Category Archives: Cerebral Palsy

3 Weeks of WBV Improved Ankle JPS & Gait Variables

Physiother Can, 2016; 68(2): 99-105, PMID: 27909356 external link

Effects of Three Weeks of Whole-Body Vibration Training on Joint-Position Sense, Balance, and Gait in Children with Cerebral Palsy: A Randomized Controlled Study.

Ko MS, Sim YJ, Kim DH, Jeon HS
Department of Physical Therapy, The Graduate School, Yonsei University; Department of Occupational Therapy, College of Health and Welfare, Woosong University, Daejeon.

Abstract

Purpose: To observe the effects of whole-body vibration (WBV) training in conjunction with conventional physical therapy (PT) on joint-position sense (JPS), balance, and gait in children with cerebral palsy (CP).

Methods: In this randomized controlled study, 24 children with CP were randomly selected either to continue their conventional PT or to receive WBV in conjunction with their conventional PT programme. Exposure to the intervention was intermittent (3 min WBV, 3 min rest) for 20 minutes, twice weekly for 3 weeks. JPS, balance, and gait were evaluated before and after treatment.

Results: Ankle JPS was improved after 3 weeks of WBV training (p=0.014). Participants in the WBV group showed greater improvements in speed (F1,21=5.221, p=0.035) and step width (F1,21=4.487, p=0.039) than participants in the conventional PT group.

Conclusion: Three weeks of WBV training was effective in improving ankle JPS and gait variables in children with CP.

Galileo – Study Shows CP Improvement

A new clinical trial shows that adolescents and young adults with cerebral palsy (CP) enjoy stronger bones and greater mobility after training on a specialized vibration plate.

Researchers at the University of Auckland (New Zealand) and The Children’s Hospital at Westmead (Sydney, Australia) conducted a clinical trial in 40 participants (11.3–20.8 years of age) with mild to moderate CP to study whole-body vibration training (WBVT) effects on muscle function and bone health. Study participants underwent 20-week WBVT on a vibration plate for 9 minutes a day, 4 times a week. Assessment measures included a six-minute walk test, whole-body dual X-ray absorptiometry (DXA), lower leg peripheral quantitative computed tomography (pQCT) scans, and muscle function.
Dr. Silmara Gusso and the WBVT plate (Photo courtesy of the University of Auckland).
The patients stood barefoot on a special vibration plate that produced a see-saw movement, stimulating a movement similar to walking. The results showed that the 20 weeks of WBVT were associated with increased lean mass in the total body, trunk, and lower limbs. Bone mineral content and density also increased in the total body, the lumbar spine, and the lower limbs. Participants also improved the distance walked in the 6-minute walk test by 11 to 35%. The study was published on March 3, 2016, in Scientific Reports.

“We expected them to increase their bone mass and muscle mass, which is what happened. What we didn’t expect was that their day-to-day functioning would also improve,” said lead author Silmara Gusso, PhD. “The feedback from parents and caregivers about the changes they were noticing was especially encouraging: improved mood, greater maneuverability, and fewer falls. In a group with troublesome constipation vibration therapy was also unexpectedly beneficial.”

CP is the most common cause of physical disability in childhood, affecting two of 1,000 children, and usually appears at birth or in early infancy. Children with CP have impaired muscle function, reduced muscle and bone mass, and a higher-than-normal risk of bone fractures. Muscles that normally work in complementary action will simultaneously go into spasm, making movement difficult, and over time the muscles waste. Treatments to relieve the disorders’ effects are limited, and include botox injection, surgery, passive stretching, and injection of bisphosphonates to increase bone density.

 

WBV on physical function, bone and muscle mass in adolescents with CP

Sci Rep. 2016 Mar 3;6:22518. doi: 10.1038/srep22518.

Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy.

Gusso S1, Munns CF2, Colle P1, Derraik JG1, Biggs JB1, Cutfield WS1, Hofman PL1.

Abstract

Objective:  We performed a clinical trial on the effects of whole-body vibration training (WBVT) on muscle function and bone health of adolescents and young adults with cerebral palsy.

Participants:  Forty participants (11.3-20.8 years) with mild to moderate cerebral palsy (GMFCS II-III)

Methods:  Underwent 20-week WBVT on a vibration plate for 9 minutes/day 4 times/week at 20 Hz (without controls).  Assessments included 6-minute walk test, whole-body DXA, lower leg pQCT scans, and muscle function (force plate).

Results:  Twenty weeks of WBVT were associated with increased lean mass in the total body (+770 g; p = 0.0003), trunk (+410 g; p = 0.004), and lower limbs (+240 g; p = 0.012). Bone mineral content increased in total body (+48 g; p = 0.0001), lumbar spine (+2.7 g; p = 0.0003), and lower limbs (+13 g; p < 0.0001). Similarly, bone mineral density increased in total body (+0.008 g/cm(2); p = 0.013), lumbar spine (+0.014 g/cm(2); p = 0.003), and lower limbs (+0.023 g/cm(2); p < 0.0001). Participants reduced the time taken to perform the chair test, and improved the distance walked in the 6-minute walk test by 11% and 35% for those with GMFCS II and III, respectively.

Conclusion:  WBVT was associated with increases in muscle mass and bone mass and density, and improved mobility of adolescents and young adults with cerebral palsy.

SUMMARY STUDY:   In a group of 40 patients with cerebral palsy whole body vibration training improved time for chair rising test, and the distance in 6 min walking test by 11 and 35% respectively. Improvements were also found in muscle mass, bone mass and density and mobility.

Cerebral Palsy Cologne Concept

Cologne Children’s Hospital, Jan 2013

Intensive Physiotherapy and Home Based Vibration Training for Children with Cerebral Palsy: 

E. Schoenau, C. Stark, O. Semler – Children’s Hospital, University of Cologne, Germany

Background: Rehabilitation of children with Cerebral Palsy (CP) aims to reduce sequelae and enhance function. Physiotherapy is a rehabilitative strategy for the treatment of patients with CP, but with little supporting evidence for the different treatment concepts. The Cologne Concept “Auf die Beine” combines Interval-Rehabilitation consisting of short and intensive in-patient stays with 6 months home-based whole body vibration training. “Auf die Beine” is a routine procedure supported by the German health care system. We are presenting the gross motor function results after 6 months of training and additional 6 months follow-up.

Design: Retrospective analysis of 356 children and adolescents

Participants and Setting: 356 children and adolescents diagnosed with CP were included in the retrospective analysis. Mean age was 8.9 years (SD 4.4) and GMFCS levels were 7.3% level I, 14.9% level II, 30.3% level III, 31.2% level IV and 7.6% level V. All patients completed 6 months of home based whole body vibration training, two blocks of intensive physiotherapy and the 12 month visit (6 months follow-up).

Methods: Gross motor function was assessed with the Gross Motor Function Measure (GMFM-66) total score after 6 and 12 (Follow-up) months and the GMFM-88-Goal-Dimensions after 6 months.

Results: GMFM-66-Totalscore improved by 2.9 points (Mean 3.35; p<0.001) after 6 months and by 0.2 points (Mean 0.63; p=0.033) after 6 months follow-up. Goal dimension A (lying) improved by 2.0% (Mean 3.8; p=0.001), B (sitting) by 3.3% (Mean 5.9; p<0.001), C (crawling) by 4.8% (Mean 6.7; p<0.001), D (standing) by 5.1% (Mean 8.0; p<0.001) and E (walking) by 2.8% (Median 4.6; p<0.001).

Conclusion: The Interval-Rehabilitation combined with home-based training shows a significant positive effect on gross motor function in patients with CP. The results could be sustained after 6 months follow-up. To our knowledge this is the first retrospective evaluation of a routine health care concept for children with mobility problems.

Galileo improves strength and balance in Diplegic cerebral palsy

Effect of whole-body vibration on muscle strength and balance in diplegic cerebral palsy: a randomized controlled trial.
Am J Phys Med Rehabil. 2014 Feb;93(2):114-21
El-Shamy SM

Abstract

OBJECTIVE:
The purpose of this study was to investigate the effects of whole-body vibration training on muscle strength and balance in children with diplegic cerebral palsy.

DESIGN:
Fifteen children were assigned to the experimental group, which received whole-body vibration training (9 mins per day, 5 days per week). Another 15 were assigned to the control group, which participated in a traditional physical therapy exercise program for 3 successive months. Baseline and posttreatment assessments were performed using the Biodex isokinetic dynamometer to evaluate the knee extensors peak torque at 60 degrees per second and 90 degrees per second and using the Biodex balance system to evaluate stability index.

RESULTS:
The children in the experimental group showed a significant improvement when compared with those in the control group (P < 0.001). The peak torque at 60 degrees per second and 90 degrees per second after treatment was 28.8 ± 0.45 and 47.5 ± 0.7 N · m and 30.9 ± 0.68 and 54.2 ± 1.7 N · m for the control and the experimental group, respectively. The overall stability index after treatment was 2.75 and 2.2 for the control group and the experimental group, respectively.

CONCLUSIONS:
Whole-body vibration training may be a useful tool for improving muscle strength and balance in children with diplegic cerebral palsy.

GalileoStabilityImprovement

PMID: 24434887 [PubMed – indexed for MEDLINE]

Cerebral Palsy Children Improve

Clinical Rehabilitation February 14, 2013

Effect of whole body vibration training on mobility in children with cerebral palsy: a randomized controlled experimenter-blinded study

Byoung-Kwon Lee,  Seung-Chul Chon Department of Physical Therapy, Konyang University, Daejeon, Republic of Korea
Seung-Chul Chon, Department of Physical Therapy, College of Medical Science, Konyang University, Gasuwon-Dong, Seo-Gu, Daejeon 302-718, Republic of Korea.

Abstract

Objective: To evaluate ambulatory function and leg muscle thickness after whole body vibration training in children with cerebral palsy.

Design: A block randomized controlled trial with two groups.

Setting: Physical therapy department laboratory.

Subjects: A total of 30 (15 experimental, mean (SD) age 10.0 (2.26) years and 15 control, 9.6 (2.58)) children with cerebral palsy, 15 males and 15 females.

Interventions: The experimental group underwent whole body vibration training combined with conventional physical therapy training; the control group underwent conventional physical therapy training three days a week for eight weeks respectively.

Main outcome measures: Three-dimensional gait analyses and ultrasonographic imaging of the leg muscles were measured at pre- and post-test of intervention for eight weeks.

Results: Whole body vibration training resulted in significantly better gait speed (P = 0.001, from 0.37 (0.04) m/s to 0.48 (0.06)), stride length (P = 0.001, from 0.38 (0.18) m to 0.48 (0.18)) and cycle time (P = 0.001, from 0.85 (0.48) s to 0.58 (0.38)) in the experimental group compared with that in the control group. The ankle angle (P = 0.019, from 7.30 (4.02) degree to 13.58 (8.79)) also showed a remarkable increase in the experimental group, but not the hip (P = 0.321) and knee angle (P = 0.102). The thicknesses of the tibialis anterior (P = 0.001, 0.48 (0.08) mm to 0.63 (0.10)) and soleus (P = 0.001, 0.45 (0.04) mm to 0.63 (0.12)) muscles were significantly higher in the experimental group than in the control group. However, no significant effect was observed in the thickness of the gastrocnemius muscle (P = 0.645).

Conclusions: These findings suggest that whole body vibration may improve mobility in children with cerebral palsy, probably through a positive effect on the leg muscles

CP-AnkleAngle

CP-StrideLength CP-GaitSpeed

 

 

 

 

 

 

 

 

 

 

CP-ThicknessTibialisAnteriorCP-ThicknessSoleus

Adult CP Improvements in Gait and Mobility

J Musculoskelet Neuronal Interact 2013

The acute effects of whole-body vibration on gait parameters in adults with cerebral palsy

D.C. Dickin, K.A. Faust, H. Wang, J. Frame

Abstract

Objectives: As adults with cerebral palsy (CP) are surviving longer, interventions are needed to reduce spasticity and increase strength to improve mobility and life quality. Adults with CP are lacking a form of independent exercise that allows them to maintain or improve their ambulation skills.  A new approach to increase muscle strength and flexibility called whole-body vibration (WBV) was assessed.

Methods: Using an individualized frequency (I-Freq) approach to WBV therapy the acute effects on gait in adults with CP was measured. In this study, eight adults with CP (age 20-51 years, two female) participated in two testing sessions: session one determined each individual’s I-Freq; and session two included a 3D gait analysis before and after a WBV treatment. The WBV was administered in five, one minute bouts of vibration followed by one minute of rest.

Results: Following WBV exposure subjects experienced a significant increase in walking speed (P=0.047), stride length (P=0.017) and dynamic ankle range of motion (P=0.042).

Conclusions: These data show that acute WBV treatments at I-Freq can improve measures of gait and mobility in adults with CP, however, future should assess potential long-term improvements.

BSCP have BMD, Muscle Force, GMF improve

J Musculoskelet Neuronal Interact. 2010 Jun;10(2):151-8.

Effect of a new physiotherapy concept on bone mineral density, muscle force and gross motor function in children with bilateral cerebral palsy.

Stark C1, Nikopoulou-Smyrni P, Stabrey A, Semler O, Schoenau E.

Abstract

OBJECTIVE: The purpose of this study was to determine the effect of a new physiotherapy concept on bone density, muscle force and motor function in bilateral spastic cerebral palsy children.

METHODS: In a retrospective data analysis 78 children were analyzed. The concept included whole body vibration, physiotherapy, resistance training and treadmill training. The concept is structured in two in-patient stays and two periods of three months home-based vibration training. Outcome measures were dual-energy x-ray absorption (DXA), Leonardo Tilt Table and a modified Gross Motor Function Measure before and after six months of training.

RESULTS: Percent changes were highly significant for bone mineral density, -content, muscle mass and significant for angle of verticalisation, muscle force and modified Gross Motor Function Measure after six months training.

CONCLUSIONS: The new physiotherapy concept had a significant effect on bone mineral density, muscle force and gross motor function in bilateral spastic cerebral palsy children. This implicates an amelioration in all International Classification of Functioning, Disability and Health levels. The study serves as a basis for future research on evidence based pediatric physiotherapy taking into account developmental implications.

Link
J Musculoskelet Neuronal Interact. 2007 Jan-Mar;7(1):77-81.

Preliminary results on the mobility after whole body vibration in immobilized children and adolescents.

Semler O1, Fricke O, Vezyroglou K, Stark C, Schoenau E.

Abstract

Objective:  The present article is a preliminary report on the effect of Whole Body Vibration (WBV) on the mobility in long-term immobilized children and adolescents.

Participants:  WBV was applied to 6 children and adolescents (diagnoses: osteogenesis imperfecta, N=4; cerebral palsy, N=1; dysraphic defect of the lumbar spine, N=1) over a time period of 6 months.

Method:  WBV was applied by a vibrating platform constructed on a tilt-table. The treatment effect was measured by alternations of the tilt-angle of the table and with the “Brief assessment of motor function” (BAMF). All 6 individuals were characterized by an improved mobility, which was documented by an increased tilt-angle or an improved BAMF-score.

Results:  The authors concluded WBV might be a promising approach to improve mobility in severely motor-impaired children and adolescents. Therefore, the Cologne Standing-and-Walking- Trainer powered by Galileo is a suitable therapeutic device to apply WBV in immobilized children and adolescents.

STUDY SUMMARY:   Children with different chronic diseases (osteogenesis imperfecta, cerebral palsy and dysraphic defect) were treated with side alternating whole body vibration for 6 months. Muscle force and mobility improved in all subjects. In a child with cerebral palsy spasticity was reduced and muscle tone reduced. As a result the treatment with botulinum toxin could be postponed. A child with a dysraphic defect showed a reduced lordosis and decreased contractions. Knee joint angle improved from 40° to 10° in the right and 0°in the left knee. An already planned surgery could be cancelled.

Botox for CP kids? Good or Bad!

J Pediatr Orthop. 2013 Jul-Aug;33(5):494-500. doi: 10.1097/BPO.0b013e318288b42a.

Conflict of interest in the assessment of botulinum toxin A injections in patients with cerebral palsy: a systematic review.

Sung KH1, Chung CY, Lee KM, Lee YK, Lee SY, Lee J, Choi IH, Cho TJ, Yoo WJ, Park MS.

Abstract

BACKGROUND:

The efficacy of using botulinum toxin A injections in cerebral palsy (CP) is controversial. The financial conflict of interest related to medical research can affect the conclusion of an evidence-based review. This study was performed to determine as to what proportion of studies on botulinum toxin A injections in patients with CP was sponsored by the industry and whether the assessments of botulinum toxin injection in CP were associated with industry support.

METHODS:

Studies were identified with a search of the PubMed database (January 1991 to November 2011). All prospective, comparative, English language studies on the use of botulinum toxin A injections in patients with CP were included. A total of 374 articles were screened, 128 potentially eligible full articles were retrieved, and 66 studies met our inclusion criteria. The funding sources of the articles were reviewed, and qualitative conclusions regarding the effect of botulinum toxin A injection were classified as being either favorable, neutral, or unfavorable.

RESULTS:

Of 66 eligible articles, 28 were funded by the industry, and 25 were not. The other 13 studies did not include information on the funding source. A significant association was observed between the funding source and qualitative conclusions (P=0.042). Fifteen (53.6%) of the 28 industry-sponsored studies had favorable conclusions, whereas only 5 (20%) of the 25 non-industry-sponsored studies had favorable conclusions.

CONCLUSIONS:

About half of studies on the effect of botulinum toxin A in CP were sponsored by the industry. This systematic review revealed that the qualitative conclusions in those studies are more favorable to the use of the botulinum toxin A than the non-industry-sponsored studies. Clinicians should be aware of an industry-related conflict of interest regarding reports on the efficacy of botulinum toxin A injections in patients with CP.