Focal muscle vibration, an effective rehabilitative approach in severe gait impairment due to multiple sclerosis

Better Understanding Rehabilitation of Motor Symptoms: Insights from the Use of Wearables

Movement disorders present a substantial challenge by adversely affecting daily routines and overall well-being through a diverse spectrum of motor symptoms. Traditionally, motor symptoms have been evaluated through manual observational methods and patient-reported outcomes. While those approaches are valuable, they are limited by their subjectivity. In contrast, wearable technologies (wearables) provide objective assessments while actively supporting rehabilitation through continuous tracking, real-time feedback, and personalized physical therapy-based interventions. The aim of this literature review is to examine current research on the use of wearables in the rehabilitation of motor symptoms, focusing on their features, applications, and impact on improving motor function. By exploring research protocols, metrics, and study findings, this review aims to provide a comprehensive overview of how wearables are being used to support and optimize rehabilitation outcomes. To achieve that aim, a systematic search of the literature was conducted. Findings reveal that gait disturbance and postural balance are the primary motor symptoms extensively studied with tremor and freezing of gait (FoG) also receiving attention. Wearable sensing ranges from bespoke inertial and/or electromyography to commercial units such as personal devices (ie, smartwatch). Interactive (virtual reality, VR and augmented reality, AR) and immersive technologies (headphones), along with wearable robotic systems (exoskeletons), have proven to be effective in improving motor skills. Auditory cueing (via smartwatches or headphones), aids gait training with rhythmic feedback, while visual cues (via VR and AR glasses) enhance balance exercises through real-time feedback. The development of treatment protocols that incorporate personalized cues via wearables could enhance adherence and engagement to potentially lead to long-term improvements. However, evidence on the sustained effectiveness of wearable-based interventions remains limited.

The Role of Technological Rehabilitation in Patients with Intensive Care Unit Weakness: A Randomized Controlled Pilot Study

Intensive-Care-Unit-Acquired Weakness (ICU-AW) is the most common neuromuscular impairment in critically ill patients and can have a significant impact on long-term disability. Early rehabilitation has been suggested to facilitate the natural recovery process. This is a pilot, randomized, single-blind study that aimed to evaluate the effectiveness of intensive combined technological rehabilitation treatment including focal muscle vibration and non-immersive virtual reality for patients with severe acquired brain injury (sABI) and ICU-AW. Twenty-four patients were randomized into the conventional group, which performed only conventional rehabilitation, and the experimental group, which also performed technological treatment. At baseline and after 3 weeks of treatment, assessments of motor function, autonomy, disability and quality of life were conducted. At the end of the intervention, both groups showed significant improvements. However, patients in the experimental group achieved greater improvements in disability (p = 0.001) and quality of life (p = 0.001). The results show that intensive structured rehabilitation is effective in improving the motor function, disability and quality of life of patients with severe acquired brain injury and acquired weakness. The combination of non-immersive virtual reality training and focal muscle vibration can result in a significant improvement in overall disability and quality of life compared with conventional treatment alone.

Plastic changes induced by muscle focal vibration: A possible mechanism for long-term motor improvements

Repetitive focal vibrations can induce positive and persistent after-effects. There is still no satisfactory interpretation of the underlying mechanisms. A rationale, which can provide consistency among different results, is highly desirable to guide both the use of the application and future research. To date, interpretive models are formulated to justify the results, depending on the specific protocol adopted. Indeed, protocol parameters, such as stimulus intensity and frequency, intervention time and administration period, are variable among different studies. However, in this article, we have identified features of the protocols that may allow us to suggest a possible common mechanism underlying the effectiveness of focal vibration under different physiologic and pathologic conditions. Since repetitive focal muscle vibration induces powerful and prolonged activation of muscle proprioceptors, we hypothesize that this intense activation generates adaptive synaptic changes along sensory and motor circuits. This may lead to long-term synaptic potentiation in the central network, inducing an enhancement of the learning capability. The plastic event could increase proprioceptive discriminative ability and accuracy of the spatial reference frame and, consequently, improve motor planning and execution for different motor functions and in the presence of different motor dysfunctions. The proposed mechanism may explain the surprising and sometimes particularly rapid improvements in motor execution in healthy and diseased individuals, regardless of specific physical training. This hypothetic mechanism may require experimental evidence and could lead to extend and adapt the application of the "learning without training" paradigms to other functional and recovery needs.

A review of current rehabilitation practices and their benefits in patients with multiple sclerosis

Multiple sclerosis (MS) is a chronic, debilitating disease characterised by demyelination of the nerves of the central nervous system that results in patients progressively losing the ability to perform daily tasks. As there is no cure for this disease, rehabilitation therapy is an important aspect of care; assisting patients to regain or retain function and improve their physical, mental and social wellbeing. At present there is no current consistent model of care for MS, likely due to the variable symptom presentation. Various forms of rehabilitation therapy are available, and these include physical rehabilitation methods, such as balance and gait therapy, speech and respiration rehabilitation, and occupational therapy. Contrary to previous understanding, exercise-based therapies have shown various benefits for patients with MS, and in addition to improving MS-related physical symptoms, have been shown to reduce the risk of developing cardiovascular disease and can improve cognitive function. Cognition rehabilitation therapy specifically focuses on behavioural tasks and is divided into two main forms: compensatory rehabilitation, which offers cognitive functioning benefits, and restorative rehabilitation, which offers memory benefits. Excitation therapies include cranial stimulation and other stimulation rehabilitation methods such as focal muscle vibration therapy and these non-invasive techniques may improve patient's physical ability. Additionally, more novel rehabilitation methods include robot-assisted gait therapy and telerehabilitation, both of which are expected to play progressively more prominent roles in the future of rehabilitation therapy. The structure of the care team has been found to impact patient outcomes, and both in- and out-patient care settings have been found to be beneficial, dependant on the patient's circumstances, with certain patients better suited to a particular setting. While a single point of care is recommended for patients, a multidisciplinary care team and regular reassessment is recommended to manage changing symptoms and ensure continuity of care. The importance of the critical components of rehabilitation have been identified, and these are of vital importance in achieving beneficial outcomes. These components include the patients' participation in the treatment, goal setting with a multidisciplinary care team, a guiding-light purpose for the patient, which focusses on recognizing their personal potential and obtaining improvements through a tailored plan. The final critical component of rehabilitation is the results measurement, which highlights the need for a quantifiable reduction in impairment and improvement in activity and participation. Overall, a lack of standardisation in outcome measurements makes comparison challenging. This is particularly important when comparing standard methods of care with more novel rehabilitation techniques. However, within the broad area of rehabilitation therapies, it is clear that patients with MS can benefit from rehabilitation practices; physically, mentally and socially.

Vibration therapy role in neurological diseases rehabilitation: an umbrella review of systematic reviews

PURPOSE

To summarize the findings and evaluate the role of vibratory therapy in the rehabilitation of neurological diseases.

METHODS

We systematically research PubMed, Scopus, Embase, Physiotherapy Evidence Database (PEDro), Web of Science, and Cochrane library databases from the inception until November 2020. We included studies that compared whole-body vibration (WBV) or focal muscle vibration (FMV) with placebo, sham, or another form of exercise in neurological disease rehabilitation in children and adults that result in motor impairments and disability.

RESULTS

We included 16 systematic reviews with good methodological quality evaluated using the Joanna Briggs Institute Umbrella Review Assessment and Review of Information appraisal tool. In stroke patients, WBV appears to play a role in improving gait and balance, while FMV is more effective in reducing spasticity. In multiple sclerosis and cerebral palsy, no evidence suggested that vibration therapy increases some patient outcomes.

CONCLUSION

WBV and FMV appear to play a considerable role in reducing spasticity and improving gait, balance, and motor function in stroke patients. By contrast, vibration therapy seems to be unable to reduce spasticity in multiple sclerosis and cerebral palsy. Also, correct use parameters for this therapy could not be defined.IMPLICATIONS FOR REHABILITATIONBased on the growing number of systematic reviews, this umbrella review aimed to summarize the findings and evaluate the role of vibration therapy in the rehabilitation of neurological diseases.Whole-body vibration and focal muscle vibration appear to play a considerable role in reducing spasticity and improving gait, balance, and motor function in patients affected by stroke.Focal muscle vibration appears to be more useful if applied to non-spastic antagonist muscles with reciprocal inhibitory action on spastic muscles in subjects affected by stroke.Vibration therapy seems not to be able to reduce spasticity in multiple sclerosis and cerebral palsy.

Development and deployment of cyclical focal muscle vibration system to improve walking performance in multiple sclerosis

Vibration, a potent mechanical stimulus for activating muscle spindle primary afferents, may improve gait performance in persons with multiple sclerosis (MS), but has yet to be developed and deployed for multiple leg muscles with application during walking training. This study explored the development of a cyclic focal muscle vibration (FMV) system, and the deployment feasibility to correct MS walking swing phase deficits in order to determine whether this intervention warrants comprehensive study. The system was deployed during twelve, two-hour sessions of walking with cyclic FMV over six weeks. Participants served as their own control. Blood pressure, heart rate, walking speed, kinematics (peak hip, knee and ankle angles during swing), toe clearance, and step length were measured before and after deployment with blood pressure and heart rate monitored during deployment. During system deployment, there were no untoward sensations and physiological changes in blood pressure and heart rate, and volitional improvements were found in walking speed, improved swing phase kinematics, toe clearance and step length. This FMV training system was developed and deployed to improve joint flexion during walking in those with MS, and it demonstrated feasibility and benefits. Further study will determine the most effective vibration frequency and dose, carryover effects, and those most likely to benefit from this intervention.

Vibrotactile somatosensory stimulus to assist the transition from level walking to stair ascent in the elderly: a pilot study

Background

Although, in daily living, almost all stair ambulation is conducted posterior to level walking, or vice versa, there are only a few studies related to the transition compared to the studies on steady-state stair walking.

Furthermore, neuromotor control in the instant of the transition is different from that of the steady-state stair walking. However, there are only a few studies investigating the transition from level walking to stair ascent in the elderly by comparing with young adults, and there is no study on the assistance of the transition movement in the elderly who are experiencing neurophysiological changes.

Thus, this pilot study aimed to compare the flat surface-to-stair ascent transition by the elderly to that seen in young adults, and to investigate how vibrotactile somatosensory stimulus (VSS), which has a positive effect on muscle performance and gait, affects the transition tasks in elderly people.

Results

In the first half of the stance phase, the elderly exhibited a higher moment and power of the hip extensor and a less moment and power of the knee extensor compared with young adults. In the second half of the stance phase, positive plantar-flexor power and support moment was higher in the elderly. In addition, during the single-limb support phase, dorsiflexion was maintained in the elderly, whereas young adults appeared to have decreased dorsiflexion.

When the VSS was applied, the moment and power of the hip extensor, the plantar-flexor moment, and the support moment in the entire of the stance phase were increased. In addition, it was found that the degree of the kinetics parameters was different depending on the frequencies of the VSS.

Conclusions

This pilot study has revealed evident biomechanical differences between elderly people and young adults during the transition from level walking to stair ascent. Additionally, it has shown that the VSS may accentuate the features of the transition movement of the elderly and regulate joint kinetics. The results of the present pilot study can provide a base for further research and understanding of movement, which can be utilized in designing assistance aids for the elderly.

Trial registration

CRIS, KCT0005434, Registered 25 September 2020, Retrospectively registered.

Effect of direct vibration on the activity of deep trunk muscles of patients with non-specific chronic low back pain

BACKGROUND

Vibration training is an adjuvant to muscle-strengthening exercises.

OBJECTIVE

To investigate the short-term effects of direct vibration on the deep trunk muscles of patients with non-specific chronic low back pain (CLBP).

METHODS

Participants with non-specific CLBP were randomly placed into two groups: the vibration-plus stabilization exercise (VSE) group (n= 31) and the conventional stabilization exercise (CSE) group (n= 31). The groups underwent 12 sessions of an exercise program. The thickness and activity of the trunk muscles were measured using ultrasonography and surface electromyography.

RESULTS

Ultrasonography revealed that the ratio of muscle thickness to contraction and relaxation was statistically increased after exercise in the bilateral transversus abdominis (TrA) and lumbar multifidus (LM) muscles in the CSE group (p= 0.031), and in the bilateral TrA, LM, and internal oblique (IO) muscles in the VSE group (p< 0.001). The LM/lumbar erector spinae (LES) ratio in the CSE group (p= 0.037), and the IO/rectus abdominis (RA), TrA/RA, and LM/LES ratios in the VSE group (p= 0.019) were statistically increased. Multiple regression analysis showed that symptom improvement was related to increased activity of the deep trunk muscles in the VSE group (p< 0.001).

CONCLUSION

Direct vibration can increase the selective activity of contracting deep trunk muscles.

Effects of low vs. high frequency local vibration on mild-moderate muscle spasticity: Ultrasonographical and functional evaluation in patients with multiple sclerosis

BACKGROUND

Local vibration (LV) is a physiotherapy application that aims to reduce spasticity. The study aimed to compare the effects of 50 Hz vs. 100 Hz LV on mild-moderate spasticity, functional performance and muscle architecture.

METHODS

Thirty-three patients were randomly divided into three groups: 50 Hz LV group, 100 Hz LV group and the control group. Physical therapy was applied for one hour a day, three days a week, for a total of eight weeks. LV was applied to the right and left medial gastrocnemius muscles for five minutes. Clinical (spasticity, ankle joint position sense, balance, gait) and ultrasonographic (gastrocnemius fascicle length and pennation angle) measurements were performed before and after treatment.

RESULTS

The study was completed with 27 patients. The decrease in spasticity and the increase in fascicle length were found to be statistically significant in the 50 Hz group (both p<0.05). Ankle joint position sense, single-leg stance time, limits of stability/postural sway range in the medio-lateral direction significantly improved in the vibration treatment groups (all p<0.05). The antero-posterior limits of stability and postural sway showed significant improvement in all groups (all p<0.05). While the 50 Hz group showed significant improvement for all walking parameters; velocity, step length and base of support values improved in the 100 Hz group (all p<0.05). The exercise group showed significant improvement only for single support and stance phase percentages of the gait cycle (both p<0.05). According to between group comparisons, significant difference was found only in medio-lateral limits of stabillity (p<0.05). Medio-lateral limits of stabillity scores were better for the 50 Hz group than the 100 Hz and exercise group.

CONCLUSION

Our findings show that LV does not have any substantial effect except for medio-lateral limits of stability.

CLINICAL TRIAL NUMBER

NCT04192786.

Improvement of Gait after 4 Weeks of Wearable Focal Muscle Vibration Therapy for Individuals with Diabetic Peripheral Neuropathy

People with diabetic peripheral neuropathy (DPN) experience lower quality of life caused by associated balance, posture, and gait impairments. While focal muscle vibration (FMV) has been associated with improvements in gait performance in individuals with neurological disorders, little is known about its effectiveness in patients with DPN. The purpose of this study was to investigate the effect of FMV on gait outcomes in patients with DPN. The authors randomized 23 participants into three FMV intervention groups depending upon the delivery of vibration. Participants applied wearable FMV to the bilateral quadriceps, gastrocnemius, and tibialis anterior, 10 min per muscle, three times per week over a four-week period. Spatiotemporal, kinematic, and kinetic gait parameters at baseline and post-intervention were calculated and analyzed. Gait speed, cadence, stride time, left and right stance time, duration of double limb support, and left and right knee flexor moments significantly improved after four weeks of FMV. Trends toward significant improvements were noted in maximum left and right knee flexion. Results indicate that FMV therapy was associated with improvements in gait parameters in individuals with DPN, warranting expanded study of FMV therapy for long-term gait performance improvement in these individuals.

Harmonization of real-world studies in multiple sclerosis: Retrospective analysis from the rirems group

BACKGROUND

Worldwide multiple sclerosis (MS) centers have coordinated their efforts to use data acquired in clinical practice for real-world observational studies. In this retrospective study, we aim to harmonize outcome measures, and to evaluate their heterogeneity within the Rising Italian Researchers in MS (RIReMS) study group.

METHODS

RIReMS members filled in a structured questionnaire evaluating the use of different outcome measures in clinical practice. Thereafter, thirty-four already-published papers from RIReMS centers were used for heterogeneity analyses, using the DerSimonian and Laird random-effects method to compute the between-study variance (τ²).

RESULTS

Based on questionnaire results, we defined basic modules for diagnosis and follow-up, consisting of outcome measures recorded by all participating centers at the time of diagnosis, and, then, at least annually; we also defined more detailed/optional modules, with outcome measures recorded less frequently and/or in the presence of specific clinical indications. Looking at heterogeneity, we found 5-year variance in age at onset (ES=27.34; 95%CI=26.18, 28.49; p<0.01; τ²=4.76), and 7% in female percent (ES=66.42; 95%CI=63.08, 69.76; p<0.01; τ²=7.15). EDSS variance was 0.2 in studies including patients with average age <36.1 years (ES=1.96; 95%CI=1.69, 2.24; p<0.01; τ²=0.19), or from 36.8 to 41.1 years (ES=2.70; 95%CI=2.39, 3.01; p<0.01; τ²=0.18), but increased to 3 in studies including patients aged >41.4 years (ES=4.37; 95%CI=3.40, 5.35; p<0.01; τ²=2.96). The lowest variance of relapse rate was found in studies with follow-up duration ≤2 years (ES=9.07; 95%CI=5.21, 12.93; p = 0.02; τ²=5.53), whilst the lowest variance in EDSS progression was found in studies with follow-up duration >2 years (ES=5.41; 95%CI=3.22, 7.60; p = 0.02; τ²=1.00).

DISCUSSION

We suggest common sets of biomarkers to be acquired in clinical practice, that can be used for research purposes. Also, we provide researchers with specific indications for improving inclusion criteria and data analysis, ultimately allowing data harmonization and high-quality collaborative studies.

Comparing the acute effect of myofascial release techniques and passive stretching on hind foot dynamic loading in patients with multiple sclerosis: A cohort-blinded study

Study aim: It is important for therapists to incorporate new practical methods into therapy programs when they have demonstrable efficacy in the treatment of multiple sclerosis. Investigating the acute effects of myofascial release techniques (MFR) and passive stretching (PS) on hind foot loading and the severity of spasticity in individuals with multiple sclerosis (MS) was the aim of the study.

Material and methods: Following the initial evaluation, 10 participants with MS (n = 20 feet) were given MFR for the plantar flexor muscle group. After the day following the first visit, participants were asked to come again and PS was applied to the plantar flexor muscle groups after the evaluation. The severity of spasticity was assessed with the Modified Ashworth Scale (MAS). Dynamic loading parameters of the hind foot – medial and lateral maximum pressure (N/cm2), active contact areas (cm2), contact percentiles (%) – were evaluated with dynamic pedobarography. Participants of the study were evaluated four times: (1) at the initial evaluation, (2) after MFR application, (3) 24 hours after the initial evaluation (pre-PS), (4) after PS.

Results: There were no differences in MAS (p > 0.05) according to time-dependent analyses (p > 0.05). After MFR, the maximum pressure of the medial heel and active contact area were increased (p < 0.05) and there was a carryover effect on the maximum pressure of the right foot.

Conclusions: This study showed that MFR was an effective method for management of plantar flexor spasticity in patients with multiple sclerosis in the short term and there was a carryover effect in favor of MFR. There was no additional effect of PS.

Sensory inflow manipulation induces learning-like phenomena in motor behavior

PURPOSE

Perceptual and goal-directed behaviors may be improved by repetitive sensory stimulations without practice-based training. Focal muscle vibration (f-MV) modulating the spatiotemporal properties of proprioceptive inflow is well-suited to investigate the effectiveness of sensory stimulation in influencing motor outcomes. Thus, in this study, we verified whether optimized f-MV stimulation patterns might affect motor control of upper limb movements.

METHODS

To answer this question, we vibrated the slightly tonically contracted anterior deltoid (AD), posterior deltoid (PD), and pectoralis major muscles in different combinations in forty healthy subjects at a frequency of 100 Hz for 10 min in single or repetitive administrations. We evaluated the vibration effect immediately after f-MV application on upper limb targeted movements tasks, and one week later. We assessed target accuracy, movement mean and peak speed, and normalized Jerk using a 3D optoelectronic motion capture system. Besides, we evaluated AD and PD activity during the tasks using wireless electromyography.

RESULTS

We found that f-MV may induce increases (p < 0.05) in movement accuracy, mean speed and smoothness, and changes (p < 0.05) in the electromyographic activity. The main effects of f-MV occurred overtime after repetitive vibration of the AD and PD muscles.

CONCLUSION

Thus, in healthy subjects, optimized f-MV stimulation patterns might over time affect the motor control of the upper limb movement. This finding implies that f-MV may improve the individual's ability to produce expected motor outcomes and suggests that it may be used to boost motor skills and learning during training and to support functional recovery in rehabilitation.

Effects of focal vibration on power and work in multiple wingate tests

The aim of the study was to assess the effects of a specific protocol, based on a focal muscle vibration, on mechanical parameters in an exercise composed of five repeated bouts of sprint interval tests (Wingate Anaerobic Tests, 10 seconds duration). Twenty-eight young male healthy subjects were randomized to two groups (VIB and CTRL). Peak power (PP), average peak between bouts (aP) and total exercise work (TW) were measured. In both groups, three different exercise sessions were carried out, interspersed by seven days: T0, T1 and T2. Between the baseline (T0) and T1, in the VIB group the intervention was administered on three successive days on quadriceps muscles, whereas a placebo administration was carried out in the CTRL group at the same time. At T1 (30 minutes after intervention) and T2 (7 days after) CTRL did not show any significant change, whereas VIB showed significant increases in PP (11.4%–9.3%), aP (6.6%–6.9%) and TW (5.7%–7.9%) with respect to T0. The results could be explained by an ameliorative agonist-antagonist balance, and this hypothesis is coherent with the literature. On the basis of the present findings, the investigated intervention might be usefully adopted to increase muscular power and endurance.

Effectiveness of Physiotherapy Interventions on Spasticity in People With Multiple Sclerosis: A Systematic Review and Meta-Analysis

OBJECTIVE

The aim of the study was to examine the effectiveness of physiotherapy (PT) interventions on spasticity in people with multiple sclerosis.

DESIGN

A systematic search was performed using PRISMA guidance. Studies evaluate the effect of PT interventions on spasticity were included. People with multiple sclerosis, spasticity, disability and PT interventions characteristics were extracted in included studies. Level of evidence was synthesized by the Grade of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses were performed by calculating Hedges g at 95% confidence interval.

RESULTS

A total of 29 studies were included in the review, and 25 were included in the meta-analyses. The included PT interventions were exercise therapy, electrical stimulation, radial shock wave therapy, vibration, and standing. The review and meta-analyses showed different evidences of benefits and nonbenefits for PT interventions on some spasticity outcomes. The best quality evidences were for beneficial effects of exercise therapy especially robot gait training and outpatient exercise programs on self-perceived spasticity and muscle tone respectively. The review results were positive regarding the acute effects, follow-up measurements, safety, progressive MS, and nonambulatory people with multiple sclerosis. The included articles were heterogeneous and badly reported in PT interventions and people with multiple sclerosis characteristics.

CONCLUSIONS

Physiotherapy interventions can be a safe and beneficial option for spasticity in people with multiple sclerosis. No firm conclusion can be drawn on overall spasticity. Further researches in different spasticity aspects are needed.

The effects of muscle vibration on gait control: a review

Background: The purpose of the review is to summarize the literature surrounding the use of muscle vibration as it relates to modifying human gait. Methods: After a brief introduction concerning historical uses and early research identifying the effect of vibration on muscle activation, we reviewed 32 articles that used muscle vibration during walking. The review is structured to address the literature within four broad categories: the effect of vibration to 'trigger' gait-like lower limb motions, the effect of vibration on gait control of healthy individuals and individuals with clinical conditions in which gait disorders are a prominent feature, and the effect of vibration training protocols on gait. Results: The acute effects of vibration during gait involving healthy participants is varied. Some authors reported differences in segmental kinematic and spatiotemporal measures while other authors reported no differences in these outcome measures. The literature involving participants with clinical conditions revealed that vibration consistently had a significant impact on gait, suggesting vibration may be an effective rehabilitation tool. All of the studies that used vibration therapy over time reported significant improvement in gait performance. Conclusions: This review highlights the difficulties in drawing definitive conclusions as to the impact of vibration on gait control, partly because of differences in walking protocols, site of vibration application, and outcome measures used across different investigative teams. It is suggested that the development of common investigative methodologies and outcome measures would accelerate the identification of techniques that may provide optimal rehabilitation protocols for individuals experiencing disordered gait control.

Effect of vibrational therapy on muscle tissue

In an adult human, on average, muscles constitute about 40% of their body mass. They are the basic structural and functional elements of the musculoskeletal system based mainly on shrinkage of their fibres. This state, among others, ensures and induces motor reactions defined in a given situation, affects balance and muscle balance, the efficiency of neuromuscular connections, and also decides the efficiency of the motor system. The aim of the work was to review literature regarding the impact of treatments using vibrational stimulus on human muscle tissue. Particular attention was paid to the observed improvement of its motor properties after the completion of t vibrational therapy application. An attempt was also made to present the widest possible use of vibrational procedures in various disease states related to the functionality of muscle tissue, which is why in the present overview, the included research was differentiated in terms of target groups and investigated muscles. The analysis included domestic and foreign literature, in which the positive effect of vibrational treatments on the motor properties of adults was discussed. Studies were selected, the authors of which described the most important parameters of the vibrational stimulus used, such as: frequency, amplitude and duration of exposure. Research work from the last 15 years has been analysed (not including the historical part). However, as many as 70% of the studies referred to have been published in the last 5 years. Data from the following databases was analysed: Medline, Embase, Cochrane CENTRAL trials register, ScienceDirect, PubMed, IEEE Xplore, Wiley Online Library. Key words used: muscles, force, vibration, WBV. Numerous reports indicate the positive effect of vibrational therapy on human muscle tissue. These treatments, among others, prevent muscle atrophy, and in this way, improve or reproduce the lost motor skills of the investigated people. Treatments with the use of vibrations can be performed by the patients themselves without special supervision, the devices that trigger them are easy to use and do not require significant physical effort, which is an undoubted advantage for the elderly and ill patients as well as athletes during the restitution period. It seems wise that any future research regarding the possibility of use of using vibrations in various disease states, including covering the broadly understood pathology of the musculoskeletal system, should focus on the development of optimal parameters and conditions for the use of vibration treatments, associating them with selected disease entities, developing indications and contraindications for their use, as well as determine hypotheses of the effectiveness of undertaken activities and their scientific verification. This article is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. null

Effectiveness of robo-assisted lower limb rehabilitation for spastic patients: A systematic review

BACKGROUND

Though many rehabilitative treatments are available for treatment of spasticity, thus the effectiveness of different robo-rehabilitative devices needs to be evaluated through a systematic review.

OBJECTIVE

The objective of this study is to focuses on the efficacy of Robot assistive rehabilitation device for the removal of spasticity from the lower limb of Spastic patients.

DATA SOURCESSOURCES

PubMed, Web of Sciences, EMBASE (Excerpta Medical database), CDSR (Cochrane database of systematic reviews), Scopus, IEEE Xplore, Wiley online library, MEDLINE (OvidSP), Science Direct, Springer Link were from January 1980 to September 2017 DATA EXTRACTIONEXTRACTION: Seventy-one publications from eleven databases published were selected using keywords Ankle foot, spasticity, robotic rehabilitation, efficacy of robotics and Ankle foot rehabilitation. The review is narrowed down to twenty-six articles which were selected for they focused on effects of Robot assistive rehabilitation device quantitatively.

RESULT

A quantitative study from analyzing 26 studies comprising of 786 subjects is carried out. The major outcome of the effectiveness of the robot assistive therapy for the movement of ankle and functioning of gait is deduced. As the used protocols and treatment procedures vary, made comparative study complex or impracticable.

CONCLUSION

Robo-rehabilitation possesses an ability to provide unified therapy protocols with greater ease in comparison to conventional therapies. They continuously prove to be irreplaceable assistant devices when it comes to providing excellent treatment in terms of improvement from this study. Though many mechatronic devices are available but the devices for treatment of early stage rehabilitation of stroke patients is very limited.

A Study on the Improvement of Walking Characteristics of the Elderly with Vibration Stimuli Applied to the Tibialis Anterior Tendon

The purpose of this study was to identify the gait pattern of the elderly with aging and to analyze the elderly's gait changes by the focal tendon vibratory stimulation. A total of 10 elderly males and 15 young adult males participated in this study. Using 3D motion analysis, we analyzed that difference between the elderly gait and young adults gait and the changes of the elderly gait by applying focal vibratory stimuli. As a result, specifically in the early stance, the elderly's gait was more flexed and the lower extremity extensors of the elderly worked harder. When the focal vibratory stimuli were applied, joint angle of the elderly was induced to that of the young adults. There was a reduction in demands for supporting bodies and progressing gait in the stance phase. This means that focal vibratory stimuli affect the gait of the elderly. Also, the changes of the gait of the elderly varied according to the characteristics of the focal vibratory stimuli. This implies that the activity of the motor may be dependent on vibratory stimuli characteristics.

Is spasticity always the same? An observational study comparing the features of spastic equinus foot in patients with chronic stroke and multiple sclerosis

Spasticity is common in stroke and multiple sclerosis. To treat spasticity we have a wide range of interventions, whose application may depend not only on the severity of spasticity but also on its etiology. Consequently, a better understanding of muscle spasticity in different neurological diseases may inform clinicians as to the more appropriate therapeutic approach. Our aim was to compare the clinical and ultrasonographic features of spastic equinus in patients with chronic stroke and multiple sclerosis. Thirty-eight patients with secondary progressive multiple sclerosis and 38 chronic stroke patients with spastic equinus were evaluated at the affected ankle according to the following outcomes: modified Ashworth scale, Tardieu scale, passive range of motion, spastic gastrocnemius muscle echo intensity and thickness. Affected calf muscles tone was significantly greater in patients with chronic stroke (modified Ashworth scale P=0.008; Tardieu scale angle P=0.004) as well as spastic gastrocnemius muscle echo intensity (P<0.001). Affected ankle range of motion was significantly greater in patients with multiple sclerosis (P<0.001) as well as spastic gastrocnemius muscle thickness (medialis: P=0.003; lateralis: P=0.004). Our findings evidenced that the same pattern of spasticity (equinus foot) has some different features according to its etiology. This may help the management of spasticity.