• The Journal of Korean Medicine
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• v.36 no.4
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• pp.8-18
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• 2015

Objectives: There have been several studies evaluated effect of electroacupuncture (EA) on spasticity but most studies could not assess spasticity quantitatively because they used clinical rating scales for assessment spasticity. The objective of this study is to evaluate effect of EA on poststroke spasticity quantitatively using tendon reflex (T-reflex). Methods: 29 stroke patients with upper extremity spasticity were randomized to EA group and control group. The EA group received combined EA and rehabilitation therapy 5 times a week for 3 weeks. Acupuncture treatment was given at Jian Yu (LI 15), Qu Chi (LI 11), Shao Hai (HT 3), Wai Guan (TE 5), He Gu (LI 4), Lie Que (LU 7), Hou Xi (SI 3) of the affected side, 30 minutes of electrical stimulation with a frequency of 40/13 Hz was applied at Qu Chi (LI 11), He Gu (LI 4). The control group received only rehabilitation therapy. The efficacy of treatment was assessed using T-reflex latency and amplitude, modified Ashworth scale (MAS) of biceps brachii, brachioradialis and triceps brachii. Fugl-Meyer motor function assessment (FMA) and functional independence measure (FIM) were also measured to assess motor function and functional independence. All outcomes were measured before treatment, immediately after 3 weeks of treatment and 1 week after 3 weeks of treatment. Results: No statistically significant differences were found in outcomes including T-reflex between the study groups except for FIM values immediately after 3 weeks of treatment (p=0.037). Conclusions: These results suggest that 3 weeks of EA does not reduce poststroke upper extremity spasticity electrophysiologically and clinically. However, small sample sizes and contradictory tendency between results from T-reflex and those from MAS require cautious judgement on interpretation of the results. A larger, well-designed clinical trials for quantitative evaluation of effect of EA on poststroke spasticity will be needed.

• The Journal of Internal Korean Medicine
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• v.27 no.2
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• pp.371-378
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• 2006

Objectives : The aim of this study is to review the effects of acupuncture on lower limb spasticity control in stroke patients. Methods: H-reflex/M-response ratio and Modified Ashworth Scale was used for evaluation of spasticity control before acupuncture, within one hours after acupuncture , at twenty-four hours, and four weeks. We divided two groups. One is the yin meridian acupunctured goup and the other is the yang meridian acupunctured group. Results: H/M ratio is declined within 1 or 24 hours after acupuncture for poststroke spasticity patients. The yin meridian acupunctured group is a bit more efficient than the yang meridian acupunctured goup. But there is no meaning in the statistics because of small patient pool. Conclusions: We need more patients group to decide the effect of electro- acupuncture on leg spasticity of stroke patients.

• Physical Therapy Korea
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• v.9 no.2
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• pp.133-144
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• 2002

The purpose of this study was to establish reliability of the Tone Assessment Scale (TAS) translated into Korean in patients with stroke. The TAS consists of resting posture, response to passive movement, and associated reaction to active effort. Fifteen patients (14 males, 1 female) were examined by two raters. Surface electromyography (EMG) data at elbow flexor muscle and joint excursion were collected from 6 patients. To identify the correlation between muscle activity and angular changes of elbow muscle, Pearson product moment correlation was used. The inter-rater and intra-rater reliability of the TAS ranged from very good to good (K/Kw=.61~1.00 for intra-rater and K/Kw=.73~1.00 for intra-rater comparisons) in the sections of resting posture and associated reaction. However, in the section of response to passive movement, the reliability coefficients ranged from very good to fair (Kw=.29~1.00). In the 11th item, correlation between EMG ratio of elbow flexor and angular changes of elbow joint showed statistically strong positive relationship (r=.94, p<.05). These results indicate that the TAS is selectively reliable in the sections of resting posture and associated reaction.

• Journal of the Korean Society of Physical Medicine
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• v.5 no.3
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• pp.477-485
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• 2010

Purpose : The clinical scale to assess spasticity of muscle was wildly used the modified Ashworth scale (MAS). But reliability of the MAS has been controverted for ambiguity among the grades. The purpose of this study was to establish the inter-rater reliability of the modified MAS (MMAS) translated into Korean in stroke patients. Methods : Twenty-five patients (sixteen men and nine women) with hemiplegia (ten right and fifteen left) were measured by two raters who were physical therapist in the rehabilitation hospital. The raters assessed spasticity of shoulder adductor, elbow flexor, wrist flexor, hip adductor, knee extensor, and ankle plantar flexor in the same patients according to ratings criteria of the MAS and the MMAS. Results : For the inter-rater reliability of the MAS, two raters agreed on 57.3% and the Kappa values were moderate ($\kappa$=0.41) between two rater. The inter-rater reliability of the MAS was fair for the wrist flexor and the hip adductor and moderate for the other muscles. The intra-rater reliability was good for the shoulder adductor and the knee extensor and moderate for the other muscles. For the inter-rater reliability of the MMAS, two raters agreed on 84.7% and the Kappa values were good ($\kappa$=0.78) between two rater. The inter-rater reliability of the MMAS was moderate for the hip adductor, and good for the shoulder adductor and the wrist flexor, and very good for the other muscles. The intra-rater reliability was good for the wrist flexor and the hip adductor and very good for the other muscles. Conclusion : This study suggests that the MMAS translated into Korean is reliable test scale for the spasticity with stroke patients in the clinical field.

• Journal of Pharmacopuncture
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• v.3 no.2
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• pp.213-232
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• 2000

Hemiplegic shoulder pain(HSP) is one of the most frequent and difficult problems affecting poststroke hemiplegic patients. Honeybee venom acupuncture therapy(BVAT) is known for its pain relieving effects in arthralgia. To evaluate the effectiveness of BVAT on HSP, 24 patients were sequential1y allocated into BVA T treatment group and control group and monitored for 4 weeks at time interval of initial(T0), 1 week(T1), 2 weeks(T2) and 4 weeks(T4). In treatment group, 1:10000 honeybee venom solution 0.2㎖ was injected into acupoint(s) following Deqi three times a week. Kyonu(LI15) was used in the first week. Thereafter Kyonu(LI15) and Nosu(SI10) were used. Visual analogue scale of pain severity showed significant decrease in treatment group compared to control group at T2 and T4 evaluation. Painless passive range of motion of shoulder external rotation showed significant increase in treatment group compared to control group at T4 evaluation. Fugl-Meyer Motor Assessment of upper limb motor function and Modified Ashworth scale of the spasticity of upper limb showed no difference between two groups. BVAT showed as an effective therapy in HSP and further extensive clinical studies are expected.

• Korean Journal of Acupuncture
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• v.23 no.1
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• pp.95-109
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• 2006

Objectives : There has been a considerable debate about how to best control for placebo effects in clinical trials of acupuncture. Recently several sham needles were developed and validated. This study aimed at summarising the validation studies of these needles and evaluating the outcomes of the randomised controlled trials (RCTs) using them. Methods : Computerised literature searches were performed using 'acupuncture' AND 'placebo OR sham' with a limitation of the results to RCTs in Medline via PubMed and the Cochrane Library. Only formally validated sham needle controlled studies were included. Data were extracted regarding study design, condition, sample size, credibility testing, intervention and outcomes. Methodological quality was assessed using a modified Jadad scale. Results : Three validated sham needles by Streitberger, Park, and Fink, were identified. Acupuncture's effectiveness for various conditions was tested using these needles in 12 RCTs. Real acupuncture was superior to sham acupuncture for rotator cuff tendonitis and hypertension. No significant differences between real acupuncture and sham acupuncture emerged for chemotherapy-related nausea and vomiting, postoperative nausea and vomiting, menstrually related migraine, acute stroke rehabilitation, chronic/episodic tension-type headache, neutrophil respiratory burst in healthy volunteers, alcohol withdrawal symptoms and chronic poststroke leg spasticity. Conclusions : The new sham devices have been adequately validated and may be useful tools for investigating specific research question. In spite of the sham needle's limits, the results of RCTs using such devices tend to suggest that the clinical effects of acupuncture are largely due to a placebo response.

• Journal of Acupuncture Research
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• v.22 no.2
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• pp.163-170
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• 2005

Background : Over the last thirty years, majority of researches on clinical effectiveness of acupuncture have been explanatory (or experimental) randomized controlled trial. The benefits of acupuncture in clinical trials are still controversial and most studies concluded that further control studies were required. Standardized combinations of acupuncture points for all the experimental subjects in various past studies have been criticized because such treatments do not reflect current routine clinical treatment. Objective : This paper aims to review pragmatic clinical trials on the effect of acupuncture treatment and to develop the ideal clinical research methodology of acupuncture study. Method : Clinical studies of acupuncture relevant with pragmatic or individualized trials were searched mainly in Pubmed and Science direct databases. All articles were fully reviewed by researchers, and data were evaluated by usage of a standardized form. Results & Suggestion : Pragmatic acupuncture researches were tried for various symptoms (eg. low back pain, hypertension, depression during pregnancy, sleep quality in HIV disease, chronic poststroke leg spasticity, headache, etc). Individualized acupuncture treatments based on oriental disease pattern diagnosis reflexes practical treatments which is more effective than unified and fixed acupuncture treatments without any theoretical basis of oriental medical philosophy. Conclusion : To overcome the controversies and limitations of past explanatory acupuncture trials, more individualized and tailored acupuncture trials with the theoretical basis of oriental medical diagnosis is highly recommended. Also clear definition and categorization of pattern identification should be established for further active clinical researches and applications of acupuncture.