**4. Evidence from objective behavioral testing**

#### **4.1 Objective behavioral testing in preclinical studies**

For years, our group has been developing testing methods to objectively measure behavioral changes before and after intermittent EA treatments in parkinsonian monkeys. Recently, we reported that EA-induced improvement of parkinsonism in rhesus macaques can be effectively measured using a non-biased, non-invasive and computerized behavioral testing battery [14]. The battery primarily includes a videotracking system to measure movement speed, an Actical accelerometer to monitor home-cage activity 24 h a day, 7 days a week, and an upper limb movement analysis panel to measure a subject retrieval time [14, 24]. As shown in **Figure 7**, significantly deceased movement speed (A), and home cage activity (B), and longer performance time of the affected hand (C) were found following MPTP administration. The movement speed and fine motor performance time were markedly

**17**

**Figure 7.**

*Functional Imaging and Physiological Modulation with Acupuncture in Parkinson's Disease…*

improved with chronic EA treatment (**Figure 7A** and **C**), and movement speed and fine motor performance times virtually returned to pre-MPTP levels. The cage activity was increased but did not reach statistically significant levels because of large variance (**Figure 7B**). Meanwhile, the fine motor performance time was still

*Behavior changes of animals following different treatments. Movement speed (A), home cage activity (B) and fine motor performance time changes (C) following MPTP administration, chronic EA treatment or post EA treatment (at least 1 months after last EA treatment). (a) P < 0.05 compared with normal; (b) P < 0.05* 

*compared with MPTP; (c) P < 0.05 compared with MPTP + EA (from [14]).*

*DOI: http://dx.doi.org/10.5772/intechopen.83419*

*Functional Imaging and Physiological Modulation with Acupuncture in Parkinson's Disease… DOI: http://dx.doi.org/10.5772/intechopen.83419*

improved with chronic EA treatment (**Figure 7A** and **C**), and movement speed and fine motor performance times virtually returned to pre-MPTP levels. The cage activity was increased but did not reach statistically significant levels because of large variance (**Figure 7B**). Meanwhile, the fine motor performance time was still

#### **Figure 7.**

*Acupuncture - Resolving Old Controversies and Pointing New Pathways*

**4. Evidence from objective behavioral testing**

*stimulation is terminated. Zoomed inset of Figure 6A.*

**4.1 Objective behavioral testing in preclinical studies**

For years, our group has been developing testing methods to objectively measure behavioral changes before and after intermittent EA treatments in parkinsonian monkeys. Recently, we reported that EA-induced improvement of parkinsonism in rhesus macaques can be effectively measured using a non-biased, non-invasive and computerized behavioral testing battery [14]. The battery primarily includes a videotracking system to measure movement speed, an Actical accelerometer to monitor home-cage activity 24 h a day, 7 days a week, and an upper limb movement analysis panel to measure a subject retrieval time [14, 24]. As shown in **Figure 7**, significantly deceased movement speed (A), and home cage activity (B), and longer performance time of the affected hand (C) were found following MPTP administration. The movement speed and fine motor performance time were markedly

*(A) Real-time measurements of the basal glutamate change in the motor cortex with and without acupuncture stimulations. Glutamate changes in the unlesioned motor cortex produced by EA stimulation at GV14 + ST36 (right side). Glutamate biosensors were used to measure glutamate levels. One biosensor recording site is coated with glutamate oxidase and capable of detecting glutamate a reference biosensor recording site lacking glutamate oxidase and incapable of detecting glutamate is used to subtract interfering agents. (B) Real-time measurement of the basal glutamate changes in the motor cortex with and without acupuncture stimulations. Glutamate changes in the unlesioned motor cortex produced by EA stimulation at GV14 + ST36 (right side) and GV14 + nonacupuncture points. TTL: transistor-transistor logic (event marker). GluOx+ (biosensor recording site coated with glutamate oxidase and capable of detecting glutamate), GluOx− (biosensor recording site lacking glutamate oxidase and incapable of detecting glutamate). Note the stimulation induced artifact in the reference channel (GluOx− recording site) during the course of stimulation that subsides when EA* 

**16**

**Figure 6.**

*Behavior changes of animals following different treatments. Movement speed (A), home cage activity (B) and fine motor performance time changes (C) following MPTP administration, chronic EA treatment or post EA treatment (at least 1 months after last EA treatment). (a) P < 0.05 compared with normal; (b) P < 0.05 compared with MPTP; (c) P < 0.05 compared with MPTP + EA (from [14]).*

improving one-month post EA treatment (**Figure 7C**). In addition, all animals responded positively to levodopa challenge evident by a 261% increase of home-cage activity measured via Actical counts.

### **4.2 Objective behavioral testing in clinical studies**

In the acupuncture clinic, objective assessments using novel computerized technologies are drawing more attention. Lei and colleagues used body-worn sensor technology in patients with PD to measure a variety of gait parameters [3]. The authors found that EA improved gait function and achieved statistically significant improvements in gait speed under a variety of walking tasks including singletask habitual walking, single-task fast walking, and dual-task fast walking. No significant changes were observed in the control group. Meanwhile, gait improvements were correlated with the activities of daily living component of the Unified Parkinson's Disease Rating Scale (UPDRS). This study further indicates that the effectiveness of EA treatment can be objectively measured and while still used with traditional instruments such as the UPDRS.
