Stroke Rehabilitation Technique
My father, uncle, elder sister and a niece died of stroke. This is a condition which devastated my family over the years. When I became a doctor in 1980, I had a determination to find a cure for this disabling and often fatal disease.
Stroke is caused when a clot from the heart floats up towards the brain through the artery, gets lodged in one of the many smaller branches and plugs it. A part of the brain, the exact area that this artery feeds, is started of oxygen, glucose and nutrients and the cells therein die. Every part of the brain is connected by nerves to a specific part of the body, thus inactivation or death of cells lead to total loss of functions in the corresponding part if the body. The clot travels to either the left or the right side of the brain, the body is paralysed on the opposite side of lesion. Usually about 20% of stroke victims die in coma due to severe brain damage. About 40% recover very slowly and regain movements with physiotherapy but live with some form of disability. About 20% are severely disabled. This disease is the largest single consumer of budget in the NHS as the patients need long-term hospitalisation and after care. In the UK more than 150,000 people suffer from stroke every year and in the US over 250, 000 people are affected every year.
After my post-graduation in Acupuncture, I returned to India in 1982. I set up an Integrated Medical Clinic in New Delhi after completing my compulsory internship in a hospital there. I began to train under eminent practitioners of traditional medicine like Ayurveda, Unani, Yoga, Homeopathy, and etc. I came across a Traditional form of physical therapy called “Marma”. It is a massage-manipulative technique that focuses on certain trigger points in the body. These are sensitive zones which somehow work through the brain and its nervous network and activate weakened or even paralysed parts of the body. I began to apply the techniques to polio children in India.
I began to hold camps in remote villages teaching parents of polio children to do this therapy. Sure enough, those who applied the technique saw improvement in their children’s limbs. I then began to treat stroke patients and also experimented with paraplegics whose spinal cord and nerves were not damaged. The results began to surprise me.
Then I discovered something amazing. The brain has two major circulatory networks, one created by the carotid arteries which run along the front if the neck, hidden behind the neck muscles and the other by the vertebral arteries hidden inside the wings of the cervical vertebrae in a canal. Anatomically speaking, the carotid arteries supplied blood to the voluntary or conscious part of the brain while vertebral arteries primarily feed the subconscious or involuntary part of the brain. It is the later part of the brain that carries out all vital functions from breathing to hormone regulation.
I developed a massage-manipulative-yoga technique which facilitated the flow of blood through the vertebral arteries to activate the brain. This improved general well-being, energy, sleep, immune system, hormone regulation etc. I began to use my technique on stroke patients that improved the rehabilitation process. The integration of all these treatments became The Ali’s Technique.
In 1995 under the supervision of Dr Mario Impallomeni, then Head, Geriatric Services Unit, at the Hammersmith Hospital in London, a trial of my technique was carried out on * MARMA THERAPY IN LATE STROKE REHABILITATION.
Over 5 months, all patients showed noticeable improvements and 3 walked with some support. One of the patients who had lost speech regained it. The study called for a larger research. I met a Professor at The National Hospital, the leading Institution for stroke research, to discuss further trials but he found my claims “anecdotal”.
In 2005 with the help of Dr Michael Dixon, Chairman NHS Alliance, we raised some funds and got a clinical trail approved by the Peninsula Medical School at Exeter. A therapist, trained in this technique, carried out the treatments at The Royal Devon and Exeter Hospital.
Unfortunately, an infection broke out in the wards and all the patients were discharged. Therapist had to travel long distances to treat these patients at home. Only 17 patients could be treated as funds ran out due to travel and other expenses. The results were published in The Journal of Physical Rehabilitation in June 1996, showed that Marma Therapy was effective and a larger study was recommended to prove if it had an edge over standard physiotherapy. It was safe and most patients enjoyed the treatment.
Following that with the help of The Sahara Group, I carried out another clinical trial at The Mayo Hospital in Lucknow (India) under the supervision of Dr. Sandip Aggarwal, a senior neuro-physician at The King George Medical College. The therapy was carried out over 8 weeks by a therapist, trained in the technique. At the end of 7 weeks, The Mayo Hospital called a press conference to demonstrate the results. Out of 10 stroke patients, 4 walked independently and 4 walked with aid and the other two remained bed bound. This was widely reported by the media. A further research is being planned in India with the aim to select poor patients for study so as to relieve the burden in their families. Needless to say many of them were bread-earners.
We have so far treated over 150 stroke patients with only a handful not showing any remarkable improvement. I want to carry out further research on a larger group here in UK or in the US. My technique is unique and I want to pass on this knowledge further. Much of the old family secrets of Traditional Therapy have been lost already. I hope my family members who are trained in this carry out the good work after me.
* Extract - MARMA THERAPY IN LATE STROKE REHABILITATION - A pilot study of Marma therapy completed by the RPMS Geriatric Unit, Acton Hospital, annexe of the Geriatric Unit at Hammersmith Hospital.
Stroke is a major cause of morbidity in the elderly. Many old people who have a stroke remain severely dependent and require long term institutional care despite conventional rehabilitation. Indeed, although there is some evidence to suggest that specialised stroke units improve acute stroke outcome, the effectiveness of conventional physiotherapy, occupational therapy and other rehabilitative interventions remain uncertain. A major reason for this uncertainty is the lack of good trial methodology in rehabilitation. The situation in late stroke is even less clear. Work in Oxford suggested that the timing of physiotherapy was unimportant, whilst other investigation failed to show any difference between conventional physiotherapy and placebo (in the form of "friendly visits"). Nevertheless, because stroke is often such a devastating illness, not only physically but also psychologically and socially, these unproven therapies are often tried for the lack of anything better to offer.
In this setting, we consider that it was important to search for effective therapies which might make an impact on the lives of many elderly people. One possibility was to integrate non-western treatments into our conventional approach. We were encouraged by successful reports of acupuncture in acute stroke. We obtained initial funding from the Foundation for Integrated Medicine for an uncontrolled study of Marma therapy in late stroke. The ancient practice of Kalarippayattu, the martial tradition of Kerala, South India, includes Marma, the knowledge of vital points in treating injuries. Marma therapy uses massage of these points healing in related parts of the body. It can be thought of as a dynamic equivalent of acupuncture.
This is the report of a pilot study of Marma therapy completed by the RPMS Geriatric Unit, in the long stay geriatric wards at Acton Hospital. This is an annexe of the Geriatric Unit at Hammersmith Hospital.
The protocol was designed by Dr Richard Petty in collaboration with Dr. Mario Impallomeni after consultation with Dr Mosaraf Ali. As it was thought highly possible that most patients would greatly improved on this treatment, the following instruments were included in the assessment protocol: walking scale, Barthel index, Frenchay arm test, MRC muscle power scale, as well as Minimental State, and Bodily Symptoms and Mood Scale.
It was envisaged to study 12 patients who had suffered at least one CVA not less than twelve months before the beginning of the study; who had not recovered enough function to return to live independently in the community, and who could give informed consent.
Two treatment sessions per week of half an hour each for a total of 20 treatments were planned. It was hoped that the ward nurses could exercise the patients in the wards in between treatments, if their busy schedule allowed it. The patients were to be assessed and scored before and after the twenty treatments were completed.
The Hammersmith Hospital Ethics Committee approved this protocol on 16th February 1994. I prepared a list of 14 long stay geriatric patients in Acton Hospital who fulfilled the inclusion criteria: out of this list Dr Ali and Mr. D Purkitt from the Hale Clinic selected 10 suitable candidates. I therefore recruited two more candidates from local old peoples homes which were accepted by Dr Ali. Most patients started the treatments on 14th March 1994, the last entered the study on the 25th April 1994.
Of the twelve patients, eleven were female, their average age was 80.9 years, range 73-91. Eight had a unilateral cerebral lesion; four bilateral lesions; five a moderate degree of dementia. Only one could walk a short distance, albeit slowly, unsteadily, with a quadripod stick and a lot of supervision. The remainder were profoundly incapacitated, chairbound and unable to transfer from bed to chair by themselves. One patient was on large doses of psychotropic and muscle relaxant drugs: lofepramine 210 mg / day, baclofen 15 mg tds.
It gradually became clear that although most patients improved, none did so to a degree large enough to be measurable by the scales we had chosen for this study. After negotiations with the Foundation for Integrated Medicine it was agreed to continue the pilot study for a total of fifty treatments; and to use a different set of measurement scales, called FIM (Functional Independence Measure), capable of measuring smaller but functionally important changes in the patients' contributions. The FIM for brain injury, developed by the State University of New York at Buffalo. The result suggest that the FIM is a suitable instrument for evaluating the effects of Marma therapy in late stroke patients. Scores fell in the mid-range of the instrument, which facilitates measurement of both improvement and deterioration. It is worth noting that in the last two months of the study the patient's gait improved more rapidly than in the previous period.
In summary, Marma therapy appears very promising in improving the function of severely dependent patients with late stroke. Further research is now indicated in the form of a controlled trial, and we are currently preparing a suitable application for funding by a major grant giving body. In view of the results in late stroke, a pilot study in acute stroke should also be pursued.
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Unique Backache Technique
I have been treating backache for over 25 years. The experience I have gathered is exceptional. In all these years, I have recommended surgery in only five cases and that’s a small number considering that I must have treated over 5000 cases. My book “The Ultimate Back Book” explains some of my unique concepts.
Most backaches is attributed to the discs which protrude or bulge, touching nerves. That in my opinion is a result of other factors and not the actual cause. We stand erect because of active muscles and not wholly because of the skeletal system. You can’t make a skeleton stand on its own without the wiring or the metal road that supports it. Muscles provide that anti-gravitational force that keeps the spine straight. Disc bulge, facet joint misalignment, scoliosis, irregular posture, etc. are a direct result of abnormal contraction of group of muscles. The disc can be compressed by applying vertical pressure on them. That is caused by excess body weight or spasms in the lumbar muscles due to stress, chronic dehydration, repetitive strain injury (carrying lifting, sports) etc. In a vast majority of cases, I discovered that lateral tortion causes the lower lumbar discs to bulge. If you put a hot water bottle between two square pieces of wood and twist them in opposite direction, there will be a bulge or protrusion in the former. In the lower back, disalignment of vertebrae caused by excess pull or tortion of the finer muscles attached to them create an ideal situation for a disc bulge. When you injure your groin (sports injury, lifting, trauma, and certain exercises like abdominal crunches or vigorous Pilates) there is subtle pain in it. This pain is relieved by the back twisting laterally to compensate. Over a period of time, this causes disc to bulge. You don’t feel the groin pain because the flexible spine spared you by adjusting its position, even at the cost of hunting later. This was my unique discovery. That is one of the secrets of my backache treatment.
Similarly, for the neck area, I discovered that tension or spasm of the numerous neck muscles lead to the disalignment of the facet joints thus causing the disc to bulge and nerve impingement follows, that causes more pain, numbness in the fingers etc.
Needless to say that is numerous other conditions like nutritional imbalance (calcium deficiency), fibromyalgia, polymyalgia rheumatica, osteophytes (salt deposit on joints which scratch nerves), stenosis (deposit of crystals of calcium salt in the inner surface of the spinal canal) etc. also cause backache. Sometimes when you are chronically dehydrated or have kidney problems (stones, inflammation), the upper lumbar area (where the kidneys are located) become very sore. The kidneys are imbedded in the lumbar muscles. Sore kidneys somehow cause muscle tension in the area. In fact physicians test kidney problems by hitting that part of the lumbar area with closed fist. If it hurts them they investigate the kidneys.
Sore lumbar muscles mimic backache. Scans and X-rays don’t show any relevant abnormality in the spine and yet the back continues to hurt. I have treated many people by making them drink lots of water and asking them to avoid alcohol, coffee, excess salt, protein etc. Many patients who were on Aitken’s Diet had backache because of this condition.
The treatment I use is therapeutic massage and yoga. Occasionally, as a quick fix to relieve excessive pain, I use my own manipulative technique. My back massage oil containing a blend of natural remedial oils helps to reduce inflammation of muscles.
My colleague Jiwan’s yoga DVD demonstrates postures that help to maintain a healthy spine.