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Published in: Chinese Medicine 1/2012

Open Access 01-12-2012 | Research

Immediate effects of acupuncture on biceps brachii muscle function in healthy and post-stroke subjects

Authors: Ana Paula S Fragoso, Arthur S Ferreira

Published in: Chinese Medicine | Issue 1/2012

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Abstract

Background

The effects of acupuncture on muscle function in healthy subjects are contradictory and cannot be extrapolated to post-stroke patients. This study evaluated the immediate effects of manual acupuncture on myoelectric activity and isometric force in healthy and post-stroke patients.

Methods

A randomized clinical trial, with parallel groups, single-blinded study design, was conducted with 32 healthy subjects and 15 post-stroke patients with chronic hemiparesis. Surface electromyography from biceps brachii during maximal isometric voluntary tests was performed before and after 20-min intermittent, and manual stimulation of acupoints Quchi (LI11) or Tianquan (PC2). Pattern differentiation was performed by an automated method based on logistic regression equations.

Results

Healthy subjects showed a decrease in the root mean-squared (RMS) values after the stimulation of LI11 (pre: 1.392 ± 0.826 V; post: 0.612 ± 0.0.320 V; P = 0.002) and PC2 (pre: 1.494 ± 0.826 V; post: 0.623 ± 0.320 V; P = 0.001). Elbow flexion maximal isometric voluntary contraction (MIVC) was not significantly different after acupuncture stimulation of LI11 (pre: 22.2 ± 10.7 kg; post: 21.7 ± 9.5 kg; P = 0.288) or PC2 (pre: 18.8 ± 4.6 kg; post: 18.7 ± 6.0 kg; P = 0.468). Post-stroke patients did not exhibit any significant decrease in the RMS values after the stimulation of LI11 (pre: 0.627 ± 0.335 V; post: 0.530 ± 0.272 V; P = 0.187) and PC2 (pre: 0.601 ± 0.258 V; post: 0.591 ± 0.326 V; P = 0.398). Also, no significant decrease in the MIVC value was observed after the stimulation of LI11 (pre: 9.6 ± 3.9 kg; post: 9.6 ± 4.7 kg; P = 0.499) or PC2 (pre: 10.7 ± 5.6 kg; post: 10.2 ± 5.3 kg; P = 0.251). Different frequency of patterns was observed among healthy subjects and post-stroke patients groups (χ2 = 9.759; P = 0.021).

Conclusion

Manual acupuncture provides sufficient neuromuscular stimuli to promote immediate changes in motor unit gross recruitment without repercussion in maximal force output in healthy subjects. Post-stroke patients did not exhibit significant reduction on the myoelectric activity and maximal force output after manual acupuncture and needs further evaluation with a larger sample.

Trial registration

Brazilian Clinical Trials Registry RBR-5g7xqh.
Appendix
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Literature
1.
go back to reference World Health Organization: The Atlas of Heart Disease and Stroke. 2004, Geneva: WHO World Health Organization: The Atlas of Heart Disease and Stroke. 2004, Geneva: WHO
2.
go back to reference World Health Organization: Cardiovascular diseases (CVDs). Fact sheet N°317. 2009 World Health Organization: Cardiovascular diseases (CVDs). Fact sheet N°317. 2009
3.
go back to reference Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, Culebras A, DeGraba TJ, Gorelick PB, Guyton JR, Hart RG, Howard G, Kelly-Hayes M, Nixon JVI, Sacco RL: Primary Prevention of Ischemic Stroke. Stroke. 2006, 37: 1583-1633.CrossRefPubMed Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, Culebras A, DeGraba TJ, Gorelick PB, Guyton JR, Hart RG, Howard G, Kelly-Hayes M, Nixon JVI, Sacco RL: Primary Prevention of Ischemic Stroke. Stroke. 2006, 37: 1583-1633.CrossRefPubMed
5.
go back to reference Wu HM, Tang JL, Lin XP, Lau JTF, Leung PC, Woo J, Li Y: Acupuncture for stroke rehabilitation. Cochrane Database of Systematic Reviews. 2006, 3: CD004131-PubMed Wu HM, Tang JL, Lin XP, Lau JTF, Leung PC, Woo J, Li Y: Acupuncture for stroke rehabilitation. Cochrane Database of Systematic Reviews. 2006, 3: CD004131-PubMed
6.
go back to reference Park J, Hopwood V, White AR, Ernst E: Effectiveness of acupuncture for stroke: A systematic review. J Neurol. 2001, 248: 558-563. 10.1007/s004150170132.CrossRefPubMed Park J, Hopwood V, White AR, Ernst E: Effectiveness of acupuncture for stroke: A systematic review. J Neurol. 2001, 248: 558-563. 10.1007/s004150170132.CrossRefPubMed
7.
go back to reference Sze FKH, Wong E, Or KKH, Lau J, Woo J: Does Acupuncture Improve Motor Recovery After Stroke? A Meta-Analysis of Randomized Controlled Trials. Stroke. 2002, 33: 2604-2619. 10.1161/01.STR.0000035908.74261.C9.CrossRefPubMed Sze FKH, Wong E, Or KKH, Lau J, Woo J: Does Acupuncture Improve Motor Recovery After Stroke? A Meta-Analysis of Randomized Controlled Trials. Stroke. 2002, 33: 2604-2619. 10.1161/01.STR.0000035908.74261.C9.CrossRefPubMed
8.
go back to reference Fragoso APS, Ferreira AS: A fisiopatologia do acidente vascular cerebral segundo a medicina Chinesa. Revista Augustus (Rio de Janeiro. Impresso), Fragoso APS, Ferreira AS: A fisiopatologia do acidente vascular cerebral segundo a medicina Chinesa. Revista Augustus (Rio de Janeiro. Impresso),
11.
go back to reference Toma K, Conatser RR, Gilders RM, Hagerman FC: The effects of acupuncture needle stimulation on skeletal muscle activity and performance. J Strength Cond Res. 1998, 12: 253-257. Toma K, Conatser RR, Gilders RM, Hagerman FC: The effects of acupuncture needle stimulation on skeletal muscle activity and performance. J Strength Cond Res. 1998, 12: 253-257.
12.
go back to reference Tough E: Lack of effect of acupuncture on electromyographic activity: a randomised controlled trial in healthy volunteers. Acupunct Med. 2006, 24: 55-60. 10.1136/aim.24.2.55.CrossRefPubMed Tough E: Lack of effect of acupuncture on electromyographic activity: a randomised controlled trial in healthy volunteers. Acupunct Med. 2006, 24: 55-60. 10.1136/aim.24.2.55.CrossRefPubMed
13.
go back to reference Costa LA, Araújo JE: The immediate effects of local and adjacent acupuncture on the tibialis anterior muscle: a human study. Chin Med. 2008, 3: 17-10.1186/1749-8546-3-17.PubMedCentralCrossRefPubMed Costa LA, Araújo JE: The immediate effects of local and adjacent acupuncture on the tibialis anterior muscle: a human study. Chin Med. 2008, 3: 17-10.1186/1749-8546-3-17.PubMedCentralCrossRefPubMed
14.
go back to reference Fragoso APS, Ferreira AS: Evaluation of the immediate effects of manual acupuncture on brachial bicep muscle function in healthy individuals and poststroke patients: a study protocol of a parallel-group randomized clinical trial. J Chin Integr Med. 2012, 10: 303-309. 10.3736/jcim20120309.CrossRef Fragoso APS, Ferreira AS: Evaluation of the immediate effects of manual acupuncture on brachial bicep muscle function in healthy individuals and poststroke patients: a study protocol of a parallel-group randomized clinical trial. J Chin Integr Med. 2012, 10: 303-309. 10.3736/jcim20120309.CrossRef
15.
go back to reference Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG: Consolidated Standards of Reporting Trials Group. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010, 63: e1-37. 10.1016/j.jclinepi.2010.03.004.CrossRefPubMed Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, Elbourne D, Egger M, Altman DG: Consolidated Standards of Reporting Trials Group. CONSORT 2010 Explanation and Elaboration: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol. 2010, 63: e1-37. 10.1016/j.jclinepi.2010.03.004.CrossRefPubMed
16.
go back to reference MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, Moher A, on behalf of the STRICTA Revision Group: Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement. J Altern Complement Med. 2010, 16: ST1-ST14.PubMed MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, Moher A, on behalf of the STRICTA Revision Group: Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): Extending the CONSORT Statement. J Altern Complement Med. 2010, 16: ST1-ST14.PubMed
17.
go back to reference Maciocia G: The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists. 1989, Churchill Livingstone Maciocia G: The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists. 1989, Churchill Livingstone
18.
go back to reference World Health Organization: WHO standard acupuncture point locations in the Western Pacific Region. 2008, Geneva: WHO World Health Organization: WHO standard acupuncture point locations in the Western Pacific Region. 2008, Geneva: WHO
19.
go back to reference Hermens HJ, Freriks B, Merletti R, Stegeman D, Blok J, Rau G, Disselhorst-Klug C, Hägg G: European Recommendations for Surface Electromyography. Results of the SENIAM project. 1999, ISBN: 90-75452-15-2, 2 Hermens HJ, Freriks B, Merletti R, Stegeman D, Blok J, Rau G, Disselhorst-Klug C, Hägg G: European Recommendations for Surface Electromyography. Results of the SENIAM project. 1999, ISBN: 90-75452-15-2, 2
20.
go back to reference Kim HJ, Bae HS, Park SU, Moon SK, Park JM, Jung WS: Clinical Approach to the Standardization of Oriental Medical Diagnostic Pattern Identification in Stroke Patients. Evidence-Based Complement Alternat Med. 2011, 201 (1): 7- Kim HJ, Bae HS, Park SU, Moon SK, Park JM, Jung WS: Clinical Approach to the Standardization of Oriental Medical Diagnostic Pattern Identification in Stroke Patients. Evidence-Based Complement Alternat Med. 2011, 201 (1): 7-
21.
go back to reference Moncayo R, Moncayo H: Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG): demonstration of the regulatory influence of antique acupuncture points. Chin Med. 2009, 4: 9-10.1186/1749-8546-4-9.PubMedCentralCrossRefPubMed Moncayo R, Moncayo H: Evaluation of Applied Kinesiology meridian techniques by means of surface electromyography (sEMG): demonstration of the regulatory influence of antique acupuncture points. Chin Med. 2009, 4: 9-10.1186/1749-8546-4-9.PubMedCentralCrossRefPubMed
22.
go back to reference Fragoso APS, Ferreira AS: Statistical distribution of acupoint prescriptions for sensory-motor impairments in post-stroke subjects. Chin J Integr Med. 2012, Fragoso APS, Ferreira AS: Statistical distribution of acupoint prescriptions for sensory-motor impairments in post-stroke subjects. Chin J Integr Med. 2012,
23.
go back to reference Reaz MBI, Hussain MS, Mohd-Yasin F: Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online. 2006, 8: 11-35. 10.1251/bpo115.CrossRef Reaz MBI, Hussain MS, Mohd-Yasin F: Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online. 2006, 8: 11-35. 10.1251/bpo115.CrossRef
24.
go back to reference The Optimising Analysis of Stroke Trials (OAST) collaboration: Calculation of sample size for stroke trials assessing functional outcome: comparison of binary and ordinal approaches. Int J Stroke. 2008, 3: 78-84.CrossRef The Optimising Analysis of Stroke Trials (OAST) collaboration: Calculation of sample size for stroke trials assessing functional outcome: comparison of binary and ordinal approaches. Int J Stroke. 2008, 3: 78-84.CrossRef
25.
go back to reference Nygaard E, Houston M, Suzuki Y, Jørgensen K, Saltin B: Morphology of the brachial biceps muscle and elbow flexion in man. Acta Physiol Scand. 1983, 117: 287-292. 10.1111/j.1748-1716.1983.tb07208.x.CrossRefPubMed Nygaard E, Houston M, Suzuki Y, Jørgensen K, Saltin B: Morphology of the brachial biceps muscle and elbow flexion in man. Acta Physiol Scand. 1983, 117: 287-292. 10.1111/j.1748-1716.1983.tb07208.x.CrossRefPubMed
26.
go back to reference Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G: Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000, 10: 361-374. 10.1016/S1050-6411(00)00027-4.CrossRefPubMed Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G: Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. 2000, 10: 361-374. 10.1016/S1050-6411(00)00027-4.CrossRefPubMed
27.
go back to reference Zhao JG, Cao CH, Liu CZ, Han BJ, Zhang J, Li ZG, Yu T, Wang XH, Zhao H, Xu ZH: Effect of acupuncture treatment on spastic states of stroke patients. J Neurolog Sci. 2009, 276: 143-147. 10.1016/j.jns.2008.09.018.CrossRef Zhao JG, Cao CH, Liu CZ, Han BJ, Zhang J, Li ZG, Yu T, Wang XH, Zhao H, Xu ZH: Effect of acupuncture treatment on spastic states of stroke patients. J Neurolog Sci. 2009, 276: 143-147. 10.1016/j.jns.2008.09.018.CrossRef
28.
go back to reference Yan T, Hui-Chan CWY: Transcutaneous electrical stimulation on acupuncture points improved muscle function in subjects after acute stroke: a randomized controlled trial. J Rehabil Med. 2009, 41: 312-316. 10.2340/16501977-0325.CrossRefPubMed Yan T, Hui-Chan CWY: Transcutaneous electrical stimulation on acupuncture points improved muscle function in subjects after acute stroke: a randomized controlled trial. J Rehabil Med. 2009, 41: 312-316. 10.2340/16501977-0325.CrossRefPubMed
29.
go back to reference Shepherd RB: Exercise and Training to Optimize Functional Motor Performance in Stroke: Driving Neural Reorganization?. Neural Plast. 2001, 8: 121-129. 10.1155/NP.2001.121.PubMedCentralCrossRefPubMed Shepherd RB: Exercise and Training to Optimize Functional Motor Performance in Stroke: Driving Neural Reorganization?. Neural Plast. 2001, 8: 121-129. 10.1155/NP.2001.121.PubMedCentralCrossRefPubMed
30.
go back to reference Hafer-Macko CE, Ryan AS, Ivey FM, Macko R: Skeletal muscle changes after hemiparetic stroke and potential beneficial effects of exercise intervention strategies. J Rehab Res Develop. 2008, 45: 261-272. 10.1682/JRRD.2007.02.0040.CrossRef Hafer-Macko CE, Ryan AS, Ivey FM, Macko R: Skeletal muscle changes after hemiparetic stroke and potential beneficial effects of exercise intervention strategies. J Rehab Res Develop. 2008, 45: 261-272. 10.1682/JRRD.2007.02.0040.CrossRef
31.
go back to reference Langevin HM, Konofagou EE, Badger GJ, Churchill DL, Fox JR, Ophir J, Garra BS: Tissue displacements during acupuncture using ultrasound elastography techniques. Ultrasound Med Biol. 2004, 30: 1173-1183. 10.1016/j.ultrasmedbio.2004.07.010.CrossRefPubMed Langevin HM, Konofagou EE, Badger GJ, Churchill DL, Fox JR, Ophir J, Garra BS: Tissue displacements during acupuncture using ultrasound elastography techniques. Ultrasound Med Biol. 2004, 30: 1173-1183. 10.1016/j.ultrasmedbio.2004.07.010.CrossRefPubMed
32.
go back to reference Langevin HM, Churchill DL, Cipolla MJ: Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 2001, 15: 2275-2001. 10.1096/fj.01-0015hyp.CrossRefPubMed Langevin HM, Churchill DL, Cipolla MJ: Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. FASEB J. 2001, 15: 2275-2001. 10.1096/fj.01-0015hyp.CrossRefPubMed
33.
go back to reference Langevin HM, Churchill DL, Wu J, Badger GJ, Yandow JA, Foxá JR, Krag MH: Evidence of Connective Tissue Involvement in Acupuncture. FASEB J. 2002, 16: 872-874.PubMed Langevin HM, Churchill DL, Wu J, Badger GJ, Yandow JA, Foxá JR, Krag MH: Evidence of Connective Tissue Involvement in Acupuncture. FASEB J. 2002, 16: 872-874.PubMed
34.
go back to reference Roth LU, Maret-Maric A, Adler RH, Neuenschwander BE: Acupuncture Points have Subjective (Needling Sensation) and Objective (Serum Cortisol Increase) Specificity. Acupunct Med. 1997, 15: 2-5. 10.1136/aim.15.1.2.CrossRef Roth LU, Maret-Maric A, Adler RH, Neuenschwander BE: Acupuncture Points have Subjective (Needling Sensation) and Objective (Serum Cortisol Increase) Specificity. Acupunct Med. 1997, 15: 2-5. 10.1136/aim.15.1.2.CrossRef
35.
go back to reference Hui KK, Nixon EE, Vangel MG, Liu J, Marina O, Napadow V, Hodge SM, Rosen BR, Makris N, Kennedy DN: Characterization of the "deqi" response in acupuncture. BMC Complement Altern Med. 2007, 7: 33-10.1186/1472-6882-7-33.PubMedCentralCrossRefPubMed Hui KK, Nixon EE, Vangel MG, Liu J, Marina O, Napadow V, Hodge SM, Rosen BR, Makris N, Kennedy DN: Characterization of the "deqi" response in acupuncture. BMC Complement Altern Med. 2007, 7: 33-10.1186/1472-6882-7-33.PubMedCentralCrossRefPubMed
36.
go back to reference Langevin HM, Churchill DL, Fox JR, Badger GJ, Garra BS, Krag MH: Biomechanical response to acupuncture needling in humans. J Appl Physiol. 2001, 91: 2471-2478.PubMed Langevin HM, Churchill DL, Fox JR, Badger GJ, Garra BS, Krag MH: Biomechanical response to acupuncture needling in humans. J Appl Physiol. 2001, 91: 2471-2478.PubMed
37.
go back to reference Tucker K, Butler J, Graven-Nielsen T, Riek S, Hodges P: Motor unit recruitment strategies are altered during deep-tissue pain. J Neurosci. 2009, 29: 10820-10826. 10.1523/JNEUROSCI.5211-08.2009.CrossRefPubMed Tucker K, Butler J, Graven-Nielsen T, Riek S, Hodges P: Motor unit recruitment strategies are altered during deep-tissue pain. J Neurosci. 2009, 29: 10820-10826. 10.1523/JNEUROSCI.5211-08.2009.CrossRefPubMed
38.
go back to reference Keenan KG, Farina D, Maluf KS, Merletti R, Enoka RM: Influence of amplitude cancellation on the simulated surface electromyogram. J Appl Physiol. 2005, 98: 120-131.CrossRefPubMed Keenan KG, Farina D, Maluf KS, Merletti R, Enoka RM: Influence of amplitude cancellation on the simulated surface electromyogram. J Appl Physiol. 2005, 98: 120-131.CrossRefPubMed
39.
go back to reference Zhang H, Bian Z, Lin Z: Are acupoints specific for diseases? A systematic review of the randomized controlled trials with sham acupuncture controls. Chin Med. 2010, 5: 1-10.1186/1749-8546-5-1.PubMedCentralCrossRefPubMed Zhang H, Bian Z, Lin Z: Are acupoints specific for diseases? A systematic review of the randomized controlled trials with sham acupuncture controls. Chin Med. 2010, 5: 1-10.1186/1749-8546-5-1.PubMedCentralCrossRefPubMed
40.
go back to reference Kaplani PA, Pattichis CS, Hadjileontiadis LJ, Roberts VC: Surface EMG analysis on normal subjects based on isometric voluntary contraction. J Electromyogr Kinesiol. 2009, 19: 157-171. 10.1016/j.jelekin.2007.03.010.CrossRef Kaplani PA, Pattichis CS, Hadjileontiadis LJ, Roberts VC: Surface EMG analysis on normal subjects based on isometric voluntary contraction. J Electromyogr Kinesiol. 2009, 19: 157-171. 10.1016/j.jelekin.2007.03.010.CrossRef
41.
go back to reference Farina D, Merletti R, Enoka RM: The extraction of neural strategies from the surface EMG. J Appl Physiol. 2004, 96: 1486-1495. 10.1152/japplphysiol.01070.2003.CrossRefPubMed Farina D, Merletti R, Enoka RM: The extraction of neural strategies from the surface EMG. J Appl Physiol. 2004, 96: 1486-1495. 10.1152/japplphysiol.01070.2003.CrossRefPubMed
42.
go back to reference Potvin JR, Brown SH: Less is more: high pass filtering, to remove up to 99% of the surface EMG signal power, improves EMG-based biceps brachii muscle force estimates. J Electromyogr Kinesiol. 2004, 14: 389-399. 10.1016/j.jelekin.2003.10.005.CrossRefPubMed Potvin JR, Brown SH: Less is more: high pass filtering, to remove up to 99% of the surface EMG signal power, improves EMG-based biceps brachii muscle force estimates. J Electromyogr Kinesiol. 2004, 14: 389-399. 10.1016/j.jelekin.2003.10.005.CrossRefPubMed
43.
go back to reference de Sá Ferreira A: Statistical validation of strategies for Zang-fu single pattern differentiation. J Chin Integr Med. 2008, 6: 1109-1116. 10.3736/jcim20081103.CrossRef de Sá Ferreira A: Statistical validation of strategies for Zang-fu single pattern differentiation. J Chin Integr Med. 2008, 6: 1109-1116. 10.3736/jcim20081103.CrossRef
44.
go back to reference Ferreira AS: Diagnostic accuracy of pattern differentiation algorithm based on traditional Chinese medicine theory: a stochastic simulation study. Chin Med. 2009, 4: 24-10.1186/1749-8546-4-24.PubMedCentralCrossRefPubMed Ferreira AS: Diagnostic accuracy of pattern differentiation algorithm based on traditional Chinese medicine theory: a stochastic simulation study. Chin Med. 2009, 4: 24-10.1186/1749-8546-4-24.PubMedCentralCrossRefPubMed
45.
go back to reference Sá Ferreira A: Misdiagnosis and undiagnosis due to pattern similarity in Chinese medicine: a stochastic simulation study using pattern differentiation algorithm. Chin Med. 2011, 6: 13-10.1186/1749-8546-6-13.CrossRef Sá Ferreira A: Misdiagnosis and undiagnosis due to pattern similarity in Chinese medicine: a stochastic simulation study using pattern differentiation algorithm. Chin Med. 2011, 6: 13-10.1186/1749-8546-6-13.CrossRef
46.
go back to reference Ferreira AS, Lopes AJ: Chinese Medicine Pattern Differentiation and Its Implications for Clinical Practice. Chin J Integr Med. 2011, 17: 818-823. 10.1007/s11655-011-0892-y.CrossRefPubMed Ferreira AS, Lopes AJ: Chinese Medicine Pattern Differentiation and Its Implications for Clinical Practice. Chin J Integr Med. 2011, 17: 818-823. 10.1007/s11655-011-0892-y.CrossRefPubMed
Metadata
Title
Immediate effects of acupuncture on biceps brachii muscle function in healthy and post-stroke subjects
Authors
Ana Paula S Fragoso
Arthur S Ferreira
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Chinese Medicine / Issue 1/2012
Electronic ISSN: 1749-8546
DOI
https://doi.org/10.1186/1749-8546-7-7

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