Clinical Observation On Treatment Of Hemiplegia Spasticity Of Ischemic Stroke By "Tong Tong Tong" Rehabilitation Training

ObjectiveTo reseach on Clinical efficacy of Ti-Yong-Tong-He for spasticity and correlations between rehabilitation evaluation and TCM syndrome by clinical observation of spasticity to initially form rehabilitation programs of TCM, which could decrease maimed rate and increase living quality.Methods1.82 stroke patients were selected, randomly divided into treatment group and control group according to 2:1 proportion. The therapy of treatment group is Ti-Yong-Tong-He combined with herb soaking, and the therapy of control group is modern rehabilitation technique, all based on routine treatment. This research last for 21 days, time points of curative effecte valuation are the 7th,14th,21th day.2. NIHSS was used for evaluating Neurological deficit, Ashworth for Spasticity, Fugl-Meyer for motor function and BI for activities of daily living. TCM syndrome was evaluated by the symptom integrating scale and analyzed by frequency statistic and cluster analysis. And correlations between level of spasm and TCM syndrome would be studied.Results1. Baseline condition:general data, such as age, gender, occupation, underlying diseases, and therapeutic effect index had no statistical differences between two groups (P>0.05).2. Main outcome measures:after treatment, neurological impairment, spasticity, motor function and activities of daily living gettd significantly improved in both groups (P<0.05); Comparison among groups:NIHSS scores of treatment group were significantly lower than control group at the time point of 21th; By comparison to the difference between baseline and follow-up measure, the improvement of neurological impairment was superior to that in the control group from 7th day. Ashworth scores of treatment group were significantly lower than control group at the time point of 21th (P=0.021), and clinical efficacy rate of treatment group was significantly higher than those in control group (64.8% vs.42.9%, P=0.043); Fugl-Meyer scores showed a rising trend without statistical difference. By comparison to the difference between baseline and follow-up measure, the improvement of upper limb function remained statistically significant at the three time points (P=0.047,0.005,0.003), and the improvement of upper limb function show statistically significant at 14th day (P=0.026). Aggregates score was significantly increased at 14th and 21th day (P=0.006,0.003). BI scores of treatment group was significantly higher than those in control group at 21th day (P=0.017).3. Assessment of TCM syndrome:82 patients were divided into effective group and invalid group according to the level of spasm. Distribution rules of manifestations:before Treatment, the two most frequent TCM syndromes were phlegm syndrome and blood stasis syndrome. Cluster analysis suggests that each of phlegm syndrome and blood stasis syndrome belonged to a category of their own. Distribution of TCM syndromes suggests that phlegm syndrome complicated with blood stasis syndrome took up the highest proportion in statistics of two-syndrome combination, and heat syndrome maybe as well in statistics of one-syndrome. After Treatment in effective group, the two most frequent TCM syndromes were qi-deficiency syndrome and blood-stasis syndrome, and cluster analysis suggests each of qi-deficiency syndrome and blood-stasis syndrome belonged to a category of their own. Distribution of TCM syndromes suggests qi-deficiency syndrome, blood stasis syndrome, and qi-deficiency syndrome complicated with blood stasis syndrome took up the highest proportion and heat syndrome complicated with phlegm syndrome was the second place in frequency statistics. After Treatment in andvoid group, heat syndrome, phlegm syndrome, blood stasis syndrome and heat syndrome complicated with phlegm syndrome took up the higher proportion; Cluster analysis suggests each of heat syndrome, phlegm syndrome and blood-stasis syndrome belonged to a category of their own. In addition, the highest proportion patients fail to meet the criteria of any TCM syndrome.4. Correlation analysis:in effective group, Ashworth was positively correlated with N1HSS and negatively correlated with Fugl-Meyer. There was no correlation between Ashworth and BI in effective group, but they were negative correlation in andvoid group. In comparison to TCM syndrome score, Ashworth was negatively correlated with heat syndrome before treatment. In effective group, there was no correlation between Ashworth and any TCM syndrome. And in andvoid group, Ashworth was positively correlated with Phlegm syndrome, which was consistent with frequency statistics and cluster analysis. 5. Satisfaction survey:The satisfaction of medium above is up to 100%in treatment group and 80.8% in control group with no difference between two groups.ConclusionRehabilitation training of Ti-Yong-Tong-He combined with herb soaking has good curative effect on spasticity caused by stroke. This Therapy can improve the degree of spasticity, neurologic impairment and especially upper limb function and activity of daily living, thus it can partly enhance the quality of life. This therapy also can reduce the frequency of pathogenic- excess syndromes. In summary, rehabilitation training of Ti-Yong-Tong-He is an innovative treatment that can use the technique of Chinese medicine for modern rehabilitation. And compared with traditional massage technique it is more targeted and more systematic and worthy for extending in clinic.