The use of Acupuncture in the treatment of incomplete spinal cord injury. Janice Champion Clinical Specialist Colin Waldock Clinical Specialist

Transcription

1 The use of Acupuncture in the treatment of incomplete spinal cord injury Janice Champion Clinical Specialist Colin Waldock Clinical Specialist

2 Learning Outcomes To enhance understanding of the use of acupuncture in individuals with an incomplete spinal cord injury To enhance understanding of potential challenges to practice, and be aware of associated implications

3 Grace

4 Patient History 53 year old lady suffered an incomplete spinal cord injury 1985 as a result of a car accident #C6/7 - independent in ADL, walks less than half a mile with one stick and AFO right foot Botulinum - for bladder and adductor muscles of lower limbs on regular basis

5 Video of Grace - early walking

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7 Examination of Gait Increased lumbar lordosis Decreased core stability Adduction/medial rotation hips Hyperextension right knee Increased activity long toe flexors

8 Acupuncture treatment Western based (1) decreasing spastic dystonia (2)improving muscle balance. e.g. by stimulating inhibited muscle and relaxing hypertonic muscle

9 Treatment one Patient s consent freely given to needling and to video assessment to aid outcome measurement Consent of treating Physiotherapist requested and obtained

10 Acupuncture plan Initial treatment aimed at tight peripheral structures Involvement of segmental levels Addition of distal points Ref Bradnam-Roberts 2007

11 Treatment one 17/4/7 Acupuncture given to muscle belly Quadratus Lumborum, attachment at iliac crest and Vastus Medialis Oblique (VMO) motor point to correct knee hyperextension Immediate improvement in trunk mobility/ stability and knee hyperextension corrected

12 Needling at L2/3 level? Medial fibres QL?? UB 23.

13 Patient perspective After treatment patient reported feeling different as though balance had changed. Can lift R leg in sitting which had not been able to do for years. Sitting more evenly on both buttocks No change in walking.

14 Treatment two 24/4/7 Improvement maintained! Trunk points repeated. Especially at level of L2/3. close relationship to Quadratus Lumborum.

15 Patient perspective Can still lift R leg in sitting higher and easier. R side back pain and tightness eased by 30% over last two weeks. R side looser. No change in walking Spasmy feeling only lasted a short time.

16 Treatment three 1/5/7 Increased tightness adductors reported Taut band clearly palpable, also low abdominal tone notable Rx to (L) adductors magnus/longus Outcome increased ability to weightbear Rx to transversus abdominis (T.Abd) Immediate enhancement of ability to cough noted

17 Adductor needling

18 Patient Perspecitve Less tightness on R side. Husband feels cough is still stronger.? any effect on walking

19 Treatment four 8/5/7 Patient reported can flex right hip actively Enhanced cough maintained Knee hyperextension happening again Rx VMO, prox. ITB, medial fibres of Glut. Medius, Tender points in T. Abd and Rectii. Post treatment examination noted lumbar lordosis with shoulder elevation -? Latissimus dorsi involvement. For treatment next time patient needs several hours after each treatment to accommodate changes

20 Patient perspective Husband feels walking is better, legs less adducted especially R knee. Manager at gym reports improved gait - walking better on treadmill. Grace feels walk from car to department is quicker and easier

21 Treatment five 15/5/7 Patient reports that walking on treadmill easier.? Functional improvements Rx as per plan to needle lat. Dorsi, (L) adductor brevis, abdominal wall needling repeated plus infraspinatus to elicit effect on upper limbs.

22 Patient perspective R leg feels stronger. Treadmill easier R leg easier to move foot to and from brake pedal!!! Husband and friend feel she is leaning on them less and is better at picking up R foot

23 Treatment six 22/5/7 Clear improvement in walking ability Rx focussed at trunk level L2/3,(Gunn 1996) hamstrings and soleus. Glut. Med. stimulation appeared to facilitate hamstring relaxation and allowed passive rotation at hip.

24 Gluteus medius needling

25 Patient perspective Happy with progress Walking easier Looking forward to treatment

26 Treatment seven 14/6/7 slight retrograde step subjectively reported though video evidence shows sustained benefit Needling focussed at paraspinal, gluteal adductor and QL muscles. Clear effects on tone noted in lower leg muscles when needling Glut med and QL attachment at iliac crest.

27 Patient perspective Slight backward step. Feels tighter as though improvement faded

28 26/6/7 Focus of Rx: Enable greater pelvic movement, improve sleep,? Beneficially effect bladder control, progress to effect upper limb control

29 Video clip of Grace walking before and during Rx

30 Video clip of Grace moving in sitting

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32 Since then Treatment unable to be given weekly Decreased subjective and objective effect noted Possible reasons = need of weekly treatment Is this viable Good use of resources? How many times would be required?

33 From here? Need for good quality research We believe we have shown that needling can give positive benefits to patient with incomplete spinal cord injury Improvements were being sustained with weekly treatment

34 To where Long term effects needs to be quantified There seems to be potential for patient benefits from inter-speciality working.

35 Summary We believe we have shown potential for acupuncture to make changes within treatment sessions We believe we have also shown some capability for sustained functional improvement.

36 Summary Perhaps most importantly has been the professional benefit resulting in improved care for the patient from collaboration between specialities. Challenges have included use of language something only noticed during write up

37 Summary Subjectively felt worse immediately after treatment. Altered responsiveness to treatment. Involvement of patient with treatment, novel use of neuro handling with needling and movement at same time.

38 References Bradnam-Roberts L (2007), A physiological underpinning for treatment progression of Western Acupuncture, Journal of Acupuncture Association of Chartered Physiotherapists, Autumn, pp25-33 Gunn C (1996) The Gunn approach to the treatment of Chronic Pain (2 nd Edn) Edinburgh UK