There is a lot of information on the internet about stroke treatment. A big research project across many pages and many tabs.
Here we have compiled an article on stroke treatment. The journey from what it is, to how to treat it.
On leaving this page we hope you will be better informed to make a decision on your health and the ones you love.
These are a few of the important facts according to the Stroke Foundation:
According to WorldLifeExpectancy , the figures are far worse for the rest of the world. Here is a glimpse of the USA.
Approximately 795,000 people in the United States have a stroke every year. Three in four being first-time strokes.
Stroke is the No. 5 cause of death in the United States, killing over 128,000 per year. That’s one in every 20 deaths.
Someone in the United States has a stroke every 40 seconds. Every four minutes, someone dies of stroke.
Stroke is a leading cause of long-term disability. It also the leading preventable cause of disability.
More women than men have strokes each year, in part because women live longer.
“Impact of Stroke (Stroke Statistics).” 2017. Accessed July 25. http://www.strokeassociation.org/STROKEORG/AboutStroke/Impact-of-Stroke-Stroke-statistics_UCM_310728_Article.jsp#.WXaxK9OGNTZ.
A stroke can happen in two main ways:
A stroke caused by a blood clot is known as a ischaemic stroke. A blood cot in the body serves a practical purpose. When you cut yourself it is the clot that slows and stops the bleeding. A necessity in daily living.
In the case of stroke, blood cots are dangerous, as they block arteries and cut of blood flow. About 4 out of every 5 strokes are ischaemic. There are two ways ischaemic stroke can occur.
(The cause of a Haemorrhagic stroke)
Strokes caused by a break in the wall of a blood vessel in the brain are called haemorrhagic strokes. This causes blood to leak into the brain, again stopping the delivery of oxygen and nutrients.
Haemorrhagic stroke can be caused by a number of disorders. These affect the blood vessels, including long-standing high blood pressure and cerebral aneurysms.
An aneurysm is a weak or thin spot on a blood vessel wall. The weak spots that cause aneurysms are usually present at birth.
Aneurysms develop over many years. They usually don’t cause detectable problems until they break. About 1 in every 5 strokes is haemorrhagic and there are two types. They are described by their location in the brain.
There are two types:
Intracerebral – when an artery inside the brain bursts and bleeds into the brain. The most common cause is high blood pressure (hypertension).
Subarachnoid (SAH) is bleeding on the surface of the brain. There are 3 layers of membrane (or meninges) that cover the brain. This haemorrhage happens between the layer closest to the brain and the second layer.
A transient ischaemic attack (TIA) is sometimes termed a minor stroke or “mini stroke”. This term is used when the signs of stroke are present but go away within 24 hours.
The causes and symptoms of a transient ischaemic attack are similar to those of a stroke. TIA episodes usually last only a few minutes but may last for several hours. They generally disappear quickly and unfortunately, are often ignored.
Like a stroke, a TIA will need emergency treatment. About 1 in 5 people who have a TIA will have a major stroke within the next three months. A large part of the risk occurs in the first few days.
Never ignore TIA.
TIA’s should be regarded as a warning sign that the person is at risk of a stroke. Investigate immediately! It is important that if stroke symptoms occur the person sees a doctor promptly… even if the signs go away and you feel completely better.
What to expect in the first few days
Once admitted to hospital the doctors will do a range of tests. These tests will determine whether the symptoms are definitely due to stroke.
They will work out the type of stroke, find out what area of the brain was damaged and how severe the damage is. If possible, they will find out and start treating the cause of the stroke.
Everyone will need a different set of tests. These include brain scans, heart tests and blood tests.
Regular observations will also be taken to monitor:
You will have one-on-one assessments with members of the treating team… as soon as possible after your stroke. Each team member will focus on a different part of your care but the team will work together to meet your needs.
Ischemic stroke patients are often given warfarin (also known by brand name coumadin).
Warfarin is an anti-coagulant, a blood thinner. It prevents formation of new clots but it does nothing about clots that have already formed. In other words, it does not help stroke patients recover.
Overdosage of warfarin or coumadin can cause internal bleeding. This side-effect is not surprising. Warfarin was first developed as a potent rodent poison.
Which acupuncture protocol is better for treating strokes?
Conventional Chinese acupuncture and scalp acupuncture are both used to treat stroke. For many years Dr Zhu had used conventional body acupuncture to treat strokes. He was not satisfied with the results.
In the 1970’s he started to explore scalp acupuncture and developed Zhu’s Scalp Acupuncture. For neurological conditions such as strokes, scalp acupuncture is the most effective.
Zhu’s Scalp Acupuncture (ZSA) is a specialised microsystem acupuncture technique.
Other variations of these microsystem techniques include the ear, hand, nose and so on.
In scalp acupuncture, very short, fine needles are inserted in the scalp. These insertions achieve desired therapeutic effects on different parts of the body.
This technique has yielded outstanding results for thousands of patients. It has become recognized worldwide. It is one of the most effective treatments for many difficult-to-manage conditions.
Three basic features of scalp acupuncture that differentiate it from body acupuncture:
1. Treatment zones have been mapped onto the scalp. These zones are associated with body functions and broad body regions.
The zones include a few standard acupuncture points. The point selection is not based on the standard body acupuncture principles though.
In general, the forward part of the zone (nearer the face) is used to treat the upper body. While the rear part of the zone is used to treat the lower body.
Functional zones, such as sensory, memory, and motor, are usually located at the back and sides of the scalp.
2. The needles are inserted within a thin layer of loose tissue beneath the scalp surface. The angle is about 15–30 degrees.
The insertion varies according to the size of the body treated. Usually it is about one inch for an adult.
For body acupuncture of the scalp a smaller insertion with a 60-90 degree angle is used.
3. For scalp acupuncture, the needles are to be subjected to rapid stimulation. This rapid stimulation can be carried out in a variety of ways. This includes pulling/thrusting, twirling, and electro-stimulation.
It is common to stimulate the needles for 2–3 minutes at a time, with a rest period of 5–10 minutes between stimulations.
Standard acupuncture applied to scalp points usually involves less rapid stimulation.
The needle is inserted along the practitioner’s pad of the finger. For a pain free experience the needle is inserted deliberately to avoid the blood vessels. The direction of needling is usually based on the mapping of the body within the zone. The needle is aimed along the line of the zone — corresponding to the area of the body affected.
Upon inserting the needle, stimulation is applied for 1–2 minutes . The needles are manipulated after intervals of 10–15 minutes, for 1–2 minutes each time. This happens throughout the duration of the patient visit, which may be as long as 2–3 hours.
The needles should remain in the scalp for at least 4 hours and up to 4 days. For treatment of acute symptoms, 0.5–1 hour is enough.
For children and weak adults, the time of retention should be shorter.
At Zhu’s clinic, the scalp needles are often left in place until the next visit, which is 24–48 hours later.
There are two basic needling methods for manipulating the qi.
In Zhu’s Scalp Acupuncture Dr Zhu has designated them jinqi and chouqi.
Jinqi (jin means move forward) is a tonifying, thrusting method.
Chouqi (chou means to withdraw) is a sedating, reducing method.
For the majority of neurological disorders, the tonification technique jinqi is used. ,
In cases of pain syndromes, the draining method chouqi is used.
During the stimulations, both the practitioner and the patient focus on the breath. This is an aspect of qigong therapy incorporated into the treatment.
There should be no talking during needle stimulus. All attention is on the needling and its effects. The mental focus is on “directing the breath” to the body part treated.
Heat lamps can be used to provide heat to an affected body part when necessary.
The affected part of the body is to be moved during needle stimulation. If the person cannot move they can visualise moving the breath to the affected part. When possible, an assistant may help.
After the needle stimulation, Dr Zhu encourages the patient to continue the movements.
In cases where the legs are involved, the patient walks. Several patients at Zhu’s clinic would walk around the block, others might walk the length of the room.
A function of scalp acupuncture is to improve or re-establish the connection. This is from the central nervous system (CNS) to the peripheral nervous system (PNS). The sending of these signals during treatment is critical.
The intention sends signals from the CNS to the PNS. Movements of the body part then sends signals back from PNS to the CNS.
Before withdrawing the needles, Zhu recommends manipulating the needle again. This happens while the patient performs breathing exercises.
Withdrawal should be rapid. The punctured site should then be pressed for a while with a dry cotton ball to avoid bleeding.
Body points are sometimes used as an adjunct to the scalp acupuncture therapy.
Daoyin is an ancient Chinese body-mind exercise. In the beginning, Daoyin was a form of health care, as well as physical and spiritual purification.
Daoyin in Chinese means “to lead and guide”. It is a term referring to any activity that helps to guide the flow of Qi.
In 1974, a silk painting was discovered in an archaeological site dated 200 B.C. in Changsha, China. Entitled Daoyin Tu it illustrated many postures and exercises that ancient people used. These exercises were used to maintain good health and physical flexibility.
Professor Zhu is the first one to integrate Daoyin into acupuncture treatments.
Patients take part in various physical and mental exercises with relaxation. This takes place during the needle retention period.
The combination of acupuncture and Daoyin magnifies the results .
Scalp acupuncture is not simply an act of inserting needles at certain points.
Scalp acupuncture is a complete therapy that involves, besides needling:
All these things are Daoyin and are integrated into every session.
Daoyin has a much broader implication than conventional physical, occupational or speech therapy.
Our acupuncturists customise specific daoyin activities to suit the needs of the patient… at particular points in time.
The following are a few examples of Daoyin:
(a) A stroke patient with slurred speech moves their tongue. This movement is in different directions while making sounds during the acupuncture.
(b) A stroke patient with facial palsy opens and closes their affected eye. At the same time, they exercise their face muscles during the acupuncture.
(c) A stroke patient with paralytic lower limb stands and walks with support.
(d) A stroke patient with paralytic upper limb pushes and pulls on their affected arm. This takes place during needle manipulation.
Acupuncture with Daoyin is not a replacement therapy. It use enhances conventional rehabilitation therapies.
But, there are several areas where they differ.
(a) Our approach is proactive. We help a patient sit before he can sit on his own.
We make the first attempt to stand when the patient cannot even imagine or believe it is possible.
We provide whatever support the patient needs to regain their lost function… instead of waiting for the first sign of the function to come back.
A proactive approach speeds up recovery and boosts the patient’s self-confidence.
9 (b) When doing Daoyin, we give the patient only minimal help. Adequate precaution and safety measures are paramount.
The more active efforts from the patient, the better the treatment results. By the same token, we discourage the use of limb supports. Muscles, tendons and ligaments are strengthened by proper exercise.
Unlike conventional therapy, we support patients on their paralyzed side. This results in a better outcome than supporting the good one.
When a medical emergency occurs, what’s the first thing we do. Thats right! We rush to the emergency department at the hospital. This indispensable service saves lives! But what happens next?
The journey for most people suffering from a stroke starts here. This is where healing and recuperation begin. The doctors usually like to track people for quite some time after the initial incident. They regulate their medication and rehab accordingly.
Few people in the general public are aware of scalp acupuncture for stroke treatment. This ancient healing system vastly improves a stroke patient’s recovery… without the fear of drug interaction or further injury.
The key to improvement lies in the gap between the stroke and the acupuncture treatment… days after the event is best. The shorter the gap the quicker the recovery. Yet, we can still make a difference: weeks, months and even years after the initial injury.
The brain and neurological system is very plastic… but after a traumatic injury such as stroke, it is in a state of shock. To change this state, treatment with acupuncture should happen as soon as possible. The repair process can begin.
Acupuncture encourages this plasticity of the neurological system to halt scar tissue development. This scar tissue will inhibit any neurological activity in that area inhibiting recovery.
Scalp acupuncture is one of our main treatment strategies for stroke victims. It is often combined with points on the body, depending on how the stroke manifests. This method is completely safe. It follows the neurological pathways in the brain and body respectively.
Needles are often retained in the scalp for several days, to achieve best results. The treatment is ongoing while the needles remain inserted.
We see a big improvement in patient health by combining scalp acupuncture and daoyin. The use of the patients own will is intrinsic to this rehabilitation. The affected area needs to be used for it to get better! And the patient needs to be the one who does this. We do not just rely only on the unaffected parts and rehabilitation/movement aids.
The act of using one’s own will gets that specific part of the neurological system to function again…. even if the body part can no longer move. The process needs to begin somewhere.
Because anti-seizure medication is usually sedative, it hampers the rehabilitation process. Scalp acupuncture is an effective substitute without causing adverse side-effects.
Avoid overuse of warfarin or coumadin to prevent secondary hemorrhage.
Spasticity does not set in immediately after a stroke. It can be avoided if more attention is given to body postures in the first month.
Always keep the patient’s head, body, and limbs in normal physiological positions. Special consideration must be given to the the joints – neck, elbow, wrist, fingers, ankle and feet.
What is Stroke Sequaelae and how can Scalp Acupuncture accelerate recovery?
Scalp acupuncture is one of the most commonly used methods to accelerate the recovery or rehabilitation from stroke sequaelae.
You may ask, what does the word sequaelae mean?
Well, according to MedicineNet.com Sequaela is a pathological condition resulting from a prior disease, injury, or attack.
In most cases a sequela is a chronic condition, that is a complication which follows a more acute condition—it is different from, but is a consequence of, the first condition.
When combined with an appropriate rehabilitation program, scalp acupuncture produces positive changes and improvement to motor and sensory function.
In comparison, traditional body acupuncture treatment for stroke sequaelae often produces slower effects.
Patients who have had previous acupuncture treatment often describe their practitioner using many points on their body. It is then a surprise to these patients, when I use points on the scalp and often on the side opposite to their affected side.
Because of the neural plasticity of the brain, scalp acupuncture can effectively facilitate and stimulate the brain’s neural pathways to reorganize or regenerate to reconnect to existing neural motor and sensory pathways.
Using non-invasive techniques, to study the human brain, it was observed the brain adapts to preserve motor function (1,3).
Neural plasticity allows the central nervous system to recover from spinal and brain injuries such as stoke (2).
Stroke patients often have damage to the area of the brain starved of oxygen and nutrient due to a blockage of blood vessels (ischaemic stroke) or breakage of blood vessels (haemorrhagic stroke) within the brain.
The resultant damage brain tissue, lead to the impairment and dysfunction of the motor neural pathways. Often there is no damage to the peripheral sensory motor neurons that mediate motor function.
This explains why traditional body acupuncture techniques, using body points are less effective in stimulating the central nervous system end of the motor neural pathway.
Consequently, scalp acupuncture which aims to stimulate the muted central nervous system within the brain is the most effective method to treat stroke.
Within the first session, we have found that patients are surprised when they see changes or improvement.
At the very least, patients should expect that they can close their fingers; regain a firmer grip; and get sensation back in their foot.
In a patient with moderate to mild debility, some patients are able to stand up and walk short distances.
Patients should expect nothing less within the first treatment.
These changes often create excitement and hope that they can return to a normal life rapidly.
Treatment plans can range between 3-6 months, depending on severity, but patients should expect to see improvement from the first session.
Often we will ask the patient to do homework exercises to assist their recovery in conjunction with the acupuncture sessions.
Ideally, patients should not delay treatment once discharged from hospital. Earlier intervention and treatment will save a lot of time in their rehabilitation recovery.
Scalp acupuncture will accelerate the rehabilitation process of stroke sequaelae.
Patients do not need to stop rehabilitation provided by their physiotherapist, nurse or any other health providers.
Ideally patients should continue with their existing rehabilitation programs which will facilitate their recovery.
Often their health care provider will notice that they are achieving their rehabilitation goals faster.
If patients are on existing medications, they can continue to take these medications, as it will not interfere with their acupuncture treatment.
Below we have a summary of the introduction to the above article. Please click the link to read the full article
Chinese scalp acupuncture is a contemporary acupuncture technique. The technique integrates traditional Chinese needling methods with Western medical knowledge. In particular, the representative areas of the cerebral cortex.
It has been proven to be a most effective technique for treating acute and chronic central nervous system disorders.
Scalp acupuncture often produces remarkable results with just a few needles. It usually brings about immediate improvement. Sometimes taking only several seconds to a minute.
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.
Acupuncture stimulation of lateral side of BL 10 combined with scalp-points has a significant benefit for stroke patients in standing-balance ability and walking ability.
The combined therapy of the scalp and body acupuncture in the staging treatment improves obviously the motor function of the lower extremities and the activities of daily living for the patients with cerebral apoplexy. This therapy recovers as quickly as possible the walking ability and speed for the patients, which is superior to the conventional acupuncture in comparison.
1. Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ. Acupuncture for stroke rehabilitation. Cochrane Database Syst Rev. 2016 Aug 26;8:Cd004131. http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD004131.pub3/epdf
2. Vados, L., Ferreira, A., Zhao, S., Vercelino, R., & Wang, S. (2015). Effectiveness of acupuncture combined with rehabilitation for treatment of acute or subacute stroke: a systematic review. Acupuncture in Medicine, 33(3), 180-187. doi:10.1136/acupmed-2014-010705 (pdf)
3. Wang, Y., Shen, J., Wang, X., Fu, D., Chen, C., Lu, L., Zheng, G. (2012). Scalp Acupuncture for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine. doi:10.1155/2012/480950 (pdf)
4. Park, S., Shin, A., Jahng, G., Moon, S., & Park, J. (2009). Effects of Scalp Acupuncture Versus Upper and Lower Limb Acupuncture on Signal Activation of Blood Oxygen Level Dependent (BOLD) fMRI of the Brain and Somatosensory Cortex. The Journal of Alternative and Complementary Medicine, 15(11), 1193-1200. doi:10.1089/acm.2008.0602 (pdf)
5. Lee SH, Lim SM. Acupuncture for insomnia after stroke: a systematic review and meta-analysis. BMC Complement Altern Med. 2016;16:228.
6. Lim SM, Yoo J, Lee E, Kim HJ, Shin S, Han G, et al. Acupuncture for spasticity after stroke: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2015;2015:870398. (pdf)
7. Zheng, G., Zhao, Z., Wang, Y., Gu, Y., Li, Y., Chen, X., Shen, J. (2011). Meta-Analysis of Scalp Acupuncture for Acute Hypertensive Intracerebral Hemorrhage. The Journal of Alternative and Complementary Medicine, 17(4), 293-299. doi:10.1089/acm.2010.0156 https://hub.hku.hk/bitstream/10722/138129/1/Content.pdf?accept=1 "the efficacy and safety of SA therapy remain to be further determined. No evidence is available on whether SA therapy can be used to treat acute ICH according to the primary outcome measure. However, SA therapy appears to be able to improve neurological deficit in patients with acute hypertensive ICH."
8. Zhang JH, Wang D, Liu M. Overview of systematic reviews and meta-analyses of acupuncture for stroke. Neuroepidemiology. 2014;42(1):50-8.
https://www.karger.com/Article/Pdf/355435 "The available evidence suggests that acupuncture may be effective for treating poststroke neurological impairment and dysfunction such as dysphagia, although these reported benefits should be verified in large, well-controlled studies. On the other hand, the available evidence does not clearly indicate that acupuncture can help prevent poststroke death or disability, or ameliorate other aspects of stroke recovery, such as poststroke motor dysfunction.”
9. Lee, S., & Lim, S. M. (2016). Acupuncture for Poststroke Shoulder Pain: A Systematic Review and Meta-Analysis. Evidence-Based Complementary and Alternative Medicine, 2016, 1-8. doi:10.1155/2016/3549878
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4983325/pdf/ECAM2016-3549878.pdf "Although there is some evidence for an effect of acupuncture on poststroke shoulder pain, the results are inconclusive. Further studies with more subjects and a rigorous study design are needed to confirm the role of acupuncture in the treatment of poststroke shoulder pain”
4 case studies from Dr Zhu's clinic
Below is an excerpt from an article written by By Ming Qing Zhu, LAc, OMD (China) and Moyee Siu, LAc, MTCM
In this article Dr Zhu highlights room for improvement in standard stroke protocol. In one study on ischemic stroke survivors who were at least 65 years of age the following disabilities were observed, six months after stroke:
Can Acupuncture Really Benefit Stroke Recovery?
Many people have asked this question. Our answer is a definite “yes”.
Recent western research make the claim that there is no clear evidence for the additional value of acupuncture for post-stroke rehabilitation.
Why is there a discrepancy?
Both statements are valid.
What is more accurate is that acupuncture can significantly benefit stroke patients if it is done right, but otherwise it is of little value.
Our experience demonstrates that when applied correctly, acupuncture can shorten recovery time. This can happen in as little as two weeks and restore function to over 95% in some patients.
In December 2010, a man in his fifties suffered an ischemic stroke. Three days after the stroke onset, he presented himself at our clinic with slurred speech, right hemiparesis and wheelchair bound. After two hours of acupuncture treatment, he was able to move his right upper extremity. The next day, less than 24 hours later, he stood up and walked on his own. On his third day of treatment, he climbed the stairs. He recovered all motor functions within two weeks.
One night in 1992 a man suddenly dropped on the floor and became stuporous. A CT scan of his brain revealed a large lesion in the left cortex and basal ganglia, due to hemorrhage of the middle cerebral artery. Within seven hours, we started Zhu’s Scalp Acupuncture treatment on him, and continued for 20 consecutive days. Two weeks later, he started to talk. After three months, he was able to return full-time to his acupuncture practice and administrative work.
In 1998, a 55 year-old man discharged himself from the Taipei Veterans General Hospital of Taiwan, despite his doctor’s advice. It was the 8th day after his stroke when he arrived at our clinic in a wheelchair. His ischemic stroke left him paralyzed on the right side. Twenty minutes after applying scalp acupuncture needles, he stood up. An hour later, he took a few steps. After two weeks of daily acupuncture, he started walking with a cane. He ultimately regained all of his gross and fine movements. Today he is living his life as a fully recovered stroke patient and still persists in his daily exercise routine to stay healthy.
In 2007, an MD referred his 58-year-old male patient to us. This patient had an ischemic stroke and was bedridden for 20 days. On the first visit, he came in a wheelchair, but walked out of our clinic down two flights of stairs without assistance. After 10 daily Zhu’s Scalp Acupuncture treatments of three hours each, he returned to work.
These four case histories are a small sample of the large number of stroke cases Zhu’s have treated. What is common in these patients is that all were treated very early and had nearly full functional recovery.
Acupuncture can be a major benefit to stroke rehabilitation when administered correctly. Results are most remarkable in the acute stage.
First, treatment must begin promptly. Earlier intervention promises fewer deficits.
Second, an effective acupuncture system should be employed.
Scalp acupuncture excels over body acupuncture in treating neurological conditions such as strokes. After insertion, needles should be manipulated to ensure qi flow.
Third, appropriate Daoyin must be carried out simultaneously.
Finally, treatments have to be repeated frequently for reinforcement. In this manner a stroke patient will achieve a faster and more complete recovery.