“ẢNH HƯỞNG CỦA ĐẦU CHÂM ĐỐI VỚI VIỆC PHỤC HỒI CHỨC NĂNG MỞ RỘNG LÊN TRONG Liệt Nửa Người.”

“ẢNH HƯỞNG CỦA CHỨC NĂNG SCALP ĐỐI VỚI VIỆC PHỤC HỒI CHỨC NĂNG MỞ RỘNG LÊN TRONG CHRONIC HEMEPLEGIA.” NGHIÊN CỨU KIỂM SOÁT NGẪU NHIÊN do Dr.K.VENKATESAN BNYS đệ trình (Reg No.461513004) Dưới sự hướng dẫn của Giáo sư Tiến sĩ RS HIMESWARI, ND (OSM), MSc (Yoga), DMT, D.Ac, YS.BSY Đã đệ trình cho Tamil Nadu Tiến sĩ Đại học Y khoa MGR, Chennai Hoàn thành một phần các yêu cầu để được cấp bằng BÁC SĨ Y HỌC TẠI CHI NHÁNH - III: CHỨC NĂNG & NĂNG LƯỢNG Y HỌC CHÍNH PHỦ YOGA VÀ BỆNH VIỆN THIÊN NHIÊN, ARUMBAKKAM, CHENNAI - 600106 THÁNG 5 2018 i ii iii BỆNH VIỆN YOGA VÀ NATUROPATHY CỦA CHÍNH PHỦ, BỆNH VIỆN, CHENNAI, TAMILNADU DO HIỆU TRƯỞNG DO HIỆU TRƯỞNG Tôi xác nhận rằng luận án mang tên “ẢNH HƯỞNG CỦA CHỨC NĂNG SCALP ĐỐI VỚI VIỆC PHỤC HỒI CHỨC NĂNG NÂNG CAO Ở CHRONIC. .VENKATESAN, thuộc Khoa Châm cứu & Y học Năng lượng, Trường Cao đẳng & Bệnh viện Y khoa & Yoga của Chính phủ, Chennai - 600 106 đã nộp bằng BÁC SĨ Y HỌC (MD) về Yoga và Naturopat hy dưới sự hướng dẫn và giám sát của tôi, và rằng công việc này không phải là cơ sở để trao bất kỳ bằng cấp, liên kết, học bổng hoặc danh hiệu nào khác trong trường Đại học này hoặc bất kỳ trường Đại học hoặc Cơ sở giáo dục đại học nào khác Ngày: CHỮ KÝ CỦA HIỆU TRƯỞNG Nơi: Chennai Dr N MANAVALAN, ND (OSM), MA (GT), M.Sc (Y&N), M Phil, PGDY, PGDHM, PGDHH, Government Yoga & Naturopathy Medical College & Hospital, Arumbakkam, Chennai - 600 106 iv. TRƯỜNG CAO ĐNG Y TẾ VÀ BỆNH VIỆN Y TẾ, CHENNAI, TAMILNADU DO THÍ SINH I, Tiến sĩ K.VENKATESAN long trọng tuyên bố rằng luận án có tiêu đề “ẢNH HƯỞNG CỦA CHỨC NĂNG SCALP ĐỐI VỚI VIỆC PHỤC HỒI CHỨC NĂNG TĂNG CƯỜNG HẤP DẪN TRONG HEMIPLEGIA CHRONIC.” ”Là công trình nghiên cứu chân thực và chân chính do tôi thực hiện tại Trường Cao đẳng Y tế & Bệnh viện Y khoa Chính phủ, Trường Cao đẳng Y tế Yoga & Naturopathy, Chennai từ tháng 7 năm 2016 - tháng 6 năm 2017 dưới sự hướng dẫn và giám sát của Tiến sĩ RS HIMESHWARI, Trưởng Bộ môn, Khoa Châm cứu và Y học Năng lượng. , Govt Yoga & Naturopathy Medical College & Hospital, Chennai Luận văn này được nộp cho Đại học Y khoa Tamilnadu Dr MGR nhằm đáp ứng một phần yêu cầu nhận Bằng MD (Nhánh - III) về Châm cứu & Y học Năng lượng Ngày: Chữ ký của Nơi ứng cử : Chennai (Dr.K.VENKATESAN) v ỦY BAN ĐẠO ĐỨC CÁCH MẠNG CHÍNH PHỦ YOGA VÀ TRƯỜNG CAO ĐNG Y TẾ VÀ BỆNH VIỆN THIÊN NHIÊN, CHENNAI - 600 106 GIẤY CHỨNG NHẬN PHÊ DUYỆT Ủy ban Đạo đức Thể chế của Chính phủ Yoga & Naturopathy Medical College Bệnh viện, Chennai đã xem xét và thảo luận về đơn xin phê duyệt của “ẢNH HƯỞNG CỦA CHỨC NĂNG SCALP ĐỐI VỚI VIỆC PHỤC HỒI CHỨC NĂNG TĂNG CƯỜNG LÊN TRONG CHRONIC HEMIPLEGIA.” cho projec Bài làm được đệ trình bởi Tiến sĩ K.VENKATESAN, Năm MD Châm cứu & Y học Năng lượng, Sau Đại học, Trường Cao đẳng & Bệnh viện Y khoa & Yoga của Chính phủ, Yoga & Naturopathy, Chennai - 600 106 Đề xuất được PHÊ DUYỆT Ủy ban Đạo đức Thể chế mong đợi được thông báo về tiến độ của nghiên cứu và phản ứng có hại của thuốc trong suốt quá trình nghiên cứu và bất kỳ thay đổi nào trong phác đồ và thông tin bệnh nhân / sự đồng ý được thông báo và yêu cầu được cung cấp bản sao của báo cáo cuối cùng vi BẢN QUYỀN TUYÊN BỐ CỦA THÍ SINH Tôi xin tuyên bố rằng Tamilnadu Dr MGR Medical Đại học, Chennai, Tamilnadu sẽ có quyền bảo quản, sử dụng và phổ biến Luận văn / Luận văn này ở định dạng in hoặc điện tử cho mục đích học tập / nghiên cứu Ngày: Chữ ký của Ứng viên Nơi ứng cử: Chennai (Tiến sĩ K.VENKATESAN) LỜI CẢM ƠN Trước hết tôi xin cảm ơn Đấng Toàn Năng vì tất cả những gì tôi may mắn, tôi cảm ơn Tiến sĩ N Manavalan, Hiệu trưởng, Govt Yoga và Cao đẳng Y tế Naturopathy, Chennai đã tạo cơ hội để theo đuổi MD trong Yoga và Naturopathy Tôi cũng cảm ơn Tiến sĩ S T.Venkateswaran HOD, Bộ môn yoga đã không ngừng hỗ trợ chúng tôi trong suốt quá trình hoàn thành bằng PG của chúng tôi. Rất vui được bày tỏ lòng biết ơn sâu sắc của tôi đối với người cố vấn, triết gia và người hướng dẫn của tôi Tiến sĩ RS Himeshwari, HOD, Khoa Châm cứu và Y học Năng lượng, GYNMC, Chennai, vì sự hướng dẫn không ngừng và động lực không mệt mỏi của cô ấy trong suốt chặng đường Tôi cũng cảm ơn bạn bè và đàn em của tôi đã luôn mở rộng sự hỗ trợ của họ. Trái tim tôi cảm ơn vợ tôi Dr. R.Priyadharsini và con trai tôi VPHishan sanjeev và mẹ, bố và các thành viên trong gia đình vì đã là chỗ dựa tinh thần cho tôi Tôi cũng ghi nhận sự hợp tác và hỗ trợ của các đối tượng đã tham gia nghiên cứu Ngày diễn ra: Chennai Dr.K.VENKATESAN DANH SÁCH CÁC BỆNH LÝ NĂNG LỰC châm cứu da đầu Xét nghiệm SA fugyl meyer Tổ chức y tế thế giới FMA Y học bổ sung và thay thế WHO Viện y tế quốc gia CAM NIH châm cứu y học phương tây WMA nghiên cứu hành động thử nghiệm cánh tay ARAT đột quỵ specifi c chất lượng cuộc sống SSQOL Tai biến mạch máu não CVA tăng căng HTN Đái tháo đường DM Động mạch não giữa MCA Cơn thiếu máu cục bộ thoáng qua TIA suy giảm sau

A Dissertation On “EFFECT OF SCALP ACUPUNCTURE ON UPPER EXTREMITY FUNCTIONAL RECOVERY IN CHRONIC HEMEPLEGIA.” A RANDOMISED CONTROL STUDY Submitted By Dr.K.VENKATESAN B.N.Y.S (Reg No.461513004 ) Under the Guidance of Prof Dr R S HIMESWARI, N.D (OSM), MSc (Yoga), D.M.T, D.Ac, YS.BSY Submitted to The Tamil Nadu Dr M G R Medical University, Chennai In partial fulfillment of the requirements for the award of degree of DOCTOR OF MEDICINE IN BRANCH – III: ACUPUNCTURE & ENERGY MEDICINE GOVERNMENT YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPITAL, ARUMBAKKAM, CHENNAI – 600106 MAY 2018 i ii iii GOVERNMENT YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPITAL, CHENNAI, TAMILNADU ENDORSEMENT BY THE PRINCIPAL I certify that the dissertation entitled “EFFECT OF SCALP ACUPUNCTURE ON UPPER EXTREMITY FUNCTIONAL RECOVERY IN CHRONIC HEMIPLEGIA.”” is the record of original research work carried out by Dr K.VENKATESAN, in the Department of Acupuncture & Energy Medicine, Government Yoga & Naturopathy Medical College & Hospital, Chennai – 600 106 submitted for the degree of DOCTOR OF MEDICINE (M.D) in Yoga and Naturopathy under my guidance and supervision, and that this work has not formed the basis for the award of any degree, associateship, fellowship or other titles in this University or any other University or Institution of higher learning Date: SIGNATURE OF THE PRINCIPAL Place: Chennai Dr N MANAVALAN, N.D.(OSM), M A (G.T), M.Sc (Y&N), M Phil, P.G.D.Y, P.G.D.H.M, P.G.D.H.H, Government Yoga & Naturopathy Medical College & Hospital, Arumbakkam, Chennai – 600 106 iv GOVERNMENT YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPITAL, CHENNAI, TAMILNADU DECLARATION BY THE CANDIDATE I, Dr K.VENKATESAN solemnly declare that dissertation titled “EFFECT OF SCALP ACUPUNCTURE ON UPPER EXTREMITY FUNCTIONAL RECOVERY IN CHRONIC HEMIPLEGIA.” ” is a bonafide and genuine research work carried out by me at Government Yoga & Naturopathy Medical College & Hospital, Chennai from July 2016 – June 2017 under the guidance and supervision of Dr R S HIMESHWARI, Head of the Department, Department of Acupuncture and Energy Medicine, Govt Yoga & Naturopathy Medical College & Hospital, Chennai This dissertation is submitted to The Tamilnadu Dr M.G.R Medical University towards partial fulfillment of requirement for the award of M.D Degree (Branch – III) in Acupuncture & Energy Medicine Date: Signature of the Candidate Place: Chennai (Dr.K.VENKATESAN) v INSTITUTIONAL ETHICAL COMMITTEE GOVERNMENT YOGA AND NATUROPATHY MEDICAL COLLEGE AND HOSPITAL, CHENNAI – 600 106 CERTIFICATE OF APPROVAL The Institution Ethical Committee of Government Yoga & Naturopathy Medical College Hospital, Chennai reviewed and discussed the application for approval of “EFFECT OF SCALP ACUPUNCTURE ON UPPER EXTREMITY FUNCTIONAL RECOVERY IN CHRONIC HEMIPLEGIA.”for project work nd submitted by Dr K.VENKATESAN, Year M.D Acupuncture & Energy Medicine, Post Graduate, Government Yoga & Naturopathy Medical College & Hospital, Chennai – 600 106 The proposal is APPROVED The Institutional Ethical Committee expects to be informed about the progress of the study and adverse drug reaction during the course of the study and any change in the protocol and patient information / informed consent and asks to be provided a copy of the final report vi COPY RIGHT DECLARATION BY THE CANDIDATE I hereby declare that the Tamilnadu Dr M G R Medical University, Chennai, Tamilnadu shall have the rights to preserve, use and disseminate this Dissertation / Thesis in print or electronic format for academic / research purpose Date: Signature of the Candidate Place: Chennai (Dr K.VENKATESAN) ACKNOWLEDGEMENT Firstly I thank the Almighty for all that I am blessed I thank Dr N Manavalan, Principal, Govt Yoga and Naturopathy Medical College, Chennai for creating an opportunity to pursue M.D in Yoga and Naturopathy I also thank Dr S T.Venkateswaran H.O.D, Dept of yoga for constantly supporting us throughout the completion of our PG degree It is a great pleasure to express my deep sense of thanks and gratitude to my mentor, philosopher and guide Dr R.S Himeshwari, H.O.D, Dept of Acupuncture and Energy Medicine, GYNMC, Chennai, for her constant guidance and tireless motivation all the way I also thank my friends and juniors for extending their support at all times My heart felt thanks to my wife Dr.R.Priyadharsini and my son V.P.Hishan sanjeev and mom, dad and family members for being my moral support I also acknowledge the subjects co-operation and support who participated in the study Date Place : Chennai Dr.K.VENKATESAN LIST OF ABBREVATIONS scalp acupuncture SA fugyl meyer assesment FMA world health organization WHO complementary and alternative medicine CAM national institutes of health NIH western medical acupuncture WMA action research arm test ARAT stroke specific quality of life SSQOL Cerebro vascular accident CVA hyper tension HTN Diabetes mellitus DM Middle cerebral artery MCA Transient ischemic attack TIA posterior inferior cerebellar artery PICA anterior inferior cerebellar artery AICA Upper extremity UE Lower extremity LE ix CONTENTS x 51 Page SJ, Levine P, Hade E Psychometric properties and administration of the wrist/hand subscales of the Fugl-Meyer assessment in minimally impaired upper extremity hemiparesis in stroke Arch Phys Med Rehabil 2012;93(12):2373–6 52.Wright A, Hannon J, Hegedus EJ, et al Clinimetrics corner: a closer look at the minimal clinically important difference (MCID) J Man Manip Ther 2012;20(3):160– 53.Ingram M, Choi YH, Chiu CY, et al Use of the minimal clinically important difference (MCID) for evaluating treatment outcomes with TMJMD patient 54 Chen RQ, Wu JX, Shen XS A research on the minimal clinically important differences of Chinese version of the Fugl-Meyer motor scale Acta Universitatis Medicinalis Anhui 2015;50(4):519–22 55.Lyle, R.C A performance test for assessment of upper limb function in physical rehabilitation treatment and research Int J Rehabil Res 1981; 4: 483–492 56 van der Lee, J.H., de Groot, V., Beckerman, H., Wagenaar, R.C., Lankhorst, G.J., and Bouter, L.M The intra- and interrater reliability of the action research arm test (a practical test of upper extremity function in patients with stroke) Arch Phys Med Rehabil 2001; 82: 14–19 58 Williams LS, Weinberger M, Harris LE, et al Measuring quality of life in a way that is meaningful to stroke patients Neurology 1999;53:1839–1843 [PubMed] 59 Williams LS, Weinberger M, Harris LE, Clark DO, et al Development of a strokespecific quality of life scale Stroke 1999;30(7):1362–9 60 Muus I, Williams LS, Ringsberg KC Validation of the Stroke Specific Quality of Life Scale (SS-QOL): test of reliability and validity of the Danish version (SS-QOL- 85 DK) Clin Rehabil 2007;21:620–627.[PubMed] 61.Boosman H, Passier PE, VisserMeily JM, et al Validation of the Stroke Specific Quality of Life scale in patients with aneurysmal subarachnoid haemorrhage J Neurol Neurosurg Psychiatry 2010;81:485– 489.[PubMed] 62.Post MW, Boosman H, van Zandvoort MM, et al Development and validation of a short version of the Stroke Specific Quality of Life Scale J Neurol Neurosurg Psychiatry 2011;82:283–286 [PubMed 61 MacPherson H, Altman DG, Hammerschlag R, et al Revised Standards for Reporting Inerventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement PLoS Med 2010;7:e1000261 64.Boutron I, Moher D, Altman DG Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration Ann Intern Med 2008;148(4):29565.Moskowitz MA, Wei EP, Saito K, et al Trigeminalectomy modifies pial arteriolar responses to hypertension or norepi-nephrine Am J Physiol 1998;255(1[pt2]):H1–H6 62 Immediate effects of scalp acupuncture with twirling reinforcing manipulation on hemiplegia following acute ischemic stroke: a hidden association study pubmed 2016;27335559(PMC4904466) 63 Effect of scalp acupuncture combined with body acupuncture on limb function in subacute stroke patients] pubmed 2012;37(6):488-92.(PMID: 23383459) 86 Appendix INFORMED CONSENT FORM Title of the study:“ “EFFECT OF SCALP ACUPUNCTURE ON UPPER EXTREMITY FUNCTIONAL RECOVERY IN CHRONIC HEMEPLEGIA.”.” Name of the Participant: Name of the Principal Investigator: Dr.K.VENKATESAN Name of the Institution: Government Yoga & Naturopathy Medical College, Chennai – 600 106 Documentation of the informed consent I _ have read the information in this form (or it has been read to me) I was free to ask any questions and they have been answered I am over 18 years of age and, exercising my free power of choice, hereby give my consent to be included as a participant in:“ “ EFFECT OF SCALP ACUPUNCTURE ON UPPER EXTREMITY FUNCTIONAL RECOVERY IN CHRONIC HEMEPLEGIA.”.” I have read and understood this consent form and the information provided to me I have had the consent document explained to me I have been explained about the nature of the study I have been explained about my rights and responsibilities by the investigator I have been informed the investigator of all the treatments I am taking or have taken in the past months including any native (alternative) treatment I have been advised about the risks associated with my participation in this study I agree to cooperate with the investigator and I will inform him/her immediately if I suffer unusual symptoms I have not participated in any research study within the past _month(s) I am aware of the fact that I can opt out of the study at any time without having to give any reason and this will not affect my future treatment in this hospital 10 I am also aware that the investigator may terminate my participation in the study at any time, for any reason, without my consent 12 I hereby give permission to the investigators to release the information obtained from me as resultof participation in this study to the sponsors, regulatory authorities, Govt agencies, and IEC Iunderstand that they are publicly presented 87 13 I have understood that my identity will be kept confidential if my data are publicly presented 14 I have had my questions answered to my satisfaction 15 I have decided to be in the research study I am aware that if I have any question during this study, I should contact the investigator By signingthis consent form I attest that the information given in this document has been clearly explained to meand understood by me, I will be given a copy of this consent document For adult participants: Name and signature / thumb impression of the participant (or legal representative if participant incompetent) Name _ Signature _ Date Name and Signature of impartial witness (required for illiterate patients): Name _ Signature _ Date Address and contact number of the impartial witness: Name and Signature of the investigator or his representative obtaining consent: Name _ Signature _ Date 88 APPENDIX -2 FUGL-MEYER ASSESSMENT UPPER EXTREMITY (FMA-UE) Assessment of sensorimotor function ID: Date: Examiner: A UPPER EXTREMITY, sitting position I Reflex activity Flexors: biceps and finger flexors (at least one) Extensors: triceps none 0 can be elicited 2 none 0 0 0 partial 1 1 1 full 2 2 2 0 1 2 none partial full Subtotal I (max 4) II Volitional movement within synergies, without gravitational help Flexor synergy: Hand from contralateral knee to ipsilateral ear From extensor synergy (shoulder adduction/ internal rotation, elbow extension, forearm pronation) to flexor synergy (shoulder abduction/ external rotation, elbow flexion, forearm supination) Extensor synergy: Hand from ipsilateral ear to the contralateral knee Shoulder Elbow Forearm Shoulder Elbow Forearm retraction elevation abduction (90°) external rotation flexion supination adduction/internal rotation extension pronation Subtotal II (max 18) III Volitional movement mixing synergies, without compensation Hand to lumbar spine hand on lap Shoulder flexion 0°- 90° elbow at 0° pronation-supination 0° Pronation-supination elbow at 90° shoulder at 0° cannot perform or hand in front of ant-sup iliac spine hand behind ant-sup iliac spine (without compensation) hand to lumbar spine (without compensation) immediate abduction or elbow flexion abduction or elbow flexion during movement flexion 90°, no shoulder abduction or elbow flexion no pronation/supination, starting position impossible limited pronation/supination, maintains starting position full pronation/supination, maintains starting position Subtotal III (max 6) IV Volitional movement with little or no synergy Shoulder abduction - 90° elbow at 0° forearm pronated Shoulder flexion 90° - 180° elbow at 0° pronation-supination 0° Pronation/supination elbow at 0° shoulder at 30°- 90° flexion immediate supination or elbow flexion supination or elbow flexion during movement abduction 90°, maintains extension and pronation immediate abduction or elbow flexion abduction or elbow flexion during movement flexion 180°, no shoulder abduction or elbow flexion no pronation/supination, starting position impossible limited pronation/supination, maintains start position full pronation/supination, maintains starting position Subtotal IV (max 6) V Normal reflex activity assessed only if full score of points is achieved in 2 none 89 full 2 0 (IV), part IV; compare with the unaffected side hyper of reflexes markedly hyperactive or points in part IV biceps, triceps, reflex markedly hyperactive or at least reflexes lively finger flexors maximum of reflex lively, none hyperactive Subtotal V (max 2) Total A (max 36) partial lively normal FMA-UE PROTOCOL B WRIST support may be provided at the elbow to take or hold the starting none position, no support at wrist, check the passive range of motion prior testing Stability at 15° dorsiflexion less than 15° active dorsiflexion elbow at 90°, forearm pronated dorsiflexion 15°, no resistance tolerated shoulder at 0° maintains dorsiflexion against resistance Repeated dorsifexion / volar flexion cannot perform volitionally elbow at 90°, forearm pronated limited active range of motion shoulder at 0°, slight finger flexion full active range of motion, smoothly Stability at 15° dorsiflexion less than 15° active dorsiflexion elbow at 0°, forearm pronated dorsiflexion 15°, no resistance tolerated slight shoulder flexion/abduction maintains dorsiflexion against resistance Repeated dorsifexion / volar flexion cannot perform volitionally elbow at 0°, forearm pronated limited active range of motion slight shoulder flexion/abduction full active range of motion, smoothly Circumduction cannot perform volitionally elbow at 90°, forearm pronated jerky movement or incomplete shoulder at 0° complete and smooth circumduction partial full 2 2 Total B (max 10) C HAND support may be provided at the elbow to keep 90° flexion, no support at none the wrist, compare with unaffected hand, the objects are interposed, active grasp Mass flexion from full active or passive extension Mass extension from full active or passive flexion GRASP a Hook grasp cannot be performed flexion in PIP and DIP (digits II-V), can hold position but weak extension in MCP II-V maintains position against resistance b Thumb adduction cannot be performed 1-st CMC, MCP, IP at 0°, scrap of paper can hold paper but not against tug between thumb and 2-nd MCP joint can hold paper against a tug c Pincer grasp, opposition cannot be performed pulpa of the thumb against the pulpa of can hold pencil but not against tug 2-nd finger, pencil, tug upward can hold pencil against a tug d Cylinder grasp cannot be performed cylinder shaped object (small can) can hold cylinder but not against tug tug upward, opposition of thumb and can hold cylinder against a tug fingers e Spherical grasp cannot be performed fingers in abduction/flexion, thumb can hold ball but not against tug opposed, tennis ball, tug away can hold ball against a tug partial full 2 2 2 Total C (max 14) D COORDINATION/SPEED, sitting, after one trial with both arms, eyes closed, tip of the index finger from knee to nose, times as fast as possible Tremor at least completed movement Dysmetria pronounced or unsystematic at least completed slight and systematic movement no dysmetria Time start and end with the hand on the knee at least seconds slower than unaffected side 2-5 seconds slower than unaffected side less than seconds difference Total D (max 6) 90 marked slight none 0 ≥ 6s - 5s < 2s TOTAL A-D (max 66) H SENSATION, upper extremity anesthesia eyes closed, compared with the unaffected side upper arm, forearm Light touch palmary surface of the hand Position small alterations in the position 0 less than 3/4 correct or absence 0 0 shoulder elbow wrist thumb (IP-joint) hypoesthesia or dysesthesia 1 3/4 correct or considerable difference 1 1 normal 2 correct 100%, little or no difference 2 2 Total H (max12) J PASSIVE JOINT MOTION, upper extremity, sitting position, compare with the unaffected side only few degrees decreased (less than 10° in shoulder) Shoulder Flexion (0° - 180°) Abduction (0°-90°) External rotation Internal rotation Elbow Flexion Extension Forearm Pronation Supination Wrist Flexion Extension Fingers Flexion Extension J JOINT PAIN during passive motion, upper extremity pronounced pain during movement or very marked normal pain at the end of the movement no pain 2 2 0 0 1 1 2 2 2 0 1 2 2 0 1 2 2 0 1 2 2 0 1 2 Total (max 24) Total (max 24) A UPPER EXTREMITY /36 B WRIST /10 C HAND /14 D COORDINATION / SPEED /6 TOTAL A-D (motor function) /66 H SENSATION /12 J PASSIVE JOINT MOTION /24 J JOINT PAIN /24 91 some pain APPENDIX -3 ACTION RESEARCH ARM TEST Instructions There are four subtests: Grasp, Grip, Pinch, Gross Movement Items in each are ordered so that:    if the subject passes the first, no more need to be administered and he scores top marks for that subtest;  if the subject fails the first and fails the second, he scores zero, and again no more tests need to be performed in that subtest;  otherwise he needs to complete all tasks within the subtest Activity Score Grasp Block, wood, 10 cm cube (If score = 3, total = 18 and to Grip) Pick up a 10 cm block _ Block, wood, 2.5 cm cube (If score = 0, total = and go to Grip) Pick up 2.5 cm block _ Block, wood, cm cube _ Block, wood, 7.5 cm cube _ Ball (Cricket), 7.5 cm diameter _ Stone 10 x 2.5 x cm _ Coefficient of reproducibility = 0.98 Coefficient of scalability = 0.94 Grip Pour water from glass to glass (If score = 3, total = 12, and go to Pinch) _ Tube 2.25 cm (If score = 0, total = and go to Pinch) _ Tube x 16 cm _ Washer (3.5 cm diameter) over bolt _ Coefficient of reproducibility = 0.99 Coefficient of scalability = 0.98 Pinch rd Ball bearing, mm, finger and thumb (If score = 3, total = 18 and go to Grossmt) Marble, 1.5 cm, index finger and thumb (If score = 0, total = and go to Grossmt) Ball bearing nd _ _ finger and thumb _ Ball bearing finger and thumb _ st rd Marble finger and thumb _ nd Marble finger and thumb Coefficient of reproducibility = 0.99 = 0.98 Coefficient of scalability _ 92 Grossmt (Gross Movement) Place hand behind head (If score = 3, total = and finish) _ (If score = 0, total = and finish _ Place hand on top of head _ Hand to mouth _ Coefficient of reproducibility = 0.98 Coefficient of scalability = 0.97 References Carroll D “A quantitative test of upper extremity function.” J Chronic Diseases 1965;18:479-491 Crow JL, Lincoln NNB, Nouri FM, De Weerdt W “The effectiveness of EMG biofeedback in the treatment of arm function after stroke International Disability Studies 1989;11:155-160 De Weerdt WJG, Harrison MA “Measuring recovery of arm-hand function in stroke patients: a comparison of the Brunnstrom-Fugl-Meyer test and the Action Research Arm test Physiotherapy Canada 1985;37:65-70 Lyle RC “A performance test for assessment of upper limb function in physical rehabilitation treatment and research.” Int J Rehabil Res 1981;4:483-492 93 APPENDIX -4 Stroke Speci!c Quality of Life Scale (SS-QOL) Scoring: each item shall be scored with the following key Total help - Couldn't it at all - Strongly agree A lot of help - A lot of trouble - Moderately agree Some help - Some trouble - Neither agree nor disagree A little help - A little trouble - Moderately disagree No help needed - No trouble at all - Strongly disagree Energy I felt tired most of the time I had to stop and rest during the day I was too tired to what I wanted to Family Roles I didn't join in activities just for fun with my family I felt I was a burden to my family My physical condition interfered with my personal life Language Did you have trouble speaking? For example, get stuck, stutter, stammer, or slur your wor ds? Did you have trouble speaking clearly enough to use the telephone? Did other people have trouble in understanding what you said? Did you have trouble !nding the word you wanted to say? Did you have to repeat yourself so others could understand you? Mobility Did you have trouble walking? (If patient can't walk, go to question and score questions 2-3 as 1.) Did you lose your balance when bending over to or reaching for something? Did you have trouble climbing stairs? Did you have to stop and rest more than you would like when walking or using a wheelchair? Did you have trouble with standing? Did you have trouble getting out of a chair? 94 Mood I was discouraged about my future I wasn't interested in other people or activities I felt withdrawn from other people I had little con!dence in myself I was not interested in food Personality I was irritable I was inpatient with others My personality has changed Self Care Did you need help preparing food? Did you need help eating? For example, cutting food or preparing food? Did you need help getting dressed? For example, putting on socks or shoes, buttoning buttons, or zipping? Did you need help taking a bath or a shower? Did you need help to use the toilet? Social Roles I didn't go out as often as I would like I did my hobbies and recreation for shorter periods of time than I would like I didn't see as many of my friends as I would like I had sex less often than I would like My physical condition interfered with my social life Thinking It was hard for me to concentrate I had trouble remembering things I had to write things down to remember them 95 Upper Extremity Function Did you have trouble writing or typing? Did you have trouble putting on socks? Did you have trouble buttoning buttons? Did you have trouble zipping a zipper? Did you have trouble opening a jar? Vision Did you have trouble seeing the television well enough to enjoy a show? Did you have trouble reaching things because of poor eyesight? Did you have trouble seeing things off to one side? Work/Productivity Did you have trouble doing daily work around the house? Did you have trouble !nishing jobs that you started? Did you have trouble doing the work you used to do? TOTAL SCORE Reference Williams LS, Weinberger M, Harris LE, Clark DO, Biller J Development of a stroke-speci!c quality of life scale Stroke 1999 Jul;30(7 96 Appendix CONTROL GROUP RAW DATA serial no Lt/rt side age FMA PRE FMA POST ARAT PRE ARAT POST SSQOL PRE SSQOL POST LT 58 26 32 16 23 97 101 RT RT 41 37 21 22 24 27 17 13 21 21 99 101 117 107 RT 55 19 21 17 19 100 114 RT 60 24 29 19 21 110 112 RT 51 21 26 15 18 112 110 RT 49 19 23 12 15 96 97 LT 38 25 28 15 15 99 102 RT 35 21 26 14 17 89 92 10 RT 60 22 31 12 18 93 95 11 RT 56 25 37 15 18 92 97 12 RT 48 22 25 13 18 102 107 13 LT 47 25 29 15 16 90 98 14 RT 36 19 22 15 17 103 109 15 RT 51 27 31 17 21 104 108 16 LT 44 25 30 19 21 109 111 17 RT 47 20 25 15 19 108 108 18 RT 43 27 32 18 17 96 99 19 RT 57 25 28 21 21 99 105 20 LT 42 22 26 15 16 101 103 21 LT 39 20 25 15 17 104 107 22 LT 35 27 31 21 23 99 102 23 RT 60 23 25 15 17 95 99 24 RT 54 22 26 18 19 89 93 25 RT 52 21 27 12 15 88 92 26 RT 46 22 26 15 17 92 99 27 LT 41 28 33 21 22 104 106 28 LT 38 33 34 18 21 101 115 29 LT 45 28 32 16 17 99 105 30 RT 38 26 27 20 22 86 90 97 Appendix SCALP ACUPUNCTURE GROUP RAW DATA scalp acupuncture group FMA ARAT ARAT POST PRE POST SSQOL PRE serial no name age FMA PRE RT 38 23 32 15 21 91 98 M RT 44 18 34 15 20 103 117 M RT 45 24 33 15 18 111 123 M RT 60 28 38 12 19 100 114 F RT 57 20 28 18 21 90 112 F LT 56 22 34 15 18 96 110 M LT 44 26 37 15 15 93 113 F LT 60 23 39 12 26 99 104 M RT 52 31 40 21 24 94 128 M 10 RT 59 20 36 18 24 104 113 F 11 RT 37 27 48 21 23 107 109 F 12 LT 49 23 31 12 27 99 110 M 13 RT 41 21 39 12 18 107 118 M 14 RT 51 27 40 20 24 100 129 F 15 LT 55 24 33 15 21 93 104 M 16 LT 53 19 27 12 22 104 109 M 17 RT 48 23 39 15 18 99 108 M 18 RT 40 20 33 12 26 90 118 M 19 RT 37 26 35 21 23 91 128 M 20 RT 57 19 23 21 24 103 105 M 21 LT 59 19 28 18 25 96 111 F 22 LT 60 31 37 19 25 105 123 M 23 LT 55 25 33 14 21 111 121 M 24 RT 52 18 32 13 27 105 109 M 25 LT 51 26 34 19 21 101 127 M 26 RT 56 17 22 18 19 99 120 M 27 LT 48 25 33 15 17 106 112 M 28 LT 39 27 31 12 15 101 119 M 29 RT 41 38 41 20 22 109 111 F 30 LT 55 39 46 21 26 99 105 M 98 SSQOL POST SEX 99