Category Archives: Stroke

Balance and Gait Function after Stroke

J Phys Ther Sci, 2016; 28(11): 3149-3152, PMID: 27942138 external link

The effects of visual control whole body vibration exercise on balance and gait function of stroke patients.

Choi ET, Kim YN, Cho WS, Lee DK
Department of Physical Therapy, Graduate School of Nambu University, Republic of Korea.


Purpose: This study aims to verify the effects of visual control whole body vibration exercise on balance and gait function of stroke patients.

Subjects and Methods: A total of 22 stroke patients were randomly assigned to two groups; 11 to the experimental group and 11 to the control group. Both groups received 30 minutes of Neuro-developmental treatment 5 times per week for 4 weeks. The experimental group additionally performed 10 minutes of visual control whole body vibration exercise 5 times per week during the 4 weeks. Balance was measured using the Functional Reach Test. Gait was measured using the Timed Up and Go Test.

Results: An in-group comparison in the experimental group showed significant differences in the Functional Reach Test and Timed Up and Go Test. In comparing the groups, the Functional Reach Test and Timed Up and Go Test of the experimental group were more significantly different compared to the control group.

Conclusion: These results suggest that visual control whole body vibration exercise has a positive effect on the balance and gait function of stroke patients.


Complications after a stroke affect not only individual muscles, but also their interaction, which is critical for posture and movement. In addition the loss of muscle strength and muscle power causes an altered perception of the body. Movements and muscle tone are disrupted, with little to no control over partial movement. Using Galileo the muscles can be trained and spasticity and muscle tone can effectively be controlled. Due to the high number of repetitions during Galileo Training residual functions are rapidly activated.

Condition Effects:

  • Improvement in chair rising test
  • Maintaining and improvement in muscle power and coordination
  • Improvement of posture and movement control
  • Faster activation of residual functions
  • Improvement in coordination and agility
  • Improvement in proprioception
  • Restoration of body symmetry by rhythmic right / left movement of the training platform
  • Improvement in balance reactions and response time, resulting in fall prevention
  • Prevention of immobility-related damage

Studies – Stroke

WBV on UE Spasticity and Grip Strength with Post Stroke

Am J Phys Med Rehabil. 2016 Jan 29.

Short-Term Effects of Whole-Body Vibration Combined with Task-Related Training on Upper Extremity Function, Spasticity, and Grip Strength in Subjects with Poststroke Hemiplegia: A Pilot Randomized Controlled Trial.

Lee JS1, Kim CY, Kim HD.


OBJECTIVE:   The aim of this study was to determine the effect of whole-body vibration training combined with task-related training on arm function, spasticity, and grip strength in subjects with poststroke hemiplegia.

DESIGN:  Forty-five subjects with post stroke were randomly allocated to 3 groups, each with 15 subjects as follows: control group, whole-body vibration group, and whole-body vibration plus task-related training group. Outcome was evaluated by clinical evaluation and measurements of the grip strength before and 4 weeks after intervention.

RESULTS:  Our results show that there was a significantly greater increase in the Fugl-Meyer scale, maximal grip strength of the affected hand, and grip strength normalized to the less affected hand in subjects undergoing the whole-body vibration training compared with the control group after the test. Furthermore, there was a significantly greater increase in the Wolf motor function test and a decrease in the modified Ashworth spasticity total scores in subjects who underwent whole-body vibration plus task-related training compared with those in the other 2 groups after the test.

CONCLUSIONS:  The findings indicate that the use of whole-body vibration training combined with task-related training has more benefits on the improvement of arm function, spasticity, and maximal grip strength than conventional upper limb training alone or with whole-body vibration in people with poststroke hemiplegia.

SUMMARY STUDY:   The study was performed in 45 subjects after stroke. Improvements were found in grip strength, spasticity, and arm function as determined in the Fugl-Mayer scale, the Ashworth scale and Wolf motor function test in the group with whole body vibration combined with task related arm training.

Figure 1

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Performance of GMFCS II participants in the 6-minute walk test prior to (red) and after (blue) 20 weeks of whole-body vibration training.

Note that 34 participants started the tests, but only 21 and 22 reached the 400-metre mark at baseline and post-training, respectively. Data are means ± standard errors of the mean. *p < 0.05, **p < 0.01, and ****p < 0.0001 for baseline vs post-training.

Figure 2

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Performance of GMFCS III participants in the 6-minute walk test prior to (red) and after (blue) 20 weeks of whole-body vibration training.

Six subjects started the tests, and the number of participants reaching a particular milestone is shown in the figure. Data are means ± standard errors of the mean. *p < 0.05 for baseline vs post-training.

Leg Muscles Increased After Stroke

Med Sci Sports Exerc. 2013 Jul 29. [Epub ahead of print]

Leg Muscle Activity during Whole-Body Vibration in Individuals with Chronic Stroke.

Liao LR, Lam FM, Pang MY, Jones AY, Ng GY.


1Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China; 2Department of Physiotherapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China; 3School of Rehabilitation Sciences, Griffith University, Australia.


PURPOSE:  It has been previously shown that whole-body vibration (WBV) can augment muscle activity in young healthy adults. However, the electromyography response of leg muscles during WBV in individuals with stroke is unknown. The objective of this study was to determine the influence of WBV on the activity of the vastus lateralis (VL) and gastrocnemius (GS) muscles during the performance of different exercises in chronic stroke patients.

METHODS:  Forty-five chronic stroke patients were studied. Each subject was exposed to three WBV conditions of 1. no WBV, 2. low-intensity WBV protocol [peak acceleration: 0.96 unit of gravitational constant (G)], and 3. high-intensity WBV protocol (peak acceleration: 1.61G) while performing 8 different static exercises involving upright standing, semi squat, deep squat, weight-shifted-forward, weight-shifted-backward, weight-shifted-to-the-side, forward lunge and single-leg-standing. Bilateral VL and GS muscle activity was recorded with surface electromyography (EMG), and expressed as percentage of the EMG amplitude recorded during a maximal voluntary contraction of the respective muscles (%MVC).

RESULTS:  Two-way analysis of variance with repeated measures revealed that exposure to WBV (low- and high-intensity protocols) significantly increased VL and GS EMG amplitude (large effect size, partial η= 0.135-0.643, p<0.001) on both the paretic and non-paretic sides in different exercise conditions, compared with no WBV. No significant difference in EMG magnitude was found between the high- and low-intensity WBV protocols (p>0.05). With a few exceptions, WBV enhanced EMG activity in the paretic and non-paretic leg muscles to a similar extent in different exercise conditions.

CONCLUSIONS:  Leg muscle activity was increased significantly with addition of WBV. Further clinical trials are needed to determine the effectiveness of different WBV protocols for strengthening leg muscles in chronic stroke patients.

PMID:  23899891

Reduce Ankle Plantarflexion Spasticity

Clin Rehabil. 2012 Dec;26(12):1087-95. doi: 10.1177/0269215512446314. Epub 2012 Oct 3.

Effects of a single session of whole body vibration on ankle plantarflexion spasticity and gait performance in patients with chronic stroke: a randomized controlled trial.

Chan KS, Liu CW, Chen TW, Weng MC, Huang MH, Chen CH.

Source:  Department of Physical Medicine and Rehabilitation, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.


OBJECTIVE:  To investigate the effects of a single session of whole body vibration training on ankle plantarflexion spasticity and gait performance in chronic stroke patients.

DESIGN:  Randomized controlled trial.

SETTING:  Rehabilitation unit in university hospital.

PARTICIPANTS:  Thirty subjects with chronic stroke were randomized into either a control group (n = 15) or a group receiving a single session of whole body vibration (n = 15).

INTERVENTION:  The intervention group was actually treated with whole body vibration while the control group was treated with placebo treatment. Main measures: The spastic changes were measured clinically and neurophysiologically. Subjective evaluation of ankle spasticity was performed via a visual analogue scale. Gait performances were evaluated by the timed up and go test, 10-meter walk test and cadence. A forceplate was used for measuring foot pressure.

RESULTS:  The changes between whole body vibration and control groups were significantly different in Modified Ashworth Scale (1.33, 95% confidence interval (CI) = 1.06~1.60). The H (max)/M (max) ratio (0.14, 95% CI = 0.01~0.26) and visual analogue scale (1.87, 95% CI = 1.15~2.58) were significantly decreased. Whole body vibration could significantly improve gait velocity, timed up and go test (6.03, 95% CI = 3.17~8.89) and 10-meter walk test (1.99, 95% CI = 0.11~3.87). The uneven body weight posture on bilateral feet was also improved after vibration.

CONCLUSION:  These results suggest that a single session of whole body vibration training can reduce ankle plantarflexion spasticity in chronic stroke patients, thereby potentially increasing ambulatory capacity.

PMID:  23035004

Lengthen Ankle Flexor Muscles

Med Sci Sports Exerc. 2009 Feb;41(2):482.

Ankle flexors produce peak torque at longer muscle lengths after whole-body vibration.

Kemertzis MA, Lythgo ND, Morgan DL, Galea MP.

Source:  Rehabilitation Sciences Research Centre, University of Melbourne, Parkville, Victoria, Australia.


INTRODUCTION:  Whole-body vibration (WBV) has become a popular training method in recent years. This study investigated the effect of WBV on the length-tension relationship of the ankle dorsi- and plantarflexors as measured by a Biodex dynamometer (Biodex Medical Systems Inc, Shirley, NY).

METHODS:  Twenty healthy young adult males participated in this study and were exposed to two treatments. The first treatment (non-vibration) involved passive stretching of the plantarflexors at end range of motion (ROM) for five 1-min bouts. The second treatment involved the same passive stretch with superimposed WBV (frequency = 26 Hz) for five 1-min bouts on a rotary vibration plate (Galileo 900; Novotec, Pforzheim, Germany). Voluntary ROM, peak torque, and corresponding joint angle of the plantar- and dorsiflexors were recorded pre- and post-treatment. Within-treatment (before and after) and between-treatment (WBV and non-vibration) outcomes were assessed by repeated-measures MANOVA.

RESULTS:  No significant changes in the measures of ankle dorsiflexion were found within or between treatments. No significant changes in the measures of ankle plantarflexion were found after the non-vibration treatment. After WBV, however, there was a significant 7.1 degree shift in the angle (P = 0.001) of peak plantarflexor torque production corresponding to a longer muscle length.

CONCLUSION:  This study shows that stretched human ankle plantarflexors respond to WBV by generating peak voluntary torque at longer muscle lengths. This has possible benefits for the rehabilitation of patients with neuromuscular disorders (e.g., stroke) who experience short ankle flexor resting lengths.

PMID:  18845976

Paretic Leg Improvements

Acta Physiol Hung. 2010 Jun;97(2):172-82. doi: 10.1556/APhysiol.97.2010.2.3.

Low resonance frequency vibration affects strength of paretic and non-paretic leg differently in patients with stroke.

Tihanyi J, Di Giminiani R, Tihanyi T, Gyulai G, Trzaskoma L, Horváth M.

Source:  Department of Biomechanics, Faculty of Physical Education and Sport Sciences, Semmelweis University, Budapest, Hungary.


Purpose:  The objective of the study was to investigate the chronic effect of low frequency whole body vibration (WBV) on isometric and eccentric strength of knee extensors with different force exertion capacity. It was hypothesized that (1) four-week WBV intervention with the low frequency domain would enhance muscle strength and (2) the improvement would be more pronounced in the weaker muscle.

Method:  To test our hypothesis twenty patients with acute stroke were recruited. Ten patients were randomly assigned to vibration and the remaining ten patients served for control. The patients in the vibration group received WBV with 20 Hz frequency three times per week standing on a vibration platform in half squat position meanwhile flexing and extending the joints and placing the weight from one leg to the other.  Knee extensor strength was determined under isometric and eccentric contraction before and after WBV intervention. Myoelectrical activity (EMG) of the vastus lateralis muscle was also measured.

Results:  Significant improvement was revealed in the vibration group only. The maximum isometric torque and EMG activity increased significantly for both paretic and non-paretic leg, but the improvement was threefold greater in the vibration group. No significant alteration was found in rate of torque development. Maximum eccentric torque and EMG increased significantly for the paretic leg only. Mechanical work enhanced significantly in the paretic side only.

Conclusion:  The results of our study indicate that the selection of the effective vibration frequency depends upon the physical condition of neuromuscular system. Low vibration frequency intervention can increase the strength in weak muscles due to neuromuscular impairment and restricted physical activity.

PMID: 20511126

One Session Increases Muscle Strength

Clin Rehabil. 2007 Sep;21(9):782-93.

One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke.

Tihanyi TK, Horváth M, Fazekas G, Hortobágyi T, Tihanyi J.

Source:  Semmelweis University, and Department of Rehabilitation Medicine, Saint John Hospital Budapest, Hungary.



To determine the effect of whole body vibration on isometric and eccentric torque and electromyography (EMG) variables of knee extensors on the affected side of stroke patients.

DESIGN:  A randomized controlled study.

SETTING:  A rehabilitation centre.

SUBJECTS:  Sixteen patients (age 58.2+/-9.4 years) were enrolled in an inpatient rehabilitation programme 27.2+/-10.4 days after a stroke.

INTERVENTIONS:  Eight patients were randomly assigned to the vibration group and received 20 Hz vibration (5 mm amplitude) while standing on a vibration platform for 1 minute six times in one session. Patients in the control group also stood on the platform but did not receive vibration.

MAIN MEASURES:  Maximum isometric and eccentric torque, rate of torque development, root-mean-squared EMG, median frequency of vastus lateralis, and co-activation of knee flexors.

RESULTS:  Isometric and eccentric knee extension torque increased 36.6% and 22.2%, respectively, after vibration (P<0.05) and 8.4% and 5.3% in the control group. Vibration increased EMG amplitude 44.9% and the median frequency in the vastus lateralis by 13.1% (all P<0.05) without changes in the control group (10.6% and 3.9%). Vibration improved the ability to generate mechanical work during eccentric contraction (17.5%). Vibration reduced biceps femoris co-activation during isometric (8.4%, ns) and eccentric (22.5%, P<0.05) contraction.

CONCLUSION:  These results suggest that one bout of whole body vibration can transiently increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke.

PMID:  17875558

Improve Proprioceptive Posture Control

Am J Phys Med Rehabil. 2004 Nov;83(11):867-73.

Short-term effects of whole-body vibration on postural control in unilateral chronic stroke patients: preliminary evidence.

van Nes IJ, Geurts AC, Hendricks HT, Duysens J.

Source:  Sint Maartenskliniek Research, Nijmegen, the Netherlands.


Purpose:  The short-term effects of whole-body vibration as a novel method of somatosensory stimulation on postural control were investigated in 23 chronic stroke patients.

Method:  While standing on a commercial platform, patients received 30-Hz oscillations at 3 mm of amplitude in the frontal plane. Balance was assessed four times at 45-min intervals with a dual-plate force platform, while quietly standing with the eyes opened and closed and while performing a voluntary weight-shifting task with visual feedback of center-of-pressure movements. Between the second and third assessments, four repetitions of 45-sec whole-body vibrations were given.

Results:  The results indicated a stable baseline performance from the first to the second assessment for all tasks. After the whole-body vibration, the third assessment demonstrated a reduction in the root mean square (RMS) center-of-pressure velocity in the anteroposterior direction when standing with the eyes closed (P < 0.01), which persisted during the fourth assessment. Furthermore, patients showed an increase in their weight-shifting speed at the third balance assessment (P < 0.05) while their precision remained constant. No adverse effects of whole-body vibration were observed.

Conclusion:  It is concluded that whole-body vibration may be a promising candidate to improve proprioceptive control of posture in stroke patients.

PMID:  15502741