Scalp acupuncture is a system of acupuncture developed in the 20th Century which – in the case of the Chinese scalp acupuncture illustrated here- integrates traditional acupuncture needling techniques with Western medical knowledge of the functions of the different areas of the cerebral cortex. This system is widely used in China alongside conventional Western treatment for neurological conditions causing motor and sensory dysfunction. In neurology wards in integrative health hospitals in China, patients can be seen performing physiotherapy exercises with needles inserted into the scalp. Many studies show the efficacy of scalp acupuncture in the treatment of mobility issues from diverse causes. (i) (ii) (iii)
Acupuncture has been used for a few decades in humanitarian
settings and there are several projects initiated by organisations based in the
US, UK, and Europe that offer treatments in different areas of the world
affected by poverty, war, and natural disasters. It is common to see protocols
such as the NADA protocol in these settings. The protocols consist of a fixed ear
or body acupuncture point prescription which is repeatedly given to every
person without modification as part of group sessions. This requires a minimum
of verbal exchange which can prove a difficulty due to language barriers. These
protocols are also suitable for limited levels of time and space and to
maximise the amount of people that can be offered treatment at the same time. There
is no record of scalp acupuncture being used in this context.
Earth Medicine is an organisation which differs from others that offer acupuncture treatments in
that it is based in the same location as the people they are serving. Currently,
this is the only organisation allowed by the Greek government to offer
rehabilitation therapies inside the Mavrovouni refugee camp in the island of
Lesvos. This organisation has been operating on the island since 2018, four
years after the beginning of the so-called “refugee crisis”, when it became
obvious that apart from the basic needs of food, water, clothing, and shelter,
there were also issues with mobility and long-term injuries amongst the
population of the refugee camps. The organisation was born to meet these needs
and over the years has been offering physiotherapy, massage, and acupuncture
focussing on individual physical needs including rehabilitation.
Because the model of this organisation does not consist of offering treatments temporarily but permanently, it is possible to bring long-term assistance to asylum seekers who stay on the island for several months/years. This article presents a case study of a person treated by Earth Medicine, within a multidisciplinary context and where the use of scalp acupuncture in combination with body acupuncture was crucial.
CASE STUDY
The patient, who will be referred to as Mr A, male asylum seeker from Somalia in his early 20s, who arrived on the island of Lesvos at the beginning of 2021. After his arrival, he was diagnosed with Pulmonary Tuberculosis (TB) and started
treatment for this condition in the Autumn, with an NGO providing medical
support. A few weeks later, he was additionally diagnosed with pleural puncture and a month later, he developed Peripheral
Neuropathy (PN). At this point, his TB treatment was temporarily stopped. Mr A was admitted to hospital three times in 2021 for the
conditions mentioned above. He also had a history of gastritis.
At the time of his initial contact with Earth Medicine, his medication was: Ethambutol 500g, Pyrazinamide 500mg, and Rifinah 300mg and Omeprazole 20mg.
Mr A’s initial visit to the Earth Medicine’s office was in
February 2022. This is a summary of his symptoms at the initial consultation:
Loss of appetite, inability to eat, abdominal pain, severe
weight loss: Mr A didn’t feel hungry and if he did eat, he had acid reflux and severe
epigastric pain. He also experienced nausea on a daily basis. As a result of
this, he had lost a lot of weight and was extremely thin (See Photo 1)
Photo 1- Mr A in 2021 Hospitalised
with lung puncture and showing signs of emaciation
Peripheral Neuropathy and loss of mobility of the lower
limbs: he presented with total loss of sensation in the lower limbs, burning
pain in the legs, inability to stand up and inability to lift or move both
feet. At this time, Mr A was spending most of his time lying on his bed as he
was too weak to move or get up. He was unable to transfer to a wheelchair or to
a chair without a lot of help. Every time he put any weight on his feet, he experienced
severe burning pain on the soles of the feet.
Breathing issues: Mr A had scarring on his left lung as a result
of the TB (See Photo 2) and experienced tightness in the chest with difficulty
breathing. His breathing was agitated when indoors as he felt there was not
enough air. He felt calmer outdoors, where he still experienced shortness of breath.
Photo 2: An Xray of Mr A’s chest
showing lung scarring
Constipation: He only passed stools twice per week. Stools were
hard, dry, and painful to pass.
Fatigue: Along with physical weakness, Mr A experienced
constant physical and mental fatigue.
Mr A Had emotional stress due to his situation which was
exacerbated by his having received two asylum rejections. He experienced
insomnia as a result of this.
As he had been unable to eat very much for several months, and lack of nourishment was deemed to be exacerbating his extreme weakness and muscle atrophy, the initial stage of his rehabilitation was focussed solely on strengthening his ability to eat and digest with the aim to help him gain the strength necessary for his physical recovery.
INITIAL STAGE OF TREATMENT
At the initial stage of Mr A’s treatment, a diet based on
the principles of Chinese medicine was followed. For the first two weeks, he
had a simple soup made with bone broth and a few vegetables prepared daily for
him at Earth Medicine’s kitchen. As he
had not eaten a proper meal for months, he initially experienced epigastric
pain, discomfort, and fullness after eating a small amount of soup. On the
third day, the pain started to diminish and it gradually subsided completely
over the next days. After two weeks of this diet, Mr A reported having more
energy.
As his ability to eat increased, other foods were gradually introduced including rice, a variety of cooked vegetables, and small portions of different types of meat. Everything was very well cooked. As his digestion stabilised, he had more appetite and the nausea subsided, his strength increased and he started to put on weight. At this time, the physical rehabilitation sessions were started.
PHYSICAL REHABILITATION BEGINS
The initial physical therapy aimed to gradually recondition Mr
A’s lower limbs and spine. When he started his physical therapy, Mr A was wheel-chair
bound, not able to stand without aid and could not lift his feet off the
ground. He received daily physiotherapy sessions that integrated games and
graded exercises which he performed with aid.
He then started to practise standing from the wheelchair
holding on to the parallel physio bars, with a helper holding him up followed
by sitting back on the chair. This simple movement was very difficult for him
at the beginning because he had severe pain on his feet and ankles on standing
and because his legs were not strong enough to hold his weight. With exercises
and nutrition, the pain became less severe and his muscles started to feel
stronger. After about three weeks, when standing became easier and he was able
to stand by himself, a physiotherapist and a helper started to work on aiding
him to move along the length of the parallel bars, one moving each foot forward
and the other bringing the chair behind him in case he needed to sit down. The
lifting of his body, standing and sliding the feet forward were very difficult
at the beginning and made the feet and ankle pain return. As he persevered with
this work, within two months he was able to move along the length of the bars
four times with one helper. After a lot
of practice, he was able to move along the bars by himself, pushing himself from
the arms and sliding each foot forward.
At this point, Mr A was able to start using a rollator
walker. He was still unable to lift the feet off the ground or move his ankle
joints.
ACUPUNCTURE ADDED TO REHABILITATION
Mr A received some acupuncture treatments at the beginning
of June 2022.
He had six body acupuncture treatments with a practitioner
from France. During these sessions, Mr A started to feel some sensation coming
back to the toes.
He had no acupuncture treatments for a few weeks and then
re-started at the beginning of July, 2022, when I came to the camp for three
weeks. We started daily treatments of scalp and body acupuncture. It was
stressed that physiotherapy would need to be done after the acupuncture and
that the scalp needles- which are threaded under the scalp and therefore do not
fall out- would be kept during the physiotherapy sessions. At this time, Mr A
was still unable to lift his feet off the ground, the numbness of the toes had
returned and he had no feeling from the knees down, he had severe insomnia and
he was passing stools every 2 to 3 days. These symptoms were treated with scalp
and body acupuncture. The scalp acupuncture lines used were from the Jiao and
Lin systems of SA: Du 20, Foot sensory and motor lines, upper parts of Sensory
and Motor lines to treat the lower limbs, Anxiety lines (See Photo 3). The body
acupuncture was aimed to strengthen his system and help the work of the scalp
acupuncture on the lower limbs. Treatments included points on the abdomen to
encourage digestion and on the legs to promote circulation and muscle function
and reduce pain.
Each day, the physiotherapist from Portugal reported big improvements in his lower limb movement and strength during Mr A’s sessions with the scalp needles. By the fourth treatment, given on July 7th, Mr A was able to lift his feet off the ground and move the feet from the ankles. After the fifth treatment, he was able to move his toes and managed to give some steps by himself without aid or support. There was a break for the weekend, after which Mr A reported that he had slept very well for three nights and that on the Sunday he had been able to walk around his container without any aid and without experiencing breathing difficulties or shortness of breath.
Photo 3: Mr A having scalp and body
acupuncture in July 2022
By the 9th and last treatment of scalp and body
acupuncture, Mr A was able to run after a basketball, walked around the city
for an appointment and climbed the stairs without help for his acupuncture
treatment. Initially his treatments had been given on the courtyard due to his
difficulty climbing stairs, then they moved to the ground floor of Earth
Medicine’s office as he was able to climb the few steps to get in and for his
last treatment, he insisted on being treated on the first floor, which required
him to climb up the entrance stairs and then two flights of stairs inside the
building. His constipation was not much improved but his sleep was steadily
better. He was experiencing pain in his ankles but this was due to excessive exercise.
He was so ecstatic about being able to walk that he had been playing basketball
in the refugee camp and walking around excessively without much rest.
Mr A had no treatments during August 2022. The next time Mr
A had acupuncture and physiotherapy treatments at the beginning of September
2022, his ability to walk was still there and his breathing was normal but he was still experiencing ankle
pain which was occasionally severe and stopped him from running, a sport he had
started to practice, he was passing stools every other day, had insomnia
related to stress and felt tired.
He had eight sessions of body acupuncture with another
practitioner from the UK. His pain subsided and he was able to run again, he
could sleep better and had more energy.
OUTCOME
This is a video compilation of the process of Mr A’s
rehabilitation. During July 2022, at the beginning of our treatments, he had
poor balance and leg weakness. It can be seen there was rapid change and
improvement in mobility during this month as he was having a combination of scalp
and body acupuncture plus physiotherapy. These improvements in mobility were
sustained https://www.youtube.com/watch?v=YpbUrDBOroY.
Mr A’s physical rehabilitation ended in October 2022 when he was transferred to another camp in mainland Greece. He was fully able to walk when he left the island, as seen in the video. He eventually was granted asylum and lives in safety with no mobility issues and no breathing difficulties which means he is able to be a productive member of the community he lives in.
This case illustrates how a multidisciplinary approach can
produce outstanding results even in severe cases seen in humanitarian settings
and how scalp acupuncture can be an effective addition to treatment for
mobility issues in this setting. It must be emphasised, that without Mr A’s
hard work, perseverance, and faith in the future, none of the treatments
provided would have achieved these remarkable effects.
The practitioners involved in the treatment of Mr A were
volunteer practitioners fully qualified in their fields of Physiotherapy,
Acupuncture and Chinese Medicine. Given the severity of the conditions that can
be seen in the refugee camp, the organisation only accepts practitioners with a
minimum of 5 years of experience in their field.
I was involved as Acupuncturist and Chinese Medicine
practitioner throughout the treatments offered to Mr A with input consisting on
the dietary advice based in Chinese medicine theory that was followed and the
scalp and body acupuncture treatments during July 2022.
I feel privileged to be able to give treatments with this amazing organisation, if you would like to help Earth Medicine continue their important work, you can donate here.
With gratitude and hope for humanity,
Sandra Arbelaez
REFERENCES
(i) Wang, Shen, Wang, Fu et al. Scalp Acupuncture for Acute Ischemic Stroke: A Meta-Analysis of Randomized Controlled Trials. Evidence-Based Complementary and Alternative Medicine (2012) https://doi.org/10.1155/2012/480950
(ii) Lan-ya LI, Zhen-huan LIU, Qiao-ling XIE, Meta-Analysis on scalp acupuncture based therapy in treating children cerebral palsy. World Journal of Acupuncture - Moxibustion, Volume 24, Issue 3, 49-53 (2014). https://doi.org/10.1016/S1003-5257(15)60012-5
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