September 2 (Tue.)
EVAUATION IN REHABILITATION MEDICINE
Derick T. Wade (Rivermead Rehabilitation Centre, Oxford, Great Britain).
The process of rehabilitation starts with assessment, and proceeds through goal planning to intervention. Following any intervention there must be reassessment, which evaluates the effects of any intervention and my lead on to further cycles of goal-planning and intervention. Thus evaluation is central to rehabilitation. Evaluation if simply assessment. Assessment is the collection, collation and interpretation of data. The great difficulties in rehabilitation are (a) knowing what data is needed and (b) interpreting the data. This talk will address some of these issues in relation to clinical practice and in relation to research.
POLYMODAL RECEPTORS: A POSSIBLE PHYSIOLOGICAL CANDIDATE FOR UNDERSTANDING OF ACUPUNCTURE ACTION AND ACUPUNCTURE POINTS
Kenji Kawakita (Meiji University of Oriental Medicine, Kyoto, Japan)
We have recently proposed a working hypothesis termed polymodal receptor hypothesis in the peripheral mechanisms of acupuncture and moxibustion. The polymodal receptors, a kind of nociceptor which responsive to mechanical (acupuncture), thermal (moxibustion) and chemical (substances produced by tissue injury) stimulation, distribute to the skin, muscle and other deep tissues of the entire body. They are free nerve endings and easily sensitized by various chemicals produced by inflammatory processes. It has been well established that both acupuncture and moxibustion produce local inflammatory response such as flare and extravasation. These responses are shown as the results of the effector function of the polymodal receptors. Selective activation of the polymodal receptor as well as acupuncture induces analgesic effects and modification of the bio-regulatory functions such as the autonomic nervous system and endocrine system.
On the other hand, morphological feature of acupuncture points has not been established but the close relations between acupuncture points and tender/ trigger points have been well demonstrated. These points are suggested to be the sites where the nociceptors such as the polymodal receptors were sensitized although the causes of the sensitization are not clarified yet.
These functional and morphological characteristics of the polymodal receptors well fit with the candidate of acupuncture, and these facts may offer a rational explanation of the reason why we insert the acupuncture needle into the acupuncture points or tender/trigger points.