Needle acupuncture in chronic poststroke leg spasticity.
OBJECTIVE
To determine whether needle acupuncture may be useful in the reduction of leg spasticity in a chronic state.


METHODS
Single-blind, randomized, placebo-controlled trial.


METHODS
Neurologic outpatient department of a medical school in Germany.


METHODS
Twenty-five patients (14 women) suffering from chronic poststroke leg spasticity with pes equinovarus deformity (Modified Ashworth Scale [MAS] score, >/=1), aged 38 to 77 years (mean +/- standard deviation, 58.5+/-10.4 y), were enrolled in the study. The mean time from stroke to inclusion in the study was approximately 5 years (mean, 65.4+/-48.3 mo; range, 7-180 mo).


METHODS
Participants were randomly assigned to placebo treatment (n=12) by using a specially designed placebo needling procedure, or verum treatment (n=13).


METHODS
MAS score of the affected ankle, pain (visual analog scale), and walking speed.


RESULTS
There was no demonstrated beneficial clinical effects from verum acupuncture. After 4 weeks of treatment, mean MAS score was 3.3+/-0.9 in the placebo group versus 3.3+/-1.1 in the verum group. The neurophysiologic measure of H-reflex indicated a significant increase of spinal motoneuron excitability after verum acupuncture (H-response/M-response ratio: placebo,.39+/-.19; verum,.68+/-.41; P<.05).


CONCLUSIONS
This effect might be explained by afferent input of A delta and C fibers to the spinal motoneuron. The results from our study indicate that needle acupuncture may not be helpful to patients with chronic poststroke spasticity. However, there was neurophysiologic evidence for specific acupuncture effects on a spinal (segmental) level involving nociceptive reflex mechanisms.
Fink
Matthias
M
Department of Physical Medicine and Rehabilitation, Medical School of Hannover, Germany.
Rollnik
Jens D
JD
Bijak
Michaela
M
Borstädt
Caroline
C
Däuper
Jan
J
Guergueltcheva
Velina
V
Dengler
Reinhard
R
Karst
Matthias
M
D015670:Acupuncture Therapy; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003025:Clubfoot / Q000209:etiology; D005260:Female; D006181:H-Reflex; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000628:therapy*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation