【鍼灸論文】Needle Acupuncture in Chronic Poststroke Leg Spasticity
鍼灸英論文
Needle Acupuncture in Chronic Poststroke Leg Spasticity
ABSTRCT
Objective
To determine whether needle acupuncture may be useful in the reduction of leg spasticity in a chronic state.
Design
Single-blind, randomized, placebo-controlled trial.Setting: Neurologic outpatient department of a medical school in Germany.
Participants
Twenty-five patients (14 women) suffering from chronic poststroke leg spasticity with pes equinovarusdeformity (Modified Ashworth Scale [MAS] score, 1), aged 38 to 77 years (mean standard deviation, 58.510.4y), were enrolled in the study. The mean time from stroke to inclusion in the study was approximately 5 years (mean, 65.448.3mo;
range, 7–180mo).
Interventions
Participants were randomly assigned to placebo treatment (n12) by using a specially designed placebo needling procedure, or verum treatment (n13).
Main Outcome Measures
MAS score of the affected ankle,pain (visual analog scale), and walking speed.
Results
There was no demonstrated beneficial clinical effects from verum acupuncture. After 4 weeks of treatment,mean MAS score was 3.30.9 in the placebo group versus 3.31.1 in the verum group. The neurophysiologic measure of H-reflex indicated a significant increase of spinal motoneuron excitability after verum acupuncture(H-response/M-response atio: placebo, .39.19; verum, .68.41; P.05).
Conclusions
This effect might be explained by afferent input of A delta and C fibers to the spinal motoneuron. The results from our study indicate that needle acupuncture may not
be helpful to patients with chronic poststroke spasticity. However, there was neurophysiologic evidence for specific acupuncture effects on a spinal (segmental) level involving nociceptive reflex mechanisms.
脳卒中ガイドライン2015の内容に記載されている鍼灸の治療効果に関する論文です。
結論では、痙縮に対して、MAS scoreとH反射の結果から痙縮には効果がなかったと結論づけられています。
しかし、内容を進めていくと興味深い内容が多々存在しました。
患者は週2回の治療で合計８回
the patients underwent 2 treatments aweek for a total of 8 treatments.
評価は4回実施
The patients were carefully examined at baseline (assessment 0);
reexamined immediately after the first acupuncture treatment (assessment 1)
again immediately after the last treatment (4wk after first acupuncture; assessment 2)
some of the efficacy variables were recorded about 3 months after completion of the study (assessment 3)
使用した鍼はセイリンBタイプ
Seirin B-type needle no. 8 [0.30.3mm] and no. 3 [0.20.15mm])
施術は最大15本、30分の置鍼
The needles (maximum of 15 needles per patient and treatment) were left in place for
30 minutes
Result
4週後の治療で有意差あり
Assessment 2 was .39.19 for placebo subjects versus .68.41 for verum subjects (z2.11, P.05).
Discussion
脊髄α運動ニューロンの興奮の興奮性を反映しており、鍼治療が下位運動ニューロンを促通したことを示してる。
This ratio reflects spinal alpha motoneuron excitability and indicates that verum acupuncture induced a facilitation of the lower motoneuron
【私見】
臨床上、痙縮筋は筋の短縮そして弱化の要素も含んでいるため評価が必要であると感じています。今回の論文では上肢の経穴を含めた置鍼での介入ですが、下位運動ニューロンに作用し促通を行えるという点では 有益な情報であると感じました。
