Author's Accepted Manuscript

Yamamoto new scalp acupuncture, applied kinesiology and breathing exercises for facial paralysis in
a young boy caused by Lyme disease A case
report
Friedrich Molsberger, C. Raak, M. Teuber

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http://dx.doi.org/10.1016/j.explore.2016.02.001
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Cite this article as: Friedrich Molsberger, C. Raak, M. Teuber, Yamamoto new scalp
acupuncture, applied kinesiology and breathing exercises for facial paralysis in a young
boy caused by Lyme disease A case report, Explore, http://dx.doi.org/10.1016/j.
explore.2016.02.001
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Yamamoto New Scalp Acupuncture, Applied Kinesiology

and breathing exercises for facial paralysis in a young boy
caused by Lyme disease a case report

1,2,3

2,3

Authors: Friedrich Molsberger C.Raak , M. Teuber

1) Corresponding author: Prof. Dr. med. Friedrich Molsberger, Amannshauser Str. 10a,
14197 Berlin
Tel.: 030 85 73 03 97, Fax.: 030 86 42 37 88, E-Mail: info@molsberger.de;
www.molsberger.de
2) Forschungsgruppe Akupunktur, Dsseldorf, Germany
3) Hochschule fr Gesundheit und Sport, Technik und Kunst, Berlin
4) Institut fr Integrative Medizin, Universitt Witten/Herdecke, Herdecke

Keywords
Yamamoto New Scalp Acupuncture, YNSA, Applied Kinesiology, breathing exercises, facial
paralysis, Lyme disease

Abstract
Objective:
The case study reports on the effect of pharmacological, complementary and alternative
medicine including YNSA, Applied Kinesiology and respiratory exercises in a 9-year old boy
with facial paralysis.
Patient and Methods:
The boy suffered from borreliosis and one-sided facial paralysis which occurred three and a
half weeks after being bitten by a tick and persisted despite four weeks of medication with
antibiotics.
Complementary medicine treatment was first applied eight weeks after the tick bite.
Examination included Applied Kinesiology with the coachmans test, assessment of breathing
pattern disorders and Yamamoto New Sculp Acupuncture. Muscle weakness related to
thoracic breathing was found in the coachmans test. Respiratory exercises and YNSA
acupuncture including permanent needles were given and speech therapy was recommended.
Results:
In the first treatment muscle function as assessed by the coachmans test normalized and
improvement in the facial paralysis was observed. Within eight additional treatments over a
period of two months the boy showed complete recovery.
Discussion:
The case shows a multimodal approach to facial paralysis integrating pharmacological
treatment and CAM including YNSA, Applied Kinesiology and breathing exercises.

Introduction
Lyme disease (LD) is the most common tick-borne infectious disease in Europe (1).
It is caused by infection with spirochete bacteria and may lead to arthritic, cardiac or
neurological symptoms. Severity varies depending on the stage and magnitude of spirochete
dissemination (2) . If the patient is treated with the appropriate antibiotics, the prognosis is
good: in 95% of the patients neuroborreliosis is cured without permanent damage while in 5%
of patients facial paralysis persists (1). A higher risk of facial paralysis is found particularly
in children with stage 2 borreliosis infection (3).
In addition to physical and neuromuscular rehabilitation strategies such as massage therapy
(4), several papers report on beneficial effects of various forms of acupuncture, in particular
for the facial paralysis (5)(6). One of these is Yamamoto New Scalp Acupuncture (YNSA)
developed in the 1970s by Japanese anesthesiologist and surgeon Toshikatsu Yamamoto (7).
This form of acupuncture is primarily used in the treatment of neurological and chronic pain
and works with somatopes located mainly on the scalp, as well as diagnostic areas on the neck
and abdomen. Points to be needled are detected by palpation of the somatopes, and spots that
are painful are selected.
While several articles have investigated the efficacy of acupuncture in the treatment of
neurological symptoms like hemiplegia or paralysis (5)(6)(9), the use of body-oriented
methods in the treatment of facial paralysis has not been sufficiently studied.
Two body-oriented methods, namely applied kinesiology (AK) and breathing therapy, have
already been applied successfully in combination with acupuncture (8).

Applied kinesiology (AK) was developed in the 1960s by American chiropractor George
Goodheart. Manual muscle testing is used to detect functional disorders and to help select
therapeutic approaches. According to Moncayo (10). AK techniques rely on the relationship
between muscles and acupuncture meridians.

Breathing therapy, aiming at promoting deep or abdominal breathing, is used in many

different ways, from meditation to the treatment of breathing disorders. Studies have revealed
positive effects on quality of life, mood, and anxiety (11)(12).
This case report shows how a combination of antibiotic therapy, YNSA acupuncture, AK and
breathing exercises, including the use of permanent needles, were used to successfully treat a
boy who developed severe facial paralysis following a tick bite.

History
Three and a half weeks after being bitten by a tick in northern Germany, the nine-year-old boy
developed erythema migrans on the side of the head. A short episode of fever and infection
ten days after the bite was followed by severe facial paralysis. Serology for Lyme disease was
positive, and the boy was treated by a pediatric specialist with an intravenous antibiotic
regime of amoxicillin, cefixime and ceftriaxone for one month. Although the boy recovered
overall, the facial paralysis remained. The family was not satisfied with the neurologists
assessment that the case was rather difficult and that the facial paralysis could take up to a
year to disappear. The father brought the boy for complementary treatment and YNSA eight
weeks after the initial bite.

Examination and diagnosis

Examination combined inspection of muscle function of the face, manual muscle testing
according to AK, and palpation of YNSA points. The initial examination revealed severe
paralysis of the right side of the face as seen in the photos. The eye could be closed only
partially, and smiling and whistling were impossible. Spontaneous forced breathing showed
thoracic expansion, accompanied by pulling in of the abdomen, during inspiration.

Figure 1: Patient before treatment*

The manual muscle test showed no strong muscles according to the AK definition. In the
coachmans test, a further development of the AK gait test (8), both feet are flat on the
floor, with about 70% of the body weight on the front foot. The tester applies resistance
against the forward arm to test muscle strength while the patient is pushing upward. This
strength can be felt by the tester in response to a slight increase in pressure on the forearm.
Flexors and extensors of the shoulder muscles were found to be weak where they should be
strong. In supine position the anterior deltoid and rectus femoris muscles tested weak as well.
The weak muscles became strong when tested immediately after deep abdominal inspiration
or expiration.

Figure 2: Coachmans test seen from above

Figure 3: Coachmans test seen from the side

Examination with YNSA showed positive palpable points 1) on the xyphoid process
corresponding to the brain point on the frontal bone, 2) on the left side of the neck
corresponding to the left gallbladder point, and 3) on the sensory points on the frontal bone.

The diagnosis of facial paralysis was confirmed. The influence of breathing was seen as a socalled challenge of the craniosacral system according to AK and was interpreted as a sign for
the involvement of the SBS (sphenobasilaer synchondrosis) (13) (19).

Figure 4: YNSA diagnostic area at the xyphoid process

Figure 5: YNSA diagnostic and therapeutic areas at scull and neck

Treatment at the first consultation

Treatment began with exercises to encourage abdominal breathing for ten minutes. First, the
patient had to develop a feeling for abdominal breathing by placing one palm on the abdomen
and one on the chest to monitor movement during abdominal breathing: the palm on the
abdomen had to be lifted during inspiration, while the palm on the chest did not move. In a
second step, the patient was instructed to flex his feet during inspiration and extend them
during expiration, while still monitoring abdominal and chest movements with the hands.

Figure 6: Breathing exercise

After the breathing exercises, the YNSA diagnostic areas as described above were palpated
again. Then the associated therapeutic points where identified and needled: brain points and
sensory points on the frontal bone and left gallbladder ypsilon point. Following the YNSA
algorithm, diagnostic areas were then immediately palpated for comparison. Points that had
been positive were now negative. Acupuncture was done with needles 0.25 mm x 25 mm.
Depth of needling was about 5 to 8 mm. The needles on the frontal bone were removed after
30 minutes and replaced by permanent needles, which were left in place for two days. To
prevent injury, the permanent needles where covered with tape.
In addition the patients father was instructed to supervise two minutes of abdominal
breathing exercises, including foot movement, every day.

Figure 7: Permanent needles on YNSA sensory points

Figure 8: Permanent needles on YNSA sensory points covered with tape.

Further treatment and results

The patient was seen eight more times over a two-month period. At each consultation the
coachmans test was administered and breathing patterns were evaluated using AK.
Immediately after the first treatment, the coachmans test was negative. After the second
treatment, abdominal breathing was no longer a challenge and did not influence the muscle
test.
Exercises to encourage abdominal breathing were performed at every appointment. YNSA
was applied with little variation, based on diagnostic palpation, followed by needling for 30
minutes and then permanent needles covered with tape. Speech therapy, with focus on smiling
and whistling, was recommended, and exercises were performed during acupuncture sessions.
From the very first treatment, slight improvements in facial movement were seen. The patient
improved steadily over the following weeks. After two months recovery was almost complete,
except for some lack of wrinkling at the nose during facial grimacing. Ten months later the
father reported that his son had completely recovered.

Figure 9: Complete recovery

Discussion
Acute Lyme disease requires antibiotic treatment. In stage 2 of Lyme disease, 60% of patients
exhibit Bannwarths syndrome (meningoradiculitis) (14), with 80% of these developing facial
paralysis (15).
Unfortunately, facial paralysis often is not cured by the antibiotic treatment. An unknown
percentage of the patients then try additional complementary treatment.
In this case, AK was used as an additional diagnostic tool. Weak muscles in the coachmans
test in connection with inspiration or expiration can be interpreted as a signal for involvement
of the craniosacral system and especially SBS movement (sphenobasilar synchondrosis) (13).
7

It is unclear whether the suspected lack of SBS movement was caused by the Lyme disease,
was a side effect of the previous treatment, or was part of the patients situation pre-Lyme
disease. It is thought that the SBS is softly activated by the patient himself through the strong,
palm-monitored abdominal breathing with the help of foot flexion and extension (16).
YNSA is discussed in the literature as a complementary method in the treatment of
neurological disorders, especially in cases of hemiparalysis caused by strokes and in pain
conditions (17)(18).
In this case YNSA was used in combination with respiratory training after antibiotic
treatment. AK was a helpful diagnostic tool to identify the dysfunctional breathing pattern.
Signs of recovery were observed during the very first treatment after breathing exercises were
performed and as soon as the acupuncture needles were inserted. It is impossible to say which
of the therapeutic approaches caused the recovery, or whether synergistic effects were
responsible. Spontaneous recovery also cannot be ruled out.
More studies need to be conducted to investigate the value of YNSA, respiratory training and
AK.
* Photos of the boy with permission of the family
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