Yu Y H, Wang H C, Wang Z J
Department of Physical Medicine and Rehabilitation, Taipei Municipal Yang-Ming Hospital, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1995 Oct;56(4):258-63.
Spasticity is a common symptom in stroke patients, and its management constitutes a major problem in their rehabilitation. Acupuncture has been applied with moderate effect; their has been clinical experience but little objective evidence to support its use. H-reflex recovery time and H recovery curve were quantitative methods applied to measure spinal motor neuron excitability. Acupuncture for stroke patients as treatment to spastic hemiparesis was studied to see the acupuncture effect on increased spinal motor neuron excitability in spasticity.
Sixteen stroke patients with spastic hemiparesis were collected to evaluate the therapeutic effect of acupuncture on their spinal motor neuron excitability. H-reflex recovery time and H recovery curve were applied as quantitative evaluations of spinal motor neuron excitability. Eleven age-matched normal volunteers were used as a control group.
The mean H-reflex recovery time of normal controls was 73.3 +/- 18.3 mesc; that of the sound-side limbs of stroke patients was 67.1 +/- 21.5msec. The difference was not significant statistically (p = 0.2). However, the mean H-reflex recovery time of the paretic limbs of stroke patients was 52.3 +/- 16.8 msec, significantly shorter than for the normal controls (p = 0.003). The mean H-reflex recovery time of the paretic limbs of stroke patients became 57.6 +/- 19.9 msec after acupuncture, significantly prolonged as compared with that before acupuncture (p = 0.03). The H recovery curve of the paretic limbs after acupuncture also approximated that of the normal controls.
This result provides positive evidence of increased spinal motor neuron excitability in paretic limbs of stroke patients and also of the acupuncture effect which decreased that excitability. The study also presents a simple and practical technique for measuring the effects of various types of treatments, including acupuncture, on other types of central nervous system disorders.
痉挛是中风患者的常见症状，其治疗是患者康复中的一个主要问题。针灸已被应用，效果一般；虽有临床经验，但支持其使用的客观证据很少。H反射恢复时间和H恢复曲线是用于测量脊髓运动神经元兴奋性的定量方法。本研究探讨针刺治疗中风后痉挛性偏瘫患者对增加脊髓运动神经元兴奋性的影响。
收集16例中风后痉挛性偏瘫患者，评估针刺对其脊髓运动神经元兴奋性的治疗效果。采用H反射恢复时间和H恢复曲线作为脊髓运动神经元兴奋性的定量评估指标。选取11名年龄匹配的正常志愿者作为对照组。
正常对照组的平均H反射恢复时间为73.3±18.3毫秒；中风患者健侧肢体的平均H反射恢复时间为67.1±21.5毫秒。差异无统计学意义（p = 0.2）。然而，中风患者患侧肢体的平均H反射恢复时间为52.3±16.8毫秒，显著短于正常对照组（p = 0.003）。针刺后中风患者患侧肢体的平均H反射恢复时间变为57.6±19.9毫秒，与针刺前相比显著延长（p = 0.03）。针刺后患侧肢体的H恢复曲线也接近正常对照组。
该结果为中风患者患侧肢体脊髓运动神经元兴奋性增加提供了阳性证据，也为针刺降低该兴奋性的效果提供了证据。该研究还提出了一种简单实用的技术，用于测量包括针刺在内的各种治疗方法对其他类型中枢神经系统疾病的效果。
