Alleviation of Motor Impairments in Patients with Cerebral Palsy: Acute Effects of Whole-body Vibration on Stretch Reflex Response, Voluntary Muscle Activation and Mobility

Integrative function of proprioceptive system in the acute effects of whole body vibration on the movement performance in young adults

Background

The proprioceptive system coordinates locomotion, but its role in short-term integration and recovery of motor activity in imbalance of motor patterns and body remains debated. The aim of this study is investigating the functional role of proprioceptive system in motor patterns and body balance in healthy young adults.

Methods

70 participants (aged 20.1 ± 0.3) were divided into experimental groups EG1 (n = 30), EG2 (n = 30), control group (CG, n = 10). EG1 performed single WBV session on Power Plate (7 exercises adapted to Functional Movement Screen (FMS). EG2 performed single session of FMS Exercises (FMSE). CG didn't perform any physical activity. All participants performed pre- and post-session of FMS and stabilometric measurements.

Results

FMS total score in EG1 increased by 2.0 ± 0.2 (p0 < 0.001), this was significantly differed (p0 < 0.001) from EG2 and CG. Acute effects of WBV and FMSE on rate of change and standard deviation (SD) of pressure center (COP) were shown in all groups during Static Test (p0 < 0.01). SD increased (p0 < 0.01) in Given Setting Test in EG1 and EG2, and in Romberg Test (p0 < 0.001) in EG1. Length, width and area (p0 < 0.01) of confidence ellipse, containing 95% of the statokinesiogram points, decreased in Static Test in EG1; width and area (p0 < 0.01) decreased in EG2 group. Significant (p0 < 0.01) decrease in Given Setting Test was in EG1, and significant (p0 < 0.01) increase was in Romberg Test (open eyes) in CG. Maximum amplitude of COP oscillations: significantly (p0 < 0.01) decreasing along X and Y axes in EG1 and EG2, and along Y axis in CG during Static Test; along Y axis (p0 < 0.01) in all groups during Given Setting Test. Significant differences were identified (p0 < 0.01) in calculated energy consumption for COP moving during all stabilometric tests. However, inter-group differences in COP after acute WBV and FMSE sessions have not been identified.

Conclusions

Acute WBV session eliminates the deficits in motor patterns which is not the case after acute FMSE session, which, according to our integrative movement tuning hypothesis, is due to high activation of integrative function of proprioceptive system. Efficacy of WBV and FMSE on COP performance indicates a high sensitivity of postural control to different levels of proprioceptive system activity.

Different Protocols for Low Whole-Body Vibration Frequency for Spasticity and Physical Performance in Children with Spastic Cerebral Palsy

Background: Whole-body vibration (WBV) is a therapeutic exercise tool that can be used in children with cerebral palsy (CP). A low vibration frequency with different protocols has been suggested, but no optimal dose has been explicitly indicated. We aimed to determine the superiority of a gradually increased 7–18 Hz WBV protocol over a static 11 Hz WBV and the immediate and short-term effects of WBV training on improving spasticity, functional strength, balance, and walking ability in children with spastic CP. Methods: Twenty-four participants with CP (mean age: 11.5 ± 2.9 years) were randomly allocated into protocols of a static 11 Hz vibration frequency group (SVF) or one that increased from a 7 to an 18 Hz vibration frequency (IVF) (n = 12/group). The WBV programmes were completed for 30 min/session/day to identify immediate effects, and the short-term programme then continued for four days/week for eight weeks. Results: Modified Ashworth Scale scores significantly and immediately improved in the IVF group (hip adductor and knee extensor, p < 0.05), and after eight weeks showed significant improvement in the SVF group (ankle plantar flexor, p < 0.05). Within groups, the Five Times Sit to Stand Test (FTSTS), the Time Up and Go Test and the Functional Reach Test significantly improved in the SVF group, whereas only the FTSTS improved in the IVF group (p < 0.05). There were no significant between-group differences at the eight-week postintervention, except reduced spasticity. Conclusions: A protocol of 7–18 Hz WBV seems to offer superior immediate results in terms of improved spasticity; however, a static 11 Hz protocol appears to offer superior results after eight weeks, although the two protocols did not differ significantly in effects on physical performance. This finding may facilitate preparations to normalise muscle tone before functional mobility therapy. The study results may support future studies about the dose-response of WBV frequency.

An overview of the effects of whole-body vibration on individuals with cerebral palsy

The purpose of this review is to examine how whole-body vibration can be used as a tool in therapy to help improve common physical weaknesses in balance, bone density, gait, spasticity, and strength experienced by individuals with cerebral palsy. Cerebral palsy is the most common movement disorder in children, and whole-body vibration is quickly becoming a potential therapeutic tool with some advantages compared to traditional therapies for individuals with movement disorders. The advantages of whole-body vibration include less strain and risk of injury, more passive training activity, and reduced time to complete an effective therapeutic session, all of which are appealing for populations with physiological impairments that cause physical weakness, including individuals with cerebral palsy. This review involves a brief overview of cerebral palsy, whole-body vibration's influence on physical performance measures, its influence on physical performance in individuals with cerebral palsy, and then discusses the future directions of whole-body vibration therapy in the cerebral palsy population.

Six weeks of whole-body vibration improves fine motor accuracy, functional mobility and quality of life in people with multiple sclerosis

People with multiple sclerosis (MS) suffer from sensorimotor deficits with the distal extremities being more severely affected than proximal ones. Whole-body vibration (WBV) training is known to enhance voluntary activation and coordination in healthy people. However, evidence about beneficial effects of WBV in MS patients is scarce. The current study aimed to investigate if six weeks of WBV enhances motor function in the ankle joint, coordination and quality of life in patients suffering from severe MS. In a longitudinal design, changes in motor function and quality of life were assessed before and after a 6-week control period without a training (CON) and a 6-week WBV training (2-3x/week) in 15 patients (53 ±10 years) with advanced MS (EDSS 3-6.5). Before CON (t0), after CON (t1) and after WBV(t2), outcome measures included (1) active range of motion (aROM) and (2) motor accuracy at the ankle joint, (3) functional mobility (Timed "Up & Go" test with preferred and non-preferred turns) and (4) physical and psychological impact of MS (MSIS-29 questionnaire). For (1) and (2), the stronger (SL) and the weaker leg (WL) were compared. After WBV, aROM (1) did not change (SL p = 0.26, WL p = 0.10), but was diminished after CON (SL -10% p = 0.06, WL -14% p = 0.03) with significant group differences (Δgroup WL p = 0.02). Motor accuracy in SL (2) was improved during dorsal flexion after WBV (p = 0.01, Δgroup p = 0.04) and deteriorated during plantar flexion after CON (p = 0.01, Δgroup p = 0.04). Additionally, participants (3) improved their functional mobility at the preferred turn (p = 0.04) and (4) ranked their quality of life higher solely after WBV (p = 0.05), without any differences between groups. However, values correlated significantly between angular precision and aROM as well as functional mobility. No further changes occurred. The results point towards an interception of degenerating mono-articular mobility and improvement of accuracy in the ankle joint. The motor effects after WBV are in line with enhanced perception of quality of life after six weeks which is why WBV could be a stimulus to enable greater overall autonomy in MS patients.

Vibration assisted rehabilitation in patients with Pompe disease: A case series

The results of three cases with infantile-onset Pompe disease participating in a rehabilitation program with home-based vibration training will be presented. In this retrospective observational case study, the cases participated in the neuromuscular training program "Auf die Beine", which combines two blocks of intensive, goal directed training with 6 months of home-based whole body vibration (WBV). Assessments by the means of a dual-energy X-ray absorptiometry and grip strength were applied at multiple points throughout the program. Two cases showed an increase in lean mass index of +0.319 kg/m², +0.721 kg/m² and bone mineral content of +0.028 kg/m², +0.031 kg/m² over one year. Additionally physiotherapeutic therapy goals could be achieved. In the remaining child lean mass index did not change, bone mineral content decreased by -0.03 kg. The neuromuscular rehabilitation program "Auf die Beine" has shown to be safe and effective in two of three cases for muscle and bone mass gain as well as in achievement of physiotherapeutic goals. To summarize, WBV is an innovative therapy in a rehabilitation concept, which might be helpful in Pompe disease, but further studies with larger cohorts are needed.

Acute effect of whole-body vibration on acceleration transmission and jumping performance in children

BACKGROUND

Whole-body vibration (WBV) has emerged as a potential intervention paradigm for improving motor function and bone growth in children with disabilities. However, most evidence comes from adult studies. It is critical to understand the mechanisms of children with and without disabilities responding to different WBV conditions. This study aimed to systematically investigate the acute biomechanical and neuromuscular response in typically developing children aged 6-11 years to varying WBV frequencies and amplitudes.

METHODS

Seventeen subjects participated in this study (mean age 8.7 years, 10 M/7F). A total of six side-alternating WBV conditions combining three frequencies (20, 25, and 30 Hz) and two amplitudes (1 and 2 mm) were randomly presented for one minute. We estimated transmission of vertical acceleration across body segments during WBV as the average rectified acceleration of motion capture markers, as well as lower-body muscle activation using electromyography. Following WBV, subjects performed countermovement jumps to assess neuromuscular facilitation.

FINDINGS

Vertical acceleration decreased from the ankle to the head across all conditions, with the greatest damping occurring from the ankle to the knee. Acceleration transmission was lower at the high amplitude than at the low amplitude across body segments, and the knee decreased acceleration transmission with increasing frequency. In addition, muscle activation generally increased with frequency during WBV. There were no changes in jump height or muscle activation following WBV.

INTERPRETATION

WBV is most likely a safe intervention paradigm for typically developing children. Appropriate WBV intervention design for children with and without disabilities should consider WBV frequency and amplitude.

Neuromuscular response to a single session of whole-body vibration in children with cerebral palsy: A pilot study

BACKGROUND

Whole-body vibration (WBV) is a relative new intervention paradigm that could reduce spasticity and improve motor function in children with cerebral palsy (CP). We investigated neuromuscular response to a single session of side-alternating WBV with different amplitudes in children with CP.

METHODS

Ten children with spastic CP aged 7-17 years at GMFCS level I-III participated in this pilot study. Participants received two sessions of side-alternating WBV with the same frequency (20 Hz) but different amplitudes (low-amplitude: 1 mm and high-amplitude: 2 mm). Each session included six sets of 90 s of WBV and 90 s of rest. Before and after each WBV session, we used (a) the modified Ashworth scale to evaluate the spasticity of the participants' leg muscles, (b) a quiet standing task to analyze center-of-pressure (CoP) pattern and postural control, and (c) overground walking trials to assess spatiotemporal gait parameters and joint range-of-motion (RoM).

RESULTS

Both WBV sessions similarly reduced the spasticity of the ankle plantarflexors, improved long-range correlation of CoP profile during standing, and reduced muscle activity of tibialis anterior during walking. The high-amplitude WBV further increased ankle RoM during walking.

CONCLUSIONS

This study demonstrates that a single session of WBV with either a low or a high amplitude can reduce spasticity, enhance standing posture, and improve gait patterns in children with CP. It suggests that low-amplitude WBV may induce similar neuromuscular response as high-amplitude WBV in children with spastic CP and can provide positive outcomes for those who are not able to tolerate stronger vibration.

Effect of Long-Term Repeated Interval Rehabilitation on the Gross Motor Function Measure in Children with Cerebral Palsy

BACKGROUND

The efficacy of interventions for cerebral palsy (CP) has been frequently investigated with inconclusive results and motor function measured by the Gross Motor Function Measure (GMFM-66) is common.

OBJECTIVE

In this observational analysis, we quantify the GMFM-66 change scores of the second and third year of a multimodal rehabilitation program (interval rehabilitation including home-based, vibration-assisted training) in children with CP.

METHODS

The study was a retrospective analysis of children with CP (2-13 years) participating for a second (n = 262) and third year (n = 86) in the rehabilitation program with GMFM-66 scores at start (M0), after 4 months (M4) of intensive training, and after 8 months of follow-up (M12). A method was previously developed to differentiate between possible treatment effects and expected development under standard of care for GMFM-66 scores using Cohen's d effect size (ES; size of difference).

RESULTS

After the treatment phase of 4 months (M4) in the second year, 125 of 262 children were responder (ES ≥ 0.2) and 137 children nonresponder (ES < 0.2); mean ES for nonresponder was -0.212 (trivial) and for responder 0.836 (large). After M4 in the third year, 43 children of 86 were responder (ES = 0.881 [large]) and 43 nonresponder (ES = -0.124 [trivial]).

DISCUSSION AND CONCLUSION

Repeated rehabilitation shows a large additional treatment effect to standard of care in 50% of children which is likely due to the intervention, because in the follow-up period (standard of care), no additional treatment effect was observed and the children followed their expected development.

Effects of whole-body vibrations on neuromuscular fatigue: a study with sets of different durations

BACKGROUND

Whole body vibrations have been used as an exercise modality or as a tool to study neuromuscular integration. There is increasing evidence that longer WBV exposures (up to 10 minutes) induce an acute impairment in neuromuscular function. However, the magnitude and origin of WBV induced fatigue is poorly understood.

PURPOSE

The study aimed to investigate the magnitude and origin of neuromuscular fatigue induced by half-squat long-exposure whole-body vibration intervention (WBV) with sets of different duration and compare it to non-vibration (SHAM) conditions.

METHODS

Ten young, recreationally trained adults participated in six fatiguing trials, each consisting of maintaining a squatting position for several sets of the duration of 30, 60 or 180 seconds. The static squatting was superimposed with vibrations (WBV30, WBV60, WBV180) or without vibrations (SHAM30, SHAM60, SHAM180) for a total exercise exposure of 9-minutes in each trial. Maximum voluntary contraction (MVC), level of voluntary activation (%VA), low- (T20) and high-frequency (T100) doublets, low-to-high-frequency fatigue ratio (T20/100) and single twitch peak torque (TWPT) were assessed before, immediately after, then 15 and 30 minutes after each fatiguing protocol.

RESULT

Inferential statistics using RM ANOVA and post hoc tests revealed statistically significant declines from baseline values in MVC, T20, T100, T20/100 and TWPT in all trials, but not in %VA. No significant differences were found between WBV and SHAM conditions.

CONCLUSION

Our findings suggest that the origin of fatigue induced by WBV is not significantly different compared to control conditions without vibrations. The lack of significant differences in %VA and the significant decline in other assessed parameters suggest that fatiguing protocols used in this study induced peripheral fatigue of a similar magnitude in all trials.

Evaluation of Whole-Body Vibration Exercise on Neuromuscular Activation Through Electromyographic Pattern of Vastus Lateralis Muscle and on Range of Motion of Knees in Metabolic Syndrome: A Quasi-Randomized Cross-Over Controlled Trial

Metabolic syndrome (MetS) is related to overweight and obesity, and contributes to clinical limitations. Exercise is used for the management of MetS individuals, who are often not motivated to perform this practice. Whole body vibration exercise (WBVE) produces several biological effects, besides being safe, effective, and feasible for MetS individuals. This pseudo-randomized and cross-over controlled trial study aimed to analyze the effects of WBVE on MetS individuals’ neuromuscular activation using the surface electromyography (sEMG) pattern (root mean square (RMS)) of the vastus lateralis (VL) muscle and on the range of motion (ROM) of the knees. Participants (n = 39) were allocated to two groups: the treatment group (TG), which was exposed to WBVE, and the control group (CG). WBVE interventions were performed twice a week, for a period of 5 weeks. ROM and sEMG were analyzed at baseline, after the first session, and before and after the last session. sEMG (%RMS) significantly increased in the acute effect of the last session of WBVE (108.00 ± 5.07, p < 0.008, right leg; 106.20 ± 3.53, p < 0.02, left leg) compared to the CG. ROM did not significantly change in TG or CG. In conclusion, 5 weeks of WBVE exerted neuromuscular effects capable of increasing VL muscle RMS in individuals with MetS, this effect being potentially useful in the physical rehabilitation of these individuals.

Potential of Vibroacoustic Therapy in Persons with Cerebral Palsy: An Advanced Narrative Review

Vibroacoustic therapy (VAT) is a treatment method that uses sinusoidal low-frequency sound and music. The purpose of this narrative review is to describe the effects of VAT on motor function in people with spastic cerebral palsy (CP) according to study design as well as providing information about the age of the participants, measurement tools, and sound frequencies that were used. The systematic search strategy based on the first two steps of a standard evidence-based approach were used: (1) formulation of a search question and (2) structured documented search including assessment of the relevance of abstracts and full texts to the search question and inclusion criteria. Out of 823 results of the search in 13 scholarly databases and 2 grey literature sources, 7 papers were relevant. Most of the relevant studies in children and adults presented significant improvement of motor function. According to the study design, only five experimental studies and two randomized controlled trial (RCT) studies were available. In the discussion, findings of this review are compared to other related methods that use mechanical vibrations without music. The authors recommend continuing to research the effects of VAT on motor function and spasticity in adolescents and young adults with spastic CP.

Alendronate Release from UHMWPE-Based Biomaterials in Relation to Particle Size of the GUR Powder for Manufacturing

Ultra-high molecular weight polyethylene (UHMWPE) is widely used in endoprosthetics and has been the subject of countless studies. This project investigates the dependence of alendronate (AL) release on the molecular weight of the UHMWPE used (GUR1020 and GUR1050). A 0.5 wt% AL was added to the UHMWPE during the production of the moldings. In addition to the 14-day release tests, biocompatibility tests such as live dead assay, cell proliferation assay (WST) and Lactate dehydrogenase test (LDH) with MG-63 cells as well as a tensile test according to DIN EN ISO 527 were carried out. The released AL concentration was determined by HPLC. A continuous release of the AL was observed over the entire period of 2 weeks. In addition, a correlation between molar mass and AL release was demonstrated. The GUR1020 showed a release four times higher than the GUR1050. Both materials have no negative influence on the proliferation of MG-63 cells. This was also confirmed in the live/dead assay by the increase in cell count. No cytotoxicity was detected in the LDH test. The addition of 0.5 wt% AL increased the elongation at break for GUR1020 by 23% and for GUR1050 by 49%. It was demonstrated that the choice of UHMWPE has an influence on the release of AL. The particle size in particular has a strong influence on the release behavior.

Clinical Approaches of Whole-Body Vibration Exercises in Individuals with Stroke: A Narrative Revision

Stroke is associated with long-term disability and patients experience numerous physical impairments including muscle weakness, particularly in the paretic limbs, balance, and functional mobility. During acute stroke rehabilitation, when individuals are less likely to be functionally independent and rely on rehabilitative care, the efficacy of low skill interventions that can reduce sedentary behaviour should be established. As such, this narrative revision focused on the use of empirical studies of whole-body vibration exercise (WBVE) on different health outcomes in stroke patients. The effects of WBVE on neuromuscular performance (muscular strength and power), mobility, spasticity, and cardiovascular responses have been highlighted. Although some positive results were reported we can conclude that there is no solid evidence confirming the beneficial effects of WBVE among people with stroke compared with either other types of physical activities or sham WBVE. Therefore, further research should be performed in this area, testing the feasibility and efficacy of using WBVE in a more homogeneous sample of stroke patients or comparing different WBVE parameters.

Vibration-Assisted Home Training Program for Children With Spinal Muscular Atrophy

The aim of this study was to determine the effect of a new method of vibration-assisted neuromuscular rehabilitation in patients with spinal muscular atrophy types II and III. In this retrospective observational study, 38 children (mean age: 4.64 ± 1.95 years) were analyzed. The physiotherapy program, Auf die Beine, combines 6 months of home-based side-alternating whole-body vibration with interval blocks of intensive, goal-directed rehabilitation: 13 days at the start and 6 days after 3 months. Assessments were applied at the beginning (M0), after 6 months of home-based training (M6), and after 6 months of follow-up (M12). Motor abilities were assessed by the Gross Motor Function Measure 66 and Hammersmith Functional Mobility Scale. The Gross Motor Function Measure showed an increase of 1.69 (3.73) points (P = .124) and the Hammersmith Functional Mobility Scale a significant increase of 2.73 ± 1.79 points (P = .007) after 12 months; however, whether this leads to a long-term clinical benefit requires further investigation.

Vibration therapy in patients with cerebral palsy: a systematic review

The neurological disorder cerebral palsy (CP) is caused by unprogressive lesions of the immature brain and affects movement, posture, and the musculoskeletal system. Vibration therapy (VT) is increasingly used to reduce the signs and symptoms associated with this developmental disability. The purpose of this narrative review was systematically to appraise published research regarding acute and long-term effects of VT on functional, neuromuscular, and structural parameters. Systematic searches of three electronic databases identified 28 studies that fulfilled the inclusion criteria. Studies were analyzed to determine participant characteristics, VT-treatment protocols, effect on gross motor function (GMF), strength, gait, posture, mobility, spasticity, reflex excitability, muscle tone, mass, and bone strength within this population, and outcome measures used to evaluate effects. The results revealed that one acute session of VT reduces reflex excitability, spasticity, and coordination deficits. Subsequently, VT has a positive effect on the ability to move, manifested for GMF, strength, gait, and mobility in patients with CP. Effects persist up to 30 minutes after VT. Long-term effects of VT manifest as reduced muscle tone and spasticity occurring concomitantly with improved movement ability in regard to GMF, strength, gait, and mobility, as well as increased muscle mass and bone-mineral density. Posture control remained unaffected by VT. In conclusion, the acute and chronic application of VT as a nonpharmacological approach has the potential to ameliorate CP symptoms, achieving functional and structural adaptations associated with significant improvements in daily living. Even though further studies including adult populations validating the neuromuscular mechanisms underlying the aforementioned adaptations should be fostered, growing scientific evidence supports the effectiveness of VT in regard to supplementing conventional treatments (physiotherapy and drugs). Therefore, VT could reduce CP-associated physical disability and sensorimotor handicaps. Goals for patients and their caregivers referring to greater independence and improved safety may be achieved more easily and time efficiently.