Positive effects of Galileo side-alternating vibration in Cerebral Palsy
- Reduction of spasticity
- Improvement of muscle force and power
- Improved gait speed
- Improvement of mGMFM (modified gross motor function measure)
- Higher bone mass
The first time 68-year-old Carmen Sandoval climbed on the whole-body vibration machine in The University of Texas at El Paso’s Stanley E. Fulton Biomechanics and Motor Behavior Laboratory, she wasn’t sure how standing on the machine while it oscillated for five minutes was going to help improve her physical fitness.
Two months later, Sandoval’s muscle strength and bone density have increased, and she feels lighter on her feet. That has helped her chase more fly balls while playing softball with Senior Moments, an El Paso women’s slow-pitch softball team.
“It gives me more blood circulation in my legs,” Sandoval said. “I feel more energized and I don’t feel heavy on my legs.”
Sandoval is taking part in one of two studies by Feng Yang, Ph.D., an assistant professor in the Department of Kinesiology at UTEP, who is researching the impact of whole-body vibration training on adults 65 years and older and on people with multiple sclerosis, or MS.
In whole-body vibration therapy, a person stands on a vibration platform. As the machine vibrates, the transmission of mechanical vibrations and oscillations to the human body forces all muscles to contract and relax tens of times each second, and leads to physiological and neuromuscular changes that can reduce falls among individuals at greater fall risk.
In November, Yang received a $78,148 grant from The Retirement Research Foundation to investigate if whole-body vibration training can prevent real-life falls in Hispanic older adults. His co-principal investigators are Loretta Dillon, DPT, clinical associate professor in the Department of Physical Therapy, and Xiaogang Su, Ph.D., associate professor in the Department of Mathematical Sciences.
Yang, along with Dillon and Su, also were awarded a separate $43,297 pilot grant from the National Multiple Sclerosis Society to use the technique to study its effect on preventing falls in individuals with MS.
“Whole-body vibration is a relatively novel training approach which we can use to reduce the risk of falls for older adults or for people with movement disorders,” explained Yang, the lab’s director since 2013. “This vibration can increase muscle strength and improve the body balance and it can also improve the function in mobility, sensation, bone density and all those factors that are closely related to falls.”
The Centers for Disease Control and Prevention reports that falls are the leading cause of both fatal and nonfatal injuries among older adults, and the consequences of falls are very costly.
For his study, Yang developed an eight-week training program for 100 adults ages 65 years and older to investigate whether or not whole-body vibration training can reduce their risk of falling and if the training is still effective three months after they finish the program. Since June 2014, about 50 older adults have participated in the 18-month study.
Participants use the whole-body vibration machine for five minutes, three times a week for eight weeks.
To test if the training has improved their resistance to falls, participants walk on a special treadmill, which simulates a slipping sensation by suddenly changing the moving direction of the belt. Participants are strapped into a harness to prevent injury.
Thirty reflective markers are attached to their skin on different parts of the body, which allow their movements to be recorded using the lab’s eight-camera high-speed motion capture system. The captured motion data will be utilized to analyze the improvement in fall resistance skills resulting from the vibration training.
The goal is to see how a person regains balance after a slip without falling to the ground.
“It (feels) like when we really stumble because we don’t know when we’re going to stumble,” Sandoval said after the treadmill stopped suddenly and she was jolted backward before regaining her composure.
Yang also evaluates the participants’ progress by measuring their muscle strength, bone density, sensation, range of motion, fear of falling, and functional mobility. All participants’ real-life fall incidences also are monitored.
Yang said the results of the study so far have been encouraging. Besides the significant improvements in all risk factors of falls among the participants, their slip-related falls on the treadmill and the fall incidences in everyday living have been reduced by about 70 percent and 30 percent, respectively.
He is currently recruiting 40 participants for his multiple sclerosis study. The National Multiple Sclerosis Foundation estimates that more than 400,000 people in the U.S. have MS. This project has particular significance for the El Paso region, which has been identified as a nationally-recognized cluster of MS by the society.
“We also want to prevent falls for patients with MS because their fall risk is even higher,” Yang said. “Their muscles are weak, their balance and sensation are impaired and MS also affects their mobility. All of those factors contribute to falls.”
Through whole-body vibration training, Yang hopes to develop a training paradigm that involves the least amount of physical activity for individuals with MS to reduce their risk of falls.
Yang is looking for participants with mild to moderate MS who have fallen at least once in the past six months for his study. Participants will take part in whole-body vibration training for five minutes a day, three days a week for four weeks.
Before the training begins, participants will be assessed to determine how many times they have fallen in the last six months. Their fall risk factors, including body balance, functional mobility, muscle strength, fear of falling and sensorimotor skills, also will be evaluated before and after the training to document any improvement.
Yang and his collaborators also are planning to apply vibration therapy to individuals with other movement dysfunctions, such as stroke and Parkinson’s disease. The long-term goal of their research is to develop cost-efficient yet effective community-based fall prevention training programs and to reduce the costs to individuals and the health care system resulting from falls among the elderly and populations with movement impairments.
Helping Yang achieve that goal are 10 research assistants from the undergraduate and graduate kinesiology programs at UTEP. They include: Chelsea Villa, Joshua Padilla, Westin Humble, Amy Lucero, Joe Anthony Rodriguez, Carlos Lopez, Maria Sanchez, JaeEun Kim, Jose Munoz and Edson Estrada.
In January 2014, Villa began working with Yang in the biomechanics lab as an undergraduate research assistant. She graduated from UTEP in December 2014 and plans to start the Doctor of Physical Therapy program in May.
From gathering medical histories, testing the participants and analyzing data, Villa said her experience working with Yang will help prepare her to become a better physical therapist.
“I know how important clinical-based research is when applied to the real world,” Villa said. “That’s the whole reason why research is done: to see what works and what doesn’t. Sometimes we think something does work and then we do the research and it turns out that it doesn’t. I know now what information is important to analyze and what information is not.”
To participate in either study, contact Yang at 915-747-8228 or 915-747-6010 or by email at email@example.com.
International Journal of Physiotherapy and Rehabilitation, October 2010, Vol. 1, Issue 1, 30-40
Junggi Hong Assistant Professor, Department of Exercise Science, Willamette University. K. Kipp, Dept of PM&R University of Michigan. S.T. Johnson & M.A. Hoffman University of Oregon State
Background: The ability to generate rapid and powerful muscle contractions within a short period of time is an important factor for both enhancing sports performance and preventing injuries. Recently, whole-body vibration (WBV) has been introduced as a novel training method designed to produce neuromuscular improvement similar to that of power and strength training. However, to date there are only limited data on the acute effects of WBV on the neuromuscular system. Furthermore, there is little understanding about the responsiveness of the neuromuscular system to acute exposure WBV.
Research question: The present study examined the effect of acute WBV training on the rate of force development (RFD) and electromechanical delay (EMD) in the soleus muscle.
Type of study: Randomized controlled study.
Methods: Forty young individuals with no leg injuries were randomly assigned to an experimental or control group. The experimental group received acute WBV (3 bouts of 2 minutes). The control group adopted the same position (squat position) on the vibration platform for an equal time but received no vibration.
Results: The experimental (WBV) group demonstrated a significant group °— time interaction for the rate of force development (RFD) and electromechanical delay (EMD) representing 15.6% (from 274Nm/sec to 323 Nm/sec) and 16% (from 23.42 ms to 19.3 ms) improvement.
Conclusions: It appears that acute WBV enhances RFD and EMD of the soleus musclin young healthy subjects.
KEY WORDS: Whole body vibration, Neurological adaptation, Rate of force development, Electromechanical delay, EMG
Institute of Sport and Sport Science, University of Freiburg, Schwarzwaldstraße 175, 79117 Freiburg, Germany. firstname.lastname@example.org
This study aimed to assess the influence of different whole body vibration (WBV) determinants on the electromyographic (EMG) activity during WBV in order to identify those training conditions that cause highest neuromuscular responses and therefore provide optimal training conditions. In a randomized cross-over study, the EMG activity of six leg muscles was analyzed in 18 subjects with respect to the following determinants:
The results are:
In conclusion, large variations of the EMG activation could be observed across conditions. However, with an appropriate adjustment of specific WBV determinants, high EMG activations and therefore high activation intensities could be achieved in the selected muscles.
The combination of high vibration frequencies with additional load on the SV platform (Galileo) led to highest EMG activities. Regarding the body position, a knee flexion of 60° and forefoot stance appear to be beneficial for the knee extensors and the plantar flexors, respectively.
Cologne Children’s Hospital, Jan 2013
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.
Clinical Rehabilitation February 14, 2013
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).
Exercise, Health and Performance, Faculty Research Group, Faculty of Health Sciences, University of Sydney, Australia.
To examine the effects of whole body vibration (WBV) exposure on muscle function in children with Cystic Fibrosis (CF). Non-randomised controlled cross-over trial.
The setting was home-based WBV exposure. The participants were children (8 – 15 years) with CF (n = 7).
participants served as their own controls for the first four weeks (usual care), then underwent four weeks of parentally-supervised home-based WBV exposure followed by four weeks washout (usual care). The WBV exposure consisted of 20 – 30 minutes of intermittent (1 min vibration:1 min rest) exposure on a Galileo platform (20 – 22Hz, 1 mm amplitude) 3 days/week. The primary outcome measures of absolute and relative lower body (leg extension (LE), leg press (LP)), upper body (chess press (CP)) strength and power, and power were measured at baseline, and weeks 4, 8 and 12. Secondary exploratory outcomes were cardiorespiratory fitness, pulmonary function and health-related quality of life.
Six participants completed the training without adverse events. Muscle function changes following WBV exposure were not statistically significant. However, moderate-to-large relative effect sizes (ES) favouring WBV were evident for leg extension strength (ES = 0.66 (-0.50, 1.82)), LP relative strength (ES = 0.92 (-0.27, 2.11)), leg press peak power (ES = 0.78 (-0.50, 2.07)) and CMJ height (ES = 0.60 (-0.56 to 1.76)).
The results from this first controlled trial indicate that WBV may be a potentially effective exercise modality to safely increase leg strength and explosive power in children with CF. Potentially clinically relevant changes support continued investigation of the efficacy, mechanism and feasibility of this intervention in future large-scale studies.
Children, Cystic Fibrosis, Muscle function, Muscle power, Vibration
J Musculoskelet Neuronal Interact. 2013 Mar;13(1):13-8.
Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska University Hospital/Östra, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden. email@example.com
To study the tolerability of whole body vibration (WBV) exercise in patients with Duchenne muscular dystrophy (DMD) and its effects on muscle and bone.
WBV was performed two to three times a week for three months. Motor function, muscle strength, bone mass and biochemical markers of bone and mineral metabolism were analyzed before and after the WBV period at 0, 3, 6 and 12 months.
Six ambulatory patients with DMD aged 5.7-12.5 years completed the study. No changes in creatine kinase activity were found, indicating that the WBV exercise did not further damage the skeletal muscle. No significant changes in bone mass, muscle strength or bone markers were found. However, there was a non-significant trend for the bone formation marker, bone-specific alkaline phosphate, to increase from a mean of 59 U/L to 73 U/L after three months of WBV. The bone formation marker levels returned to baseline three months after discontinuing WBV and were still at that level after nine months.
WBV therapy appears to be safe and well tolerated among ambulatory DMD patients. The potential benefits of WBV on bone and muscle in DMD remain to be elucidated.
Vibration therapy tolerated in children with Duchenne muscular dystrophy: a pilot study.
Pediatr Neurol. 2014 Jul;51(1):126-9
Myers KA1, Ramage B2, Khan A3, Mah JK4.
Duchenne muscular dystrophy is an X-linked recessive muscular dystrophy. Clinical management primarily involves rehabilitation strategies aimed at preserving functional mobility as long as possible. Side-alternating vibration therapy is a rehabilitation intervention that has shown promise in a number of different neuromuscular disorders, and has the potential to preserve strength, functional mobility, and bone mass. There has been little research regarding the tolerance to side-alternating vibration therapy in muscle diseases such as Duchenne muscular dystrophy.
Four patients were recruited for a pilot study assessing the safety and tolerance of side-alternating vibration therapy in individuals with Duchenne muscular dystrophy. All patients participated in a 4-week training period involving side-alternating vibration therapy sessions three times per week. Serum creatine kinase was measured, and adverse effects reviewed at each session with functional mobility assessed before and after the training period.
All patients tolerated the training protocol well, and there were no major changes in functional mobility. One patient had a transient increase in creatine kinase during the study; however, levels of this enzyme were stable overall when comparing the pretraining and posttraining values. Some patients reported subjective improvement during the training period.
Side-alternating vibration therapy is well tolerated in children with Duchenne muscular dystrophy and may have potential to improve or maintain functional mobility and strength in these patients.
Copyright © 2014 Elsevier Inc. All rights reserved.
Duchenne muscular dystrophy; rehabilitation; safety; side-alternating vibration therapy; whole-body vibration therapy
PMID: 24830767 [PubMed – indexed for MEDLINE]
Institute of Sport Sciences, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. firstname.lastname@example.org
We investigated spontaneous effects of random whole-body vibration (rWBV) on postural control in Parkinsonian subjects. Effects were examined in biomechanical tests from a total of 52 patients divided equally into one experimental and one control group. Postural control was tested pre- and post-treatment in two standardized conditions (narrow standing and tandem standing).
The intervention was based on rWBV (ŷ: 3 mm, f: 6 Hz/sec) consisting of 5 series lasting 60 seconds each.
The main findings from this study were that: