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Châm cứu và Trung Quốc truyền thốngThuốc được sử dụng để điều trị bệnh bại nãotrừu tượngHầu hết y học cổ truyền Trung Quốc (TCM)phương pháp điều trị bệnh bại não ở trẻ em làcác liệu pháp không dùng thuốc, chẳng hạn như châm cứu, xoa bóp tui na và tắm thuốc.So với các phương pháp phục hồi chức năng thông thường, châm cứu, tập tễnh và các liệu pháp khácđược gọi là các liệu pháp phục hồi chức năng TCM. Ngày nay, tất cả chúng đều được cung cấp dưới dạngchăm sóc y tế cho trẻ em bại nãoở Trung Quốc. Hầu hết bệnh nhân trải qua điều trị TCM ở Trung Quốc. Ở các nước khác, liệu pháp điều trị TCM được coi là phương pháp điều trị bổ sungcho bệnh nhân bại não. Tuy nhiên,nghiên cứu nên được thiết kế khách quan hơn
Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy Shuyun Jiang Contents Introduction Treatment Acupuncture and Moxibustion Tui Na Therapy (Massage Therapy) Traditional Chinese Medication for Topical Use Comprehensive Chinese Medicine Therapy and Intervention 2 7 Complications Pain Infection Acupuncture Syncope Allergy Curved or Fixed Needles 8 8 8 Case Conclusion 12 Cross-References 12 References 12 Abstract Most traditional Chinese medicine (TCM) treatments for cerebral palsy in children are nonpharmaceutical therapies, such as acupuncture, tui na massage, and medicated baths Compared with the conventional rehabilitation, acupuncture, tui na, and other therapies S Jiang (*) Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China e-mail: yadancoo@hotmail.com are called TCM rehabilitation therapies Nowadays, all of them are provided as primary medical care for children with cerebral palsy in China Most patients experience TCM treatment in China In other countries, TCM therapies are considered complementary treatments for patients with cerebral palsy However, research should be designed more objectively Keywords Cerebral Palsy · Acupuncture · Tui na therapy · Chinese medicine # Springer International Publishing AG, part of Springer Nature 2018 F Miller et al (eds.), Cerebral Palsy, https://doi.org/10.1007/978-3-319-50592-3_90-1 Introduction Chinese medicine has a more than 5000-year history Even in today’s era, Chinese medicine still plays a significant role throughout the world In China, most clinicians would choose a therapy from traditional Chinese medicine (TCM) in combination with conventional rehabilitation as the primary intervention for children with cerebral palsy It is necessary for patients to improve their motor function before and after surgery, and treatment with TCM helps them this TCM is the preferred treatment for families of children with cerebral palsy, particularly those who live in remote areas In other countries around the world, TCM is considered to be an alternative solution when families and physicians believe that primary medical services could not solve the problems Many TCM therapies are available for patients with cerebral palsy, such as acupuncture, tui na massage, medications for external use, as well as the combined use of these treatments In TCM, no such disease as cerebral palsy exists However, some similar diseases were described in the ancient Chinese literature Cao Yuan Fang, a famous physician during the Sui Dynasty (600 A.D.), described such as disease in his book The Source of All Disease: Various Syndromes in Children, “The kids cannot walk, cannot talk at the age of 4, no tooth is grown, or no hair is grown.” Ceng Shi Rong, in the Yuan Dynasty (1200 A.D.), described in his book New Viewpoints of Children “five softness,” which can be explained as “the muscle weakness of [the] head, neck, arm[s], feet and body.” Xu Chun Fu, in Ming Dynasty (1500 A.D.) described “five stiffness and five paralysis” syndrome, which can be explained as tensions of the head, neck, arms, feet, and body, in addition to the five paralysis above In 1700 A.D., the Textbook of Traditional Chinese Medicine defined a series of “five paralyses,” “five stiffnesses,” and “five delays” (delays in standing, walking, speaking, body growth, and tooth growth) as symptoms of cerebral disabilities in children To treat these symptoms, medicinal fumigation, acupuncture, and tui na massage therapies were applied Nowadays these theories have been developed more fully, S Jiang and many families prefer to apply acupuncture, tui na massage, and Chinese herbal medicine externally to treat children with cerebral palsy Treatment Acupuncture and Moxibustion According to the etiology and pathogenesis of cerebral palsy, acupuncture and moxibustion treatments of cerebral palsy mainly include scalp acupuncture, electrical acupuncture, acupuncture point injection, among other treatment methods Scalp Acupuncture Therapy In classic theory from one Chinese medicine book, Ling Shu stated, “The twelve meridians line, three hundred and sixty-five collaterals line, all the Xue (blood) and Qi (gas) are on the surface and flow through channels.” The brain is the headquarters of human activities and is in charge of people’s spiritual consciousness and various activities Scalp acupuncture is based on the functional localization of the cerebral cortex and uses corresponding stimulation areas to treat a variety of diseases The scalp acupuncture is a method in which acupuncture needles are placed in the head to manage various conditions Based on theories of the meridians system and collaterals of organs, clinicians select the relevant acupuncture points on the surface of the head for treatment For perform scalp acupuncture, patients take a sitting or lying position, depending on which acupuncture points and areas need to be stimulated for the particular disease For example, when only one limb is involved, a contralateral stimulation area needs to be chosen if both limbs are involved, the therapist should select the respective stimulation area Before treatments, therapists should disinfect the areas Acupuncturists usually use 1.5 to in stainless steel needles The angle between the needle and scalp should be about 30 The needles should be inserted into the scalp quickly When the needle enters the lower layer of galea aponeurotica, the therapist will feel less resistance from the scalp Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy Then the needle is set parallel to the scalp and rotation continues Based on the acupuncture point, therapists usually pierce 0.5–1.0 in deep with the needle Scalp acupuncture needles are only manipulated through rotation (they are not lifted or inserted) To keep a relatively fixed depth and to switch needles easily, hold the handle of the needle with the palmar side of the thumb and the radial side of the index finger, quickly flex and extend the metacarpophalangeal joints in an uninterrupted motion, and then make the needle rotate from right to left and vice versa The needles can rotate up to 200 times each minute, turn continuously for 2–3 min, and are retained in place for 5–10 min; this is repeated two to three times, after which the needles are finally removed Hemiplegic patients are asked to exercise their limbs the needles are in place in order to strengthen the legs’ functional ability (For patients who cannot actively move, the therapist helps them perform passive movements) The therapist should pull the needle out quickly or slowly Finally, the therapist presses a sterile, dry cotton ball to the pinhole for to prevent bleeding Usually, the therapist performs scalp acupuncture every day or every other day, 10–15 times for one course, and then every 5–7 days After that, the patients continue on to the next course Dr Dong (famous acupuncture specialist in neurological diseases such as stroke, cerebral palsy, etc.) developed an innovate theory of scalp acupuncture combined with Wuzhang acupuncture in the back to make better progress in treating children with cerebral palsy (Yang et al 2014) His scalp acupuncture program was based on both the characteristics of the pathogenesis of children with cerebral palsy and the classical TCM theory that “All diseases should be managed by the spirit” and “The specific acupuncture points are relevant with the essential organs.” This theory also emphasizes that “Scalp acupuncture administer the mind and make the neuron network more active,” “Utilizing the acupuncture points in the back could manage significant function,” and “Acupuncture therapy combined with modern rehabilitation could reconstruct functional activity.” One randomized controlled clinical study explored the impact of scalp acupuncture on motor function in children with cerebral palsy (Wang et al 2010) In that study, 74 children with cerebral palsy were randomly assigned to either the treatment group or the control group Children in the treatment group were treated with an individual acupuncture treatment plan combined with physical exercise The researchers selected the Sishencong acupuncture point and many others based on motor and balance areas in Jiao’s acupuncture theory They also added more specific acupuncture points and areas according to patients’ individual disabilities For spastic cerebral palsy, acupuncture points at the premotor area and the Ashi acupuncture point (located in the spindle of spastic muscles) were selected For cerebral palsy with involuntary movement and poor coordination, the acupuncture points in the application area and the Niesanzhen point were added For mental retardation, the Ewuzhen point was added The control group was treated with Jinsanzhen therapy, which is a set of acupuncture points at Zhisanzhen, Sishencong, Niesanzhen, and Naosanzhen Treatment was conducted every other day for months The Gross Motor Function Measure (GMFM) was used to evaluate patients both before and after treatment The scores of children with spastic cerebral palsy were significantly different before and after treatment (P < 0.01) The GMFM grade was considerably improved in both groups (P < 0.01), but the treatment group experienced more improvement than the control group (P < 0.05) Scalp acupuncture combined with rehabilitation exercise has a positive effect on the motor functions of children with cerebral palsy Individual acupuncture treatment plans improve the motor functions of children with spastic cerebral palsy better than conventional treatment One study combined acupuncture and physical therapy to manage motor functions and intelligence in children with cerebral palsy and to provide more evidence for medical decisions (Wang et al 2011) The results showed that the combination of scale acupuncture with rehabilitation could effectively improve the motor function and cognitive ability of children with cerebral palsy – more so than conventional acupuncture combined with rehabilitation treatment Another randomized controlled trial compared outcomes of different retaining time of scalp acupuncture therapy (Yuan et al 2006) The results showed that retaining the needles in the points for an appropriate duration has a positive effect on improving motor function in children with cerebral palsy The optimal duration was 60 Furthermore, while the needles were retained, the therapeutic effect was more significant in children being treated with tui na massage at the same time Electrical Acupuncture Therapy Electrical acupuncture therapy could regulate the body’s physiological function, reduce pain, manage sedation, promote blood circulation, and adjust muscle tension, among other effects The amount of stimulation during electrical acupuncture treatment in patients with cerebral palsy is objective, and the frequency of stimulation can be reduced, which may lead to abnormal responses in children A randomized trial noticed effects of treatment with and without electrical acupuncture on spastic cerebral palsy (Qi et al 2008) Both the study group and the control group received conventional rehabilitation therapy and massage The study group also received electrical acupuncture therapy, whereas the control group did not receive any acupuncture treatment Patients laid on the bed, and the following acupuncture points were selected: Yongquan, Taixi, Chengshan, Chengjin, Heyang, Fuyang, and Feiyang The results showed that, compared with the control treatment, electrical acupuncture might reduce spasticity, correct the severity of toe-walking, and improve gait in children with cerebral palsy Another study focused on the effect of electrical acupuncture therapy in reducing spasticity in patients with cerebral palsy (Xie and Wang 2009) Thirty children with cerebral palsy were randomly divided into two groups: the control group, receiving conventional rehabilitation, and the treatment group, which received conventional rehabilitation and electrical acupuncture as treatment The S Jiang acupuncture points were Huatuo and Jiaji The results showed that electrical acupuncture with the Huatuo and Jiaji acupuncture points might reduce the spasticity of children with cerebral palsy Moreover, the study suggested that if the duration of treatment had been extended, the results would have been much better One randomized controlled trial used a method combining electrical acupuncture and exercise therapy for children with cerebral palsy under the age of (Tan et al 2009) The results showed that electrical acupuncture therapy combined with exercise therapy made a significant difference compared with simple exercise therapy only, and the younger the patient, the better the effect The research noted that the early diagnosis of cerebral palsy in children plays an important role in early treatment Brain Doppler ultrasonography also confirmed that the scalp acupuncture could improve cerebral blood flow in children with cerebral palsy Acupuncture Point Injection Therapy Acupuncture point injection, also known as “water needling.” So-called water needles or syringe needles are relative to original metal needles used in acupuncture The main part of acupuncture point injection therapy is to inject medicine into an acupuncture point, which is thought to significantly increase the drug’s therapeutic effects The medicine can be from Chinese medicine, Western medicine, or both Acupuncture point injection therapy was founded in the 1950s, and it vigorously modernized Chinese medicine Many clinicians started to use syringe needles instead of original acupuncture needles in clinical practice The acupuncture point injection method quickly expanded to many research fields, such as acupuncture point treatment for analgesia, and fostered significant developments This therapy is quite different from traditional acupuncture The reaction that occurs after the medicine gets into the meridian and collaterals is completely different from that which occurs with traditional acupuncture Acupuncture point injection therapy has shown efficient clinical outcomes, but the traditional meridians and Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy collaterals theory cannot fully explain and guide modern acupuncture point injection therapy The medicine for acupuncture point injection therapy is divided into two categories: vitamins and Chinese medicine Vitamins include vitamin B12, vitamin D2-calcium fructose injection Vitamin B12 is necessary for cell division and myelin integrity in nerve tissue It also participates in nucleoprotein synthesis and methyl conversion, maintains, promotes tetrahydrofolate recycling, and promotes nerve myelin quality synthesis Calcium ions are necessary to maintain the proper functions of nerves, muscles, and bones; they also are involved in regulating the secretion and storage of neurotransmitters, maintaining normal muscle excitability, and promoting the absorption of vitamin B12 An excellent TCM theory says, “Stasis leads to pain.” Chinese medicine refers to the use of herbs, such as salvia miltiorrhiza and Angelica sinensis, with the role of activating blood circulation to reduce stasis Injection of the drug into the TCM meridian and collaterals system might enhance its effects Modern medical research shows that the medication used in topical areas might promote blood circulation, expand peripheral blood vessels, improve peripheral blood distribution, repair damaged biofilms, reduce tissue damage, reconstruct homeostasis, ease disturbance of blood flow, and improve brain blood supplication with anti-inflammatory and abirritative effects Other clinical research showed a significant effect of acupuncture point injection therapy combined with functional exercise in children with cerebral palsy (Xu et al 2008) One randomized controlled trial explored acupuncture point injection therapy combined with exercise, compared with exercise alone, in the treatment of children with cerebral palsy (Chen et al 2009) The results showed that acupuncture point injection therapy could improve the motor function of children with cerebral palsy, as well as develop their intelligence and language and correct behavioral abnormalities Therefore, a combination intervention including Chinese and Western medical therapies for children with cerebral palsy might have a better outcome than a single method Acupuncture point injection therapy was used to treat hypoxic-ischemic encephalopathy (Guo 2009) The results showed that the combination of intravenous infusion of brain protein hydrolysates and acupuncture point injection with Salvia was significantly better than intravenous infusion alone Tui Na Therapy (Massage Therapy) Tui na therapy is a manipulative therapy based on the meridian and collaterals theory of Chinese medicine In general, tui na therapy comprises various categories of manipulation, such as pushing, holding, rubbing, shaking, jiggling, pressing, and plucking The primary principles of tui na therapy are to smooth the meridian and collaterals, make joints flexible, regulate yin and yang, and accelerate blood circulation The classical TCM book, Yellow Emperor Confucian, described treating weakness and spasticity with manipulative therapies The effect of tui na therapy on patients with cerebral palsy is based on the relation between the force of tui na stimulation and the function of the viscus Tui na therapy could regulate the tension and elasticity of muscles and strengthen their power and function (Jiang et al 2009) Also, tui na therapy might make the ligaments and joints more mobile and flexible, and accelerate the blood and lymphatic circulation (Ku et al 2009) All these effects may eliminate joint synovial fluid stagnation, stasis, and joint capsule contracture Because nonsurgical treatment is recommended for most children with cerebral palsy, tui na therapy has good opportunities for further development Tui na therapy can be applied to the following anthropometric areas and acupuncture points to treat children with cerebral palsy (Huang et al 2013; Lu and Jiang 2015) Supine Position First, move from the acupuncture points of Yintang to Shangxing then Touwei using the wiping method, then press and rub the area of motion at the scalp acupuncture points Second, knock the acupuncture point of Sishencong and rub the Baihui acupuncture point Third, press, knead, pinch, and clutch the limbs After point-pressing the Yanglingquan acupuncture point, pinch and squeeze the lateral part of the lower leg muscles After pinching the Taichong and point-pressing the Weizhong acupuncture points, pinch and rub the posterior of the calf down to the Achilles tendon Then pinch and knead the Achilles tendon, rubbing the Yongquan acupuncture point After point-pressing the Huantiao acupuncture point, pinch the adduction muscles of the lower limbs After point-pressing the Zhongfu acupuncture point, pinch and rub the anterior muscles of the upper arms After point-press the Jianjing acupuncture point, pinch and rub the posterior and anterior muscles of the forearms Finally, pinch the Shaochong acupuncture point Prone Position First, push the ridge area along the spine, from top to bottom, with the palmar surfaces of the index and middle fingers 20 times Second, point-press and knock the acupuncture points from Zhiyang to Mingmen along the spine Then point-press all the acupuncture points of the Pangguang meridian Finally, push the Pangguang and Du meridians Alternative Treatment According to the individual’s gait analysis, the following alternative treatments are available Triceps Surae Spasticity Roll along the posterior calf, from the popliteal fossa to the Achilles tendon, and repeat the manipulation ~5–10 times The therapist should dorsiflex the ankle and toes, with the at knee 90 flexion With the palmar surface of the thumb, knead the acupuncture points of Weizhong, Chengshan, Zusanli, Yanglingquan, and Xiexi Each acupuncture point takes about half a minute, and the best effect is achieved with feelings of sourness, pain, numbness, and bloating in the areas of the acupuncture points and meridians Knee Hyperextension In children with mild flexion of the lower limb, place a soft pillow under the knee joint Push with S Jiang the thumb on the Zusanyang and Zusanyin meridians around the knee joint; repeat this three times With the palmar surface of the thumb, slightly rub the Heding acupuncture point and inside and outside the Xiyan, Liangqiu, Zusanli, Feiyang, and Yanglingquan points The best effect is achieved with a feelings of sourness, pain, numbness, and bloating in the area of the acupuncture points and meridians Rub the bilateral collateral ligament from the popliteal fossa, rubbing around both sides of the Xiyan acupuncture point and patella until the patient feels warm Adductor Muscle Spasticity The therapist places the involved leg in abduction until the maximum passive range of motion is achieved, while the assistant helps to hold the pelvis and the involved leg at the hip joint This is repeated for 3–5 Then the therapist pushes and rubs the adductor muscles from the hip to the knee, repeating three to five times This is followed by a light plucking method used to pluck the thighs, inside the rigid tendon, dozens of times Finally, the therapist presses and rubs the acupuncture points of Huantiao, Fengshi, Zhongdu, Yangyingquan, Xuehai, and Jimen, for about a half minute at each point until the patient feels sourness, pain, numbness, and bloating in the areas of the acupuncture points Children with cerebral palsy might experience gastrointestinal disorders, resulting in malnutrition and a poor physical state Studies have shown that one-fifth of total nutrients absorbed are supplied to the nervous system Simple research indicated that tui na therapy, which focuses on promoting gastrointestinal function (Qian et al 2009), can improve the quantities of serum iron, zinc, and hemoglobin in children with cerebral palsy and can make their physical situation better With the assistance of comprehensive rehabilitation, the children can further improve the function of their entire body Selective spinal tui na therapy based on the main acupuncture points of the Du meridian reported that the severity of muscle spasticity and joint mobility were improved after treatment (Sun et al 2017) A study that mainly explored the therapeutic effect of antagonistic muscles on Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy children with cerebral palsy showed that toe walking was corrected in the majority of children, and their lower-limb motor dysfunction improved significantly after the treatment Tui na therapy applied to antagonistic muscles provides an alternative solution to spasticity in patients with cerebral palsy patients (Zhao 2008) Tui na therapy combined with ankle orthosis in children with cerebral palsy might relieve spasticity of the lower limb The results of one study showed that combined treatment plays a significant role in improving function in children with cerebral palsy (Tang et al 2009) The short-term effects of tui na therapy, which promotes the development of motion, could improve overall gross motor function in children with cerebral palsy Also, the function gained can be maintained for a short time (Chen et al 2012; Yang and Li 2016) Traditional Chinese Medication for Topical Use Some traditional Chinese medications are applied externally, through baths, fumigation, or other methods These traditional Chinese medications are absorbed quickly into the skin and accelerate blood circulation, relax muscle spasticity, and smooth the meridian According to TCM theories, the pathophysiologic mechanisms of cerebral palsy are described as an overpowering of Gan (the liver), a weakened Pi (spleen), and the existence of phlegm stasis on the meridian Chinese herbal baths, including Lycopodii herb, Gramineae, mulberry twigs, Angelica, cassia twig, caulis spatholobi, and Radix Paeoniae Alba, when combined with tui na therapy, can reduce spasticity in children with cerebral palsy These treatments work through two principal mechanisms First, the herbal bath can improve blood circulation and nutritional supplies in local muscles, thereby strengthening the muscles Second, tui na therapy can release muscle tension and spasticity (Guo et al 2014) A combined treatment using TCM fumigation with modern rehabilitation therapy in children with spastic cerebral palsy was reported (Xiao and Xi 2012) In the treatment group, 24 cases were treated with TCM fumigation, which contains Lycopodium clavatum, Artemisia rupestris, and unprocessed Radix Aconiti, combined with modern rehabilitation therapy Gross motor function was evaluated before and after treatment, and the results showed that TCM fumigation combined with modern rehabilitation therapy had significant therapeutic effects on global function in children with spastic cerebral palsy (Xiao and Xi 2012) Comprehensive Chinese Medicine Therapy and Intervention In the treatment of cerebral palsy with Chinese medicinal therapy, families often try multiple combinations of treatments for their children with cerebral palsy It is common for a child to receive both Chinese medicinal treatments and modern conventional rehabilitation at the same time With this dual treatment, the families and clinicians expect more practical outcomes for cerebral palsy One study applied plum blossom needle combined with scalp acupuncture, tui na therapy, and modern rehabilitation methods to explore a solution to involuntary motion in children with cerebral palsy Sixty cases were randomly divided into two groups: the control group, which received only conventional rehabilitation methods (Bobath, tui na therapy, and scalp acupuncture), and the treatment group, which received conventional rehabilitation and the addition of plum blossom needles on the back, at the lumbosacral spine, at the Du and Jiaji acupuncture points The two groups’ outcomes were compared, and the incurvation reflex and spasticity of muscles are improved after months of treatment Results showed that both types of treatment had significant therapeutic effects, but the treatment group, which received the plum blossom needle, showed better results (Han et al 2010) A complicated issue is how to improve the body functions after selective dorsal rhizotomy A study that combined Chinese medicine and rehabilitation used electrical acupuncture, instantaneous biofeedback, tui na therapy, and other physical therapies showed very good results Because weakened muscle strength is a complication of selective dorsal rhizotomy, it is necessary to use appropriate functional improvement therapies after the operation (Xu 2013) Complications Many complications may occur during the TCM treatments TCM is not suggested for use in patients with spontaneous hemorrhagic disease or skin infection/ulcers Pain After puncturing the needles into the acupoints and beginning needle rotation, patients may feel sourness, numbness, swelling, and pain These symptoms are completely normal and will disappear after the treatment If many capillaries exist near the acupoints, the puncturing may cause bleeding and blood congestion, and finally pain Infection Puncturing devices and needles that are not thoroughly disinfected could cause infection in children This also applies to the acupoints themselves Acupuncture Syncope If children are nervous or fearful, weak, or hungry, acupuncture may cause them to faint If fainting occurs, remove the needle immediately and allow the child to rest until their condition returns to normal Allergy Acupuncture point injection therapies and herbal baths may cause drug allergies An allergy test S Jiang must be applied before those treatments are implemented Curved or Fixed Needles If the muscles tense or the body is in the wrong position, the needles could become too hard to efficiently puncture or could become curved Nervous tension before the treatment may also cause the needle to curve or be fixed Case Case describes a 23-year-old woman with a diagnosis of cerebral palsy and diplegia, with a Gross Motor Function Classification System score of She was not born premature and did not have a low birth weight She could walk independently until the age of 3.5 years She was diagnosed with cerebral palsy at age at Huashan Hospital, Shanghai, China, which has a famous neurological department When the physician diagnosed the girl with cerebral palsy and told the family that she merely had mild motion disorder with normal cognition, there was no perfect treatment that could cure her condition at that time The parents were concerned that ineffective treatment might cause side effects, so she never received special treatment for the cerebral palsy – neither physical therapy nor acupuncture or tui na therapy to manage her mild spasticity Because she had normal cognition, the girl went to a common school After she graduated with good grades, she found a great job far from home, and she had to take the subway back and forth to the office However, the problem of instability while walking still exists, especially when going down stairs, and she must rely on handrails for help One day, she fell going down stairs and fractured her right lateral malleolus While she was recovering from the surgery, she got a prescription for a gait analysis to help make a decision for rehabilitation She made an appoint and received a full gait analysis at a gait laboratory in Shanghai The woman’s gait problems were listed as follows: Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy MotionAnalysis Patient Name: I.D # Test Date: Measure: Comment: File Name: Norm File: shenyi 3/17/16 Multiple Conditions Comparison Sagittal Joint Powers (Watts/kg) Comparison Overlay TRIMMED_WALK17.XLS 21.nrm Right (RHS to RHS) Generation Ankle Left (LHS to LHS) 3.00 3.00 2.00 2.00 1.00 1.00 0.00 0.00 –1.00 –1.00 Absorption –2.00 –2.00 Generation 2.00 2.00 1.00 0.00 Knee 0.00 –1.00 –2.00 Hip Absorption –3.00 –3.00 Generation 3.00 3.00 2.00 2.00 1.00 1.00 0.00 0.00 Absorption –1.00 –1.00 Condition Labels 2015.12.14 2016.3.17 Data Properties by Condition File (Solid) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: File (Dashed) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: File (Dotted) Rt Cycles Lt Cycles 3 2 3 2 Rt Cycles Lt Cycles 2 2 2 2 2 Rt Cycles Lt Cycles Fig The power of the lower limbs Absent heel initial contact Drop foot during the swing phase Overflexion of the knee upon absorption energy On the basis of data from the gait analysis, we found that the patient had hip joint adduction and excessive flexion, a forward pelvis, and a plantarflexed ankle joint Thus a tui na therapy program was applied Tui na therapy was referenced in 1998 by the People’s Republic of China Ministry of Health, which launched the “Chinese Rehabilitation Medicine Routine.” Tui na therapy is applied with the patient in two positions: With the patient in the prone position, roll the patient on the back from the bottom of the spine to the thoracic and lumbar spine, and roll and press the Zutaiyang and Pangguang meridians Combine this with passive hip extension Point and move the bilateral acupuncture points of Chengshan, Weizhong, and Zusanli for 20–30 s per acupuncture point Then roll the triceps surae through the Achilles tendon while the ankle undergoes passive dorsiflexion (on both sides but with focus on the left side, three to five times) With the patient in the supine position, point and rub the acupuncture points of Biguan and Xuehai for 20–30 s per acupuncture point Then roll the lateral side of the thigh muscles, and combine this with passive hip abduction The entire process takes about 45 twice a week for months After months of treatment, the woman felt more powerful and more confident when she was walking, especially down stairs Her lower limbs were much more powerful, but the left ankle showed a more significant result (Fig 1) External tibial torsion improved on the right side (Fig 2), and the maximum angle of hip extension in 10 Patient Name: I.D # Test Date: S Jiang Measure: Comment: File Name: Norm File: shenyi 3/17/16 Knee Joint Angles (deg) Comparison Overlay TRIMMED_WALK17.XLS 21.nrm Right (RHS to RHS) Flexion Flex/Extension Left (LHS to LHS) 80.0 80.0 60.0 60.0 40.0 40.0 20.0 20.0 0.0 0.0 Extension –20.0 –20.0 Valgus 20.0 20.0 10.0 10.0 Internal Tibial Torsion External 2016.3.17 Data Properties by Condition File (Solid) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: Rt Cycles 3 Lt Cycles 3 2 Rt Cycles 2 2 Lt Cycles 2 2 2 Rt Cycles Lt Cycles 0.0 0.0 –10.0 –10.0 –20.0 –20.0 File (Dashed) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: 10.0 10.0 File (Dotted) Varus/Valgus Varus Condition Labels 2015.12.14 0.0 0.0 –10.0 –10.0 –20.0 –20.0 –30.0 –30.0 Fig Knee joint motion Right (RHS to RHS) Flexion Flex/Extension Left (LHS to LHS) 60.0 60.0 40.0 40.0 20.0 20.0 Data Properties by Condition File (Solid) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: Rt Cycles 3 Lt Cycles 3 2 Rt Cycles Lt Cycles 2 2 2 2 2 Rt Cycles Lt Cycles 0.0 0.0 Extension –20.0 –20.0 Adduction 15.0 15.0 10.0 10.0 0.0 0.0 –12.6 –12.6 File (Dashed) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: 40.0 40.0 File (Dotted) 20.0 20.0 Abd/Adduction Abduction Internal Rotation 0.0 0.0 –20.0 –20.0 External –40.0 –40.0 Fig Hip joint motion Acupuncture and Traditional Chinese Medicine Used to Treat Cerebral Palsy Patient Name: I.D # Test Date: Measure: Comment: File Name: Norm File: shenyi 3/17/16 Rotation Shoulder Trailing Anterior Forward Lean Posterior Shoulder Up Lateral Flexion Shoulder Down Condition Labels Trunk Orientation Relative to Room Comparison Overlay 2015.12.14 TRIMMED_WALK17.XLS 21.nm 2016.3.17 Right (RHS to RHS) Shoulder Forward 11 Left (LHS to LHS) 20.0 20.0 10.0 10.0 0.0 0.0 –15.0 –15.0 10.00 10.00 5.00 5.00 0.00 0.00 –5.00 –5.00 –10.00 –10.00 4.00 4.00 2.00 2.00 0.00 0.00 –2.00 –2.00 –4.00 –4.00 –6.00 –6.00 Data Properties by Condition File (Solid) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: Rt Cycles 3 Lt Cycles 3 2 File (Dashed) TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: TRIMMED_WAL: Rt Cycles Lt Cycles 2 2 2 2 2 Rt Cycles Lt Cycles File (Dotted) Fig Pelvic joint motion terminal support phase was larger on both side (Fig 3) The woman, now in her twenties, has started to have initial contact with the heel for the first time – although she should have experienced this at no more than years old In the foot pressure test, the trajectory of the center of pressure changed to the hindfoot, and pelvic motion and the center of mass moved to the posterior (Figs and 5) She and her family have started to accept various rehabilitation remedies, including speech therapy She had slightly abnormal pronunciation, which was affected by spasticity Before treatment she had refused to marry anyone, but now she has started to think about marriage She and her family are happy that her motor function has recovered significantly However, she works and sometimes had little time to the exercises and therapy After months she felt a bit worse, and we again evaluated her gait Compared with data from the previous analysis, we found that her function had worsened, but was still better than that before the tui na therapy We hope she can find an appropriate balance between work and rehabilitation, so that she can benefit 12 S Jiang 2015/12/14 T1 T2-5 M1 M2 M3 M4 M5 MF HM Right Foot Left Foot HL T1 2016/3/17 T2-5 M1 M2 M3 M4 M5 MF HM Left step #1 Right step #1 HL Fig Foot pressure from long-term intervention Her goal is to live a normal life Cross-References Conclusion ▶ Complementary and Alternative Medicine in Cerebral Palsy ▶ Manipulative Treatment for Persons with Cerebral Palsy Nowadays, many options for remedies are available for children with cerebral palsy, and these children’s parents always experience new challenges It is confusing and difficult to decide what kind of medical care is necessary and beneficial for a child with cerebral palsy TCM therapies are still not fully explained, and clinical research should include more randomized controlled multicenter trials with large samples to confirm the outcomes Also, various races and countries should be included References Chen T, Wu Y, Meng Q (2009) Acupoint injection with functional training in the treatment of children with cerebral palsy Liaoning J Tradit Chin Med 7:1201–1203 Chen D, Zhong N, Huang H (2012) 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