Using fMRI and sEMG to Evaluate the Effects and Mechanism on Abdominal Acupuncture Combined With Upper Limb Rehabilitation Training on Brain Plasticity of Hemiplegic Patients With Stroke
Phase: NA
Conditions: Brain Ischemia, Hemiplegic Patients With Stroke, Image Science, Electrophysiology of Neuromuscular, Abdominal Acupuncture
Sponsor: Guangzhou University of Traditional Chinese Medicine

 
Version Number:2017.09.15/01 
 
 
 
 
Using fMRI and sEMG to Evaluate the Effects and 
Mechanism on Abdominal Acupuncture Combined 
With Upper Limb Rehabilitation Training on Brain 
Plasticity of Hemiplegic Patients With Stroke 
 
 
 
 
 
 
 
Head of Clinical Research Unit: Guangdong Provincial Hospital of 
Chinese Medicine    
 
Director of Clinical Research: Chen Hongxia 
 
Clinical Research Participating Unit: Guangdong Provincial Hospital of 
Chinese 
Medicine 
,Chinese 
University of Hong Kong . 
 
Reporting Unit: Guangdong Provincial Hospital of Chinese Medicine 
 
Research Director: Chen Hongxia 

 
Version Number:2017.09.15/01 
 
1. Title 
Using fMRI and sEMG to Evaluate the Effects and Mechanism on Abdominal 
Acupuncture Combined With Upper Limb Rehabilitation Training on Brain Plasticity 
of Hemiplegic Patients With Stroke. 
 
2. Background 
Cerebral infarction is the main type of stroke which has become hotspot and difficulty 
of the research in medical science because of its high morbidity, disability and mortality. 
Stroke has caused great harm and burden to patients' family and society. It was reported 
by WHO that 80% of stroke patients have different degrees of limb dysfunction. With 
the intervention of rehabilitation therapy, some patients would recover in different 
degrees within 6 months. However, more than 60% of patients still remain upper limb 
dysfunction in chronic phase. According to the literature, only 15% of patients with 
stroke can recover to 50% of the original hand function. Only 3% of them can recover 
to more than 70% of the original. Because the motor function recovery of upper limb 
and hand is more difficult than that of lower limb. So we often pay more attention to 
the motor function recovery of lower limb and ignore the motor function rebuilding of 
upper limb. In addition, the disuse of affected hand and compensatory of unaffected 
hand of stroke patients lead to “learning without practice” and hand muscles contracture. 
If we start rehabilitation training now, the effects of rehabilitation training will be 
unpleasant and reduce the activities of daily living and quality of life seriously. 
Professor Bo, the famous abdominal acupuncture expert , using abdominal acupuncture  
treated hemiplegic patients with stroke and achieved remarkable effects. The 
acupuncture points of abdominal acupuncture form a turtle chart at the abdomen. 
Zhongwan point is on behalf of head, Shangqu point is on behalf of neck and shoulder  
joint, Wailing point, Upper rheumatic point and Upper rheumatic external point are on 
behalf of shoulder in the turtle figture. The affected upper limb motor function can be 
improved by acupuncturing the Zhongwan, Shang Qu, Wailing, Upper rheumatic and 
Upper rheumatic external points. Because it can regulate and control the head, shoulder 
and hemiplegic limb and achieve the "holographic feedback" phenomenon. But the 
exact mechanism is not yet clear. Therefore, it is very important and urgent to use 
modern medical technology to elucidate its treatment mechanism. 
 
3. Purpose 
3.1 Hemiplegic patients with first onset stroke were treated with abdominal acupuncture 
combined with upper limb rehabilitation training to observe the recovery of upper limb 
motor function, the muscles synergy monitored by sEMG, local brain area activation 
by fMRI and the integrity of pyramidal tract of cerebral white matter.  
3.2 To analyze the changes of upper limb motor function the relationship between the 
changes and sEMG or brain fMRI   

 
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3.3 to explore the possible mechanism of abdominal acupuncture combined with upper 
limb rehabilitation training on brain plasticity of upper limb motor function recovery in 
hemiplegic patients with stroke. 
 
4. Reporting Units and Research Units 
Reporting unit: Rehabilitation Department of Guangdong Provincial Hospital of 
Chinese Medicine 
Address: No.111,Dade Road, Yuexiu District, Guangzhou City, Guangdong Province 
Research Director: Chen Hongxia 
e-mail:chx2004@126.com 
Clinical Auditor: Chen Hongxia         e-mail:chx2004@126.com 
Head of Clinical Research Unit: Rehabilitation Department of Guangdong Provincial 
Hospital of Chinese Medicine  
Address: No.111,Dade Road, Yuexiu District, Guangzhou City, Guangdong Province 
Research Director: Chen Hongxia 
e-mail:chx2004@126.com 
Participating Units: 
Rehabilitation Department of Guangdong Provincial Hospital of Chinese Medicine 
Director: Chen Hongxia 
Chinese University of Hong Kong 
Director：Vincent Chi-kwan Cheung 
 
5. Research Design 
5.1 Case selection: 66 patients diagnosed with initial stroke by CT/MRI and hospitalize 
in rehabilitation department of our hospital who meet the inclusion criteria will be 
included. 
 
5.2 Random method: Patients met the inclusion criteria will be randomized into 3 
groups by MATLAB stratified randomization software:  
Treatment group A: abdominal acupuncture +upper limb rehabilitation training, 22 
cases; 
Treatment group B: Sham abdominal acupuncture +upper limb rehabilitation training, 
22 cases; 
Control group : upper limb rehabilitation training only , 22 cases. 
Sample size calculation: Using the SAMPSIZEPWR function calculation of MATLAB 
software Statistic Toolbox (Statistics Toolbox) to calculate, it is assumed that Fugl-
meyer assessment (FMA) is the outcome index, and the FMA before rehabilitation 
training is also assumed to be 30±10 (average ± Standard deviation), the FMA after 
rehabilitation training is 37 (average). The amount of effect between groups is ~0.7. If 
0.8 of the statistical verification force is required, the sample size is 19 cases calculated 
by T –Test. Taking some uncontrollable factors that may causing dropping off into 
consideration, each group increases 3 cases with a 15% fall rate. Each group will 
include 22 cases. 

 
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5.3 Inclusion Criteria: 
① First onset stroke, Left hemiplegia, Right-handed，and diagnosed by brain CT or 
MRI; 
② Age 35 to 75 years old; 
③ Course of disease 0.5 to 3 months with stable vital signs; 
④ No cognitive impairment. Can understand and execute commands. MMSE score 
more than 7 points. ; 
⑤ Can control the sitting balance. Brunnstrom stage of hemiplegic upper limb and 
hand is Ⅳ or V ，Fugl-Meyer Motor Assessment score of upper limb 20-50 
point; 
⑥ Agree to sign the informed consent; 
⑦ Unilateral neglect. 
 
5.4 Exclusion Criteria: 
①  Recurrent stroke，subarachnoid hemorrhage, brain tumors patients; 
② Contraindication to undergo a 3T MR imaging; 
③ Claustrophobia; 
④ Have severe heart, hepatic or renal failure; 
⑤ Don' t cooperate with the treatment; 
⑥ Have participated in other clinical trails recently. 
 
5.5 Treatment Method: 
Treatment group A: abdominal acupuncture +upper limb rehabilitation training; 
Treatment group B: Sham abdominal acupuncture +upper limb rehabilitation training; 
Control group : upper limb rehabilitation training only . 
All the treatments above last for 30mins a time, once a day, five times a week, totally 4 
weeks. 
Upper limb Rehabilitation Training programme is based on the recommendations of the 
American AHA-ASA-2016-Stroke Rehabilitation Guideline , including instrumental 
activities of daily life training and upper limb operation therapy. 
A：Instrumental activities of daily life training: 
Extend elbow (side): Subject attempts to reach across the table by extending the elbow 
(to the side).Extend elbow (to the side), with weight: Subject attempts to push the 
sandbag against outer wrist joint across the table by extending the elbow.Extend elbow 
(to the side), with weight: Subject attempts to push the sandbag against outer wrist joint 
across the table by extending the elbow. Hand to box (front): Subject attempts to place 
hand on the box.Pick up paper clip (front): Subject attempts to pick up paper clip by 
using a pincer grasp.Stack 3 checkers and flip 3 cards.Turning the key in the lock,fold 
towel,pick up the basket by grasping the handle and place it on the beside 

 
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table.Treatment Duration: 45 minutes a session,once a day, 5 times a week for 4 weeks. 
B:Upper limb operation therapy： 
According to the patient's specific situation, take the routine operation treatment. It 
includes the training of shoulder blades loosening, the active assistant and active 
training of the side upper limb, the joint activity training of the upper limb, the upper 
extremity training, and the grasping and opening of the side finger. Mainly with the side 
training, but also included a small number of contralateral auxiliary side training. 
Treatment time: 30 minutes/times, 1 times/day, 5 days/week, total 4 weeks. 
 
5.6 Evaluation Method: 
(1) Screening Assessment 
Simple intelligent mental state scale (MMSE),and Brunnstrom upper limb movement 
staging will be evaluated once when included. 
(2) Primary Outcome Measure: 
Functional magnetic resonance imaging (fMRI) and surface electromyography (sEMG) are 
the two primary outcome, which will be tested before and 4 weeks after treatment , twice 
totally. 
(3) Secondary Outcome Measure: 
Wolf Motor Function Test; Brunnstrom staging of upper limb movement; Fugl-Meyer 
Motor Assessment of upper limb; Modified Barthel Index. 
Time Frame: Before treatment, 2 weeks and 4 weeks after treatment， 3 times totally.