title: Immediate effects of scalp acupuncture with twirling reinforcing manipulation on hemiplegia following acute ischemic stroke: a hidden association study.
abstract: Data mining has the potential to provide information for improving clinical acupuncture strategies by uncovering hidden rules between acupuncture manipulation and therapeutic effects in a data set. In this study, we performed acupuncture on 30 patients with hemiplegia due to acute ischemic stroke. All participants were pre-screened to ensure that they exhibited immediate responses to acupuncture. We used a twirling reinforcing acupuncture manipulation at the specific lines between the bilateral Baihui (GV20) and Taiyang (EX-HN5). We collected neurologic deficit score, simplified Fugl-Meyer assessment score, muscle strength of the proximal and distal hemiplegic limbs, ratio of the maximal H-reflex to the maximal M-wave (Hmax/Mmax), muscle tension at baseline and immediately after treatment, and the syndromes of traditional Chinese medicine at baseline. We then conducted data mining using an association algorithm and an artificial neural network backpropagation algorithm. We found that the twirling reinforcing manipulation had no obvious therapeutic difference in traditional Chinese medicine syndromes of "Deficiency and Excess". The change in the muscle strength of the upper distal and lower proximal limbs was one of the main factors affecting the immediate change in Fugl-Meyer scores. Additionally, we found a positive correlation between the muscle tension change of the upper limb and Hmax/Mmax immediate change, and both positive and negative correlations existed between the muscle tension change of the lower limb and immediate Hmax/Mmax change. Additionally, when the difference value of muscle tension for the upper and lower limbs was > 0 or < 0, the difference value of Hmax/Mmax was correspondingly positive or negative, indicating the scalp acupuncture has a bidirectional effect on muscle tension in hemiplegic limbs. Therefore, acupuncture with twirling reinforcing manipulation has distinct effects on acute ischemic stroke patients with different symptoms or stages of disease. Improved muscle tension in the upper and lower limbs, reflected by the variation in the Hmax/Mmax ratio, is crucial for recovery of motor function from hemiplegia.
authors.affiliation: School of Acupuncture and Manipulation, Gansu University of Chinese Medicine, Lanzhou, Gansu Province, China.
authors.forename: Xiao-Zheng
authors.identifier: 0000-0002-8995-4710
authors.initials: XZ
authors.lastname: Du
authors.affiliation: Department of Acupuncture, Yueyang Hospital of Integrated Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Chun-Ling
authors.initials: CL
authors.lastname: Bao
authors.affiliation: Department of Acupuncture, Yueyang Hospital of Integrated Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Gui-Rong
authors.initials: GR
authors.lastname: Dong
authors.affiliation: School of Acupuncture and Manipulation, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Xu-Ming
authors.identifier: 0000-0002-2880-2609
authors.initials: XM
authors.lastname: Yang
keywords: Hmax/Mmax; artificial neural network algorithm; association algorithm; hemiplegia due to acute ischemic stroke; immediate effect; needling; nerve regeneration; neural regeneration; neurological deficit score; reinforcing manipulation; scalp acupoints; simplified Fugl-Meyer assessment; traditional Chinese medicine; traditional Chinese medicine syndromes