Cerebral palsy (CP) is a syndrome caused by non-progressive brain injury and developmental defects from conception to infancy, mainly manifesting as movement disorders and postural abnormalities. In the rehabilitation treatment of children with cerebral palsy with pointed foot deformity, the author used acupuncture at the brain-clearing point, which is an extra-meridian point, to observe its effect on the correction of lower limb pointed foot deformity and intellectual development of children with spastic cerebral palsy. Song Xiaolei, Rehabilitation Center, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
General information
One hundred and sixty children who met the diagnostic criteria of spastic cerebral palsy were numbered according to the order of consultation and randomly grouped by Stata 11.0 software, and randomly divided into 80 cases each in the brain-clearing point group and the conventional acupuncture group. In the brain clearing acupuncture group, 6 cases were shed and rejected, and 74 cases (140 feet) were completed, aged 12 to 36 months, with a mean of (22±7) months; 14 cases were classified as GMFCS grade I, 25 cases were classified as grade II, and 35 cases were classified as grade III. In the conventional acupuncture group, 8 cases were dislodged and rejected, and 72 cases (137 feet) were completed, aged 12 to 36 months, with a mean of (21±9) months; 16 cases of GMFCS grade I, 27 cases of grade II, and 29 cases of grade III. The age and pre-treatment dorsiflexion angle of the feet and Comprehensive Spasticity Scale (CSS) score of the two groups were tested by two independent samples t-test, and the gender and GMFCS grading were tested by non-parametric test, and the differences were not statistically significant (all P > 0.05), and the two groups were comparable.
Treatment method
Acupuncture point: Brain clearing point (located 2 inches straight up from the midpoint of the anterior transverse stripe of the outer ankle joint, 2 inches above the outer edge of the tibia, i.e., Xiexi). Operation: 0.30 mm×25 mm
Universal brand ordinary stainless steel milli-needle. The child was placed in a seated position, the ankle joint was fixed by the assistant, and the acupuncture point was disinfected routinely and then the needle tip was directed toward the ankle joint at an angle of 45° to the skin.
Observation index
Before treatment, 30 min after the first acupuncture treatment, and at the end of the three courses of treatment, the dorsiflexion angle of the child’s foot was measured and the change in the score of the Comprehensive Spasticity Scale was evaluated to assess the immediate and long-term effects of acupuncture on the treatment of spastic cerebral palsy.
(1) Foot dorsiflexion angle measurement: The child was placed in a supine position, knees flexed at 90°, lower limbs relaxed, and the intersection of the longitudinal axis of the fibula and the outer edge of the foot was taken as the axis, and the measureer held the child’s lower leg with the left hand, the right palm heel against the child’s heel, and pressed the child’s foot with the palm of the hand to the maximum pressure, and the assistant measured the angle between the longitudinal axis of the fibula and the longitudinal axis of the fifth metatarsal with a goniometer, and the average value was taken after three times of measurement.
(2) Gesell intelligence test: It is applicable to children aged 0 to 3 years old and can objectively reflect the neuromotor and psycho-psychological development patterns of normal children, mainly including five behavioral areas: adaptive behavior, gross motor behavior, fine motor behavior, language behavior, and personal social behavior. A developmental quotient (DQ) is calculated for each domain to indicate the child’s developmental level based on the observations of the rehabilitation evaluator and parental reports. Higher scores indicate higher levels of neuromotor development. (3) Comprehensive Spasticity Scale (CSS): It is applicable to the assessment of lower limb spasticity, especially ankle spasticity, including Achilles tendon reflex, triceps muscle tone and ankle clonus. The scoring criteria are as follows: ① Achilles tendon reflex: 0 is no reflex; 1 is diminished reflex; 2 is normal reflex; 3 is active reflex; 4 is hyperreflex. (2) Ankle plantar flexor muscle tone: 0 was classified as no resistance; 2 was classified as reduced resistance; 4 was classified as normal resistance; 6 was classified as mild to moderate increase in resistance; 8 was classified as severe increase in resistance. (iii) Ankle clonus: 1 was classified as no clonus; 2 was classified as 1 to 2 clonus; 3 was classified as more than 2 clonus; 4 was classified as clonus lasting more than 30 s. There were 4 levels of clonus.
Results: In this study, using the dorsiflexion angle of the foot, the Comprehensive Spasticity Scale (CSS), and the Gesell intelligence test as efficacy evaluation indexes, it was found that acupuncture at the brain-clearing point could significantly improve the children’s joint mobility and relieve the ankle spasm, and the immediate effect was the most significant, and the evaluation results at the end of the treatment course showed that its treatment effect was still better than that of the conventional acupuncture group. The results of the intelligence test showed that the children in the Brain Clear acupuncture group had higher intellectual development than the conventional acupuncture group. Therefore, acupuncture at the Brain Clear acupuncture point is suitable for the treatment of children with spastic cerebral palsy with acromegaly and mental retardation because of its small number of acupuncture points, quick effect, multiple targets and satisfactory efficacy.