Stimulated by Wang et al 2020.
This paper was published online on the 2nd January. I was drawn to read the abstract because the title mentioned a comparison of EA (electroacupuncture) and MA (manual acupuncture) in spasticity, although MA is referred to in the paper as body acupuncture.
The abstract suggested a difference in favour of EA in an objective outcome, so I tried to access the full text to check it out.
I was pleasantly surprised to find that I did indeed have online access (care of the Royal Society of Medicine), as this was the first time I had tried to access this journal.
The journal was launched in 1995 entitled Chinese Journal of Integrated Traditional and Western Medicine (English Edition), and it became the Chinese Journal of Integrated Medicine in 2003. A quick scan over the most recent online publications suggests that the majority of papers are concerned with Chinese herbal medicine.
The paper I am highlighting is a small study (n=36) from China in children with cerebral palsy (CP). The outcomes were measured by a blinded assessor before and immediately after a single treatment of either EA or MA. Surface electromyography (sEMG) and a functional scale was used to assess the outcome. RMS (root mean square) of the sEMG and the area under the curve of the sEMG (so called integrated EMG, or iEMG for short). The functional scale used was the MTS (Modified Tardieu Scale), which assesses a muscles response to stretch at different velocities, and is recorded by joint angle achieved either at first ‘catch’ (reflex contraction of the spastic muscle on fast passive stretch) or the maximum angle achieved with a slow stretch. An increase in the difference between these angles is associated with reduced spasticity.
The points used in each affected limb were ST36, ST37, SP6 and GB39. Obviously, I was happy to see ST36 and ST37 wired up for EA, and also to see 2Hz used at a level of 3.0mA.
But none of the points were in gastrocnemius I hear you exclaim. I too would have made such an exclamation in the past.
This group did almost exactly what I had suggested in a previous blog post on spasticity, rather than needle the affected muscle compartment as done in the paper I highlighted in the previous blog, they applied EA to an antagonist muscle. Something I had been led to try by a patient a few years ago.
Well the EA proved to be significantly better in some measures (RMS and MTS), despite the small numbers, and there were marked changes in both groups, as one might expect.
Of course, the key question is how long does this effect last? My suspicion is that it is not sustained, and it simply provides a brief window of opportunity to facilitate other rehabilitation, such as improvement in joint range or balance and mobility exercises.
I was a little surprised to see no mention of this sort of combination in the paper, and there were one or two other surprises…
The patients were 24 to 60 months old, ie 2 to 5 years! EA at 3.0mA in a 2-year-old seems rather strong, so I looked for dropouts and there were none apparently. Well it was a single treatment, so we don’t get to see how many were happy to have it again.
Another slightly odd thing was that “Children were included when they… signed the written informed consents.”
Well I cannot see this catching on in the UK just yet, but it is something to keep in mind as practitioners when we are asked to help out in difficult cases perhaps.
1 Wang L, Shan L, Du L, et al. Comparison of Electroacupuncture and Body Acupuncture on Gastrocnemius Muscle Tone in Children with Spastic Cerebral Palsy: A Single Blinded, Randomized Controlled Pilot Trial. Chin J Integr Med 2020;26:14–9. doi:10.1007/s11655-019-3082-y
2 Sánchez-Mila Z, Salom-Moreno J, Fernández-de-Las-Peñas C. Effects of dry needling on post-stroke spasticity, motor function and stability limits: a randomised clinical trial. Acupunct Med 2018;:acupmed-2017-011568. doi:10.1136/acupmed-2017-011568