Effect of manual acupuncture and transcutaneous electrical nerve stimulation on the H-reflex

Modern acupuncture-like stimulation methods: a literature review

Acupuncture therapy has been proved to be effective for diverse diseases, symptoms, and conditions in numerous clinical trials. The growing popularity of acupuncture therapy has triggered the development of modern acupuncture-like stimulation devices (ASDs), which are equivalent or superior to manual acupuncture with respect to safety, decreased risk of infection, and facilitation of clinical trials. Here, we aim to summarize the research on modern ASDs, with a focus on featured devices undergoing active research and their effectiveness and target symptoms, along with annual publication rates. We searched the popular electronic databases Medline, PubMed, the Cochrane Library, and Web of Science, and analyzed English-language studies on humans. Thereby, a total of 728 studies were identified, of which 195 studies met our inclusion criteria. Electrical stimulators were found to be the earliest and most widely studied devices (133 articles), followed by laser (44 articles), magnetic (16 articles), and ultrasound (2 articles) stimulators. A total of 114 studies used randomized controlled trials, and 109 studies reported therapeutic benefits. The majority of the studies (32%) focused on analgesia and pain-relief effects, followed by effects on brain activity (16%). All types of the reviewed ASDs were associated with increasing annual publication trends; specifically, the annual growth in publications regarding noninvasive stimulation methods was more rapid than that regarding invasive methods. Based on this observation, we anticipate that the noninvasive or minimally invasive ASDs will become more popular in acupuncture therapy.

The mechanistic studies of acupuncture and moxibustion in Taiwan

Traditional Chinese acupuncture has a history of over 2500 years. It is effective in the treatment of many conditions with few side effects. The best known mechanism is via endogenous opiates and their receptors. In addition to opioids, researchers have focused on the role of central monoamimergic systems. Acupuncture therapy is used not only to relieve pain but also to treat various medical conditions in traditional Chinese medicine (TCM). Some experiments have revealed a relationship between acupuncture and the autonomic nervous system (ANS). Besides, electroacupuncture (EA) can modulate the imbalance between innate and acquired immune systems. This review is focusing on the mechanistic studies of acupuncture that my colleagues and I have performed in Taiwan in recent years. We found that EA analgesia was closely related to not only the serotonergic neurons but also the adrenergic neurons in the central nervous system. The electrophysiological recordings suggested the involvement of the cerebral cortex in acupuncture. Local somatothermal stimulation inhibited the motility of sphincter of Oddi and internal anal sphincter through nitrergic neural release of nitric oxide. Mild local heat stress upregulated hepatic gene expression of heat shock protein 70 and protected the liver from subsequent ischemia-reperfusion injury. These studies supplement the knowledge of the mechanism of acupuncture.

Does electrical stimulation reduce spasticity after stroke? A randomized controlled study

OBJECTIVE

To investigate the therapeutic effect of electrical stimulation on plantarflexor spasticity in stroke patients.

DESIGN

A randomized controlled clinical trial study.

SETTING

Rehabilitation clinic of Semnan University of Medical Sciences.

SUBJECTS

Forty stroke patients (aged from 42 to 65 years) with ankle plantarflexor spasticity.

INTERVENTION

Fifteen minutes of inhibitory Bobath techniques were applied to one experimental group and a combination of 9 minutes of electrical stimulation on the dorsiflexor muscles and inhibitory Bobath techniques was applied to another group for 20 sessions daily.

MAIN MEASURES

Passive ankle joint dorsiflexion range of motion, dorsiflexion strength test, plantarflexor muscle tone by Modified Ashworth Scale and soleus muscle H-reflex.

RESULTS

The mean change of passive ankle joint dorsiflexion in the combination therapy group was 11.4 (SD 4.79) degrees versus 6.1 (SD 3.09) degrees, which was significantly higher (P = 0.001). The mean change of plantarflexor muscle tonicity measured by the Modified Ashworth Scale in the combination therapy group was -1.6 (SD 0.5) versus -1.1 (SD 0.31) in the Bobath group (P = 0.001). Dorsiflexor muscle strength was also increased significantly (P = 0.04) in the combination therapy group (0.7 +/- 0.37) compared with the Bobath group (0.4 +/- 0.23). However, no significant change in the amplitude of H-reflex was found between combination therapy (-0.41 +/- 0.29) and Bobath (-0.3 +/- 0.28) groups.

CONCLUSION

Therapy combining Bobath inhibitory technique and electrical stimulation may help to reduce spasticity effectively in stroke patients.

Acupuncture and the modulation of cortical excitability

Although acupuncture is increasingly utilized for medical therapy, its mechanism of action remains uncertain. We used transcranial magnetic stimulation to demonstrate lateralized effects of motor cortex excitability with this technique. Right-sided reduction in motor cortex excitability and a tendency to the opposite effect on the left side was seen with acupuncture. Sham needle insertions did not result in significant changes of motor cortex excitability. These findings provide new neurophysiological evidence of cortical excitability modulation complementary to findings derived from functional neuroimaging studies.