| Poststroke aphasia is the secondary to acute cerebrovascular disease. Aphasia refers to the loss and damage of speech induced by the injury of brain and is the disturbance of the use and perception of language symbol communication. Human language is the complex psychological reaction being different from other animals. With the ever-increased incidence of cerebrovascular disease, aphasia becomes a major symptom of stroke, bringing the patients both great physical and psychological harms, resulting in a serious impact on the quality of life for stroke patients. Therefore, it is crucial to enhance the study on poststroke aphasia.With modern linguistics,psychology,neural function impairment evaluation and functional magnetic resonance image technology developing, there are all kinds of chances to appraise the clinic effect and explore mechanism of producing and recovery of aphasia.As for the condition of poststroke aphasia ,the research was carried on the clinic randomized control study and fMRI of electri-acupuncture language pair-acupoints.1 Clinical StudyAim: To compare the therapeutic effects between the acupuncture based on the symptomatic differentiation associated with the language rehabilitation training and the simple language rehabilitation training; to observe the symptomatic distribution and syndrome development of the cases on three time-spots, named the day of being included, 1 month after treatment and 3-month after treatment; and analyze the differences in the locations of brain lesions between motor aphasia after stroke and classical motor aphasia. To discuss the properties of disorder by observing the characteristics of dysphasia and imaging data for 10 cases of aphasia with injury of the left basal ganglia area. Methods: According to diagnostic and entry standard,49 cases were included and randomized into experimental group and control group, of which, 27 cases were in experimental group and 22 cases in control group. In experimental group, acupuncture based on the differentiation of symptoms was applied in combination with language rehabilitation training and only simple language rehabilitation training was used in control group. The course of treatment was 3 months. The clinical investigations were conduced on 3 time-spots, named the day being included (Time No.1), 1 month after treatment (Time No.2) and 3-month after treatment (Time No.3) successively. The items of evaluation in one month of Time No.1: general data investigation, standard Chinese examination of aphasia, investigation of four diagnostic methods, judgment of syndromes, NIHSS Scale, BDAE severity grading, MMSE, BI index and CT/MRI reports. The items of evaluation of Time No.2: standard Chinese examination of aphasia, investigation of four diagnostic methods and judgment of syndromes. The items of evaluation of Time No.3: standard Chinese examination of aphasia, investigation of four diagnostic methods, NIHSS Scale, BI index and judgment of syndromes. The investigated data were analyzed in statistics with SPSS13.0 software with descriptive analysis, X2 test, T test and multiple variance analysis. On the 12th week after the onset, 10 cases were evaluated with Standard Aphasia Examination Scale of Chinese Rehabilitation Research Center and the imaging data were stored. Results: 1. The results of listening understanding, speaking, reading, hearing and writing and description in experimental group were superior to those in control group, P<0.05; of which, the results of speaking and description in experimental group were remarkably superior to those in control group, indicating significant difference, P>0.05. 2. For the group comparison on the data of BDAE severity grading among Time No.1, No.2 and No.3, it showed that the difference was not significant between experimental group and control group after 1 month with acupuncture treatment, P>0.05; the therapeutic effects of experimental group were superior to those of control group after 3-month treatment, P<0.05. 3. For the group comparison on NIHSS and BI index between Time No.1 and Time No.3, P>0.05, there was no significant difference between experimental and control groups, without statistical significance.4.Exploring age,sex,disease character and culture degree impact on curative effect of 1 month treatment,it showed that above factors have no affect on curative effect (P>0.05),the same as 3 months treatment. 5 For the syndrome distribution on 3 time-spots, it showed that the cases were primarily qi deficiency on Time No.1 and yin deficiency secondarily; on Time No.2, qi deficiency was released remarkably and turbid phlegm was predominated, while qi deficiency became the secondary; on Time No.3, qi deficiency turned to be the primary once again, while turbid phlegm was the secondary. 6. The symptomatic distribution on 3 time-spots: On Time No.1, incoherence of speech, poor memory and red tongue were the primary, while dull expression, hemiplegia and numbness were the secondary. After 1 month treatment, hemiplegia and numbness turned to be the primary, while poor memory and red tongue were the secondary. After 3 month treatment, lassitude was the top symptom and poor memory was the secondary. In the whole process of clinical observation, poor memory appeared the highest incidence, and hemiplegia, numbness and slightly purplish tongue were presented all the way round. 7. It was shown in the results of MRI data for the 23 cases in preserved Dongzhimen hospital that the brain lesions were distributed in cortex and the extensive structure of subcortex in the cases of motor aphasia after stroke. The highest incidence appeared in the left basal ganglia and the secondary highest incidence was presented in temporal cortex, and then in frontal and parietal cortexes. Besides, the injury was also seen in the right basal ganglia area. 8 .There are partially common views between 10 cases of aphasia with the left basal ganglia injury and dysphasia with traditional basal ganglia aphasia. But, because of individual differences, the specific language injury characteristics appear.Conclusion: 1. Acupuncture in combination with language rehabilitation training is effective on listening and understanding, reading, hearing and writing, speaking and description and the remarkable improvement is especially achieved on speaking and description. It is determined that the therapeutic effect is definite in the treatment of acupuncture in combination with language rehabilitation training. 2. The symptom distribution and syndrome development have a good coincidence. As the symptom distribution on 3 time-spots concerned, the cases develop from the deficiency of qi and yin to turbid phlegm, in the tendency of heat transformation, and terminally the cases appear turbid phlegm in combination with qi deficiency. Additionally, blood stasis runs through the whole evolution of disease. 3. The diagnosis of aphasia type is mainly based on the symptomatic patterns of aphasia, rather than based on the simple lesion location. The analysis has been conducted on the aphasia symptomatology and the properties of imaging data in the aspects of linguistics, psychology and anatomy for guiding the language rehabilitation.4.Language producing have complicated psychology background ,language symptom have intensive individuality. Base on independency of language module and complexity of function of basal ganglia area , so symptom of aphasia have complicated traits .2 Laboratory ResearchAim: To observe the therapeutic effects of point combination on linguistics by the evaluation in linguistics before and after needling Tongli (通里HT 5) and Xuanzhong (悬钟GB 39). To explore the improvement and recovery mechanism of language on these points by observing fMRI alternations on Tongli (HT 5) and Xuanzhong (GB 39) with electric acupuncture. Methods: 1. One volunteer case of subcortical aphasia and cortical aphasia was treated with needling on Tongli (HT 5) and Xuanzhong (GB 39) for 1 month. The evaluation in linguistics was conduced before after the treatment with Standard Chinese Aphasia Examination Scale. 2. The cases with subcortical aphasia were treated with electric acupuncture on Tongli (HT 5) bilaterally. The cases of aphasia with cortical injury and 9 health volunteers were treated with electric acupuncture of Tongli (HT 5) and Xuanzhong (GB 39) on the left side and sham-acupuncture on the left side. In the trial, block design was applied with alternative resting phase and stimulating phase. BOLD technology and SPM2 software analyzing method were used in fMRI to show the activation of cerebral cortical functional area. Results: In the three types of experiments with left-side electric acupuncture, the commonly activated objects in brain area were bilateral superior temporal gyrus, temporal transversal gyrus, insular lobe and precentral gyrus; and the temporal lobe was activated in both the cases of aphasia with cortical injury and health group with left-side acupuncture together with left-side sham acupuncture. For the health volunteers, after electric acupuncture, the cluster numbers in the activated brain functional area were higher than those in the cases of aphasia. In general, for the three objects, after electric acupuncture on the target points of the left side, the bilateral temporal lobes were both activated and the activation on the left side was superior to the right side. Conclusion: Acupuncture achieves the active role in the recovery of dysphasia on Tongli (HT 5) and Xuanzhong (GB 39). Language function is controlled by nerval net in the brain,and distributed in brain, but its functional orientation is relative.3 Innovation pointIntegrating traditional acupuncture therapy with modern language rehabilitation therapy in the aspect of therapy ; modern evaluation method appraise effect of acupuncture and language rehabilitation therapy ;selecting Tongli,Xuanzhong acupoint and Yangci manipulation for the first time in the aspect of acupoints combination and acupuncture manipulation; integrate group research with case analyse in aspect of the design of clinical research from the multi-point of view; self-control in single-subject and contrast aphasia patient with health people in the aspect of functional magnetic resonance experiment design;contrast left acupoint with right acupoint in a group, and contrast left acupoint with left sham puncture.In the future, the research of mechanism on the occurrence and recovery of aphasia, and the evaluation of the therapeutic effect of acupuncture, language task should be combined with imaging study on brain function with acupuncture on acupoints, and the linguistics evaluation table and fMRI are adopted as the approaches in the assessment to evaluate poststroke aphasia in multiple time-spots and dynamically. |
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