Neurology · Medical Literature
[Effect of acupuncture of "twelve hand and foot acupoints" combined with neural mobilization on limb motor function in patients with cerebral infarction hemiplegia of qi-deficiency and blood-stasis type].
Abstract
To observe the effect of acupuncture of "twelve hand and foot acupoints" (in fact "12 acupoints on the hands and feet") combined with neural mobilization intervention (a manual treatment method that directly applies force to some related nerve tissue through the placement and movement of multiple joints) on the limb motor function and quality of life in patients with cerebral infarction (CI) hemiplegia of qi-deficiency and blood-stasis type. Ninety-eight patients with CI hemiplegia of qi-deficiency and blood-stasis type were randomly divided into a neural mobilization group (49 cases, 2 cases dropped out) and a combination (acupuncture plus neural mobilization) group (49 cases, 3 cases dropped out) using a random number table method. All patients underwent basic treatment and rehabilitation training, and those of the neural mobilization group received various manipulations at different portions of the body related to the innervation of radial nerve, median nerve, ulnar nerve, sciatic nerve, common peroneal nerve, tibial nerve and femoral nerve through the placement and movement of multiple joints. The patients of the combination group received manual acupuncture stimulation of 12 acupoints (including bilateral Neiguan [PC6], Hegu [LI4], Quchi [LI11], Yanglingquan [GB34], Zusanli [ST36] and Sanyinjiao [SP6], with the acupuncture needles retained for 30 min in every session of treatment) on the basis of the neural mobilization. The treatment was conducted once daily, 5 d a week for 4 weeks. The degree of neurologic impairment was assessed by China stroke scale (CSS). The score of qi-deficiency and blood-stasis syndrome was given according to "quantitative scoring scale for qi-deficiency and blood-stasis syndrome". The limb motor function was assessed using Fugl-Meyer assessment scale (FMA). The blood plasma viscosity and fibrinogen level were detected using a blood rheology analyzer. The score of quality of life was assessed using the stroke-specific quality of life scale (SS-QOL). After 4 weeks of treatment, the CSS score, the score of qi-deficiency and blood-stasis syndrome, plasma viscosity and fibrinogen level were significantly lower in both groups than those pre-treatment (P<0.05), with the combination group showing obviously lower values than the neural mobilization group (P<0.05). The FMA score and SS-QOL score were considerably increased in both groups compared with those pre-treatment (P<0.05), and were strikingly higher in the combination group than in the neural mobilization group (P<0.05). Acupuncture of "twelve hand and foot acupoints" combined with neural mobilization can effectively regulate blood rheology, improve symptoms and limb motor function, and raise the quality of life in patients with hemiplegia of qi-deficiency and blood-stasis type.
Clinical relevance
This RCT addresses the management of post-cerebral infarction hemiplegia in patients with the Traditional Chinese Medicine (TCM) phenotype of qi-deficiency and blood-stasis, a common and functionally debilitating sequela for which adjunctive rehabilitation strategies remain an active area of investigation. The study evaluates whether combining structured acupuncture at twelve standardized hand and foot acupoints with neural mobilization—a manual therapy directly targeting peripheral nerve tissue mechanics—offers superior motor and functional recovery over neural mobilization alone. Given the global burden of stroke-related hemiplegia and persistent gaps in optimizing neurorehabilitation protocols, clinicians managing stroke recovery should be aware of multimodal approaches that may augment standard rehabilitation.
Key findings
1. Both groups demonstrated statistically significant reductions in China Stroke Scale (CSS) neurologic impairment scores after 4 weeks of treatment compared to baseline (P<0.05); the combination group (acupuncture + neural mobilization) achieved significantly greater CSS reduction than the neural mobilization-only group (P<0.05). 2. Fugl-Meyer Assessment (FMA) scores for limb motor function improved significantly from baseline in both groups (P<0.05), with the combination group showing markedly higher FMA scores than the neural mobilization group at 4 weeks (P<0.05); specific pre/post means and effect sizes were not reported in the abstract. 3. Stroke-Specific Quality of Life Scale (SS-QOL) scores increased significantly in both groups versus baseline (P<0.05), with the combination group demonstrating strikingly higher SS-QOL scores than the neural mobilization group (P<0.05); exact delta values and confidence intervals were not provided. 4. Plasma viscosity and fibrinogen levels—markers of blood rheology and hypercoagulability relevant to post-infarction pathophysiology—were significantly reduced from baseline in both groups (P<0.05), with the combination group exhibiting significantly greater reductions than the neural mobilization group (P<0.05). 5. Quantitative scores for qi-deficiency and blood-stasis syndrome decreased significantly in both groups post-treatment (P<0.05), with the combination group showing significantly lower syndrome scores than the neural mobilization group (P<0.05). 6. The study enrolled 98 patients (49 per arm) with 5 total dropouts (2 in the neural mobilization group, 3 in the combination group), yielding an evaluable population of 47 and 46 patients respectively; no between-group differences in dropout rates or adverse events were reported in the abstract. Note: No confidence intervals, effect sizes, or NNT/NNH values were reported in the abstract.
Practice implications
In post-stroke hemiplegia patients—particularly those meeting TCM criteria for qi-deficiency and blood-stasis—adding structured manual acupuncture at six bilateral acupoints (PC6, LI4, LI11, GB34, ST36, SP6) with 30-minute needle retention per session to an established neural mobilization and standard rehabilitation program may meaningfully enhance limb motor recovery and quality of life beyond neural mobilization alone, suggesting this combination warrants consideration as an adjunct in integrative stroke rehabilitation settings. The observed improvements in plasma viscosity and fibrinogen suggest a plausible hemorheological mechanism, which may be of particular relevance for patients with post-infarction hypercoagulable states, though clinicians should interpret these biomarker changes cautiously in the absence of reported effect sizes and confidence intervals. Given the 5-days-per-week, 4-week protocol and the absence of reported adverse events, implementation feasibility appears reasonable, but replication in larger multicenter trials with blinded outcome assessment and longer follow-up is needed before broader adoption into standard neurorehabilitation guidelines.