Abstract
The withdrawal reflex is a defensive reaction to nociceptive stimuli and can be used to regulate locomotor gait during rehabilitation. We investigated the effect of successive needle-pricking of the plantar and dorsal foot surfaces on poststroke lower limb function. Thirty-five hemiplegic patients, within one month after primary stroke, with an affected lower limb (Brunnstrom stage III) were randomly divided into intervention and control groups. Both groups received routine drug treatment, rehabilitation training, and upper limb acupuncture treatment on the hemiplegic side. The control group also received routine acupuncture on the hemiplegic side of the lower limb, while the intervention group received successive needle-pricking on the sole and instep of both the unaffected and affected side feet. Outcomes were assessed before inception (D0) and after three (D3) and six (D6) treatment days, using Brunnstrom stage (Ueda assessment), total Fugl–Meyer lower extremity assessment (FMA-LE) and its subscores (FMA-LE-ss), active lower limb range of motion (AROM-LL), Modified Ashworth Scale Score (MAS-LL), and manual muscle testing (MMT-LL). The Brunnstrom stage was better in the intervention group than in the control group at both D3 and D6 (P < 0.01). The total FMA-LE score and sections B, C, D, and G FMA-LE-ss were significantly better in the intervention group than in the control group at D3 and D6 (P < 0.05). The AROM-LL hip and knee flexion and hip extension improved more in the intervention group than in the control group (P < 0.05). In the intervention group, MAS-LL hip flexion significantly improved at D6 (P < 0.01). Improvement in lower limb joints on the MMT-LL in the intervention group exceeded that in the control group at D6 (P < 0.01). Successive needle-pricking on the plantar and dorsal foot aspects of Brunnstrom stage III in poststroke patients contributed to rapid lower limb motor function improvement via the withdrawal reflex. This trial is registered with ChiCTR1900020633.
Highlights
Stroke is a common cerebrovascular disease, characterised by high disability and mortality; it threatens the health of patients and increases the social burden [1]
All patients data were obtained from the Department of Neurology and Rehabilitation, Jiangsu Province Hospital of Chinese Medicine. e recruitment date was from December 5, 2017, to February 28, 2019. irty-five hemiplegic patients volunteered to participate in the study and were randomly divided into an intervention group (18 cases) and a control group (17 cases)
Primary Outcomes of the Two Groups. e Mann–Whitney U test showed that Brunnstrom stage in the intervention group was better than that in the control group at both D3 and D6 (P < 0.01; Table 2)
Summary
Stroke is a common cerebrovascular disease, characterised by high disability and mortality; it threatens the health of patients and increases the social burden [1]. In addition to protective mechanisms, the nociceptive withdrawal reflex might have potential applications in the regulation of locomotion [5]. E ultimate withdrawal reflex is determined by the location of the evoking stimulus, which is within the cutaneous reflex receptive field (RRF) [6,7,8]. A meta-analysis has shown that acupuncture involving placement of needles into the conventional acupoints has no additional effect on motor recovery after stroke [10].
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