A Clinical Study Of Acupuncture Combined With Rehabilitation Training In The Treatment Of Shoulder-hand Syndrome After Stroke

Objective To observe the effects of acupuncture combined with rehabilitation training on neurological function, upper limb motor function, pain degree, comprehensive function in the patients with shoulder-hand syndrome(SHS) after stroke. To study the therapeutic effects of acupuncture combined with rehabilitation training on SHS after stroke and to supply the evidence of its clinical application.Methods All the cases were the inpatients of The First Affiliated Hospital of Guangzhou University of Chinese Medicine.90 cases of shoulder-hand syndrome after stroke enrolled according to inclusion criteria were randomized into three groups:the acupuncture group(group A), the rehabilitation training group (group B) and the acupuncture combined with rehabilitation training group (group C),30 cases in each group. Patients in the acupuncture group (group A) were treated only with acupuncture, patients in the rehabilitation training group (group B) were treated only with rehabilitation training, and the patients in acupuncture combined with rehabilitation training group (group C) were treated with both acupuncture and rehabilitation training. The treatment course lasted for 28 days, acupuncture and rehabilitation training were given five days a week, and basic drug therapy was given throughout the whole course in all the three groups. The three groups were evaluated before treatment,14 days after the treatment and after the whole treatment course. Neurological function was evaluated by Neural Dysfunction Scale (NDS), upper limb motor function was evaluated by Simplified Fugl-Meyer Assessment (FMA), pain degree was evaluated by Visual Analogue Scale (VAS), and comprehensive function was evaluated by Functional Comprehensive Assessment (FCA). The comprehensive effect was evaluated after the treatment course.Results Before the treatment, there was no significant difference of age, sex, NDS score, Simplified FMA score, VAS score and FCA score between three groups (P>0.05)1. Results of NDS:Compared with before treatment, the NDS scores decreased significantly both after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of NDS after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:the acupuncture combined with rehabilitation training group (group C), the acupuncture group (group A) and the rehabilitation training group (group B). There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B, as well as between group A and group B (P<0.01).2. Results of Simplified FMA:Compared with before treatment, the Simplified FMA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of Simplified FMA after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:group C, group A and group B. There was no significant difference between three groups after 14 days of treatment (P>0.05). The increased scores of group C was significantly higher than group B (P<0.01), and the increased scores of group A was also significantly higher than group B (P<0.05). There was no significant difference between group C and group A (P>0.05).3. Results of VAS:Compared with before treatment, the VAS score decreased significantly after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of VAS after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).4. Results of FCA:Compared with before treatment, the FCA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of FCA after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05), the difference was significant between group C and group B, as well as between group A and group B (P<0.01).5. Results of the comprehensive effect evaluation:Apparent rate of the three groups was:group A 26.7%, group B 3.3% and group C 36.7%. Total effective rate of the three groups was:group A 90.0%, group B 83.3%, and group C 96.7%. By the effect of therapy from better to worse three groups were sorted as: group C, group A and group B. There was no significant difference between group C and group A (P>0.05), and the difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).Conclusion Acupuncture, rehabilitation training and acupuncture combined with rehabilitation training can all improve the neurological function, upper limb motor function and comprehensive function and release pain of patients with shoulder-hand syndrome after stroke. Acupuncture combined with rehabilitation training is significantly more effective than simple rehabilitation training. Although the difference was not significant, acupuncture combined with rehabilitation training improved the condition better than simple acupuncture, and the difference was more obvious as the treatment course extended. There is a synergetic effect of acupuncture and rehabilitation training in the therapy of SHS after stroke.