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PROBLEM INTRODUCTION
Brain stroke (BS) is the second leading cause of death in
the world and the leading cause of adult disability. In Vietnam,
the level of recovery after the acute phase is less than 20%,
mainly due to paralysis, which makes it impossible to walk as
well as the ability to perform daily activities. Thus, more than
80% of patients need rehabilitation after the acute phase.
Rehabilitation for motor patients by electro-acupuncture is one
of the most effective methods of rehabilitation after stroke, easy
to apply and less expensive.
Physiotherapy is one of the most important techniques in
rehabilitation. Assistive and supportive exercise tools are one of
the indispensable parts to create a comprehensive recovery
result in rehabilitation. In particular, the exercise bicycle is a
supportive exercise tool that meets most forms of exercise to
achieve the goals of therapeutic movement and the goal of
rehabilitation after stroke. Exercise bicycle is a simple device,
easy to use, is used at home, in many rehabilitation facilities and
can exercise for long-term after stroke.
The goal of the thesis:
1. Evaluate the motor functional rehabilitation with the
treatment using electro-acupuncture in combination with
exercises on Motomed viva 2 bicycle for hemiplegia patients
after acute phase of ischaemic stroke.
2. Evaluate a number of factors affecting the
rehabilitation for patients with hemiplegia after stroke with


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the treatment using electro-acupuncture in combination

pages

for

conclusion,

and

01

page

for

recommendation. The thesis has 138 references (45 Vietnamese, 88
English, 05 Chinese), 50 tables, 05 charts, 14 pictures, 06 diagrams
and appendices.


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Chapter 1: OVERVIEW
1.1. Ischaemic stroke in modern medicine
1.1.1. The definition of brain stroke and ischaemic stroke
stroke
Brain stroke is a sudden occurrence of neurological
dysfunction, usually localized rather than diffuse, persists for
more than 24 hours or causes death within 24 hours, determined
by vascular origin and not by injury.
Currently, modern technology is applied in diagnosis and
treatment. A new definition: Transient Ischemic Attack is a shortterm neurological dysfunction due to cerebral ischemia or retina,

cause is often combined internal and external qi.
*Rehabilitation movement after the acute phase
After the acute phase of windstroke, there are still severe
sequelae and pathological properties, including empty symtom and
full symtom. Principles must simultaneously treat the template;
improve the righteous temperament, increase physicality and
eliminate evil spirits; fostering kidneys, qi, blood, balancing the
organs to eliminate evil wind.
The treatment of hemiplegia due to windstroke with the nonpharmacologic recovery phase in which electro-acupuncture has
been applied has many good results. In addition to electroacupuncture, other methods are widely applied such as pharmacoacupuncture, acupressure massage. In addition, patients need
combination therapy of modern medicine to control functional
factors and combination of exercises for rehabilitation.


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1.3. Treatment with electro-acupuncture
1.3.1. Outline
The purpose of acupuncture is to regulate qi; to bring the
imbalance of yin and yang of viscera and bowels, meridian and
collateral back to balance state; to open the circulation of the qi. In
the empty symtom, it is necessary tonification to increase the qi. In
the full symtom, use the dispertion to reduce the qi of that part.
Previously, after the acupuncture is completed, twist the needle to
perform the complementary tonification and dispertion, this makes
qi not fast, not strong, uneven, hurting patients, and it takes a lot of
effort and time. Electro-acupuncture with two tonification and
dispertion frequencies, regular and constant stimulating electric
pulses have the effect of fast, strong qi recovery without pain.
1.3.2. Affection mechanism of electro-acupuncture
Acupuncture is a stimulus that causes a new reflex pulse to

strength, joint range, increasing coordination and balancing ability
of people with hemiplegia. The paralyzed party has straps fixed to
the device. Passive training equipment helps patients to practice
from the early stages of the disease when the signs of survival have
stabilized. Early movement helps to mentally faster, the half of the
healthy side is not weakened, stimulating motor movement reflexes
of the paralyzed person. Early movement also helps to eat and sleep
better, quickly improve the body, get used to and adapt to the sitting,
standing postures, preventing secondary injuries. Thus, exercising
with bicycles can be used as passive exercise, assisted active
exercise, active exercise and increased resistance.


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Cycling in the lower limbs is done by most of the muscle groups
and joints of the lower limbs, which are most effective in the muscles
that create the extension of the knees and hip, so that the hip, knee
and ankle joints are exercised. There are four main muscle groups
involved: knee extension, hip extension, knee flexion, hip flexion. In
addition, the muscle group plantarflexion and dorsiflexion are also
involved in cycling.
For the upper limb, the biking is primarily due to flexes,
extensors of elbows and shoulders. The participating muscle
groups are the elbows flexion and elbows extension, shoulders
flexion and shoulders abduction. In addition, there is the
participation of crank muscles in the shoulder flexion, large back
muscles and large round muscles in shoulder extension, upper
spine muscles in shoulder abduction.
Chapter 2: SUBJECTS AND RESEARCH METHOD
2.1. Research subjects


pregnant

women,

accompanied by diseases: Tuberculosis , mental disorders,
HIV/AIDS. Patients who do not cooperate with the study, do not
participate in sufficient time for treatment, patients who are
being treated have more severe and life-threatening symptoms.
2.2. Research facilities
2.2.1. Electro-acupuncture
Acupuncture needles: Types of stainless steel acupuncture
needles made by Vietnam, with lengths from 6cm to 20 cm. M8 ac
electro-acupuncture produced by Vietnam National Hospital of
Acupunture. Aseptic alcohol-free cotton wool, clip without pin, bean
tray, stethoscope, blood pressure, shock-proof box with full of
medicine.
2.2.2. Exercise bicycle
Exercise bicycles are of Reck, Germany, model Motomed
viva 2, produced in 2015. A bicycle has 2 separate hand and foot


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training modes, using the standard program. Passive exercise
with the help of motor, maximum speed of 60 rpm. Active set
without resistance and active set with resistance, adjust the
resistance level from 1 to 20.
2.2.3. Electromyography recorder
Electromyography motors were recorded by Neuropack,
manufactured by Medilec-Synergy, UK, at the electromyography room

2.4.4. Evaluation of neurological function on the Orgogozo
scale
The scale has 10 items with a total score of 100: Grade I
(Good): 90-100 points, Grade II (Fair): 70-89 points, Grade III
(Medium): 50-69 points, Level IV (Poor):
treament using electro-acupuncture in combination with
exercise bicycle
Table 3.1. Average evaluation of muscle force before and after treatment
Group
Muscle

knee
extension
p

dorsiflexion
p

shoulder
abduction
p

Research group
(n=60)
± SD
Before (1)

After (2)

1,62±0,89

3,85±0,36

< 0,001
0,72±0,72


< 0,001
1,17±0,92

2,42±0,67

< 0,001



1,27±0,61

< 0,001

2,08±1,08

1,25±0,86

< 0,001

2,37±0,94

1,58±0,90

< 0,001

muscle level after treatment in the research group was higher than the
control group, p 2 levels) the research group was

Barthel



< 0,001

Barthel

49,17±11,83

34,92±8,46

< 0,001

Orgogozo

43,58±12,76

31,58±9,50

< 0,001

p


15

Comment: the changing scales of the study group were improved
over the control group with statistical significance p
2

Dependent

15

Total

60

p

25,0

0

6
0
P1-2
was 61.7% which is statistically significant higher than that of the
control group (23.3%), p
Frequenc
y
Amplitud
e
Frequenc
y

Delta

Biceps
brachii

353,00±181,8
9

273,00±138,2
7

< 0,05

6,10±2,98

5,52±2,93

< 0,05

406,83±198,2
6

336,41±162,3


< 0,05

Tibialis
anterior

Amplitude

258,67±179,70

191,26±135,09

< 0,05

Frequency

5,33±3,32

4,08±3,04

Amplitude

249,83±169,68

147,83±136,18

Frequency

4,77±2,63


Control group
n=60, ± SD
233,50±185,64

< 0,05

p

Comment: Difference in frequency amplitude of the motor
unit before and after treatment was higher than the control
group with p

63,64±13,38

< 0,001

> 0,05

< 0,01

Research

29,40±10,14

69,00±13,39

< 0,001

Control

31,36±8,62

60,23±10,29

< 0,001

> 0,05

< 0,05

p

< 0,01

Research

35,14±8,27

86,86±12,78

< 0,001

Control

36,05±9,46

73,42±13,31

< 0,001

> 0,05

< 0,001

Research

27,43±6,23

73,86±12,90

< 0,001


Independent

Dependent

Total

OR
(CI 95%)
p


19
> 60

22

21

43

≤ 60

16

1

17

Total


Female

14

10

24

Total

38

22

60

OR
(CI 95%)
p
0,70
(0,24-2,04)
> 0,05

Comment: gender does not affect the independent status in life
on a Barthel scale with p> 0.05.

Table 3.12. Relationship between illness duration (> 6 months) and
independence of living on Barthel scale
Duration



OR
(CI 95%)
p
0,25
(0,42-1,50)
> 0,05


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Comment: long illness duration does not affect the
independence of daily activities on the Barthel scale, p> 0.05.
Table 3.13. The relationship between diabetes and independence in
living activities on a Barthel scale
Diabetes

Độc lập

Không độc
lập

Tổng

Yes

11

7

18

Independent

Depende
nt

Total

Dominance
Nondominance
Total

23

13

36

15

9

24

38

22

60

Comment:


Dependent

Tota
l

28

7

35

Empty symtom

10

15

25

Total

38

22

60

OR
(CI 95%)

muscles in the posterior thigh area (biceps femoris, semi-tendonic,
semi-percipular muscles); hip flexion due to pelvic muscle;
plantarflexion due to the tibialis posterior. The upper torso muscle
group also has an impact during cycling such as the rectus
abdominis, the spine muscles ensure the posture and balance of the
pelvis and spine.


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In the upper limb, cycling motions are performed by flexor
and extensor elbow, shoulder, shoulder abduction and wrist
flexor with biceps, triceps, delta, and flexors. hand. In addition,
there is the participation of crows arm muscles, large back
muscles, large round muscles, muscles on spines in flexor,
extenxor, abductor shoulder. In addition, many groups of upper
limb muscles are also effective when riding the lower limbs such
as the biceps and triceps to help hold the handlebars, especially
when cycling with high resistance. Normally, in order to perform
a rotation cycle, there will be two parts of push and pull, so the
groups of flexors and extensors of the upper limb work more
regularly than the lower limbs with the main push on pedal.
4.1.2. Improvement in active function
Assessing the rehabilitation of functions in daily life, the
recovery degree of disability after treatment, and neurological
function in both research and control groups gave good results.
Improvement after treatment in the research group was higher than
that of the control group in all the indicators.
In

addition

the restoration of motion expressed by the frequency and voltage
range of the motor units. In all muscle groups, the difference in
amplitude and frequency of the motor unit before and after
treatment in the combination group was higher than in the
electro-acupuncture group.
Each motor neuron located in the horns behind the spinal
cord creates a motor unit that governs many muscle fibers. The
stronger the muscle contraction, the more motor units there will
be, the more muscle fibers in the motor unit participate in,
making the amplitude of motor units increase.
The electro-acupuncture stimulated, through the feedback
mechanism that acts on the cells that govern motor to help
repair. The rhythmic movements are repeated through motor
commands from the motor cortex, activating the spinal cord
network. The spinal cord network works to regulate the rhythmic
movements of the limbs in coordinated movements. Cycling on
upper and lower limbs is a repetitive motion, providing the same
movement as walking. Exercise also creates stimulating effects
on motor cortex receptors, which may contribute to the elasticity


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of the ischaemic stroke. And it has good effect on motor cortex
receptor region.
4.2. Factors affecting the rehabilitation results when
combining electro-acupuncture with exercise bicycle
4.2.1. Age and gender
The treatment method works well for all ages, for both men
and women. However, the level of independence after treatment is
affected by age, not by sex. In our opinion, the younger age usually

limbs.
The results of this research showed that patients suffering
from diabetes did not affect the results of rehabilitation of motor
function of hemiplegia patients by electro-acupuncture treatment
combined with exercise bicycles. This may be due to the fact that
patients in this study did not have clinical or vascular complications
due to clinical diabetes, early mobilization patients should limit
these complications and stabilize blood sugar better. On the other
hand, in our opinion, early exercise helps patients limit the risk of
embolism due to prolonged lying.
4.2.4. Hemisphere injury
The treatment method works well on both sides of the
brain. Injured hemisphere also shows no correlation with the
degree of independence in daily life after treatment.
Electro-acupuncture performed on both sides was the
same. Doing same exercises with bicycles on both sides, so the
rehabilitation of the paralyzed side is not affected. Exercise with
bicycles depends on the progression of the muscle strength,
when the muscle strength is below level 3, the limbs are fixed to