ABSTRACT
145 cases of paralysis due to poliomyelitis between
the age of 9 months and 22 years were studied for the effect of
Acupuncture Therapy at the "Indian Acupuncture Research Training Centre",
RamsagarPara, Raipur, INDIA, over a period from June 1975 to December
1978.
Involvement of one limb was found in 66.9% of two limbs in
26.2% and of more than two limbs in 4.8% cases, 102 patients (70.3%) had
grade 'O' muscle power when therapy was started. 61 cases(42.07%) showed
good improvment and 12 cases (8.2%) showed no improvment after varying
period of treatment. the remaining cases showed slight to moderate
improvment. The criteria for assessment of improvment will be
discussed.
Better improvment in power was seen after therapy for
more than 30 days.
Benificial effect of acupuncture therapy as
shown in the study is being compared with conventional methods of
treatment at this
centre.
INTRODUCTION
Acupuncture therapy has been claimed to be
benificial in various acute and chronic nourological conditions including
conditions associated with pain (Rudolph, A.N. -1974). Jayasuriya,
A.&Fernando, F. 1977) has shown 46% sucess in treatment of
poliomyelitis by acupuncture therapy.
Poliomyelitis is a common
includes rest, Orthopaedic appliances, physiotherapy and arthopaedic
correction at later age if required. These conventional forms of therapy
are generally known to be unsatisfactory and have no limited sucess in
preventing ultimate disability. (Jayasuriya A) The rate and degree of
recovery depands upon the natural history of the disease, the number of
the neurones affected and the extent of their functional impairment rather
than the effectiveness therapy produces remearkably rapid and at times
dramatic improvement of motor function and relief from accompanying
disabilities.
The aim of this study was to note the effects of
acupuncture therapy on cases of Polio -
Paralysis.
MATERIALS AND METHODS
145 cases of paralysis due to poliomyelitis
attending the Acupuncture Clinic of " India Acupuncture research &
Training Centre", Raipur, M.P., INDIA during the period from June 1975 to
Dec. 1978, constituted the material for the present study.
The
diagnosis of poliomyelitis was based on the history and Clinical
examination. a lower motor acuron type of paralysis after febrile illness
was considered as polio. In all the cases muscle testing and evaluationof
motordamage was done, as advocated by the M.R.C.(Great Britain). The age
of patients included in the ranged from 9 months to 22 years, and reported
for treatment within 3 months to 16 years after the initial
attcak
SELECTION OF ACUPUNCTURE
The points for acupuncture
wereselected from the following group limb affected by poliomyelities and
the muscle affected (Jayasuriya A. & limbs A. Fernando F. 1977). The
points selected for the treatment of the affectedlimbs are as
follows:
I. POINTS FOR THE UPPER
EXTREMITY PARALYSIS
| 1 |
Hegu |
(LI-4) |
2 |
Shousanli |
(LI-10)
|
| 3 |
Quchi |
(LI-11) |
4 |
Binao |
(LI-14)
|
| 5 |
Jianyu |
(LI-15) |
6 |
Yanglao |
(SI-6)
|
| 7 |
Jianzhen |
(SI-9) |
8 |
Waiguan |
(SJ-5)
|
| 9 |
Tainjing |
(SJ-10) |
10 |
Tianliao |
(SJ-15)
|
| 11 |
Jianlio |
(SJ-14) |
12 |
Jianshi |
(P-5) |
| 13 |
Shenmen |
(H-7) |
14 |
Tiamuan |
(L-9) |
II POINTS FOR LOWER
EXTRAEMITY PARALYSIS
| 1 |
Biguan |
(ST-31) |
2 |
Femur-Futu |
(ST-32) |
| 3 |
Dubi |
(ST-32) |
4 |
Zusanli |
(ST-36) |
| 5 |
Fenglong |
(St-40) |
6 |
Netting |
(ST-44) |
| 7 |
Chengpu |
(UB-36) |
8 |
Yinmen |
(UB-37) |
| 9 |
Weizhong |
(UB-40) |
10 |
Chengshan
|
(UB-57)
|
| 11 |
Kunlun |
(UB-60) |
12 |
Muantiao |
(GB-30) |
| 13 |
Fengsht |
(GB-31) |
14 |
Yanglingquan |
(GB-34) |
| 15 |
Taixi |
(K-3) |
16 |
Quanuan |
(Liv-8) |
| 17 |
Sanyinjiao |
(SP-6) |
|
|
|
Yanglingquan(GB-34) is the specific that for muscle and
tendons which was used in all cases irrespective of the part
affected.
Baihui (DU-20) was used in all the cases above the age of
five years.
ELECTRICAL PULSE
STIMULATION:
In all the cases the neddles were connected to an
electric pulses stimulator (Medi-puncture, Model -922, Hong Kong). The
frequency of the pulse was adjusted to 60 to 120 cycles per minute with an
intensity of 4 to 10 volts. The pulsatile current of adjustable type was
used. The intensity of the stimulation was gradually increased depending
on the patient's sensitivity and tolerance to the
stimulation.
COURSE AND TIME OF
THERAPY:
The patiemts were treated
by the acupuncture in the following manner:
A) One
sitting daily for 10 days.
B) Then a rest period for
10 days.
C) Followed by another course daily for 10
days.
D) Then again a rest for 20
days.
E) Followed by a course of sitting, on alternate
day.
The patients were out on Electro-Stimulator, and needles were
stimulated daily for about 20 to 30 minutes.
At the termination of the
therapy the patients were re-examined for muscle power and signs of
improvement.
CRITERIA FOR ASSESSMENT OF
IMPROVMENT:
A) Good :
Improvement in muscle power by 4 to 5 stages and any cases in which power
became grade 5
irrespective of the grade at the starting of the treatment.
B)
Moderate :
Improvement in muscle power by 2 or 3 stages.
C)
Slight:
Improvement in muscle power by 1 stage.
D) No
Improvement: No change in muscle
power.
OBSERVATION
70 (48.27%) cases were below
the age of 3 years. 27 (18.62%) cases between the age of 3 and 5 years and
48 cases (33.1%) were above that age (Table No.1) The youngest patient was
9 months and the oldest was 22 years of age. Males were more affected than
females in the ratio of 1.74:1.
TABLE NO. 1
Table showing age and sex
distribution of cases
|
9 Months-3 Years |
3-5Years |
Above 5 Years |
Total |
| Male |
45(31.03%) |
18(12.41%) |
29(20%) |
92(63.44) |
| Female |
25 (17.24%) |
9(6.21%) |
19(13.10%) |
53 |
| Total |
70 (48.27%) |
27(18.62%) |
48(33.1%) |
145(100%) |
Involvement of one limb was found in 97 cases (66.90%) of
two limbs in 41(28.28%) and of more than two limbs in 7(4.82%) cases
(Table 2)
TABLE NO. 2
Table showing site of damage of
extremity
| One
Limb |
Two Limb |
Multiple Limb |
| 97 |
41 |
7 |
| (66.90%) |
(28.28%) |
(4.28%) |
Table No. 3 shows the degree of muscular
weakness before the treatment started. Most of the patients (70.34%) had
grade '0' Power.
TABLE NO. 3
| Grade 0 |
Grade I |
Grade II |
Grade III |
Grade IV |
Grade V |
| 102 |
33 |
6 |
4 |
0 |
0 |
| (70.34%) |
(22.76%) |
(4.14%) |
(2.76%) |
- |
- |
28 cases (19.30%) received treatment for 10
sittings. 37 cases (25.52%) for 20 sittings and 80 cases (55.18%) for 30
sittings, (Table No. 4).
TABLE NO. 4
Showing relationship of duration of
Acupuncture Therapy in terms of Improvement
| No. of Sittings |
Total No.of |
No Improvement |
Slight Improvement |
Moderate Improvement |
Good Improvement |
| 10 |
28(19.30%) |
5(17.86%) |
11(29.28%) |
6(21.43%) |
6(21.43%) |
| 20 |
37(25.52%) |
3(8.11%) |
9(24.32%) |
11(29.73%) |
14(37.84%) |
| 30 |
80(55.18%) |
4(5%) |
9(11.25%) |
26(32.5%) |
41(51.25%) |
| Total |
145 |
12(8.28%) |
29(20%) |
43(29.66%) |
61(42.07%) |
61 cases (42.07%) showed good improvement, 43(29.66%) showed
moderate improvement. 29(20%) slight improvement, and 12(8.28%) showed no
improvement in the muscle power, irrespective of the duration of therapy.
In relation to the duration of therapy received it was observed that
improvement was better with longer duration of treatment. Out of 80
patients who received treatment for more than 30 sittings, 41(51.25%)
showed good improvement. Ascompared to this in patoents who received the
treatment for 10 to 20 sittings, good improvement was observed in
6(21.43%) and 14(37.84%) cases respectively(Table No. 4).
37 cases
came for therpy within 6 weeks to 3 months from the onset, 18 cases within
3 onths to 1 years, 9 cases within 1 to 2 years and 81 cases after 2 years
of onset. The percentage of good improvement is remarkably higher in those
patients in whom the treatment was started within 1 year from onset of the
disease (Table No.5)
| Interval between the onset of the disease and
starting of treatment |
No. of cases |
No Improvement |
Slight Improvement |
Moderate Improvement |
Good
Improvement |
| 6 weeks to 3 months |
37 |
0 |
4 |
11 |
22(59.46%) |
| 3 months to 1 year |
18 |
2 |
3 |
3 |
10(55.56%) |
| 1 year to 2 year |
9 |
0 |
2 |
4 |
3(33.33%) |
| 2 years and above |
81 |
10 |
20 |
25 |
26(32.10%) |
| |
145 |
12 |
29 |
43 |
61(42.07%) |
DISCUSSION
In India poliomyelitis is still a common disease. The exact
incidence of polio in our country is different to assess. As reported in
W.H.O. report for the year 1972, 4331 cases of poliomyelitis were
diagnosed. A large proporation of these cases are crippled.
Numerous
method pf physical therapy such as message, heat treatment, excercise and
electro-therapy do not appera to have any significant effect on the long
term prognosis of this disorder although they may be helpful in preventing
complication like muscular wasting, constructure and other
deformities.
By the judicious use of acupuncture it was found that this
therapy shows satisfactory motor recovery in a significant proportion of
our cases.
It is a well established fact that acupuncture affords
relief of pain which has been explained on the basis of the gate control
theory pain proposed by R.Melzack and P.D. Wall in 1965, Regarding the
motor effects of acupuncture however, there is still no satisfactiry
explanation. Jayasuriya A. and Fermando F. have expalined the phenomenon
of late motor recovery by the "Motor gate Therapy". According to this
theory the lower motor neuron failed, as in poliomyekitis to function in
most cases because the disease has closed "Functional Gate" therapy
preventing the motor impulses from reaching paralysis and should therefore
be the logical point of attach in any retional from of therapy for
poliomyelitis.
Conventional methods of treatment and drugs are unable
to open this gate.But acupuncture therapy by setting up aheavy afferent
barrage at the gate or by initiating a stream of antidromic impulses to
impinge on the anterior horn cell, is able to do so either completely or
partially.
these effects are considerably enhanced by suing strong
mannual or electric stimulation.
CONCLUSION AND
SUMMARY.
Following observation
were made following acupuncture therapy in case of polio-Paralysis.
1.
Acupuncturetherapy appeared to be effective in cases of paralysis from
poliomyelitis. Good improvement in muscle power was noted in 42.07%
cases.
2. Better improvement in motor power was noted in patients who
reported for treatment within one year from the onset of disease.
3.
Better improvement was observed in cases treated for 30 sittings or
more.
The present study shows that acupuncture therapy plays an
important role in the long term rehabiliation of the patients of
poliomyelitis where conventional methods have not been proved to be very
satisfactory. A comparative study of acupuncture and other methods of
therapy in the management of poliomylitis in warranted and it being
carried out at this centre. This is especially important looking to the
cripping nature of the
disease.
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