OBJECTIVES: Acupressure, a complementary and alternative medicine (CAM) treatment, uses fingertips, rather than needles, to stimulate acupoints on the skin and has been implicated as a successful treatment for a variety of medical disorders. However, acupressure's underlying mechanisms remain unclear. One theory is that acupoint stimulation modulates autonomic nervous system activity. Previous studies have suggested that acupressure may positively affect heart rate and blood pressure. The current study investigated the effects of a type of acupressure, Jin Shin, on cardiovascular function in stroke survivors, a population that could especially benefit from a treatment promoting cardiovascular health. The study tested the hypothesis that active acupressure treatments would reduce heart rate and blood pressure (i.e., induce a greater relaxation response) above and beyond that seen during placebo acupressure treatments. METHODS: A randomised, placebo-controlled, single-blind crossover design was utilised, in which 16 participants received 8 weeks of either active or placebo acupressure followed by washout and crossover into the opposite treatment condition. Heart rate and blood pressure measurements were taken throughout treatments. RESULTS: Active acupressure treatments were associated with a significantly greater (p=.043, eta(2)=.30) and faster (p=.002, eta(2)=.76) reduction in heart rate compared to that seen during placebo treatments. No treatment effect on blood pressure was found. CONCLUSIONS: Active acupressure reduced heart rate significantly more than did placebo acupressure during treatments. Although no treatment effect on blood pressure was found, this could be due to 67% of participants taking antihypertensive medications during the study.

Past studies have suggested that acupuncture may reduce spasticity in stroke survivors. We do not know, however, whether acupuncture may enhance the effect of strength training on motor function. This study compared upper-limb motor functional improvement in chronic stroke survivors who received a combination of acupuncture and strength training with that of subjects who received strength training alone. A total of 10 chronic stroke patients with moderate or severe wrist muscle spasticity were recruited for this study. The study used a crossover design with a random order of either combined electroacupuncture and strength training or strength training alone. Each subject received one of the two types of treatment twice a week for the first 6 weeks and switched to the other for another 6 weeks. Quantitative measurements of wrist spasticity, active wrist extension range of motion, isometric wrist strength, and clinical evaluation with Fugl-Meyer (FM) upper-limb motor scores were conducted before and after either treatment. After the combined treatment, the quantitative spasticity level, active wrist extension range of motion (increased by a mean of 16.3 degrees), and FM upper-limb motor score (increased by a mean of 4.9 points) changed significantly (p<0.01) but no significant changes were noted in isometric wrist strength. The strength training alone resulted in no significant changes to any measured variable. The results of the current study indicate that the combined acupuncture and strength training treatment reduced muscle spasticity and may have improved motor function for chronic stroke survivors with moderate or severe muscle spasticity.

Stroke is a major cause of death worldwide. Previous studies have suggested both exercise and mitochondrial biogenesis contribute to improved post-ischemic recovery of brain function. However, the exact mechanism underlying this effect is unclear. On the other hand, the benefit of exercise-induced mitochondrial biogenesis in brain has been confirmed. In this study, we attempted to determine whether treadmill exercise induces functional improvement through regulation of mitochondrial biogenesis after brain ischemia. We subjected adult male rats to ischemia, followed by either treadmill exercise or non-exercise and analyzed the effect of exercise on the amount of mitochondrial DNA (mtDNA), expression of mitochondrial biogenesis factors, and mitochondrial protein. In the ischemia-exercise group, only peroxisome proliferator activated receptor coactivator-1 (PGC-1) expression was increased significantly after 3 days of treadmill training. However, after 7 days of training, the levels of mtDNA, nuclear respiratory factor 1, NRF-1, mitochondrial transcription factor A, TFAM, and the mitochondrial protein cytochrome C oxidase subunit IV (COXIV) and heat shock protein-60 (HSP60) also increased above levels observed in non-exercised ischemic animals. These changes followed with significant changes in behavioral scores and cerebral infarct volume. The results indicate that exercise can promote mitochondrial biogenesis after ischemic injury, which may serve as a novel component of exercise-induced repair mechanisms of the brain. Understanding the molecular basis for exercise-induced neuroprotection may be beneficial in the development of therapeutic approaches for brain recovery from the ischemic injury. Based upon our findings, stimulation or enhancement of mitochondrial biogenesis may prove a novel neuroprotective strategy in the future.

Purpose: Canada's Best Practice Recommendations for Stroke Care state that a minimum of one hour per day of each of the relevant core therapies be provided to patients admitted for inpatient rehabilitation. We examined whether this standard was met on a single, specialized stroke rehabilitation unit and if amount of therapy was an independent contributor to functional improvement. Methods: One-hundred and twenty-three, consecutive patients admitted to a 30-bed stroke rehabilitation program over a 6-month period with the confirmed diagnosis of stroke, were included. Workload measurement data were used to estimate the amount of therapy that patients received from core therapists during their inpatient stay. A multivariable model to predict Functional Independence Measure (FIM) gains achieved was also developed using variables that were significantly correlated with functional gain on univariate analysis. Results: On average, patients received 37 min of active therapy from both physiotherapists (PT) and occupational therapists (OT) and 13 min from speech-language pathologists per day. Admission FIM, length of stay, total OT and PT therapy time (hrs) were significantly correlated with FIM gain. In the final model, which explained 35% of the variance, admission FIM score and total amount of occupational therapy (OT) emerged as significant predictors of FIM gain. Conclusions: Patients admitted to a specialized rehabilitation unit received an average of 37 min a day engaged in therapeutic activities with both occupational and physical therapists. Although this value did not reach the standard of one hour, total amount of OT time contributed significantly to gains in FIM points during hospital stay. [Box: see text].

BACKGROUND AND OBJECTIVE: Our previous findings showed that 4 weeks of intensive Tai Chi practice improved standing balance in healthy seniors. This study set out to investigate whether Tai Chi could improve standing balance in subjects with chronic stroke. METHODS: One hundred thirty-six subjects>6 months after stroke were randomly assigned to a control group (n = 62) practicing general exercises or a Tai Chi group (n = 74) for 12 weeks of training. Each week, 1 hour of group practice was supplemented by 3 hours of self-practice. We used a short-form of Tai Chi consisting of 12 forms that require whole-body movements to be performed in a continuous sequence and demands concentration. A blinded assessor examined subjects at baseline, 6 weeks (mid-program), 12 weeks (end-program), and 18 weeks (follow-up). The 3 outcome measures were (1) dynamic standing balance evaluated by the center of gravity (COG) excursion during self-initiated body leaning in 4 directions, (2) standing equilibrium evaluated in sensory challenged conditions, and (3) functional mobility assessed by Timed-up-and-go score. Mixed model repeated-measures analysis of variance was used to examine between-group differences. RESULTS: When compared with the controls, the Tai Chi group showed greater COG excursion amplitude in leaning forward, backward, and toward the affected and nonaffected sides (P<.05), as well as faster reaction time in moving the COG toward the nonaffected side (P = .014) in the end-program and follow-up assessments. The Tai Chi group also demonstrated better reliance on vestibular integration for balance control at end-program (P = .038). However, neither group improved significantly in Timed-up-and-go scores. CONCLUSIONS: Twelve weeks of short-form Tai Chi produced specific standing balance improvements in people with chronic stroke that outlasted training for 6 weeks.