A serendipitous treatment of cerebral palsy with TCM

In the initial phase of a NIH funded study (Grant #P50 AT00008-03) at the University of Arizona Pediatrics Department acupuncture was used on several children with cerebral palsy. The hypothesis of the study was that acupuncture would reduce muscle hypertonicity in children with cerebral palsy. In the course of administering acupuncture the writer was reminded that needles are only one of several media for communicating with a patient’s Qi.

The object of treating disqualified subjects in the first phase was to settle logistical issues which could have stopped the study soon after it began. A particularly important question was whether or not children would tolerate scalp acupuncture. The study team reasoned that the fastest way to get accurate answers was to simply start treating and see what happened.

The Patient

One child in this ‘logistical’ group was a five year old boy who had suffered a severe and permanently damaging blow to his head at four months of age. His musculature was extremely tight and distorted which also resulted in a distorted skeleton. He quite literally was bent in the coronal plane approximately 60 degrees at the waist. Organ development and function were stunted by this distortion. He had been diagnosed as cortically blind and virtually the only vocal sound he was capable of making was a ‘clicking’ in his throat. He had had an esophageal feeding tube for several months after his initial trauma and this was likely a significant component in his paucity of vocal and verbal ability. His affect was totally flat. According to his foster mother, he had cried only four times in the four and a half years she had cared for him

The Treatment

The first four treatments used such body points as LI 4, LI 11, GB 34, GB 39, SP 6, SJ 5, PC 6 to open the channels and scalp acupuncture upper and lower limb motor regions were used.

The Significant Event

There was reduction of the hypertonicity but the intensity and duration was small; lasting only a few hours. In the second session the patient began crying during the needling which increasingly worried his foster mother. During the fourth session he began crying soon after the needles were inserted. He continued crying with periodic intermissions. His foster mother asked if the ”pain and upset” were worth the gain and then enumerated the rest of her concerns about negative effects due to acupuncture. During her expression of concern the needles were removed from the patient. He remained discomfited and agitated. The writer wanted to calm him as his foster mother and the writer talked. Unable to use needles the writer resorted to use of an ear probe on the auricular point Shenmen. An instant after stimulation of the point by probe began, the patient relaxed, his eyes brightened and focused on something far away.

Both his foster mother and the writer noticed his change in affect and focused their attention on the patient. After a few minutes of stimulus on auricular Shenmen a point within the auricular liver region called “relax muscles” was stimulated by the ear probe and the foster mother massaged his arms and legs. She said that his muscles were no longer “rock hard”. After a bit more massage the writer tried moving the patient’s limbs and they did indeed allow themselves to be moved to small degree.

During the subsequent sixteen treatments needles were not used and instead the ear probe was used to stimulate all points. Points used were auricular Shenmen, Relax Muscles, all auricular joint points (e.g. elbow, ankle) and the channel points listed above. After a couple of more treatments the writer instructed the foster mother in the use of the probe and prescribed points for home treatment. Between the office visits and home the patient began receiving daily treatment.

By the end of the treatment course the patient’s lower body and upper body were within a few degrees of sharing the same axis. His muscles were much softer and his involuntary limb thrusting was reduced by about 50%. His appetite and weight had increased. He had begun to cry more frequently. When an object was passed in front of his eyes they followed it. He had developed a small repetoire of facial expressions and vocal sounds. After the course of office treatment had ended the foster mother continued daily treatment at home. A month after that the foster mother reported that there were two new foster infants in her care in whose proximity the patient spent much time and that he had begun babbling in a manner very similar to that of the new children.

Conclusion

This case underscores the utility and necessity of individualized treatment designed according to the needs of the patient. The method of applying pressure to a point is as well known to Oriental Medicine practitioners as acupuncture, yet the writer was still very surprised to witness these changes and so discovered a forgotten personal prejudice. He had assumed that because most of the children he would be treating were significantly impaired that the ‘greater strength’ of acupuncture was necessary to effect change. But in this case clinical experience was a reminder that it is appropriateness rather than strength of treatment which is the reliable guide to selection of treatment modalities.