnant that time thru IVF. Due to large infarcts in right brain, doctors went for craniotomy same day at 11:30 PM and she had 28 stitches in head.

After staying 6 days unconscious, and 22 days in ICU, she was brought home after 1 month from hospital. Now at home, her baby is normally growing and double marker test is fine. She is taking all foods from mouth directly, no support and no tubes.

But, she has no movement in her left hand and leg. Physiotherapy is going on. She is speaking well, brain working fine, memory is sharp.

Could acupuncture can help with  her paralysis?

A: We are really sorry to hear of your sister's problems; that must have been a terrible shock to all of you. It's good that she has made the recovery she has so far, and that the baby is well.

The nearest equivalent research that we have which can offer some positive hope of a good outcome is research into the use of acupuncture treatment in the recovery from stroke. On our website there is a rather dense review paper

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which goes through in great detail the various papers which show encouraging possibilities for the use of acupuncture treatment. It used to be the case, and is still likely to be, that acupuncture treatment was commenced on the day of a stroke itself. The Chinese medicine understanding of what is happening in a stroke or CVA is given the generic term 'wind stroke' and is seen as a disruption of the flow of energy in the channels caused by an uncontrolled upsurge in the head. The treatment strategy is very straightforward; restore proper flow in the channels or meridians on the affected side as soon as possible. Treatment would often involve a course of daily or even twice daily sessions for several weeks to try to restore energy flow as quickly as possible before the post-stroke pattern is established as a norm.

This always raises questions in the West, where if someone is lucky acupuncture treatment might be possible four to six weeks after the CVA itself, of whether a late start hinders the chance of recovery. We would have to be honest and say that the later start would possibly slow down progress, but not stop it. The received wisdom is that within the first year there is always something that can be done, but this is not a precise judgement. This expert has seen good changes in someone two years down the line and treated others within the year to no effect. It really is a matter of the individual circumstances and the strength of someone's constitutional energy. At 31 your sister has a better chance than many.

The confounding factor is the pregnancy. Generally we all try to treat with as little intervention as possible during the pregnancy, and there is now a solid strand of postgraduate training in acupuncture for pregnancy, fertility and childbirth that we are on the verge of defining what would constitute expert practice and the ability to define oneself as a specialist. It would be ideal if any practitioner your sister saw had this training. However, the issue here is what may have caused the infarct. From a Chinese medicine perspective there are a number of possibilities, the treatment of which alongside the pregnancy and the post-stroke recovery might call for a level of expertise and experience which not all of our members might feel that they have. You may have to ask around a little to see who might be the best person to see. We tend to be a very honest bunch, and we direct people to those colleagues who we think will be best for the patient's needs.

We hope that your sister finds acupuncture treatment beneficial, if she decides to go ahead with it, and that the rest of her pregnancy is trouble-free and rewarded with a happy outcome.

Q: My father suffered cerebral haemorrhage and left side paralysis due high B.P.  Accordingly he was treated without operation. All is normal now except left side paralysis. Since last 4 days he is being treated with electro acupuncture. Will this help in his recovery and if so, then to what extent? 

 

A:  We are glad to hear that your father has made a good recovery apart from the left side paralysis.

There is no doubt that acupuncture can be used to help in stroke recovery. In a review paper which we have on our website which is probably far too complex for your immediate needs 

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

we take a good look at the evidence, and there is no doubt that research has shown that there is a benefit. Indeed, in China acupuncture is often used as a frontline treatment against the immediate effects of a stroke. It is not uncommon for someone to begin a course of treatment on the day of admission to hospital, the logic being that restoring the flow of energy as soon as possible can stop the body becoming 'set.'

If someone starts treatment a little later it appears to reduce the effectiveness a little, and our experience is that change may take longer to achieve. We have to remind people, though, that we treat people, not conditions, and our aim is to restore balance in all of the system. This might mean, for example, having an impact as well on the high BP, as well as helping the patient to feel more focused and positive about their recovery.

It is impossible to predict any outcome with accuracy, though. So much will depend on the amount of damage caused by the stroke and by the person's state of health before it happened. That there will be a benefit we have no doubt. Whether it is worth the investment in time and money is a judgement call, and we would expect a reputable practitioner to be as alert to this as a patient - none of us likes to treat someone when there is limited improvement, and we would often consider what might work better as an alternative.

We hope that you do see some positive changes soo 



Q:  Three years ago my wife suffered a severe cranial infarction which has left her totally incapacitated on her right side permanently bed ridden and doubly incontinent. She is well cared for in a nursing home and is fortunately left handed. There is no prospect of any sort of recovery, but she is troubled by very severe pains which she agrees are of a cramp like nature in her right lower arm and elbow area. These come and go and leave her in agony for hours each day and seriously depressed. Is there any possibility that acupuncture techniques might reduce or remove these sudden bouts of pain?re sorry to hear of your wife's continuing problems.

A:  We are always a little careful when we answer questions based on possibility. Everything is possible. Every treatment works for someone but this falls a long way short of some treatment working for everyone. We have produced a fairly hefty review paper


http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which details the many studies of post stroke/CVA treatment. In China acupuncture has a much more central place in the treatment of stroke/CVA, especially immediately after the event. Treatment often commences the day of the event itself, and the aim is to restore the proper flow of energy as soon as possible. It is also used quite frequently in this context as well, getting rid of a residual symptom which either does not leave after the stroke or emerges as a consequence of the change of use associated with the problem.

As you probably know from your researched so far traditional acupuncture is based on theories of energy, called qi, and its flow and balance in the body. Pain only arises where the flow is blocked or where it is seriously deficient or in excess, and the needles are used to restore balance. In order to get a really good idea of what may be possible for your wife's problem you will need someone to take a look and make a face to face assessment. At this remove all that we could say is that it is not untypical of the sorts of problems we have addressed, and sometimes very effectively, but we are reluctant to say 'go ahead' because there may be aspects of your wife's condition which a practitioner would see immediately were likely to cause difficulties beyond the scope of acupuncture.

Hopefully your wife's nursing home is near enough to a BAcC member that they could easily pop in and give you a better sense of what is possible. Home visits are not the most popular option for some members because many are reluctant to charge for the additional time it takes to arrive and set up, but there are still enough who do to encourage us that this is a reasonable possibility.


A: A great deal depends on the time that has lapsed since he has had the stroke.

We have produced a fairly hefty review paper on the use of acupuncture for the treatment of post-stroke problems

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which  is a bit of dense document, but basically concludes that there is growing evidence that acupuncture treatment speeds up recovery.

In China, acupuncture is amongst the first interventions after a stroke, and it is not uncommon for someone to have treatment within hours  of the episode. The underlying logic is that the stroke, often called a 'windstroke' in Chinese medicine, disrupts the flow of energy, called 'qi'. The sooner this can be restored to its normal flow, the better, and daily or even twice daily treatment is often used to try to restore function as quickly as possible.

This is not an unusual concept. There was some fascinating research some years ago suggesting that people with artificial limbs fared much better if they had them fitted within days of the amputation. Stumps healed quicker, and movement was better. It seems like the body has a kind of habit energy which if tapped into can recover quickly, whereas if someone develops a new 'habit' this can take a while to shift.

That is not to say that acupuncture treatment cannot have an impact when started a little later, simply that it can take a little longer to achieve the same results. We are always very cautious in offering a prognosis since we have found that the extent of the initial symptoms is not a reliable indicator or future progress, and mild strokes can sometimes cause permanent changes which defy the best efforts at treatment. However, each person is unique and different, and their underlying pre-stroke constitution will have an impact on recovery. This is why acupuncture treatment, which is aimed at treating the whole person and not simply the presenting problem, is such a valuable intervention. It may be able to improve basic functioning and hasten what recovery may be possible over and above getting better movement in a limb.

The advice we invariably give is to contact a BAcC member local to your father and arrange for a brief face to face assessment. This will give them a much clearer idea of what may be possible that we can do at a distance. 

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