Maiduguri based acupuncturist ,Dr Kaka Kyari speaks on stroke rehabilitation.He holds Bsc in Botany ,Bsc in Herbal Medicine and MD in Acupuncture (OIUAM)
Jounalist: Tell us about stroke.
Dr Kaka Kyari: Due to an aging population, dietary changes, and work-related stress, stroke morbidity is on the rise and the age at first occurrence is getting younger. Stroke is responsible for increasingly high rates of mortality and disability worldwide. World Health Organization estimates that 15 million individuals suffer from stroke annually.
Journalist: What are the causes of stroke?
Dr Kaka Kyari: Hypertension, Hypercholesterolemia, diabetes and Cardiac diseases are responsible for Stroke – which is the third leading cause of fatality and ranks highest as a cause of disability.
Journalist: What made acupuncture so unique and special in stroke rehabilitation.
Dr Kaka Kyari: Earlier to inclusion of Acupuncture, Post-stroke cares with one to two weeks of physiotherapy, occupational therapy and speech therapy – produced incomplete results; the following disabilities were observed six months after stroke in studies conducted in 65 year old survivors:
• 50% had some hemiparesis
• 30% were unable to walk without some assistance
• 26% were dependent in activities of daily living
• 19% had aphasia
• 26% were institutionalized in a nursing home
Acupuncture – a major drugless resource is a low-risk treatment and effective for post stroke rehabilitation. It has been extensively used to treat stroke for several millennia and regarded as a very effective and popular intervention. Systematic clinical trials have proved the effects on improving dependency, global neurological deficiency – known as Qi deficiency and overall structured Neurotransmitter flow in people with stroke.
Journalist: How soon should acupuncturist start therapy after stroke?
Dr Kaka Kyari: Acupuncture should intervene promptly, as it has exceptional value in the first 3 to 72 hours. The best treatment windows are, in decreasing order of therapeutic value: (1) the first three hours, (2) the first three days, (3) the first week, (4) the first month, (5) the first three months, and (6) the first six months. Both ischemic and hemorrhagic stroke can receive acupuncture treatment from the first day, but they differ in operation details.Speech recovery will be much possible only if Acupuncture is started immediately. In China and Japan, an acupuncturist is likely to start therapy as soon as possible after a stroke since Acupuncture opens blood vessels for better flow and decreases clotting and inflammation.
Journalist: What is the frequency of treatment?
Dr Kaka Kyari: An Acupuncturists with experience in treating stroke believe treatment 3 times a week as optimal. Several approaches have been used to treat stroke, demonstrating that acupuncture for this disorder remains a healthcare art.
Journalist: How does acupuncture treats swallowing difficulties after stroke?
Dr Kaka Kyari: Post-stroke condition known as dysphagia – that makes eating and drinking challenging and results in choking and aspiration was found to be set right in a few sessions. comparing different treatments for dysphagia in people who had a stroke within six months of enrolling in the study. In their review, the report authors found evidence that acupuncture reduced dysphagia.
Journalist: How is spasticity reversed?
Dr Kaka Kyari: Within six months post-stroke combined with conventional care can help to reduce spasticity in the upper and lower limbs. The muscle stiffness and involuntary contractions can be brought down greatly using Electric Stimulation of Points moderately.
Journalist: How does acupuncture restores neuro-plasticity & structural reorganization?
Dr Kaka Kyari: In recent studies it was found that structural neuro-plastic changes in the grey matter volume (GMV) of the brain, in the key regions viz., supplementary motor area (SMA) as well as the Frontal and Parietal Sensory-Motor areas and hippocampus – responded well to Acupuncture intervention.
Structural reorganization resulted due to the potential mechanism of acupuncture treatment for ischemic stroke – resulting in motor and cognition recovery.
Journalist: Explain the mechanism in details.
Dr Kaka Kyari: Acupuncture seems to solve the penumbra surrounding the core of the stroke. Usually, about 72 hours after a stroke, cerebral edema starts to form and it is very damaging. Acupuncture triggers changes in the brain that result in the protection of brain cells from necrosis, thereby preventing or reducing edema and consequently promising a better prognosis. The often dramatic results in stroke patients suggest that acupuncture could promote the reperfusion of the brain in a very short time through the activation of the collaterals or the dissolution of fibrin around the clot.
The Structured Neurotransmission can be achieved in Acupuncture treatment by using the Jueyin Meridians of the foot and hand (Liver and Pericardium as the world knows) – that occupy the spaces of the intra-peritoneum, Diaphragm and Pericardium through the Vena Cava. The points along this meridian can open the inner gates to allow the Qi and Blood to flow smoothly and quickly.
Moreover, the Posterior midline, along neck and occipital ascending the corona and descending anterior into the upper labium, contains potentially active neural crest cell activity to enhance the Nitric Oxide perfusion needed for the restoration of blood flow to brain areas.
Journalist: There are difference types of acupuncture such as meridian, auricular, scalp, reflexology, etc which one is applied for stroke rehabilitation?
Dr Kaka Kyari: For neurological conditions such as strokes, scalp acupuncture is by far the most effective with the correct needle manipulation. Acupuncture is not just about inserting needles at certain points; it is about regulating the qi flow. Hence manipulation of the needles is necessary to elicit DeQi – the sensation of a spark flowing along the meridians (Progressive Meridian Sensation).If the patient is hypertensive, nervous or still hemorrhaging, very light stimulation is desirable on the scalp treatment areas.
Journalist: In acupuncture, what is the secret behind “setting mounting on fire”?
Dr Kaka Kyari: The paralyzed side of the body may feel colder to touch. When this happens, the classical technique “Setting Mountain on Fire” often brings miraculous change to the body temperature. Technically setting mountains on fire entails Unblocking the channels, warming the Yang and promoting Qi, as these practices are called in Chinese medicine, will certainly benefit the patient’s speedy recovery. However, this warming effect is not achievable through electrical stimulation.
Journalist: Is strong stimulation always necessary?
Dr Kaka Kyari: During the recovery stage, one can use stronger stimulation both on the scalp and meridian. A comatose stroke patient whose vital signs are stable needs stronger stimulation. Strong stimulation is contraindicated for spasms.
Journalist: Briefly summarize the general technique involved acupuncture stroke rehabilitation.
Dr Kaka Kyari: In every Acupuncture session the following should be integrated – Psychological counseling, encouragement, building the patient’s confidence to heal, helping the patient to relax, and teaching the patient how to talk and to move. A proactive approach not only speeds up recovery, it boosts the patient’s self-confidence. A stroke patient with dysarthria or Broca’s aphasia is instructed to move his/her tongue in different directions and make sounds during acupuncture.
A stroke patient with facial palsy is instructed to open/close his/her affected eye, and to exercise his/her face muscles during acupuncture.
A stroke patient with paralytic lower limb is instructed to stand and walk with support.
A stroke patient with paralytic upper limb is instructed to push and pull on his/her affected arm during needle manipulation.
Journalist: What final message do you have for Nigerians about acupuncture stroke rehabilitation.
Dr Kaka Kyari: Primarily, Acupuncture can be a major benefit to stroke rehabilitation when administered correctly. Results are most remarkable in the acute stage. First, treatment must begin promptly. Earlier intervention promises fewer deficits.
Secondly, an effective acupuncture system should be employed. Scalp acupuncture excels over body acupuncture in treating neurological conditions such as strokes. Meridian acupuncturist should know how to activate and re-structure the Qi in an otherwise deficient state. After insertion, needles should be manipulated to ensure Qi flow.
Thirdly, appropriate counseling and other therapies should be carried out simultaneously.
Finally, treatments have to be repeated frequently for reinforcement. In this manner a stroke patient will achieve a faster and more complete recovery.
By sharing this, we hope that acupuncture treatments for stroke can be optimized and that Govt should encourage future research on this topic to yield more meaningful results.