Self-made Chinese herbal compound decoction on the frequency of attacks and symptom improvement in patients with external contraction limb joint spasms
Abstract
Background: After suffering a stroke, external contraction limb joint spasms frequently occur as a sequela, leading to increased muscle tension in patients and affecting the normal control of contraction and relaxation of limbs and joints, significantly impacting their daily activities and productivity. Current clinical treatments often rely on surgery or anti-spasm medications, which may be accompanied by prolonged treatment durations and significant side effects. These methods only provide short-term relief from muscle tension and spasms, falling short of satisfactory results. Therefore, there is an urgent need to explore effective biomechanical therapies to alleviate limb joint spasms. Traditional Chinese medicine, with its unique theoretical framework and treatment modalities, has garnered global attention. This study aims to investigate the impact of a self-made traditional Chinese medicine compound decoction on the frequency of attacks and symptom improvement in patients suffering from external contraction limb joint spasms, hoping to offer additional avenues for the development of traditional Chinese medicine in treating limb joint spasms. Objective: To evaluate the biomechanical effects of the self-formulated Chinese medicine compound decoction on the frequency of attacks and symptom improvement in patients with external contraction limb joint spasms. Methods: A total of 94 patients with external contraction limb joint spasms following stroke were randomly allocated into two groups: the traditional Chinese medicine (TCM) group and the rehabilitation group, each consisting of 47 patients. The rehabilitation group received routine symptomatic treatment for stroke and biomechanical rehabilitation training, while the TCM group received the self-formulated Chinese medicine compound decoction in addition to routine treatment and rehabilitation training. Both groups underwent continuous treatment for one month. The number of limb joint spasm attacks before and after treatment was recorded for both cohorts. Comparisons were made regarding the degree of joint spasm at the elbow, wrist, knee, and ankle joints, clinic spasticity index (CSI) scores, Fugl-Meyer assessment (FMA) scale scores, and activities of daily living (ADL) scores between the two cohorts before and after treatment. Clinical efficacy was also compared between the two groups. Results: No significant difference was detected in the number of limb joint spasm attacks between the two groups before treatment (P > 0.05). After treatment, the number of attacks in both groups significantly decreased compared to before treatment (P < 0.05), with a lower number of attacks in the TCM group (P < 0.05). Prior to treatment, there were no statistically significant disparities in the degree of spasm at the elbow, wrist, knee, and ankle joints between the two cohorts (P > 0.05). Following treatment, notable improvement was observed in the spasm of each joint in both groups, with better improvement in the TCM group than in the rehabilitation cohort (P < 0.05). Before treatment, we found no substantial disparities in tendon reflex, muscle tension, and spasm scores between the two groups (P > 0.05). After treatment, scores in each parameter were reduced in both cohorts, with scores lowered in the TCM group compared to the rehabilitation group (P < 0.05). Prior to treatment, no substantial differences existed in FMA and ADL scores between the two groups (P > 0.05). After treatment, both FMA and ADL scores were elevated in both groups compared to before treatment, with higher scores observed in the TCM cohort than in the rehabilitation cohort (P < 0.05). The total effective rate in the TCM group reached 95.74%, while in the rehabilitation group, it was 80.85%, with significantly higher clinical efficacy in the TCM group compared to the rehabilitation cohort (P < 0.05). Conclusion: The use of self-formulated Chinese medicine compound decoction can reduce the number of attacks and achieve a more significant improvement in symptoms for the treatment of external contraction limb joint spasms, demonstrating good biomechanical therapeutic value and deserving clinical promotion.
References
1. Guzik A, Bushnell C. Stroke Epidemiology and Risk Factor Management. Continuum (Minneap Minn). 2017 Feb;23(1, Cerebrovascular Disease):15-39. doi: 10.1212/CON.0000000000000416. PMID: 28157742.
2. Boursin P, Paternotte S, Dercy B, Sabben C, Maïer B. Sémantique, épidémiologie et sémiologie des accidents vasculaires cérébraux [Semantics, epidemiology and semiology of stroke]. Soins. 2018 Sep;63(828):24-27. French. doi: 10.1016/j.soin.2018.06.008. PMID: 30213310.
3. Perera KS, de Sa Boasquevisque D, Rao-Melacini P, Taylor A, Cheng A, Hankey GJ, Lee S, Fabregas JM, Ameriso SF, Field TS, Arauz A, Coutts SB, Arnold M, Mikulik R, Toni D, Mandzia J, Veltkamp RC, Meseguer E, Haeusler KG, Hart RG; Young ESUS Investigators. Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source: The Young ESUS Longitudinal Cohort Study. JAMA Neurol. 2022 May 1;79(5):450-458. doi: 10.1001/jamaneurol.2022.0048. PMID: 35285869.
4. Markus HS. Reducing disability after stroke. Int J Stroke. 2022 Mar;17(3):249-250. doi: 10.1177/17474930221080904. PMID: 35191348.
5. Schinwelski MJ, Sitek EJ, Wąż P, Sławek JW. Prevalence and predictors of post-stroke spasticity and its impact on daily living and quality of life. Neurol Neurochir Pol. 2019;53(6):449-457. doi: 10.5603/PJNNS.a2019.0067. Epub 2019 Dec 17. PMID: 31845749.
6. Wissel J, Manack A, Brainin M. Toward an epidemiology of poststroke spasticity. Neurology. 2013 Jan 15;80(3 Suppl 2):S13-9. doi: 10.1212/WNL.0b013e3182762448. PMID: 23319481.
7. Hsieh HC, Liao RD, Yang TH, Leong CP, Tso HH, Wu JY, Huang YC. The clinical effect of Kinesio taping and modified constraint-induced movement therapy on upper extremity function and spasticity in patients with stroke: a randomized controlled pilot study. Eur J Phys Rehabil Med. 2021 Aug;57(4):511-519. doi: 10.23736/S1973-9087.21.06542-4. Epub 2021 Jan 15. PMID: 33448755.
8. Thibaut A, Chatelle C, Ziegler E, Bruno MA, Laureys S, Gosseries O. Spasticity after stroke: physiology, assessment and treatment. Brain Inj. 2013;27(10):1093-105. doi: 10.3109/02699052.2013.804202. Epub 2013 Jul 25. PMID: 23885710.
9. Dong Y, Wu T, Hu X, Wang T. Efficacy and safety of botulinum toxin type A for upper limb spasticity after stroke or traumatic brain injury: a systematic review with meta-analysis and trial sequential analysis. Eur J Phys Rehabil Med. 2017 Apr;53(2):256-267. doi: 10.23736/S1973-9087.16.04329-X. Epub 2016 Nov 11. PMID: 27834471.
10. Salazar AP, Pinto C, Ruschel Mossi JV, Figueiro B, Lukrafka JL, Pagnussat AS. Effectiveness of static stretching positioning on post-stroke upper-limb spasticity and mobility: Systematic review with meta-analysis. Ann Phys Rehabil Med. 2019 Jul;62(4):274-282. doi: 10.1016/j.rehab.2018.11.004. Epub 2018 Dec 22. PMID: 30582986.
11. Sharififar S, Shuster JJ, Bishop MD. Adding electrical stimulation during standard rehabilitation after stroke to improve motor function. A systematic review and meta-analysis. Ann Phys Rehabil Med. 2018 Sep;61(5):339-344. doi: 10.1016/j.rehab.2018.06.005. Epub 2018 Jun 26. PMID: 29958963.
12. Pandian S, Arya KN, Davidson EWR. Comparison of Brunnstrom movement therapy and Motor Relearning Program in rehabilitation of post-stroke hemiparetic hand: a randomized trial. J Bodyw Mov Ther. 2012 Jul;16(3):330-337. doi: 10.1016/j.jbmt.2011.11.002. Epub 2011 Dec 6. PMID: 22703742.
13. Feng S, Zhou Y, Tang M, Wang J, Lv Y, Gu L. Efficacy and safety of acupuncture combined with rehabilitation in the treatment of strephenopodia after stroke: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2022 Feb 18;101(7):e28867. doi: 10.1097/MD.0000000000028867. PMID: 35363192.
14. Qin Y, Liu X, Zhang Y, Wu J, Wang X. Effects of transcranial combined with peripheral repetitive magnetic stimulation on limb spasticity and resting-state brain activity in stroke patients. Front Hum Neurosci. 2023 Apr 4;17:992424. doi: 10.3389/fnhum.2023.992424. PMID: 37082150.
15. Pashmdarfard M, Azad A. Assessment tools to evaluate Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) in older adults: A systematic review. Med J Islam Repub Iran. 2020 Apr 13;34:33. doi: 10.34171/mjiri.34.33. PMID: 32617272.
16. Kimura H. [Stroke]. Brain Nerve. 2020 Apr;72(4):311-321. Japanese. doi: 10.11477/mf.1416201530. PMID: 32284456.
17. Zeng H, Chen J, Guo Y, Tan S. Prevalence and Risk Factors for Spasticity After Stroke: A Systematic Review and Meta-Analysis. Front Neurol. 2021 Jan 20;11:616097. doi: 10.3389/fneur.2020.616097. PMID: 33551975.
18. Kotila M, Waltimo O. Epilepsy after stroke. Epilepsia. 1992 May-Jun;33(3):495-8. doi: 10.1111/j.1528-1157.1992. tb 01698.x. PMID: 1592026.
19. Coletti RH. The ischemic model of chronic muscle spasm and pain. Eur J Transl Myol. 2022 Jan 18;32(1):10323. doi: 10.4081/ejtm.2022.10323. PMID: 35044134.
20. Kofler M, Quirbach E, Schauer R, Singer M, Saltuari L. Limitations of intrathecal baclofen for spastic hemiparesis following stroke. Neurorehabil Neural Repair. 2009 Jan;23(1):26-31. doi: 10.1177/1545968308317700. Epub 2008 Sep 16. PMID: 18796543.
21. Fiore P, Santamato A, Ranieri M, Bellomo RG, Saggini R, Panza F, Megna G, Cristella G, Megna M. Treatment of upper limb spasticity after stroke: one-year safety and efficacy of botulinum toxin type A NT201. Int J Immunopathol Pharmacol. 2012 Jan-Mar;25(1 Suppl):57S-62S. doi: 10.1177/03946320120250s109. PMID: 22652163.
22. Zhang ZQ, Li KP, He J, Jiang LM, Wang W, Hu XS, Feng W. Acupuncture of fascia points to relieve hand spasm after stroke: a study protocol for a multicenter randomized controlled trial. Trials. 2020 Jan 10;21(1):69. doi: 10.1186/s13063-019-3999-7. PMID: 31924256.
23. Zhang J, Mao W, Dai F, Wu M, Yang K, Qin X, He C, Wang L, Wang L, Zhu C, Han W, Wang Y. Tongdu Tiaoshen acupuncture combined with Bobath rehabilitation training for upper limb spasm after stroke: a randomized controlled trial. Zhongguo Zhen Jiu. 2023 Jan 12;44(1):43-47. English, Chinese. doi: 10.13703/j.0255-2930.20230711-k0002. PMID: 38191158.
24. Hao M, Fang Q, Wu B, Liu L, Tang H, Tian F, Chen L, Kong D, Li J. Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke. Open Life Sci. 2023 Sep 30;18(1):20220724. doi: 10.1515/biol-2022-0724. PMID: 37791058.
25. Zhu X, Hu H, Li Z, Lin R, Mao J, Chen L. Gua Lou Gui Zhi decoction attenuates post‑stroke spasticity via the modulation of GABAB receptors. Mol Med Rep. 2015 Oct;12(4):5957-62. doi: 10.3892/mmr.2015.4207. Epub 2015 Aug 11. PMID: 26260947.
26. Wang JX, Yang X, Zhang JJ, Zhou TT, Zhu YL, Wang LY. [Effects of Shaoyao Gancao decoction on contents of amino acids and expressions of receptors in brains of spastic paralysis rats]. Zhongguo Zhong Yao Za Zhi. 2016 Mar;41(6):1100-1106. Chinese. doi: 10.4268/cjcmm20160621. PMID: 28875677.
27. Xue BY, Li W, Li L, Xiao YQ. [A pharmacodynamic research on chromone glucosides of fangfeng]. Zhongguo Zhong Yao Za Zhi. 2000 May;25(5):297-9. Chinese. PMID: 12512455.
28. Wegener T, Heimueller E. Treatment of Mild Gastrointestinal Disorders with a Herbal Combination: Results of a Non-interventional Study with Gastritol® Liquid. Phytother Res. 2016 Jan;30(1):72-7. doi: 10.1002/ptr.5502. Epub 2015 Nov 2. PMID: 26522087.
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