Introduction
The use of acupuncture to treat the devastating aftereffects of a stroke at first seems strange, but is grounded in a long, successful clinical precedent as well as solid scientific evidence. For the twenty centuries that acupuncture was used in China, no one ever studied its clinical effects. Only in the last twenty years have scientifically sound research trials begun to uncover the potential benefits of acupuncture for a variety of problems. Much research work still remains in the acupuncture treatment for brain injury but due to the medical, social and economic costs of stroke recovery, it is important to explore the potential utility of many credible means to effect brain recovery. Remember that the brain and central nervous system are neural networks that have a “plasticity” or a changeable nature, that means there is potential for recovery of different levels of function.

Acupuncture is not a miracle cure in stroke recovery. It is a component of rehabilitative medicine and works in conjunction with physical therapy. Just as physical therapy techniques attempt to reinvigorate the connection between the body and damaged brain areas, so too, does acupuncture - but by biochemical, vascular, and other mechanisms.

Treatment
At the University of Colorado’s Clinic for Integrative Medicine, treatment can begin as soon as a patient is physically able to attend our clinic. Patients are encouraged to begin treatment early to realize the greatest benefits.

1. Evaluation - Patients that are interested in being treated in our clinic are first evaluated by a physician who is the medical director of our service. Upon thorough evaluation, this physician will determine if it is appropriate for a patient to be referred to one of the Chinese medicine acupuncturists, who will perform the acupuncture. Unfortunately, not every patient that wishes to be treated is appropriate for an acupuncture intervention. The minimum criteria for treatment include: a) able to sit up for one hour, b) being aware and able to learn, c) having a family member who is able to attend clinic visits with you.

2. Early Detection - Ideally, once a patient is stabilized, treatment should begin as soon as possible in conjunction with physical therapy. This is because in brain injury, methods that stimulate the brain, central and peripheral nervous systems, force the nervous system components to change and grow. New connections are easier to establish in a recently injured brain than in an individual who has allowed the brain to become passive and accommodating to the injury.

3. Later Intervention - Benefits to patients that seek treatment six months or more after a stroke can still realize benefit, but with longer, more extensive acupuncture treatments.
These include:
     a. Regaining function and reducing impairment in hemiplegia and paralysis.
     b. Even in cases where functional improvement is very small, many patients report a feeling of improved mood, zest for living and increased quality-of-life (QOL).
     c. Dealing with associated symptoms that occur in recovering stroke patients such as stiff joints, rigid muscles and limbs and difficulty with urination and defecation.
     d. Treating other illness that impacts life such as problems that existed before stroke like low back pain, digestive disturbances, menstrual problems and hypertension, to name a few.

4. Acupuncture
    a. Scalp acupuncture – This technique involves inserting needles into the scalp on unique zones of the head. The needles do not penetrate or even come in contact with skull but remain in an area called the scalp galea aponeurotica while treatment is occurring. This technique is most commonly used during early intervention.
    b. Body acupuncture – This technique is used in early but primarily later interventions to deal with specific areas of the body that are impaired. Local tissues can be quite responsive to acupuncture especially when they become stiff through disuse. Depending on the physical deficit, electricity can be applied to the acupuncture needles to enhance the effects. Electroacupuncture is a sophisticated, well-researched aspect of physical medicine used throughout rehabilitative medicine and is applied at a level that is comfortable and tolerable to each patient’s preference.
    c. Ear acupuncture – Use of this method is fairly recent in history and was pioneered by French anatomists in the 1950s and 60s, and then rapidly adopted by Chinese acupuncturists. The technique is very helpful for patients experiencing headache pain as well as other body pain. The effects of ear acupuncture extend to many ailments involving the head, face and throat such as appetite, thirst, salivation and lowering blood pressure, to name a few.

5. Promising Treatments
Every brain injury is a unique event, in that patients all have individual rates of recovery that can be difficult to predict. There are, however, some general ideas based on the areas of the brain damage that guide us in identifying cases with the greatest possibility of recovery. These include:
• Difficulty walking – Can be aided by acupuncture in conjunction with PT.
• Paralysis (hemiplegia) – Benefit can be realized if the lesion occupies half or less than half of the motor pathway areas, diagnosed by CT scan.
• Difficult breathing – Often due to phlegm obstruction in the bronchi, this problem can be aided by acupuncture and herbal medicine.
• Difficult swallowing – Often referred to as “dysphagia,” difficulty swallowing is associated with a higher mortality rate and poorer quality of life due to malnutrition and increased infections. Acupuncture has been used in hospitals around the world to treat this problem.
• Incontinence – A common problem in some that is only partially treatable by drug interventions. It is frequently, but not in all cases, treated successfully with acupuncture.
• Depression – Positive mood changes often occur as a result of acupuncture treatment through the release of naturally occurring endorphins.
• “Locked-in Syndrome” – Paralysis of the extremities with intact consciousness can improve with stimulation of the sensory nerves by acupuncture treatment.

6. Less-Promising Treatments
•  Fine motor weakness and/or deficits
•  Fine sensation deficits
•  Agnosia - difficulty recognizing through one of the senses, either auditory, visual or tactile
•  Agraphia and alexia - difficulty with writing and reading
•  Anomia - difficulty with naming
•  Apraxia - difficulty with learned movements
•  Aphasia - difficulty speaking due to damage of language centers in the brain

Integrative Medicine
Historically, complementary and alternative medicine (CAM) refers to a broad range of medical and health care practices, beliefs, and products used for prevention and treatment of diseases that are presently not considered to be part of conventional western medicine. Complementary medicine refers to the use of CAM treatments in addition to the use of conventional care. Integrative Medicine is a comprehensive approach based on the belief that health is a state of complete physical, mental and social well-being not just the absence of
disease. Integrative Medicine is patient-centered, emphasizes the importance of the doctor-patient relationship while blending CAM and conventional medical care to facilitate the patient’s healing process.

The Center for Integrative Medicine (www.uch.edu/integrativemed) is an outpatient hospital-based clinic that offers the following benefits that you would not usually receive from seeing CAM providers in the community:

Safety: By receiving your care in the Center for Integrative Medicine, you can be assured that treatments are safe and won’t interfere with your conventional care.

Enhanced Communication: Our integrative medicine practitioners will communicate with your conventional health care providers to make sure that everyone is working together for your benefit. Our practitioners can “speak the language” of conventional providers and translate between different philosophies and styles.

Better Care: The care you receive in the Center is improved because it is overseen and coordinated by a physician. Additionally, the Center for Integrative Medicine is the only program in Colorado housed in a respected university medical center environment. This allows you access to world-class physicians and highly qualified, credentialed CAM practitioners in one place.

Individualized Care: The care you receive will be designed to meet your physical concerns, cultural and spiritual beliefs, and emotional and psychological needs.

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