Nghiên cứu hiệu quả kết hợp điện châm với tập xe đạp motomed viva 2 trong phục hồi chức năng vận động ở bệnh nhân liệt nửa người sau nhồi máu não TT tieng anh

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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


2
the treatment using electro-acupuncture in combination

exercise bicycles.


3
THE PRACTICAL APPLICATION AND CONTRIBUTION OF
THE THESIS
Brain stroke is the leading cause of multiple disabilities in
adults, hemiplegia is one of the main disabilities affecting the quality
of life of patients. Researching for easy and cost-effective solutions
to reduce the level of paralysis is essential, consistent with the
rehabilitation of motor functions after brain stroke to improve the life
quality of patients.
The thesis proposes a method for rehabilitation of motor
function after ischaemic stroke by combining electro-acupuncture of
traditional medicine with rehabilitation method as a highly effective
tool to support zmovement. The research is inherited and applies new
techniques suitable to the practical situation. The research results
have confirmed the effect of occupational rehabilitation after
ischaemic stroke of two combined clinical and subclinical methods.
The research is based on adding a new option, a new intervention
method for physicians and patients, which is feasible and widely
applicable.
THE STRUCTURE OF THE THESIS
The thesis consists of 126 pages: 02 pages for problem
introduction, 39 pages for overview, 19 pages for subjects and
research methods, 32 pages for research results, 31 pages for
discussion,

02

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,

with clinical symptoms usually lasting below 1 hour without the
evidence of critical brain stroke.
A ischaemic stroke occurs when a brain blood vessel is
blocked. Areas irrigated by un-nourished vessels will be
destroyed.
1.1.2. Rehabilitation of ischaemic stroke patients after acute
phase
After the acute phase of ischaemic stroke, there are many
complex disorders in which hemiplegia greatly affects the quality
of life. It is necessary to apply many methods and techniques at
the same time to make the recovery faster and more complete.
Rehabilitation measures include strengthening paralysis muscle
strength by passive, active, resistance-based exercises, enhanced
functional activities and control of secondary injuries. Exercise
aids are important, including exercise bicycles, which help
improve motor function more quickly and comprehensively.


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1.2. Ischaemic stroke in traditional medicine
* Concept and the cause
Windstroke disease appeared more than 2000 years in the
Noi kinh book, also known as other names: Thien phong, thien
kho, thien than bat dung, phuc kich ... In " Kim quy yeu luoc" also
stated the disease Windstroke, and it is used till now. After acute
stage with symptoms of prominent hemiplegia, it is classified as
half-disabled.
The cause of windstroke: commonly with the elderly,
impaired heart, liver and kidney activity causing negative
phenomena, sputum, internal wind to cause seizures, coma. The

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

inhibit and break the pathological reflex pulse. There are many
unified views and many studies indicate the mechanism of
neurological and humoral effects with three types of body
reactions: local reactions, sectional reactions, systemic reactions.
From the traditional medicine point of view, the negative
balance of yin and yang leads to the occurrence of disease.
Acupuncture works to balance yin and yang, raising the righteous
temperament, expelling the evil wind. Depending on the nature of
the disease, use acupuncture or moxibusion, tonification or
dispertion. Ailments arose to disturb the normal functioning of the
meridian and collateral system, acupuncture regulates the function
of them. If the viscera and bowels is sick, there will be changes in


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the corresponding pathology of the meridian, using the points on
the meridian to correct the function of those organs.
1.4. Methods of using exercise bicycles with resistance
1.4.1. Exercise bicycle structure
A exercise bicycle is a device that has the same structure as
a bicycle with adjustable resistance, some devices have a
structure for the upper limb. Devices often have straps or gloves
to hold to the pedal. There are two types of vehicles depending
on the seat position and the pivot: straight bikes and tilt bikes.
Nowadays, there are many electric-powered devices that are
capable of passive exercise, usually in the form of an inclined bicycle, so that
patients can practice from the early stages after a stroke when the signs
of survival have stabilized.
1.4.2. The effectiveness of training bike exercises
Exercise on bicycle has the effect of increasing muscle

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.


8
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

2.1.1. Criteria for selecting patients
120 patients were diagnosed after acute phase of
ischaemic stroke (ICD10-2014). Patients aged from 18 years old
and above, regardless of gender, occupation, First time of
ischaemic stroke, stable treatment of cardiovascular, respiratory,
neurological disorders ... after acute phase, hemiplegia people,
mentally alert to cooperate with physicians (Mini - mental state
examination test ≥ 20 points), agreed and voluntarily
participated in research.
Hemiplegic patients due to ischaemic stroke region of
perfusion of the mid cerebral artery, determined clinically and


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subclinically according to the World Health Organization's
diagnostic criteria. Patients who have been treated with acute
phase stabilize their vital signs at specialized hospitals. The acute
phase is difficult to determine the duration depending on the
patient's condition, minimum of 7 days.
The patients were then examined according to traditional
medicine through eight notions, four ways of examination to
divid into: full and empty symtom.
2.1.2. Criteria for excluding patients
Patients with cardiopathy, cerebrovascular malformation,
pulmonary embolism, chronic lung disease, arthropathy, blood
pathology,

postoperative,

postpartum,

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

of Vietnam National Hospital of Acupunture.
2.3. Research Methods
Methods of clinical intervention were controlled, compared
before and after treatment, compared with the control group.
Qualified patients were divided according to pairing
method (similar in age and gender) into two groups:
- Study group: 60 patients treated with electroacupuncture and exercise bicycle.
- Control group: 60 patients treated only with electroacupuncture.
2.4. Research targets
Examined and assessed: upon admission, after 30 days of
treatments.
2.4.1. Motor function evaluation
We assessed the stretching of the muscles in the knee
extension, the dorsiflexion, the elbow flexion, and shoulder
abduction. Mechanical gradation according to the British Medical
Research Council, consisting of 6 degrees from 0 to 5.
Assessment measure: Good: increase ≥ 2 levels, Fair: increase 1
level, Poor: no increase


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2.4.2. Assess the level of reduced ability and disability
according to the Modified Rankin Scale
The scale has 7 levels of disability from 0 to 6: Good: switch
≥ 2 degrees, Fair: transfer 1 degree, Poor: no improvement or
worse
2.4.3. Assess the independence of daily activities on the
Barthel scale
The scale has 10 contents, total score of 100, level assessment:
Independent: 80-100 points, need support: 30-75 points, Dependent: 025 points.

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): <50 points.
2.4.5.

Assess

the

level

of

motor

rehabilitation

by

electromyography
Electromyography recording in 4 muscles: quadriceps
femoris, tibialis anterior, delta, biceps brachii. Each muscle is
defined with two indices: Motor unit frequency (MUP).
Amplitude of motor unit (µV).
2.4.6. Assess muscle stiffness using the modified Ashworth
scale
Evaluate

muscle

groups:

the

knee

extension,

the

dorsiflexion, the elbow flexion, and shoulder abduction. How to
determine: No muscle spasms: below 1+, Muscle spasms: From


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1+ degrees. Assess progress: Good: no increase or decrease, Fair:
increase 1 degree, Poor: increase from 2 degrees or above.
2.5. Data processing
The collected data were analyzed and processed by the
method of biomedical statistics by SPSS 16.0 statistical software.
2.6. Ethics in research
The research was conducted through the Scientific and Ethical
Council of the Military Institute of Traditional Medicine, the patient
understood and voluntarily participated in the study, all information
about the patient was kept confidentially, only published aggregate
results.
Chapter 3: RESEARCH RESULTS
3.1. Evaluate the rehabilitation of motor function after

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

2,87±0,77

< 0,001
0,90±0,93

2,98±0,87

< 0,001

Control group
(n=60)
± SD
Before
After (4)
(3)
1,77±0,79

3,48±0,65

P2-4

<0,001

< 0,001
0,92±0,67

2,18±0,60

<0,001

< 0,001
1,17±0,92

2,42±0,67

< 0,001

<0,001


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elbow
flexion

1,18±0,93

p

3,55±0,68

< 0,001

1,45±0,93

3,03±0,74

<0,001

< 0,001

Comments: The muscularity in all muscle groups after treatment in both
groups increased compared to before treatment, p <0.001. The mean
Group
Muscle

knee
extension
dorsiflexion
shoulder
abduction
elbow
flexion

Research
group
(n=60); ± SD

Control group
(n=60); ± SD

p

2,23±0,87

1,72±0,89

< 0,01

2,15±0,95

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 <0.001.

Table 3.2. Assess the average increase in muscle force
Comment: muscle level increase before and after treatment all four muscle
groups in the study group were statistically significant higher than the
control group.
Figure 3.1. Good degree of muscle elevation after treatment of the two
groups


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Comment: the level of good (increased> 2 levels) the research group was

higher than the control group at all evaluation agencies with statistical
significance.
Table 3.3. Change the average score on the scale of before and after
treatment
Research group
(n=60); ± SD
Before
After
(1)
(2)

Group
Index
Rankin

3,80±0,40

p

Control group
(n=60); ± SD
Before
After
(3)
(4)

2,17±0,91 3,87±0,34 2,75±0,77

< 0,001

Barthel

<0,001

< 0,001

82,58±13,9 34,92±9,8 69,83±14,0
33,42±8,46
<0,001
2
1
5

p

< 0,001

Orgogoz
o

P2-4

28,25±8,07

P

< 0,001

71,83±13,2 31,33±9,1 62,92±11,4
<0,001

1
5
4

< 0,001

< 0,001

Comment: Post-treatment indexes were improved compared to
before treatment, p <0.001 in both groups. After treatment, the
research group's indicators improved better than the control group, p
<0.001.
Table 3.4. The average difference between the scales between the
two groups
Group
Index

Research group
n=60
± SD

Control group
n=60
± SD

Rankin

1,63±0,82

1,12±0,61

< 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 <0.001.

Figure 3.2. The change level of reduced ability and disability before
and after treatment according to Rankin scale

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Comment: good level (decreased from 2 degrees) in the
study group (63.3%) was higher than the control group (25.0%)
with statistical significance, p <0.01.
Table 3.5. Assess the independence of daily activities on the
Barthel scale before and after treatment
Group
Level
Independent
Support

Research group
Before
After
(1)
(2)
n
%
n
%
3
0
0
61,7
8
2
45
75.0
38,3

2

Dependent

15

Total

60

p

25,0

0

6
0
P1-2 <0,05
100

0
100

Control group
Before
After
(3)
(4)
n

%
n
%
1
0
0
23,3
4
4
4
78,3
76,7
7
6
1
21,7
0
0
3
6
6
100
100
0
0
P3-4 <0,05

P1-3 > 0,05; P2-4< 0,001

Comment: The independent status after the treatment group

was 61.7% which is statistically significant higher than that of the
control group (23.3%), p <0.001.
Table 3.6. Average electromyography index after treatment of 2 groups
Group
Muscle

Quadriceps
femoris
Tibialis
anterior

Amplitud
e
Frequenc
y
Amplitud
e
Frequenc
y

Research
group
(n=60); ± SD
481,50±318,5
7

Control group
(n=60); ± SD

p

372,33±165,5
3

< 0,05

8,60±4,06

7,10±2,82

< 0,05

367,00±244,7
9

273,17±128,9
0

< 0,05

6,33±3,42

5,38±2,86

< 0,05


17
Amplitud
e

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

2

< 0,05

7,83±3,39

6,42±2,82

< 0,05

Comment: after treatment, the amplitude and frequency of the motor
units of the study group were higher than the control group, p <0.05.
Table 3.7. Difference of electromyography indexes before and after
treatment of 2 groups
Group

Quadricep
s femoris

Amplitude

Research group
n=60, ± SD
330,50±274,56

Frequency

6,17±3,40

4,85±3,09

< 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

3,40±2,63

< 0,05
<
0,001
< 0,01

Amplitude

277,33±145,08

181,74±162,77

< 0,01

Frequency

5,77±3,45

3,82±2,93

< 0,01

Muscle

Delta

Biceps
brachii

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 <0.05.
Table 3.8. Average score of empty symtom between the two groups
Scale

Research

Before
± SD
3,80±0,41

After
± SD
2,44±0,96

< 0,001

Control

3,86±0,35

3,09±0,68

< 0,001

> 0,05

< 0,05

Group

Rankin
p

p


18
Barthel

Research

31,00±8,29

76,60±13,44

< 0,001

Control

32,95±10,31

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

Orgogozo
p

Comment: After treatment, the research group indexes
were improved more than the control group.
Table 3.9. Average of test scores between the two groups
Scale

Research

Before
± SD
3,80±0,41

After
± SD
1,97±0,82

< 0,001

Control

3,87±0,34

2,55±0,76

< 0,001

> 0,05

< 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

Control

31,32±9,56

64,47±11,90

< 0,001

> 0,05

< 0,01

Group

Rankin
p
Barthel
p
Orgogozo
p

p

Comment: After treatment, the research group indexes
were improved more than control group with p <0.05.
3.2. Influential factors of motor rehabilitation in electroacupuncture group combined with exercise bicycle
Table 3.10. The relationship between the old (> 60 years old) and
independence of daily activities on Barthel scale after treatment
Age

Independent

Dependent

Total

OR
(CI 95%)
p


19
> 60

22

21

43

≤ 60

16

1

17

Total

38

22

60

0,065
(0,008-0,538)
< 0,01

Comment: the age of over 60 affects the independence of
daily activities on the Barthel scale after treatment, p <0.01.
Table 3.11. Relationship between sex and independence
in Barthel scale
Sex

Independent

Dependent

Total

Male

24

12

36

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

Independe
nt

Dependent

Total

> 6 months

2

4

6

≤ 6 months

36

18

54

Total

38

22

60

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


20
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

No

27

15

42

Total

38

22

60

OR
(CI 95%)
p
0,87
(0,28-2,73)
> 0,05

Comment: patients with diabetes do not affect the
independence of daily activities on the Barthel scale.
Table 3.14. Relationship between dominant hemisphere injury and
independence in daily life on a Barthel scale
Hemisphere

Independent

Depende
nt

Total

Dominance
Nondominance
Total

23

13

36

15

9

24

38

22

60

Comment:

hemisphere

injury

does

not

OR
(CI 95%)
P
1,06
(0,36-3,10)
> 0,05

affect

the

independence in daily life on a Barthel scale, p> 0.05.
Table 3.15. Relationship between the status in traditional medicine
and the independence in life on the Barthel scale
Status in
traditional
medicine
Full symtom

Independe
nt

Dependent

Tota
l

28

7

35

Empty symtom

10

15

25

Total

38

22

60

OR
(CI 95%)

P
0,17
(0,05-0,53)
< 0,05


21
Comment: status in traditional medicine affects the
independence of daily activities on the Barthel scale with p
<0.05.

Chapter 4: DISCUSSIONS
4.1. Results of motor rehabilitation
4.1.1. The improvement in muscle force
On all muscle groups, the post-treatment muscle level
increased compared to before treatment in the two target groups.
Average increase in muscle level, the level of good (increased> 2
levels) on group combined with exercise bicycle is higher in all assessed
muscles.
The effect of motor function recovery after ischaemic stroke
by electro-acupuncture has been confirmed. However, in order to
gain better muscle strength, it is necessary to have a combination of
a exercise bicycle to increase muscle strength. In cycling with the
lower limbs, the muscle groups involved in the movements flexion,
extension of the hip, knee and ankles all play a role. The knee
extension is maintained by the quadriceps femorris muscle and the
hip extension muscle is 60% of the cycling force. In addition, the
participation of many other muscle groups: knee flexion due to the
biceps femoris muscle, semitendinosus and semimembranosus
muscles; hip extension due to large gluteal muscles, adjuvant

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.


22
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

to

restoring

motor

function,

electro-

acupuncture also has a good effect in recovering other disorders
after stroke such as language, swallowing disorders, etc. These
good function recovery will support patients in moving, taking
care of themselves in daily activities.
In addition to increase muscle strength, bicycle exercises
also increase the flexibility of the muscles, anti-stiffness,
increasing the ability to keep balance in movement. When
cycling, almost all lower limb joints are exercised as hip, knee,


23
ankle, upper limb joints such as shoulders, elbows, wrists. This
helps maintain joint mobility, prevents joint adhesion, stimulates
folding reflexes. Post-stroke patients perform their daily
activities, in addition to having a good muscle, need flexibility of
the limb joints, flexibility in movement as well as balance,
coordination of movement of the whole the body.
4.1.3. The improvement of electromyography index
Electromyography method was used to objectively assess

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


24
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

recovers better health and is more adaptable after the exacerbation,
so the exercise is usually more active, the sense of autonomy in
living better and also consistent with the physiological characteristics
of the age .
Since electro-acupuncture is a passive procedure for patients,
so all age groups and sexes receive the same level. In terms of
bicycle exercise, the younger age group usually learns the technique
faster, knows how to practice the most paralyzed group, especially
the transition from passive to active exercise, but between the sexes.
age groups perform similarly.
4.2.2. Ilness duration
Short-term illness usually gives better treatment results
due to better health recovery, often with more motivation to
practice, so exercise more actively, focus more, less muscle spasm
and adapt. after the exacerbation, the training is usually more
active. However, patients who have been sick for more than 6
months have no relation to the ability to be independent in their
daily activities. We think that the number of patients treated after
6 months is much less than that of patients under 6 months. . On


25
the other hand, it may be because in these 6 months the patient
has partially recovered and has adapted to the condition.
4.2.3. Diabetes
Diabetes damages blood vessels and peripheral nerves,
autonomic nerves affect the rehabilitation process. It particularly
causes superficial disorders, such as limb paresthesia, reduced
sensation aggravated sensory disorders caused by ischaemic
stroke, affecting the ability of movement and the functions of the

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