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Ask an expert - neuro and psycho logical - stroke

6 questions

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

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

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. 

Q:  My husband has had a stroke and he also has weakness on the left side.  He also had a heart attack this May and had a pacemaker fitted. He has difficulty walking.  Can acupuncture help him. If so how many treatments would he need to see any improvement.

A:  We are very sorry to hear about your husband's problems.  Either problem would be bad enough in itself but the two together are a major  burden.  With such a complex background it is very difficult to say sight unseen whether acupuncture would be of great benefit to your husband. Certainly there is some hope if the difficulty in walking arises from the stroke. In China it is not uncommon for people who have had a stroke to be given acupuncture daily or twice daily as soon as they are admitted to
hospital, the idea being that the energies of the body have been disrupted, and the quicker the flow is reinstated the better. In this country this is not yet a popular option, so we tend to see people a little later down the line, often after conventional treatment has reached a point where there has been no further progress. In the circumstances progress tends to be a little slower, but over time there can be some very positive changes. This is very difficult to show by research, because there is often a process of natural recovery alongside the acupuncture treatment, and deciding what has been the cause of improvement can be difficult.

The confounding factor is the heart attack. This can also be a major contributory factor to difficulties in walking, and without being able to assess the impact of the two events on the energy of the body by direct observation it is really hard to be able to offer good advice. We often advise people to see a BAcC member local to them for a chat about whether acupuncture treatment would be a good option, and in most cases they are happy to do this without charge in order to give a balanced view of whether treatment would be worthwhile.

The imponderable would be how many sessions it might take to see improvement. This is really impossible to say. We have all had the experience of fit young people taking months to get better, and seemingly impossible cases changing overnight, so we are never happy to venture guesses. What we do say, though, is that a practitioner should review progress after the first four or five sessions, and then maintain a constant review if it seems worth continuing. We always advise members to establish with a patient a good set of measurable outcomes - distances walked, times on fee, etc - to provide some objective as possible measure of progress. Otherwise a lot will come down
to how someone feels on the day, which is never a reliable option.


Q:  5 years ago a colleague suffered brain damage after a serious car smash. He was in a coma for three days and has been left with stroke like disability in his left arm and leg. He has feeling down to his wrist but little in his hand. would accupuncture help in any way to restore nerve function?


possible after the stroke in ten day courses to try to restore the function in the affected limbs. The research is not conclusive, and we cannot give an unequivocal recommendation, but as our fact sheet on stroke shows

please click here
 and a much more detailed review paper please click here
 there is a growing body of evidence suggesting that acupuncture treatment may be of benefit.
This is not quite the same as restoring nerve function, and we would not make any claims of this kind. From a western medical point of view, when most nerve function has been lost or compromised there are serious difficulties in recovering what has been lost. Chinese medicine is based on a theory that the body mind and emotions are all manifestations of the flow of energy, called 'qi', in the body. When this flow is blocked or impaired, as is the case with a stroke, then the aim is to restore the flow and try to recover the functions which have been lost.
However, your friend hasn't had a stroke but instead a serious car smash, and to some extent it would be unfair to use information based on a naturally occurring phenomenon as a basis for comment on what may or may not be possible in his case. If there has been substantial damage to the tissue of the brain, then there may not be any possibility of recovery, and it would be wrong of us to create hope or expectation. However, you could do a lot worse than see if a BAcC member local to you can give him a short face to face assessment of what acupuncture may be able to achieve, based on what the practitioner can actually observe. We are sure that he will get an honest and realistic view.
It may also be worth mentioning cranial osteopathy as a modality which may have something to offer. This is based on a number of theories in which the structural integrity of the skill is crucial, and while it more often addresses subtle changes which can have a profound effect on function, there is no reason in principle why it should have an effect here. It is highly likely that your local BAcC member may be able to give you a good referral; many work closely with other local practitioners and have a network of trusted colleagues with whom they cross-refer patients. 

A: We have published a rather dense review paper on our website please click here  
which is perhaps aimed more at the medical reader than the public, but the bottom line is that there is an increasing amount of eviden which suggests that acupuncture may be of considerable benefit for treating people who have suffered strokes. However, since much of the research takes place in China and is not always as methodologically rigorous as in the West, it is not yet considered good enough to make a firm recommendation. This is not because the research is sloppy, by the way. The main problem is that acupuncture is already believed to work by the Chinese, so research is often focused on what works better or best. In the West people still aren't wholly convinced that it works, so take issue with studies which don't make this the priority.
In China acupuncture is often used to treat stroke victims, often within hours of the stroke and as much as possible within the first few weeks. The underlying belief is that the stroke has severely disrupted the flow of energy, called 'qi', in the channels of flow, and it is this disruption which causes the temporary paralysis and spasms associated with strokes. The acupuncture is used to reinstate the proper flow, and that's why it is administered so quickly. The longer it is left untreated, the more the untoward patterns become locked in and harder to shift. In the West, where people often come to acupuncture as a last resort after six months of other treatments, this can reduce the effectiveness of treatment a little.
Everyone is different, though, and it is this factor which is central to diagnosis and treatment planning in Chinese medicine which makes it difficult to generalise about all cases. The best advice always is to discuss the unique presentation with a BAcC local to you and see what they say. Most of our members are more than happy to give up some time to assess with a potential patient face to face whether treatment may be of benefit, and we trust that they are honest enough to tell you if they think it isn't.        



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