The Journal of Internal Korean Medicine (대한한방내과학회지)

The Society of Internal Korean Medicine (대한한방내과학회)
권호 표지
DOI QR코드

DOI QR Code

Case Report of Multiple Cerebral Infarction in Middle Cerebral Artery with Gait Disturbance Treated by Korean Medicine

중대뇌동맥 영역에 발생한 다발성 뇌경색 환자의 보행장애에 대한 한의 복합 치료: 증례보고 1례

  • Chae, In-cheol (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Choi, In-woo (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Yang, Ji-hae (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Kang, Jie-yoon (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Ryu, Ju-young (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Jung, Eun-sun (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Kim, Yoon-sik (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Seol, In-chan (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University) ;
  • Yoo, Ho-ryong (Dept. of Cardiology and Neurology of Korean Medicine, College of Korean Medicine, Dae-Jeon University)
  • 채인철 (대전대학교 한의과대학 심계내과학교실) ;
  • 최인우 (대전대학교 한의과대학 심계내과학교실) ;
  • 양지혜 (대전대학교 한의과대학 심계내과학교실) ;
  • 강지윤 (대전대학교 한의과대학 심계내과학교실) ;
  • 유주영 (대전대학교 한의과대학 심계내과학교실) ;
  • 정은선 (대전대학교 한의과대학 심계내과학교실) ;
  • 김윤식 (대전대학교 한의과대학 심계내과학교실) ;
  • 설인찬 (대전대학교 한의과대학 심계내과학교실) ;
  • 유호룡 (대전대학교 한의과대학 심계내과학교실)
  • Received : 2021.03.23
  • Accepted : 2021.05.28
  • Published : 2021.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Objectives: This study reported about a patient with a right middle cerebral artery infarction whose gait disturbance was improved by Korean medicine treatment. Methods: The patient was treated with a Korean herbal medicine (Gami-yukmijihwang-tang) along with acupuncture, electroacupuncture, moxibustion, cupping, and physical therapy. The treatment effect was evaluated with the manual muscle test (MMT) and the Korean version of the modified Barthel index (K-MBI). The gait of the patient was evaluated by a 10-m walk test (10MWT), the timed up and go (TUG) test, the functional ambulation profile (FAP) score, and the functional ambulatory category (FAC) score. Spatiotemporal parameters were evaluated using a walkway system (GAITRite®, CIR Systems, Inc., USA). Results: After 83 days of traditional Korean medicine treatment, the K-MBI and FAC scores improved from 50 to 70 and from 1 to 4, respectively. The 10MWT and TUG tests also improved from 24.86 to 16.66 sec and from 22.35 to 17.62 sec, respectively. GAITRite® measurements reflected gait improvements: the FAP score improved from 55 to 86 sec; the step time improved from 0.72 to 0.669 sec; the step length improved from 31.076 cm to 41.284 cm; the gait velocity improved from 42.8 cm/sec to 64.1 cm/sec; the cadence improved from 93.6 steps/min to 90.8 steps/min. No adverse effects resulting from treatment or evaluation occurred during the admission period. Conclusions: This study suggests that traditional Korean medicine treatment may reduce symptoms and improve the quality of life in patients with cerebral infarction.

Keywords

References

  1. Langhorne P, Coupar F, Pollock A. Motor Recovery after Stroke: A Systematic Review. Lancet Neurol 2009;8(8):741-54. https://doi.org/10.1016/S1474-4422(09)70150-4
  2. Korean Stroke Society. Text Book of Stroke. Seoul: Panmuneducation; 2015, p. 529, 533, 535.
  3. Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of Walking Handicap in the Stroke Population. Stroke 1995;26(6):982-89. https://doi.org/10.1161/01.str.26.6.982
  4. Chiou IIL, Burnett CN. Values of Activities of Daily Living: A Survey of Stroke Patients and Their Home Therapists. Phys Ther 1985;65(6):901-6. https://doi.org/10.1093/ptj/65.6.901
  5. Bohannon RW, Horton MG, Wikholm JB. Importance of Four Variables of Walking to Patients with Stroke. Int J Rehabilitation Res 1991;14(3):246-50. https://doi.org/10.1097/00004356-199109000-00010
  6. Lord SE, McPherson K, McNaughton HK, Rochester L, Weatherall M. Community Ambulation after Stroke: How Important and Obtainable Is It and What Measures Appear Predictive? Arch Phys Med Rehabil 2004;85(2):234-9. https://doi.org/10.1016/j.apmr.2003.05.002
  7. Department of Cardiology Internal Medicine, College of Korean Medicine. Cardiovascular and neurological medicine in Korean medicine. Seoul: Wooripub; 2018, p. 243, 250.
  8. Kim KH, Lee YU, Chu HM, Lim HS, Kim CH, Lee JY, et al. A Case Report of Gait Disturbance, Cognitive Impairment, Dysuria, and Dysphagia in a Stroke Patient Treated with Traditional Korean Medical Treatment. J Int Korean Med 2020;41(2):204-12. https://doi.org/10.22246/jikm.2020.41.2.204
  9. Chu HM, Lim HS, Kim KH, Lee YU, Park KT, Jang JW, et al. A Improved Case of Post Cerebral Infarction Dizziness and Gait Discomfort after Treated with Korean Medicine Treatment and Vestibular Rehabilitation Practice. J Korean Med Rehabi 2020;30(4):179-86. https://doi.org/10.18325/jkmr.2020.30.4.179
  10. Lee SM, Shin YS, Nam DW, Choi DY. Korean translation of the CARE guidelines. The Acupuncture 2015;32(4):1-9.
  11. Kendall FP, McCreary EK, Provance PG, Rodgers MM, Romani WA. Muscles, Testing and Function: With Posture and Pain. Seoul: Hanmi Medical Publishing Co.; 2006.
  12. Jung HY, Park BK, Shin HS, Kang YK, Pyun SB, Paik NJ, et al. Development of the Korean Version of Modified Barthen Index (K-MBI): Multi-center Study for Subjects with Stroke. Ann Rehabil Med 2007;31(3):283-97.
  13. McDonough AL, Batavia M, Chen FC, Kwon S, Ziai J. The Validity and Reliability of the GAITRite System's Measurements: A Preliminary Evaluation. Arch Phys Med Rehabil 2001;82(3):419-25. https://doi.org/10.1053/apmr.2001.19778
  14. Titianova EB, Pitkanen K, Pa kkonen A, Sivenius J, Tarkka IM. Gait Characteristics and Functional Ambulation Profile in Patients with Chronic Unilateral Stroke. Am J Phys Med Rehabil 2003;82(10):778-86. https://doi.org/10.1097/01.PHM.0000087490.74582.E0
  15. Gouelle A. Use of Functional Ambulation Performance Score as Measurement of Gait Ability. Journal of Rehabilitation Research & Development 2014;51(5):665-74. https://doi.org/10.1682/JRRD.2013.09.0198
  16. Rossier P, Wade DT. Validity and Reliability Comparison of 4 Mobility Measures in Patients Presenting with Neurologic Impairment. Arch Phys Med Rehabil 2001;82(1):9-13. https://doi.org/10.1053/apmr.2001.9396
  17. Ng SS, Hui-Chan CW. The Timed Up&Go Test: Its Reliability and Association with Lower-limb Impairments and Locomotor Capacities in People with Chronic Stroke. Arch Phys Med Rehabil 2005;86(8):1641-7. https://doi.org/10.1016/j.apmr.2005.01.011
  18. Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. Predictive Validity and Responsiveness of the Functional Ambulation Category in Hemiparetic Patients after Stroke. Arch Phys Med Rehabil 2007;88(10):1314-9. https://doi.org/10.1016/j.apmr.2007.06.764
  19. Gaviria M, D'Angeli M, Chavet P, Pelissier J, Peruchon E, Rabischong P. Plantar Dynamics of Hemiplegic Gait: A Methodological Approach. Gait & Posture 1996;4(4):297-305. https://doi.org/10.1016/0966-6362(95)01055-6
  20. Goldie PA, Matyas TA, Evans OM. Deficit and Change in Gait Velocity during Rehabilitation after Stroke. Arch Phys Med Rehabil 1996;77(10):1074-82. https://doi.org/10.1016/S0003-9993(96)90072-6
  21. Schmid A, Duncan PW, Studenski S, Lai SM, Richards L, Perera S, et al. Improvements in Speed-based Gait Classifications are Meaningful. Stroke 2007;38(7):2096-100. https://doi.org/10.1161/strokeaha.106.475921
  22. Hsu AL, Tang PF, Jan MH. Analysis of Impairments Influencing Gait Velocity and Asymmetry of Hemiplegic Patients after Mild to Moderate Stroke. Arch Phys Med Rehabil 2003;84(8):1185-93. https://doi.org/10.1016/S0003-9993(03)00030-3
  23. Lin PY, Yang YR, Cheng SJ, Wang RY. The Relation Between Ankle Impairments and Gait Velocity and Symmetry in People With Stroke. Arch Phys Med Rehabil 2006;87(4):562-8. https://doi.org/10.1016/j.apmr.2005.12.042
  24. Balaban B, Tok F. Gait Disturbances in Patients With Stroke. PM R 2014;6(7):635-42. https://doi.org/10.1016/j.pmrj.2013.12.017
  25. Kim BO, Kim KS, Jeon HY, Kang HJ, Kim JS, Hong S, et al. Effects of Yukmijihwang-tang to Recover the Brain Damage of Mice. J Int Korean Med 2002;23(2):191-201.
  26. Cheng XR, QI CH, Wang TX, Zhou WX, Zhang YX. Characteristics of the Traditional Liu-Wei-Di-Huang Prescription Reassessed in Modern Pharmacology. Chinese Journal of Natural Medicines 2019;17(2):103-21. https://doi.org/10.1016/S1875-5364(19)30013-5
  27. Liu W, Mukherjee M, Sun C, Liu H, McPeak LK. Electroacupuncture may Help Motor Recovery in Chronic Stroke Survivors: a pilot study. Journal of Rehabilitation Research & Development 2008;45(4):587-96. https://doi.org/10.1682/JRRD.2007.11.0181
  28. Moon SK, Whang YK, Park SU, Ko CN, Kim YS, Bae HS, et al. Antispastic Effect of Electroacupuncture and Moxibustion in Stroke Patients. The American journal of Chinese medicine 2003;31(3):467-74. https://doi.org/10.1142/S0192415X03001077
  29. Lee JH, Lee IW, Moon SH, Kang JS, Lim SM, An JJ, et al. The Effects of Juheng Acupuncture Treatment on Gait Disturbed Patient Caused by Stroke. Korean J Orient Int Med 2007;fal:77-87.
  30. Jang JH, Park SS, An J, Choi JD, Seol IC, Park GH, et al. Gait Disturbance Improvement and Cerebral Cortex Rearrangement by Acupuncture in Parkinson's Disease: A Pilot Assessor-Blinded, Randomized, Controlled, Parallel-Group Trial. Neurorehabil Neural Repair 2020;34(12):1111-23. https://doi.org/10.1177/1545968320969942
  31. Jang JH, Kim HT, Jung IC, Yoo HR. Acupuncture for Improving Gait Disturbance in Parkinson's Disease: A Study Protocol for a Pilot Randomized Controlled Trial. Eur J Integr Med 2018;20:16-21. https://doi.org/10.1016/j.eujim.2018.04.002