HISTORY:Abstract:Traumatic Brain Injuries (TBI) are a broad category, which includes physical traumas to the head and results in differing degrees of brain tissue damage. Electro-Acupuncture Medicine (EAM) is a solid modality or therapy to include in the treatment of TBI.Presentation and history of presenting condition:21 year old male was shot with a 22 caliber bullet in the head, while in his apartment during a robbery. The bullet remained lodged in his brain. He had already underwent several exploratory surgeries to remove the bullet, however these were unsuccessful. He has partial paralysis on the right side of his body, his right arm and hand were more severely affected than his right leg. He is walking with an altered gate, and balance issues. He also has slower than normal thinking or a tougher time communicating, as well as anger, anxiety, depressive symptoms, frustration, and insomnia.Physical Examination:Unaffected arm has full range of motion. The right arm is in semi-spasm, and is stiff and unable to be raised fully above his head. His right hand fingers are also in semi-contraction and unable to be used in fine motor skills, such as grabbing a coin off of a table, or buttoning a shirt. His right leg was stiffer than normal, in semi contraction. His entire right side of his body felt cooler to the touch than the left side of his body. Investigations:The incident occurred approximately six months before his initial appointment. The scarring from the incident and from the surgeries are extensive. He was undergoing physical therapy at a rate of 3 times per week, and the progress was minimal to moderate.Diagnosis:The head CT scans showed that the primary motor cortex, precentral gyrus, and portions of his frontal lobe had been damaged either directly from the bullet or as a sequelae from the incident. The surgeons believed that this is where fragments of the bullet are still lodged. Broca’s area of the brain which is also in close proximity to the frontal lobe had also been damaged, and this explains his difficulty in speaking, and his slowed down rate of thinking about what he would like to say.
THERAPY:
Scalp EAM is typically the mainstay of TBI treatments. However due to the restricted scope of practice of licensed acupuncturists in the state of NJ, I chose to not use scalp EAM. Because the bullet or fragments of the bullet were still lodged in the brain, I can not take a chance to be blamed for anything bad happening. The risk vs reward was not sufficiently in balance to use scalp EAM in this case. However if I were to use scalp EAM, I would have chose DU20, Shishencong, left sided upper and lower limb motor points, and left sided Broca’s area. The great thing about scalp EAM in the treatment of TBI is that you can place needles over the affected or damaged neuroanatomy, and a CT scan can usually foretell the optimal locations and points to use. I would have chosen 150HZ for 10 minutes, and then dropped down to 1-4HZ for an additional 10-20 minutes. This scalp tx is normally done simultaneously with the other body points.
LI17, HT1, TW9, LU3/4, and Baxie with 1HZ was used to elicit full contraction and relaxation cycling of the majority of the affected muscle groups of the upper limb, neck, and shoulder. ST36, GB34, SP7, Ki6, Ub62, LV3, and Bafeng with 1HZ was used to elicit full contraction and relaxation cycling of the majority of the affected muscle groups of the lower limb and foot. Bafeng has a link to the frontal lobe, and so has the benefit of balancing emotions such as depression, and anxiety. Spinal segmental levels for sympathetic vascular tone of T1-T4, and T10-L2 were chosen at a frequency of 1-4HZ for 8-12 minutes, the intention here is to modulate the vascular flow going to the affected areas, including the brain. Tendinomuscular channel treatments as well as channel unblocking treatments were also used alternating, and the channels chosen were Taiyang and Shaoyang, frequencies for this were 150HZ and 1-4HZ. Ear points:
Shen Men, Frontal lobe, precentral gyrus, depression point on the front of the ear (sensory), and motor neuronal points on the back of the ear were used such as the areas related to upper and lower muscle groups that were in semi-contraction.
Frequencies for the ear included 150HZ, 80HZ, 10HZ, and 2HZ.
After the acupuncture portion of the treatment was complete, we spend a few minutes using passive and active movements of the limbs with tuina combined.
Outcome, and evolution over time with final resolution
A total of 5 treatments was given at a rate of 1 time per week for 5 weeks. The first portion of each appointment was spent re-evaluating range of motion, muscle quality, and emotional state. The first treatment made the most significant jump in reducing muscle spasticity. The last four treatments made slower progress however steadily improved the muscle quality. After the 5th treatment the muscle spasticity was improved by 50 to 60%, and he was able to raise the right arm nearly completely above his head. His right hand regained flexibility and movement, it was around 35% improved. His right leg was also greatly improved with around a 70-80% improvement in gait, and reduction of muscle spasticity. His anger, insomnia and frustration also seemed approximately 50% better after the 5th treatment. His pattern of slowed speech didn’t seem to change much. On the 5th treatment his father informed me that they would be stopping the
acupuncture therapy in order to proceed with a course of botox injection therapy, which was on the recommendation of their rehabilitation physician.
It is my opinion that the EAM was working very well, and that treatments should have been continued. Optimally treatment would be done three times per week for a course of 12 weeks, after which a reevaluation could be done. I also think the botox injections should have been delayed or cancelled until this course of EAM treatments could be completed.
Discussion:
Scalp EAM has shown significant clinical results that warrants further use in the treatment of TBI. It appears to modulate circulation going to the brain, especially going to the damaged tissues of the brain, and appears to change the quality of the brain tissue and heals injury.
Body EAM is very useful in correcting physical abnormalities such has hemiparesia, as well as reconnecting the body to the brain.
Ear EAM is a wonderful neural input, and the applications of what is possible are almost endless.
5. Summary:
EAM should be one of the primary treatment modalities in the physical medicine and rehabilitation process of almost all TBI patients.
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