Category Archives: Spasticity Management

Acute Corticospinal and Spinal Modulation

J Musculoskelet Neuronal Interact, 2016; 16(4): 327-338, PMID: 27973385 external link

Acute corticospinal and spinal modulation after whole body vibration.

Krause A, Gollhofer A, Freyler K, Jablonka L, Ritzmann R
Department of Sport Science, University of Freiburg, Freiburg, Germany.

Abstract

OBJECTIVES: The objective of this study was to investigate neural effects of acute whole body vibration (WBV) on lower limb muscles regarding corticospinal and spinal excitability.

METHODS: In 44 healthy subjects (16 f/ 28 m), motor evoked potentials (MEP) and H-reflexes in m. soleus (SOL) and gastrocnemius medialis (GM) were elicited before (t1), immediately after (t2), 2 (t3), 4 (t4) and 10 min after (t5) WBV.

RESULTS: After WBV, MEP amplitudes were significantly increased in SOL (t2+15+/-30%, t3+22+/-32%, t4+15+/-35%, t5+20+/-30%, P<0.05), but not in GM (t2+32+/-62%, t3+9+/-35%, t4+8+/-36%, t5+22+/-47%; P=0.07). Contrarily, H-reflexes were significantly reduced in SOL (t2-19+/-28%, t3-21+/-22%, t4-20+/-21%, t5-14+/-28%, P<0.05) and GM (t2-14+/-37%, t3-16+/-25%, t4-18+/-29%, t5-16+/-28%, P<0.05).

CONCLUSIONS: A temporary sustained enhancement of corticospinal excitability concomitant with spinal inhibition after WBV points towards persisting neural modulation in the central nervous system. This could indicate greater neural modulation over M1 and descending pathways, while the contribution of spinal pathways is reduced.

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.

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.

Abstract

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.

H-Reflex, Stretch Reflex & Short-Latency

Scand J Med Sci Sports, 2011

The effect of whole body vibration on the H-reflex, the stretch reflex, and the short-latency response during hopping.

Ritzmann R, Kramer A, Gollhofer A, Taube W
Institute of Sport and Sport Science, University of Freiburg, Freiburg, Germany.

Abstract

The effect of whole body vibration (WBV) on reflex responses is controversially discussed in the literature.

PURPOSE: In this study, three different modalities of reflex activation with increased motor complexity have been selected to clarify the effects of acute WBV on reflex activation: 1) the electrically evoked H-reflex, 2) the mechanically elicited stretch reflex, and 3) the short-latency response (SLR) during hopping.

METHOD: WBV-induced changes of the H-reflex, the stretch reflex, and the SLR during hopping were recorded in the soleus and gastrocnemius muscles and were analyzed before, during (only the H-reflex), immediately after, 5 min and 10 min after WBV.

RESULTS: The main findings were that: 1) the H-reflexes were significantly reduced during and at least up to 5 min after WBV, 2) the stretch reflex amplitudes were also significantly reduced immediately after WBV but recovered to their initial amplitudes within 5 min, and 3) the SLR during hopping showed no vibration-induced modulation. With regard to the modalities with low motor complexities, the decreased H- and stretch reflex responses are assumed to point toward a reduced Ia afferent transmission during and after WBV. However, it is assumed that during hopping, the suppression of reflex sensitivity is compensated by facilitatory mechanisms in this complex motor task.

PMID: 22011018

MS Improve Standing Time & Balance

Is 8 weeks of side-alternating WBV a safe & acceptable modality to improve functional performance in Multiple Sclerosis patients

Disabil Rehabil. 2011 Oct 12. School of Sport and Exercise, Massey University , Palmerston North , New Zealand.

Purpose: To examine whether an 8-week period of side-alternating whole-body vibration (WBV) exercise is an acceptable and effective exercise intervention to improve and maintain functional performance in multiple sclerosis people.

Methods: A total of 15 participants with MS (11 women [mean age 50.2 ± 6.9 years; body mass 65.7 ± 19.2 kg; height 165.3 ± 6.1 cm; EDSS 3.5 ± 0.9] and 4 males [mean age 50.5 ± 5.2 years; body mass 85.3 ± 16.0 kg; height 175.3 ± 3.2 cm; EDSS 3.4 ± 0.5]) were selected for this study. Quality of life, timed up-and-go, functional reach, standing balance and 10-m walk test were performed prior to and after 4 and 8 weeks of vibration exercise, and 2 weeks after cessation of vibration exercise.

Results: There was no evidence of vibration exercise producing any anxiety or discomfort. Compared with baseline measurements, the 10-m walk test showed significant improvements in 2, 8 and 10 m times at 8 week (p < 0.05) and 2 week post-vibration (p < 0.05). Timed up-and-go demonstrated a significant and positive time effect (p < 0.05). Standing balance showed significant improvements from baseline, at 4- (p < 0.05) and 2-weeks post-vibration (p < 0.05).

Conclusion: This is the first study to investigate side-alternating WBV as an exercise training modality for MS people. From an active MS population, this study has shown that WBV training not only improved the standing balance and walking time but there were also no adverse effects from using this modality.

PMID:21992525

SUMMARY STUDY: Patients with multiple sclerosis improved the SF36 questionnaire for quality of life, timed up and go test, functional reach test, standing balance and 10 m walk test. (see slide) The improvements persisted 2 weeks after the end of training. No adverse side effects were observed.

MSSpasticity Compared with baseline measurements, the 10-m walk test showed significant improvements in 2, 8 and 10 m times at 8 week and 2 week post-vibration. Timed up-and-go demonstrated a significant and positive time effect. Standing balance showed significant improvements from baseline, at 4- and 2-weeks post-vibration

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.