A Case Report of a Stroke Patient with Dysarthria Treated with Korean Medicine

Abstract

This case study examined the effect of Korean Medicine on a 72-year old male with a habitual history of smoking and drinking, and a family history of hypertension who had suffered an acute stroke. A couple of months later he complained of upper extremity weakness and was diagnosed with dysarthria. The patient received Korean Medicine treatment of acupuncture and herbal medicine for 39 days at the Samse Oriental Hospital, in conjunction with physiotherapy and Western medicine. Articulation accuracy, vowel accuracy, alternation and speed of reading sentences were evaluated every 7days. The results showed that the patient had improvement of articulation (10%) and vowel (37%) accuracy, alternation (12%) and speed of reading sentences (28%) suggesting that Korean Medicine treatment contributed to this progress.

Full text

This case study examined the effect of Korean Medicine on a 72-year old male with a habitual history of
smoking and drinking, and a family history of hypertension who had suered an acute stroke. A couple of
months later he complained of upper extremity weakness and was diagnosed with dysarthria. e patient
received Korean Medicine treatment of acupuncture and herbal medicine for 39 days at the Samse Oriental
Hospital, in conjunction with physiotherapy and Western medicine. Articulation accuracy, vowel accuracy,
alternation and speed of reading sentences were evaluated every 7days. e results showed that the patient
had improvement of articulation (10%) and vowel (37%) accuracy, alternation (12%) and speed of reading
sentences (28%) suggesting that Korean Medicine treatment contributed to this progress.
©2018 Korean Acupuncture & Moxibustion Medicine Society. is is an open access article under the CC BY-
NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Article history :
Submitted: May 10, 2018
Revised: June 8, 2018
Accepted: July 4, 2018
Keywords:
dysarthria,
Korean traditional medicine,
stroke
https://doi.org/10.13045/jar.2018.00115
pISSN 2586-288X eISSN 2586-2898
J Acupunct Res 2018;35(3):138-140
Case Report
A Case Report of a Stroke Patient with Dysarthria
Treated with Korean Medicine
Ji Young Baek 1,*, Yeo Bin Park 1, Ho-Joon Song 2, Ji Won Baek 1, Won Ho Kong 1, Shin-Young Kim 1, Chang-beom Ahn 1
1 Department of Acupuncture & Moxibustion Medicine, Samse Korean Medical Hospital, Busan, Korea
2 Department of Acupuncture & Moxibustion Medicine, MokdongDongshin Hospital of Korean Medicine, Seoul, Korea
ABSTRACT
Journal of Acupuncture Research
Journal homepage: http://www.e-jar.org
Introduction
Strokes are the 2nd most common cause of death worldwide [1],
and approximately 20%–30% of stroke survivors suer dysarthria
[2]. Dysarthria is associated with physiological function and
self-identity, social and emotional confusion, and feelings of
stigmatization [3]. Dysarthric speech is incoherent because of
poor control of oral articulator muscles, particularly the tongue
and lips, and poor respiratory control [4]. In the Western world,
speech therapy is used to improve dysarthria. In Korea, there
are few studies of treatment of dysarthria after a stroke. In this
case study, the results of using Korean medicine to treat a patient
suering from dysarthria are reported. e patient was admitted to
Samse Oriental hospital on April 8, 2017 and had treatment until
discharge on July 1, 2017.
Case Report
A 72-year-old male, habitual smoker of 40 years and daily
drinker, witha family history of hypertension on his father’s side,
was admitted to Samse Oriental Hospital (April 8, 2017) where
blood tests and an MRI brain scan was performed. Clinical
chemistry results were in the normal range but radiology showed
acute infarction in the right basal ganglia region (Fig. 1). On the
T2WI and Flair images, multiple small high signal intensities in
both periventricular white matter were noted (Fig. 1). ere was
no evidence of the pathologic condition in the cerebral arteries,
and he was diagnosed as having had an episode of acute stroke. On
June 4, 2017, aer waking up, the patient had a feeling of weakness
in his left arm. He received treatment at the Samse Oriental
Hospital until July 1, 2017.
Treatments
Acupuncture: A Korean medical doctor with3years clinical
experience, performed acupuncture at 7acupoints:“Seven points
of CVA”; Baekhoe (GV20), Gokbin (GB7), Gyeonjeong (GB21),
Pungsi (GB31), Joksamni (ST36), Hyeonjong (GB39), Gokji
(LI11). Disposable 0.20 mm × 30 mm-sized stainless-steel needles
(Dongbang Acupuncture Inc., Korea) were used every morning
*Corresponding author.
Department of Acupuncture & Moxibustion Medicine, Samse Korean Medical Hospital, Busan, Korea
E-mail: jybgood1985@daum.net
©2018 Korean Acupuncture & Moxibustion Medicine Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-
nd/4.0/).
Aug-016

Ji Young Baek et al / The Effect of Korean Medicine on Dysarthria 139
at 9:00 AM, the treatment lasted for about 15 minutes. In the
afternoon, sterilized, single use needles (0.20 mm × 30 mm,
stainless steel, Dongbang, Korea) were used for the intervention
using directional supplementation and draining (DSD), needles
that were inserted at Joksamni (ST36). It remained for 7 minutes
and 30 seconds in the supplementation direction and then the
direction was changed and maintained for 7 minutes and 30
seconds more. At the same time, a needle was inserted at Yeongok
(KI2) along the draining direction, at Igan (LI2) along the
supplementation direction for 15 minutes.
Herbal medicine: Banhahoobagtang powder insurance medicine
(mixed extract, JungWoo Medicines, Seoul, Korea) was prescribed
from May 29, 2017 until July 2, 2017. One packet was taken 3 times
a day, aer meals.
Physiotherapy: Transcutaneous Electrical Nerve Stimulation
(TENS) and infrared heat therapy were performed on the injured
part of the patient’s body once a day from May 29, 2017 until July 2,
2017.
Western medicine treatment: Western medicine was prescribed
daily during from May 29, 2017 until July 2, 2017 (Table 1).
Speech Assessments: The assessment tools used in this study
were developed by Lee [5] to evaluate the effects of articulatory
organ training on speech enhancement of patients with a paralytic
speech disorder.
Articulation accuracy: An articulation evaluation sheet was
used to check the accuracy of the phonemes according to the
test site, and the number of correctly pronounced phonemes
were calculated as an average percentage of 3 tests. On May 23,
the accuracy of articulation was 87.29% and on June 29, it was at
97.09% (Fig. 2).
Vowel accuracy: 10 basic vowels were used inthe articulation
test, and the number of correctly articulated words were recorded.
On the rst day of treatment (May 23), 6 words were articulated
correctly, and the last day of treatment (June 29), 10 vowels were
pronounced correctly (Fig. 3).
Medication Dose Medication Purpose
Lavit-A Tablet 1T BID (8AM,7PM) Antiulcerants
Plvix Tablet 1T QD (8AM) Antithrombotics
Sermion Tablet 1T BID (8AM,7PM) Circulatory Improvement Agents
BID, bis in die (twice a day); P, post meridiem; QD, quaque die (once a day); T, tablet;
TID, ter in die (3 times a day).
Table 1. Medication Administered at Samse Oriental Hospital Following the Diagnosis of
an Acute Stroke.
Fig. 2. e treatment eect on articulation accuracy over time.
Fig.3. e treatment eect on vowel accuracy over time.
Fig.1. Brain MRI (April 08, 2017).

J Acupunct Res 2018;35(3):138-140140
Alternate exercise velocity test: To evaluate the degree of
continuous articulation, we noted the time spent repeating
“Papapa,” “Tatata” and “Kakaka” 10 times, respectively. On May
23,the time taken to repeat 10 cycles of “Papapa,” “Tatata” and
“Kakaka” was 27.47 seconds, and on the June 29, 24.21 seconds
was recorded (Fig. 4).
Speed of reading sentences: The patient was asked to read a
sentence containing 69 syllables that was presented to him and the
time taken was recorded. On May 23, it took 23.96 seconds to read
the sentence and on June 28, it took 17 seconds (Fig. 5).
Discussion
Speech disorders are conditions that include; aphasia, dysarthria,
and neurological abnormalities [6]. Aphasic patients may have
trouble understanding the spoken word and may not understand
what someone is saying in conversation or on TV [7]. Dysarthria
is caused by damage to areas of the brain that control language;
as a result, their speech may sound slurred because they have
problems making sounds correctly [7]. Neurological abnormalities
are caused by fundamental changes in the cerebral cortex; such
as dementia [8]. In this case study, the patient had no diculty in
understanding spoken language, but his speech was slurred and
he had difficulty in communicating, indicateng that the patient
haddysarthria.
Acupuncture treatment for dysarthria used 3 main acupoints;
Joksamni (ST36), Yeongok (KI2) and Igan (LI2) with reference
to “Sa-amdoinchimguyogyeol” According to a study conducted
by Song et al [6], these acupuncture points have a significant
therapeutic effect on language, compared to body acupuncture;
“Joksamni” helps vocal energy, “Yeongok” protects the lungs
by releasing heat, and “Igan” also acts to help the lungs as a
“suyangmyeongdaejang-gyeong” [8]. Furthermore, the patient’s
sputum was assessed and thought to impede the effectiveness of
the acupuncture treatment, so herbal medicine was administered
to remove the sputum.
e accuracy of articulation increased from 87.29% at the start
of treatment to 97.09% at the time of discharge. In the vowel
accuracy test, the average score increased from 6.3 words out of 10
correctly pronounced at the time of treatment, to 10 at discharge.
e speed of the alternating exercise where the time taken to repeat
10 cycles of “Papapa”, “Tatata” and “Kakaka” decreased from 27.47
seconds to 24.21 seconds, indicating that the degree of continuous
articulation had improved. In the reading sentence test where 69
syllables were read, the time decreased from 23.96 seconds to 17.26
seconds.
Korean medicine seems to be effective in improving speech
disorders, as reported in this case study. At the point of
hospitalization, the patient’s words were incoherent but at the time
of discharge, language crumbling was reduced, and the patient was
less likely to repeat words.
ere are several limitations to this study. It is unclear whether
the western medicines and physiotherapy treatment affected the
improvement of language as this could not be controlled for. Also,
this is a case study of 1 patient and many more patients would be
needed to test a hypothesis and power a study.
Conflicts of Interest
e authors have no conicts of interest to declare.
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Fig. 4. e treatment eect on alternate exercise velocity over time.
Fig. 5. Treatment eect on the speed of reading a sentence containing 69 syllables over
time.