Traumatic Brain Injury (TBI) in the Military: Treatment with Scalp Acupuncture

By Xiaolong Alcocer L.Ac. 

www.alcoceracupuncture.com

Abstract:

According to Chinese medicine trauma causes obstruction to the normal flow of blood in the affected or adjacent areas. This obstruction prevents the blood from circulating therefore preventing the body from receiving vital nutrients resulting in disfunction of the organ or body part, blood stagnation or stasis must be resolved in order to recover to normal body functions. 

Keywords: traumatic brain injury, TBI, military, scalp acupuncture.  

Introduction:

According to the Defense and Veterans Brain Injury Center, active duty and reserve service members are at increased risk for sustaining a TBI compared to their civilian peers. This is a result of several factors, including the specific demographics of the military; in general, young men between the ages of 18 to 24 are at greatest risk for TBI. Many operational and training activities, which are routine in the military, are physically demanding and even potentially dangerous. Military service members are increasingly deployed to areas where they are at risk for experiencing blast exposures from improvised explosive devices (IEDs), suicide bombers, land mines, mortar rounds and rocket-propelled grenades. These and other combat related activities put our military service members at increased risk for sustaining a TBI.

Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.(Hoge et al, 2008). Overall TBI admission rates were 24.6 for Afghanistan and 41.8 for Iraq per 10,000 soldier-years. TBI hospitalization rates rose over time for both Iraq and Afghanistan campaigns. (Wojcik et al, 2010).

TBI Basics and Statistics: 

What is a TBI?

▪ A traumatic brain injury (TBI) can be classified as mild, moderate, severe or penetrating.  The severity is determined at the time of injury.

▪ A TBI is a blow or jolt to the head that disrupts the normal function of the brain. It may knock you out briefly or for an extended period of time, or make you feel confused or “see stars” (alteration of consciousness).

▪ Not all blows or jolts to the head result in a TBI.

▪ The most common form of TBI in the military is mild. Concussion is another word for a mild TBI.

What are the causes?

In the military, the leading causes of TBI both deployed and non-deployed are (in no particular order):

▪ Blasts

▪ Bullets

▪ Fragments

▪ Falls

▪ Motor vehicle – crashes and rollovers

▪ Sports

▪ Assaults

In the deployed setting, blasts are the leading cause of TBI.

Who is at greatest risk for TBI?

Those who are at a higher risk for sustaining TBIs are young men who are performing military duties, or have a history of prior concussion and/or substance abuse.

What are common signs and symptoms of TBI?

Physical

▪ Headaches

▪ Sleep disturbance

▪ Dizziness

▪ Balance problems

▪ Nausea/vomiting

▪ Fatigue

▪ Visual disturbances

▪ Sensitivity to light

▪ Ringing in the ears

Cognitive

▪ Concentration problems

▪ Temporary gaps in memory

▪ Attention problems

▪ Slowed thinking

▪ Difficulty finding words

Emotional

▪ Irritability

▪ Anxiety

▪ Depression

▪ Mood swings

How long does recovery take?

▪ Recovery is different for every person.

▪ Most people recover from a concussion.

▪ Symptoms usually begin to improve within hours and typically resolve completely within days to weeks.

▪ Even after more than one concussion, full recovery is expected; however, every time an additional concussion is sustained, healing time might take longer.

What helps recovery from a concussion?

▪ Be honest about symptoms with your medical provider.

▪ Drink plenty of water.

▪ Eat a healthy diet.

▪ Rest during the day — don’t overexert — mentally or physically.

▪ Get plenty of sleep at night.

▪ Avoid smoking or drinking alcohol.

▪ Avoid over-the-counter medications unless prescribed by a provider.

▪ Take prescribed medications as directed by a provider.

▪ Avoid caffeine and “energy-enhancing” products.

▪ Take precautions to avoid another concussion: Avoid contact sports, combatives, etc.

▪ Stay engaged with family members and medical provider.

▪ If symptoms persist or worsen, see a medical provider.

▪ Be patient. Give the brain time to heal.

Warning signs

▪ Worsening headaches

▪ Worsening balance

▪ Double vision or other vision changes

▪ Decreased level of alertness

▪ Increased disorientation

▪ Repeated vomiting

▪ Seizures

▪ Unusual behavior

▪ Amnesia/memory problems

Traumatic Brain Injury treatment using Scalp Acupuncture:

Scalp Acupuncture is a technique developed in the early 70’s by Dr. Jiao Shun-fa, a neurosurgeon from China who combined traditional acupuncture techniques with the knowledge of modern neuroanatomy and neurophysiology of the brain. 

For the treatment of traumatic brain injury the acupuncturist is going to assess the condition, signs and symptoms of the patient and needle areas on the scalp that corresponds to the neurophysiological functions in the brain. Also needles may be inserted in other areas of the body to help promote blood flow and to stimulate motor neurons to help regain sensation and movement. After all the needles are in place the acupuncturist may stimulate the needles manually or by using an electrical stimulation device that runs electrical current to the needles, also known as electroacupuncture which provides stimulation to the desired areas for greater effectiveness. 

During the treatment patients may feel like a slight pinch sensation, numbness, tingling, itching, tiredness, heaviness and/or muscle twitches, all those sensations are normal and usually well tolerated. The needles are left in place for about 30 to 45 minutes, then the needles are removed; there might be slight bleeding, especially the scalp due to the normal increased vascularity. 

Treatments are given 1-5 times a week depending on the severity of the TBI until desired results are achieved or if no significant results are observed after a few treatments; some patients may also receive maintenance treatments to help with their symptoms. The most common adverse effects are soreness and bruising, rarely patients may feel lightheaded and usually goes away within a few minutes.   

According to research acupuncture improved neurological recovery after traumatic brain injury by activating BDNF/TrkB pathway. (Li et al, 2017),  acupuncture increases the excitability of the cortico-spinal system in patients with chronic disorders of consciousness following traumatic brain injury (Matsumoto-Miyazaki  et al, 2016) patients with TBI who receive acupuncture treatment have reduced the use of emergency care and hospitalization in the first year after injury. (Shih et al, 2013) and acupuncture treated insomnia in patients with traumatic brain injury (Zollman et al, 2012).  

 Source: Captain Robert L. Koffman, M.D., MC, USN

Conclusion:

Acupuncture can be an important part of the integrative medicine model for the treatment of TBI. The US Department of Defense (DoD) shows particular interest in and usage of IM for managing chronic conditions including the signature "polytrauma triad" of chronic pain, traumatic brain injury (TBI), and post traumatic stress disorder (PTSD) among its beneficiaries in the Military Health System (MHS). These modalities range from conventional nondrug, nonsurgical options such as cognitive-behavioral therapy to nonconventional options such as acupuncture. (Madsen et al, 2017). 

It is important to always consult your Doctor first to see if Acupuncture can be an option for you, and be sure that the Acupuncturist has a valid license to practice in your state.

For License verification in California click here or visit http://www.acupuncture.ca.gov/ for more information about Acupuncture.

References 

Hoge CW, Mcgurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358(5):453-63. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/18234750

Li X, Chen C, Yang X, et al. Acupuncture Improved Neurological Recovery after Traumatic Brain Injury by Activating BDNF/TrkB Pathway. Evid Based Complement Alternat Med. 2017;2017:8460145. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28243312

Madsen C, Vaughan M, Koehlmoos TP. Use of Integrative Medicine in the United States Military Health System. Evid Based Complement Alternat Med. 2017;2017:9529257. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28690665

Matsumoto-miyazaki J, Asano Y, Yonezawa S, et al. Acupuncture Increases the Excitability of the Cortico-Spinal System in Patients with Chronic Disorders of Consciousness Following Traumatic Brain Injury. J Altern Complement Med. 2016;22(11):887-894. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27662495

Shih CC, Lee HH, Chen TL, et al. Reduced use of emergency care and hospitalization in patients with traumatic brain injury receiving acupuncture treatment. Evid Based Complement Alternat Med. 2013;2013:262039. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23970929

Traumatic Brain Injury. Defense and Veterans Brain Injury Center website http://dvbic.dcoe.mil/article/tbi-basics. Updated on November 6, 2017. Accessed November 7, 2017.

Wojcik BE, Stein CR, Bagg K, Humphrey RJ, Orosco J. Traumatic brain injury hospitalizations of U.S. army soldiers deployed to Afghanistan and Iraq. Am J Prev Med. 2010;38(1 Suppl):S108-16. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20117583

Zollman FS, Larson EB, Wasek-throm LK, Cyborski CM, Bode RK. Acupuncture for treatment of insomnia in patients with traumatic brain injury: a pilot intervention study. J Head Trauma Rehabil. 2012;27(2):135-42. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21386714

Stroke Rehabilitation Treatment with Acupuncture

Stroke Rehabilitation Treatment with Acupuncture 

by Xiaolong Alcocer L.Ac. 

Stroke or Brain Attack is a disease of the blood vessels that supply blood to the brain, when a stroke occurs the brain is injured by the lack of oxygen and nutrients. Stroke is considered a medical emergency and requires immediate medical treatment. 

Each year, about 795,000 people experience a new or recurrent stroke. Approximately 610,000 of these are first attacks, and 185,000 are recurrent attacks. It is the No. 5 cause of death and a leading cause of disability in the United States. 1.

Warning Signs: 

Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
 

Sudden CONFUSION, trouble speaking or understanding speech
 

Sudden TROUBLE SEEING in one or both eyes
 

Sudden TROUBLE WALKING, dizziness, loss of balance or coordination
 

Sudden SEVERE HEADACHE with no known cause

If someone shows any of these symptoms, immediately call 9-1-1 or emergency medical services.

What are the types of stroke?

Ischemic stroke is the most common type of stoke, it accounts 87% of strokes.  An ischemic stroke occurs when a clot or a mass blocks a blood vessel, cutting off blood flow to a part of the brain.1.

Hemorrhagic Stroke is when a blood vessel ruptures in the brain preventing adequate blood flow. 

Transient Ischemic Attack (TIA), also known as mini stroke is caused by a temporary blockage of blood flow to the brain. A mini stroke or TIA is also considered a medical emergency, Call 911.

How to minimize the risks of a stroke?

80 % of strokes are preventable, You can’t control some stroke risk factors, like heredity, age, gender, and ethnicity. Some medical conditions—including high blood pressure, high cholesterol, heart disease, diabetes, overweight or obesity, and previous stroke or transient ischemic attack (TIA)—can also raise your stroke risk. Avoiding smoking and drinking too much alcohol, eating a balanced diet, and getting exercise are all choices you can make to reduce your risk. 2.

Treatment

The treatment of strokes requires rapid interventions including use of medications for dissolving clots or endovascular mechanical removal of the clot, and use of neuroprotectants and close critical care monitoring.

Patients at risk of stroke or with TIA’s can be treated with medications to thin their blood, reduction of risk factors, and correction of the cause of the clots or vascular occlusion.

Carotid stenosis can be treated with surgery to remove the fatty buildups or with applications of angioplasty and stents.

Intracranial narrowing of the vessels can be treated with angioplasty and stenting or extracranial to intracranial bypass surgery

Inadequate blood supply, due to diseases like moyamoya, is treated with revascularization techniques including bypass surgery and EDAS.3.

Stroke rehabilitation

After initial treatment was provided patients may continue with rehabilitation programs such as: 

Rehabilitation Nursing, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Audiology, Recreational Therapy, Nutritional Care, Counseling, Social Work, Psychiatry/Psychology, Chaplaincy, Patient/Family Education and Support Groups. 

Acupuncture Treatment for Stroke Rehabilitation

In conjunction with any rehabilitation program research have shown that acupuncture can be beneficial to restore cognitive functions 4, post stroke neurological impairment and dysfunction such as dysphagia 5, insomnia 6 and depression 7.

Acupuncture for stroke rehabilitation also known as Scalp Acupuncture is a technique developed in the early 70’s by Dr. Jiao Shun-fa, a neurosurgeon from China who combined traditional acupuncture techniques with the knowledge of modern neuroanatomy and neurophysiology of the brain. 

For the treatment of stroke rehabilitation the acupuncturist is going to needle areas on the scalp that corresponds to the somatotopic system on the scalp, by stimulating these sensory and motor regions, acupuncture can have a direct effect on the nervous system.  

Needles are inserted in the scalp on side of the brain where the patient had the stroke which controls the movement and sensation of the opposite side of the body, also needles may be inserted in other areas of the body to help promote blood flow and to stimulate motor neurons to help regain sensation and movement. After all the needles are in place the acupuncturist may stimulate the needles manually or by using an electrical stimulation device that runs electrical current to the needles, also known as electroacupuncture which provides stimulation to the desired areas for greater effectiveness. 

During the treatment patients may feel like a slight pinch sensation, numbness, tingling, itching, tiredness, heaviness and/or muscle twitches, all those sensations are completely normal and usually well tolerated. 

The needles are left in place for about 30 to 45 minutes. When the needles are removed there might be slight bleeding, especially the scalp due to the normal increased vascularity. 

Treatments are given 1-5 times a week depending on the condition of the stroke until desired results are achieved or if no significant results are observed after a few treatments; some patients may also receive maintenance treatments to help with their symptoms. 

The most common adverse effects are soreness and bruising, rarely patients may feel lightheaded and usually goes away within a few minutes.   

Lt. Col. Dean Hommer, a doctor at Womack Army Medical Center, performs scalp acupuncture on Spc. Daniel Ebensteiner, Warrior Transition Battalion, June 12 to treat the hypersensitivity of a scar on Ebensteiner's left ankle from an airborne injury sufferred in 2008.

photo by Eve Meinhardt/Paraglide 8.

It is important to always consult your Doctor first to see if Acupuncture can be an option for you, and be sure that the Acupuncturist has a valid license to practice in your state.

For License verification in California click here or visit http://www.acupuncture.ca.gov/ for more information about Acupuncture.

www.alcoceracupuncture.com

References

1. Benjamin EJ, Blaha MJ, Chiuve SE, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation. 2017;135:e146–e603. doi: 10.1161/CIR.0000000000000485.

2. https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_stroke.htm

3. http://neurosurgery.ucla.edu/brain-attack

4. Liu F, Li ZM, Jiang YJ, Chen LD. A meta-analysis of acupuncture use in the treatment of cognitive impairment after stroke. J Altern Complement Med. 2014;20(7):535-44.

5. Zhang JH, Wang D, Liu M. Overview of systematic reviews and meta-analyses of acupuncture for stroke. Neuroepidemiology. 2014;42(1):50-8.

6. Lee SH, Lim SM. Acupuncture for insomnia after stroke: a systematic review and meta-analysis. BMC Complement Altern Med. 2016;16:228.

7. Qian X, Zhou X, You Y, et al. Traditional Chinese Acupuncture for Poststroke Depression: A Single-Blind Double-Simulated Randomized Controlled Trial. J Altern Complement Med. 2015;21(12):748-53.

8. https://www.flickr.com/photos/armymedicine/6026713256