Stroke Rehabilitation

2021 Evidence-Based Complementary and Alternative Medicine

Acupuncture combined with rehabilitation was more effective in improving the motor function and the ability of daily living.

The mechanism for the effects of acupuncture in the improvement of motor function and activity of daily life may be explained by two reasons. First, acupuncture can directly enhance the motor function and daily life of stroke patients. Acupuncture has been shown to lead to a higher improvement in motor function than conventional treatment. Acupuncture when combined with rehabilitation may have a positive effect on motor function, activity of daily life, neurological deficits, and spasticity. Indeed, the meta-analysis concluded that no matter what kind of acupuncture therapy was combined with rehabilitation, it was better than the rehabilitation group when it came to significantly improving the activity of daily life of patients after ischaemic stroke.

Second, acupuncture may indirectly improve the motor function and daily living ability of stroke patients by improving the symptoms of unilateral neglect and making them aware of their limbs. Acupuncture points may be the more intensive parts of the sensory organs that produce needle sensation. Acupuncture sensation is continuously transmitted to the central nervous system through the peripheral receptors of acupuncture point of contact, which facilitates new cognitive neural pathways for effective information, processing, and analysis, which may be one of the mechanisms for improving the perception of an injured hemisphere and alleviating the symptoms of unilateral neglect in patients.

Acupuncture plus Rehabilitation for Unilateral Neglect after Stroke: A Systematic Review and Meta-Analysis Hou, Y., Liu, Y., Li, M., Ning, B., Wen, Z., & Fu, W.

2020 Complementary Therapies in Clinical Practice

This review discovered that acupuncture might be a safe and effective adjuvant therapy for individuals with poststroke spastic hemiplegia.

Researchers retrieved 2452 articles in total, after screening, thirty-eight studies with 2628 participants of were included. In this meta-analysis, twenty-seven trials revealed that acupuncture therapy was associated with an increase in FMA scores compared with rehabilitation training (RT).

Acupuncture therapy for poststroke spastic hemiplegia: A systematic review and meta-analysis of randomized controlled trials Fan W, Kuang X, Hu J, Chen X, Yi W, Lu L, Xu N, Wang L.

2020 Integrative Medicine Research

The combination of acupuncture and speech rehabilitation training may improve total response rate of stroke patients with dysarthria.

Our study revealed that, compared with speech rehabilitation training alone, additional acupuncture has a beneficial effect on clinical response rate (when using FDA for evaluation), based on low-quality evidence. Furthermore, no serious adverse events were reported among the studies analyzed.

Acupuncture combined with speech rehabilitation training for post-stroke dysarthria: a systematic review and meta-analysis of randomized controlled trials Xie Q, Chen X, Xiao J, Liu S, Yang L, Chen J, Lai J, Lan R, Chen Y, Yang H, Guo X.

2019 Frontiers in Neurology

Acupuncture therapy seems effective for motor function, pain relief and activities of daily living in stroke patients with mild Shoulder-Hand Syndrome, when it is used in combination with rehabilitation.

This systematic review shows that adding acupuncture to routine rehabilitation can improve clinical outcomes (pain and motor function) for people with mild post-stroke SHS. However, the evidence was assessed as “low” by GRADE due to the methodological limitations and heterogeneity of included studies, which made our certainty in recommending acupuncture for this condition in clinical practice as “low.” Well-designed placebo-controlled RCTs with a long treatment duration and follow up, as well as standardized reporting, are needed to support acupuncture's safe and effective use in the management of post-stroke SHS.

Acupuncture for Post-stroke Shoulder-Hand Syndrome: A Systematic Review and Meta-Analysis Liu, S., Zhang, C. S., Cai, Y., Guo, X., Zhang, A. L., Xue, C. C., & Lu, C

2018 Acupuncture in Medicine

Acupuncture in combination with rehabilitation may have benefits for the treatment of acute and subacute stroke sequelae in comparison with rehabilitation alone.

A systematic review was carried out. A search was conducted in March 2014 using PubMed, Medline, the Cochrane Library, Chinese National Knowledge Infrastructure database (CNKI) and Wanfang databases. English and Chinese language articles published within 10 years of the search were reviewed for inclusion. Randomised control trials comparing combined treatment with acupuncture and rehabilitation and rehabilitation alone in patients with acute or subacute stroke (onset until 3 months after stroke) were included in this review. Three review authors independently checked the titles and abstracts of trials for inclusion based on selection criteria. Studies measuring changes of motor function, activities of daily living, neurological deficit or spasticity/range of motion during the treatment period and at the end of follow-up were included.

17 trials met the inclusion criteria, of which five were of good quality. 14 trials had results favourable to acupuncture combined with rehabilitation, compared with conventional rehabilitation treatment alone.

Effectiveness of Acupuncture Combined with Rehabilitation for Treatment of Acute Or Subacute Stroke: A Systematic Review Vados, L., Ferreira, A., Zhao, S., Vercelino, R., & Wang, S.

2018 Clinical Rehabilitation

Current evidence suggests that traditional manual acupuncture integrated with rehabilitation therapy is more effective in alleviating pain, improving limb movement and activities of daily living.

A total of 20 studies involving 1918 participants were included in this study. Compared to rehabilitation therapy alone, the combined therapy significantly reduced pain on the visual analogue scale and improved limb movement on the Fugl–Meyer Assessment scale and the performance of activities of daily living (ADL) on the Barthel Index scale or Modified Barthel Index scale. Of these, the visual analogue scale score changes were significantly higher favoring the combined therapy after treatment, with severe heterogeneity.

Traditional manual acupuncture combined with rehabilitation therapy for shoulder hand syndrome after stroke within the Chinese healthcare system: a systematic review and meta-analysis Peng, L., Zhang, C., Zhou, L., Zuo, H. X., He, X. K., & Niu, Y. M. (

2018 Chinese Journal of Integrative Medicine

Our meta-analysis provides a new evidence supporting the efficacy and safety of acupuncture in treatment to post-stroke dysphagia in short-term compared with rehabilitation or medication.

Twenty-nine RCTs comprising 2,190 patients were included. The included studies had a medium quality grade based on the Consolidated Standards of Reporting Trials (CONSORT) and Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA) checklist. Acupuncture therapy provided a higher effective rate compared with nonacupuncture treatments. Subgroup and meta-regression analyses suggested that acupuncture intensity and measurement method were main sources of heterogeneity and resulted in a significant difference for pooled effect size. No severe adverse events were documented in these RCTs.

Acupuncture Treatment for Post-Stroke Dysphagia: An Update Meta-Analysis of Randomized Controlled Trials Li, Lx., Deng, K. & Qu, Y.

2018 Frontiers in Neurology

Most studies reviewed concluded that conventional and electroacupuncture could be effective for management of shoulder pain after stroke.

This review suggests that conventional acupuncture and electroacupuncture could be effective treatments for survivors with poststroke shoulder pain, with regard to reducing pain and improving upper extremity function and physical function. However, the results of this review should be interpreted with consideration of its limitations.

Effects of Acupuncture on the Recovery Outcomes of Stroke Survivors with Shoulder Pain: A Systematic Review Chau, J., Lo, S., Yu, X., Choi, K. C., Lau, A., Wu, J., Lee, V., Cheung, W., Ching, J., & Thompson, D. R.

2017 Archives of Physical Medicine and Rehabilitation

Electroacupuncture combined with conventional routine care has the potential of reducing spasticity in the upper and lower limbs and improving overall and lower extremity motor function and activities of daily living for patients with spasticity, within 180 days poststroke.

EA combined with conventional routine care has the potential of reducing spasticity in the upper and lower limbs and improving overall and lower extremity motor function and activities of daily living for patients with spasticity, within 180 days poststroke. Further studies of high methodological and reporting quality are needed to confirm the effects and safety of EA, and to explore the adequate and optimal protocol of EA for poststroke spasticity, incorporating a group of comprehensive outcome measures in different populations.

Electroacupuncture for Poststroke Spasticity: A Systematic Review and Meta-Analysis Cai Y, Zhang CS, Liu S, Wen Z, Zhang AL, Guo X, Lu C, Xue CC

2016 BMC Complementary Medicine and Therapies

Our results suggest that acupuncture could be effective for treating insomnia after stroke.

A total of 165 studies were identified; 13 RCTs met our inclusion criteria. Meta-analysis showed that acupuncture appeared to be more effective than drugs for treatment of insomnia after stroke, as assessed by the PSQI and by the efficacy standards of Chinese medicine. Intradermal acupuncture had significant effects compared with sham acupuncture, as assessed by the ISI and the AIS.

Acupuncture for insomnia after stroke: a systematic review and meta-analysis. Lee, SH., Lim, S.M.

2016 Cochrane Database of Systematic Reviews

Acupuncture may have beneficial effects on improving dependency, global neurological deficiency, and some specific neurological impairments for people with stroke in the convalescent stage, with no obvious serious adverse events.

Although acupuncture may have positive effects in stroke rehabilitation and there were no reported serious adverse events, the small number of low quality studies and the probability of publication bias means that there was insufficient evidence to support the routine use of acupuncture for people with subacute or chronic stroke.

Acupuncture for stroke rehabilitation Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ.

2016 Scientific Reports

Acupuncture is a prospective therapy targeting neurogenesis for ischemic stroke.

Our findings indicate that acupuncture ameliorates neurological deficits and reduces brain edema in experimental ischemic stroke and the mechanisms positively correlate with endogenous neurogenesis, in which acupuncture therapy can promote the proliferation, migration and differentiation of NSCs.

Acupuncture for neurogenesis in experimental ischemic stroke: a systematic review and meta-analysis Lu, L., Zhang, Xg., Zhong, L. et al.

2014 PLOS One

Current evidence provisionally demonstrates that acupuncture treatment is superior to either non-acupuncture or conventional therapy for cerebral infarction.

The results of this systematic review shows that acupuncture therapy is significantly effective in improving the Clinical Efficacy Rate, Fugl-Meyer Assessment Scores, Barthel Index Scores and Neurological Deficit Scores in ischemic stroke patients when compared with the conventional medication. Further large-scale, well-designed RCTs on this topic are still warranted.

An Updated Meta-Analysis of the Efficacy and Safety of Acupuncture Treatment for Cerebral Infarction Li Li, Hong Zhang , Shu-qing Meng, Hai-zhou Qian

2014 Neuroepidemiology

Acupuncture may be effective for treating poststroke neurological impairment and dysfunction such as dysphagia.

The current evidence suggests that acupuncture is not effective for death or dependency/disability. However, acupuncture may be effective for treating poststroke neurological impairment and dysfunction, particularly poststroke dysphagia, although these findings require verification in rigorous RCTs. Future studies should place more emphasis on the efficacy of acupuncture for treating poststroke neurological impairment and dysfunction and on the development of more precise tools for assessing these outcomes.

Overview of Systematic Reviews and Meta-Analyses of Acupuncture for Stroke Zhang J. Wang D. Liu M.

2014 The Journal of Alternative and Complementary Medicine

This meta-analysis suggests that acupuncture had positive effects on cognitive function after stroke.

Twenty-one trials with a total of 1421 patients met inclusion criteria. Pooled random-effects estimates of the change in the Mini-Mental State Examination were calculated for the comparison of acupuncture with no acupuncture in addition to medicine or rehabilitation. Following 4 weeks and 8 weeks of intervention with acupuncture, the merged mean difference was 3.14 (95% confidence interval [CI], 2.06–4.21; p<.00001) and 2.03 (95% CI, 0.26–3.80; p=0.02), respectively. For the comparison of 3–4 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the merged MD in Neurobehavioral Cognitive State Examination total scores was 5.63 (95% CI, 3.95–7.31; p<.00001). For the comparison of 8–12 weeks of acupuncture with no acupuncture in addition to medicine or rehabilitation groups, the P300 latency merged MD was −12.80 (95% CI, −21.08 to −4.51; p<.00001), while the P300 amplitude merged MD was 1.38 (95% CI, 0.93–1.82; p<.00001). Overall, the study quality was rated as moderate on the basis of the Cochrane Handbook for Systematic Reviews of Interventions (part 2: 8.5).

A Meta-Analysis of Acupuncture Use in the Treatment of Cognitive Impairment After Stroke Fang Liu, Zhuang-Miao Li, Yi-Jing Jiang, and Li-Dian Chen.

2012 The Journal of Alternative and Complementary Medicine

Acupuncture combined with exercise is effective for shoulder pain after stroke.

It was found in this review of reported RCTs that acupuncture is an effective treatment for shoulder pain after stroke. Acupuncture can be considered as an adjuvant therapy in combination with exercise for rehabilitation of the stroke patients who are suffering from shoulder pain. Further trials concerning this topic should be conducted according to the highest methodological standards for certainty.

Acupuncture for Shoulder Pain After Stroke: A Systematic Review Jung Ah Lee, Si-Woon Park, Pil Woo Hwang, Sung Min Lim, Sejeong Kook, Kyung In Choi, and Kyoung Sook Kang.

2010 Stroke

Randomized clinical trials demonstrate that acupuncture may be effective in the treatment of poststroke rehabilitation.

Randomized clinical trials demonstrate that acupuncture may be effective in the treatment of poststroke rehabilitation. Poor study quality and the possibility of publication bias hinder the strength of this recommendation and argue for a large, transparent, well-conducted randomized clinical trial to support this claim and implement changes to clinical practice.

Acupuncture in Poststroke Rehabilitation Ping Wu , Edward Mills , David Moher , and Dugald Seely