Objective

2

To observe the efficacy of electroacupuncture (EA) combined with suspension exercise therapy in elderly patients with post-stroke spastic hemiplegia and its effect on lower limb motor function.

Methods

2

A total of 120 elderly patients with post-stroke spastic hemiplegia were enrolled. Using a 2×2 factorial design

all the patients were assigned to a group A (conventional treatment)

a group B (conventional treatment combined with suspension exercise therapy)

a group C (conventional treatment combined with EA at Jiaji [EX-B2

]

and limb acupoints)

and a group D(conventional treatment combined with suspension exercise therapy and EA at Jiaji [EX-B2

]

and limb acupoints)

with 30 patients in each group. The main acupoints were bilateral Jiaji (EX-B2) points at the C

2

-C

7

T

2

-T

12

L

1

-L

5

and S

1

segments. The adjunct acupoints included Jianyu (LI15)

Binao (LI14)

Huantiao (GB30)

Chengfu (BL36)

etc. on the affected side.Continuous wave was applied at a frequency of 100 Hz with a current intensity of 1.5-3.0 mA

and needles were retained for 30 min

once daily for 4 weeks. Before treatment and after 2 and 4 weeks of treatment

the modified Ashworth scale (MAS)

Fugl-Meyer assessment (FMA)

Berg balance scale (BBS)

and Barthel index scores were evaluated in the four groups. Root mean square (RMS) values of surface electromyography (sEMG) of the erector spinae and rectus abdominis muscles on the affected side

as well as balance function indexes

including the mean pressure symmetry index (SI)

contact area SI

ellipse area

and displacement distances of the center of pressure in the anteroposterior (AP) and mediolateral (ML) directions

were measured. Clinical efficacy was also compared among the four groups.

Results

2

After 2 and 4 weeks of treatment

MAS scores in all groups were lower than those before treatment (

P

<

0.05)

whereas FMA

BBS

and Barthel index scores were higher than those before treatmen

t (

P

<

0.05). After 4 weeks of treatment

MAS scores were lower than those after 2 weeks of treatment (

P

<

0.05)

whereas FMA

BBS

and Barthel index scores were higher than those after 2 weeks of treatment (

P

<

0.05) in the four groups. At both 2 and 4 weeks after treatment

group D had lower MAS scores (

P

<

0.05) and higher FMA

BBS

and Barthel index scores (

P

<

0.05) than the other three groups. After 2 and 4 weeks of treatment

RMS values of sEMG of the erector spinae and rectus abdominis muscles on the affected side at all tested angles were higher than those before treatment in all groups (

P

<

0.05)

and the values after 4 weeks of treatment were higher than those after 2 weeks of treatment(

P

<

0.05). At both 2 and 4 weeks after treatment

all these indexes in the group D were higher than those in the other three groups (

P

<

0.05). After 2 and 4 weeks of treatment

the mean pressure SI

contact area SI and ellipse area of each group were lower than those before treatment (

P

<

0.05). After 4 weeks of treatment

the mean pressure SI

contact area SI and ellipse area of each group were lower than those after 2 weeks of treatment (

P

<

0.05). After 2 and 4 weeks of treatment

the AP displacement distances of groups A

C and D were lower than those before treatment (

P

<

0.05)

and after 4 weeks of treatment

the AP displacement distances of groups A

C and D were lower than those after 2 weeks of treatment (

P

<

0.05);after 2 weeks of treatment

there was no statistically significant difference in AP displacement distance in the group B compared with before treatment (

P

>

0.05)

and after 4 weeks of treatment

the AP displacement distance of group B was lower than that before treatment (

P

<

0.05). After 2 weeks of treatment

there was no statistically significant dif

ference in ML displacement distance in group A compared with before treatment (

P

>

0.05); after 4 weeks of treatment

the ML displacement distance of group A was lower than that before treatment (

P

<

0.05). After 2 and 4 weeks of treatment

there was no statistically significant difference in ML displacement distance in the group B compared with that before treatment (

P

>

0.05).After 2 and 4 weeks of treatment

the ML displacement distances of groups C and D were lower than those before treatment(

P

<

0.05)

and after 4 weeks of treatment

the ML displacement distances of groups C and D were lower than those after 2 weeks of treatment (

P

<

0.05). At both 2 and 4 weeks after treatment

mean pressure SI

contact area SI

ellipse area

and AP and ML displacement distances in the group D were lower than those in the other three groups (

P

<

0.05). Factorial analysis of variance showed that EA had the strongest main effect on FMA score (

F

=6.243

P

<

0.05)

suspension exercise therapy had the strongest main effect on BBS score (

F

=6.292

P

<

0.05)

and the interaction effect was most significant for MAS score (

F

=5.941

P

<

0.05)

indicating that the combined therapy produced a greater synergistic effect on reducing muscle tone than on the other outcome measures. The total effective rate in the group D was 93.3% (28/30)

which was higher than those in the group A (53.3% [16/30

]

)

group B (56.7% [17/30

]

)

and group C (66.7% [20/30

]

P

<

0.05).

Conclusion

2

EA combined with suspension exercise therapy could effectively promote the recovery of lower limb function in elderly patients with post-stroke spastic hemiplegia

improve motor and balance functions

and enhance activities of daily living.