visualizing-motion-patterns-in-acupuncture-manipulation

Visualizing Motion Patterns in Acupuncture Manipulation

Acupuncture manipulation varies widely among practitioners in clinical settings, and it is difficult to teach novice students how to perform acupuncture ...

Kyung Hee University

Acupuncture is a therapeutic treatment that is defined as the insertion of needles into the body at specific points (ie, acupoints). Advances in functional neuroimaging have made it possible to study brain responses to acupuncture; however, previous studies have mainly concentrated on acupoint specificity. We wanted to focus on the functional brain responses that occur because of needle insertion into the body. An activation likelihood estimation meta-analysis was carried out to investigate common characteristics of brain responses to acupuncture needle stimulation compared to tactile stimulation. A total of 28 functional magnetic resonance imaging studies, which consisted of 51 acupuncture and 10 tactile stimulation experiments, were selected for the meta-analysis. Following acupuncture needle stimulation, activation in the sensorimotor cortical network, including the insula, thalamus, anterior cingulate cortex, and primary and secondary somatosensory cortices, and deactivation in the limbic-paralimbic neocortical network, including the medial prefrontal cortex, caudate, amygdala, posterior cingulate cortex, and parahippocampus, were detected and assessed. Following control tactile stimulation, weaker patterns of brain responses were detected in areas similar to those stated above. The activation and deactivation patterns following acupuncture stimulation suggest that the hemodynamic responses in the brain simultaneously reflect the sensory, cognitive, and affective dimensions of pain.

Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation.

Background. The appropriate selection of acupoints is fundamental to obtain a therapeutic effect from clinical acupuncture. Objective. Using a network analysis method, we investigated the acupoints that are combined to treat low back pain (LBP). Methods. To analyze the patterns of the combinations of acupoints, we used acupoint information from clinical trials to calculate the modified mutual information (MI) value, integrated these data, and visualized the network. Results. Based on the highest MI values, we found two different types of acupoint pairs used in the treatment of LBP: pairs of distant acupoints and pairs of local acupoints. Using modular analysis, we found that three acupoint modules were applied in the treatment of LBP: local acupoints, distant acupoints along the meridian, and distant acupoints based on the symptom differentiations. Conclusion. Using the modified MI technique, we provide a systematic framework for the acupoint combination network, and reveal how the technique of acupoint combination is used in the treatment of LBP. Application of this knowledge in acupuncture research may help clarify the mechanisms underlying acupuncture treatment at the systems level, bridging the gap between traditional medicine and modern science.

Network analysis of acupuncture points used in the treatment of low back pain.

In clinical practice, acupuncture manipulation is highly individualised for each practitioner. Before we establish a standard for acupuncture manipulation, it is important to understand completely the manifestations of acupuncture manipulation in the actual clinic. To examine motion patterns during acupuncture manipulation, we generated a fitted model of practitioners' motion patterns and evaluated their consistencies in acupuncture manipulation.

Motion patterns in acupuncture needle manipulation.

Acupuncture stimulation increases local blood flow around the site of stimulation and induces signal changes in brain regions related to the body matrix. The rubber hand illusion (RHI) is an experimental paradigm that manipulates important aspects of bodily self-awareness. The present study aimed to investigate how modifications of body ownership using the RHI affect local blood flow and cerebral responses during acupuncture needle stimulation. During the RHI, acupuncture needle stimulation was applied to the real left hand while measuring blood microcirculation with a LASER Doppler imager (Experiment 1, N = 28) and concurrent brain signal changes using functional magnetic resonance imaging (fMRI; Experiment 2, N = 17). When the body ownership of participants was altered by the RHI, acupuncture stimulation resulted in a significantly lower increase in local blood flow (Experiment 1), and significantly less brain activation was detected in the right insula (Experiment 2). This study found changes in both local blood flow and brain responses during acupuncture needle stimulation following modification of body ownership. These findings suggest that physiological responses during acupuncture stimulation can be influenced by the modification of body ownership.

Decreased peripheral and central responses to acupuncture stimulation following modification of body ownership.

Throughout the history of East Asian medicine, different kinds of acupuncture treatment experiences have been accumulated in classical medical texts. Reexamining knowledge from classical medical texts is expected to provide meaningful information that could be utilized in current medical practices. In this study, we used data mining methods to analyze the association between acupoints and patterns of disorder with the classical medical book DongUiBoGam of Korean medicine. Using the term frequency-inverse document frequency (tf-idf) method, we quantified the significance of acupoints to its targeting patterns and, conversely, the significance of patterns to acupoints. Through these processes, we extracted characteristics of each acupoint based on its treating patterns. We also drew practical information for selecting acupoints on certain patterns according to their association. Data analysis on DongUiBoGam's acupuncture treatment gave us an insight into the main idea of DongUiBoGam. We strongly believe that our approach can provide a novel understanding of unknown characteristics of acupoint and pattern identification from the classical medical text using data mining methods.

Data Mining of Acupoint Characteristics from the Classical Medical Text: DongUiBoGam of Korean Medicine.

From a neuroscientific perspective, the sensations induced by acupuncture are not only the product of the bottom-up modulation of simple needling at somatosensory receptors, but also of the reciprocal interaction of top-down modulation from the brain. The present study investigated whether acupuncture stimulation to incorporated body parts produces brain responses that are similar to the responses observed following acupuncture stimulation to the real hand. The present study included 17 participants who watched a rubber hand being synchronously stroked with their unseen left hand to induce incorporation of the rubber hand into their body. After the experimental modification of body ownership, acupuncture needle stimulation was applied to the LI4 acupoint on the incorporated rubber hand while brain activity was measured with functional magnetic resonance imaging (fMRI). When the rubber hand was fully incorporated with the real body, acupuncture stimulation to the rubber hand resulted in the experience of the DeQi sensation as well as brain activations in the dorsolateral prefrontal cortex (DLPFC), insula, secondary somatosensory cortex (SII), and medial temporal (MT) visual area. The insular activation was associated with the DeQi sensation from the rubber hand. The psychophysical and neurophysiological responses associated with acupuncture stimulation to the incorporated rubber hand were influenced by an enhanced bodily awareness of the hand, which was likely due to top-down modulation from the interoceptive system in the brain.

Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand.

This report describes the brain responses to acupuncture in an upper limb amputee patient. A 62-year-old male had previously undergone a lower left arm amputation following an electrical accident. Using functional MRI, we investigated brain responses to acupuncture stimulation in the aforementioned amputee under three conditions: (a) intact hand, (b) prosthetic hand (used by the patient), and (c) fake fabric hand. The patient described greater de qi sensation when he received acupuncture stimulation in his prosthetic hand compared to a fake hand, with both stimulations performed in a similar manner. We found enhanced brain activation in the insula and sensorimotor cortex in response to acupuncture stimulation in the amputee's prosthetic hand, while there was only minimal activation in the visual cortex in response to acupuncture stimulation in a fake hand. The enhanced brain responses to acupuncture stimulation of the patient's prosthetic hand might be derived from cortical reorganisation, as he has been using his prosthetic hand for over 40 years. Our findings suggest the possible use of acupuncture stimulation in a prosthetic hand as an enhanced sensory feedback mechanism, which may represent a new treatment approach for phantom limb pain.

Brain responses to acupuncture stimulation in the prosthetic hand of an amputee patient.

We investigated commonalities and differences in brain responses to enhanced bodily attention around acupuncture points with and without stimulation. Fourteen participants received acupuncture needles at both PC6 and HT7 acupoints in the left hand. To enhance bodily attention to acupoints, participants responded to the locations of stimulations in a two-alternative forced choice task. Two fMRI scans were taken in a block design: session 1 labeled with manual stimulation (genuine stimulation) and session 2 labeled with electro-acupuncture (pseudo-stimulation). To compare cortical activation patterns, data were analyzed using the Freesurfer software package. Both genuine-and pseudo-stimulation resulted in brain activations in the insula, anterior cingulate cortex, secondary somatosensory cortex, superior parietal cortex, and brain deactivation in the medial prefrontal cortex, posterior cingulate cortex, inferior parietal cortex, and the parahippocampus. Genuine acupuncture stimulation exhibited greater brain activation in the posterior insula, posterior operculum and the caudal part of the anterior cingulate cortex, compared with pseudo-stimulation. We demonstrated that enhanced bodily attention triggered by genuine acupuncture stimulation can activate the salience network and deactivate the default mode network regardless of the type of stimulation. The component of enhanced attention to a certain part of the body is significant in the brain response to acupuncture stimulation.

Cortical Activation Patterns of Bodily Attention triggered by Acupuncture Stimulation.

Nowadays a lot of trials for collecting electronic medical records (EMRs) exist. However, structuring data format for EMR is an especially labour-intensive task for practitioners. Here we propose a new mark-up language for medical record charting (called Charting Language), which borrows useful properties from programming languages. Thus, with Charting Language, the text data described in dynamic situation can be easily used to extract information.

Development of Markup Language for Medical Record Charting: A Charting Language.

Humans can acquire a wide variety of motor skills using sensory feedback pertaining to discrepancies between intended and actual movements. Acupuncture needle manipulation involves sophisticated hand movements and represents a fundamental skill for acupuncturists. We investigated whether untrained students could improve their motor performance during acupuncture needle manipulation using visual feedback (VF).

Sensorimotor Learning of Acupuncture Needle Manipulation Using Visual Feedback.

The indications of acupoints are thought to be highly associated with the lines of the meridian systems. The present study used data mining methods to analyze the characteristics of the indications of each acupoint and to visualize the relationships between the acupoints and disease sites in the classic Korean medical text Chimgoogyeongheombang. Using a term frequency-inverse document frequency (tf-idf) scheme, the present study extracted valuable data regarding the indications of each acupoint according to the frequency of the cooccurrences of eight Source points and eighteen disease sites. Furthermore, the spatial patterns of the indications of each acupoint on a body map were visualized according to the tf-idf values. Each acupoint along the different meridians exhibited different constellation patterns at various disease sites. Additionally, the spatial patterns of the indications of each acupoint were highly associated with the route of the corresponding meridian. The present findings demonstrate that the indications of each acupoint were primarily associated with the corresponding meridian system. Furthermore, these findings suggest that the routes of the meridians may have clinical implications in terms of identifying the constellations of the indications of acupoints.

Article	Year
Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation. The journal of pain : official journal of the American Pain Society\| PubMed ID: 23395475	2013
Network analysis of acupuncture points used in the treatment of low back pain. Evidence-based complementary and alternative medicine : eCAM\| PubMed ID: 23956769	2013
Motion patterns in acupuncture needle manipulation. Acupuncture in medicine : journal of the British Medical Acupuncture Society\| PubMed ID: 24938530	2014
Decreased peripheral and central responses to acupuncture stimulation following modification of body ownership. PloS one\| PubMed ID: 25285620	2014
Data Mining of Acupoint Characteristics from the Classical Medical Text: DongUiBoGam of Korean Medicine. Evidence-based complementary and alternative medicine : eCAM\| PubMed ID: 25574179	2014
Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand. Neuroscience letters\| PubMed ID: 25681621	2015
Brain responses to acupuncture stimulation in the prosthetic hand of an amputee patient. Acupuncture in medicine : journal of the British Medical Acupuncture Society\| PubMed ID: 26033865	2015
Cortical Activation Patterns of Bodily Attention triggered by Acupuncture Stimulation. Scientific reports\| PubMed ID: 26211895	2015
Development of Markup Language for Medical Record Charting: A Charting Language. Studies in health technology and informatics\| PubMed ID: 26262181	2015
Sensorimotor Learning of Acupuncture Needle Manipulation Using Visual Feedback. PloS one\| PubMed ID: 26406248	2015
Spatial Patterns of the Indications of Acupoints Using Data Mining in Classic Medical Text: A Possible Visualization of the Meridian System. Evidence-based complementary and alternative medicine : eCAM\| PubMed ID: 26539224	2015

Won-Mo Jung

Biography

JoVE Journal Publications

Other Publications