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

Preliminary feasibility and acute physiological effects of a single session of upper limb vibration training for persons with spinal cord injury

CONTEXT

Strong upper limb musculature is essential for persons with spinal cord injury (SCI) to operate a manual wheelchair and live independently. Targeted upper limb vibration may be a viable exercise modality to build muscle efficiently while eliminating some of the barriers associated with exercise for persons with SCI.

OBJECTIVE

The purpose of this study was to assess preliminary feasibility of completing a single exercise session of upper limb vibration and compare the acute physiological effects to a single session of standard dumbbell resistance exercise.

METHODS

Individuals with SCI performed seven upper limb exercises (1) isometrically using a vibrating dumbbell at 30 Hz for 60 s (n = 22) and (2) using a standard isotonic resistance protocol (n = 15).

RESULTS

Nineteen (86.4%) of 22 participants were able to perform all vibration exercises at 30 Hz but hold time success rates varied from 33% (side flies and front raises) to 95% (internal rotation). No significant differences were found between vibration exercise and standard resistance protocol for blood lactate, power output, and heart rate (P > 0.05). Perceptions of the training were positive, with most participants (>70%) expressing interest to train with vibration in the future.

CONCLUSIONS

Vibration training was not feasible for all participants, suggesting an individualized approach to starting weight and progression may be necessary. Similar acute physiological changes were seen between vibration exercise and standard resistance protocol, suggesting they could have similar benefits. Additional research is needed to determine if vibration exercise is feasible and beneficial to incorporate into a long-term training program.

Effects of whole-body vibration training on physical function, activities of daily living, and quality of life in patients with stroke: a systematic review and meta-analysis

Purpose: This systematic review and meta-analysis aimed to evaluate the efficacy of whole-body vibration training (WBVT) in patients with stroke, specifically focusing on its effects on physical function, activities of daily living (ADL), and quality of life (QOL). Additionally, potential moderators influencing WBVT outcomes were explored. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library from inception to September 2022. Eligible studies were randomized controlled trials employing WBVT in patients with stroke. Two investigators independently extracted the data and calculated the standardized mean difference (SMD) using random-effect models. Results: Twenty-five studies involving 991 patients were included in this meta-analysis. WBVT demonstrated significant reductions in spasticity (SMD = -0.33, 95% CI = -0.61 to -0.06, p = 0.02), improvements in motor function (SMD = 0.39, 95% CI = 0.16 to 0.61, p < 0.01), and enhancements in balance function (SMD = 0.28, 95% CI = 0.09 to 0.47, p < 0.01) in patients with stroke. However, no significant effects were observed for gait (SMD = -0.23, 95% CI = -0.50 to 0.04, p = 0.10), ADL (SMD = -0.01, 95% CI = -0.46 to 0.44, p = 0.97), or QOL (SMD = 0.12, 95% CI = -0.30 to 0.53, p = 0.59). Subgroup analyses revealed that variable frequency vibration and side-alternating vibration exhibited significant efficacy in reducing spasticity and improving motor and balance functions, while fixed frequency vibration and vertical vibration did not yield significant therapeutic benefits in these domains. Conclusion: Our findings indicate that WBVT may serve as a viable adjunct therapy for stroke patients to alleviate spasticity and enhance motor and balance functions. Variable frequency and side-alternating vibration appear to be crucial factors influencing the therapeutic effects of WBVT on these dysfunctions. Nonetheless, WBVT did not show significant effects on gait, ADL, or QOL in stroke patients. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42022384319).

Effects of vibration therapy for post-stroke spasticity: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The efficacy of vibration therapy (VT) in people with post-stroke spasticity (PSS) remains uncertain. This study aims to conduct a comprehensive meta-analysis to assess the effectiveness of VT in PSS.

METHODS

PubMed, Embase, Cochrane Library, Physiotherapy Evidence Database, and Web of Science were searched from inception to October 2022 for randomized controlled trials (RCTs) of VT in people with PSS. The primary outcome was spasticity, and secondary outcomes included pain, motor function, gait performance, and adverse events. A meta‑analysis was performed by pooling the standardized mean difference (SMD) with 95% confidence intervals (CI).

RESULTS

A total of 12 studies met the inclusion criteria. Overall, VT had significant effects on reducing spasticity (SMD = - 0.77, 95% CI - 1.17 to - 0.36, P < 0.01) and pain (SMD =  - 1.09, 95% CI - 1.74 to - 0.45, P < 0.01), and improving motor function (SMD = 0.42, 95% CI 0.21 to 0.64, P < 0.01) in people with PSS. However, VT had no significant effect on gait performance (SMD =  - 0.23, 95% CI - 0.56-0.10). In addition, subgroup differences in short-term anti-spasticity effects between different vibration subtypes, vibration frequencies, vibration durations, frequency of sessions, control therapy, spasticity distribution, and population classification were not significant.

CONCLUSION

We found that VT significantly alleviated spasticity and pain in people with PSS and improved motor function, but its effect on gait performance was unclear. However, further studies are needed to validate these findings.

Efficacy and safety of whole-body vibration therapy for post-stroke spasticity: A systematic review and meta-analysis

Background

One of the main objectives of stroke rehabilitation is to alleviate post-stroke spasticity. Over the recent years, many studies have explored the potential benefits of whole-body vibration (WBV) treatment for post-stroke spasticity, but it is still controversial.

Objective

The current study aims to assess the efficacy and safety of WBV for post-stroke spasticity and determine the appropriate application situation.

Methods

From their establishment until August 2022, the following databases were searched: PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, China National Knowledge Infrastructure (CNKI), and Wanfang. Only randomized controlled trials (RCTs) that were published in either English or Chinese were taken into consideration. We independently filtered the research, gathered the data from the studies, and evaluated the research quality (Cochrane RoB tool) and the overall evidence quality (GRADE). Rev Man 5.4 software was utilized to conduct statistical analysis.

Results

In this analysis, 11 RCTs with 475 patients that reported on the effectiveness of WBV therapy for post-stroke spasticity were taken into account. Compared to the control groups, the results revealed that WBV combined with conventional rehabilitation at a vibration frequency lower than 20 Hz (SMD = -0.58, 95% CI: -0.98 to -0.19, P = 0.004) was more effective in relieving upper (SMD = -0.53, 95% CI: -1.04 to 0.03, P = 0.03) and lower limb spasticity (SMD = -0.21, 95% CI: -0.40 to -0.01, P = 0.04); similarly, it was superior for patients aged under 60 years (SMD = -0.41, 95% CI: -0.66 to -0.17, P = 0.0008) with acute and subacute stroke (SMD = -0.39, 95% CI: -0.68 to -0.09, P = 0.01). The valid vibration for reducing spasticity was found to last for 10 min (SMD = -0.41, 95% CI: -0.75 to -0.07, P = 0.02). None of the included studies revealed any serious adverse impact.

Conclusion

Moderate-quality evidence demonstrated when WBV was used as an adjuvant, vibration <20 Hz for 10 min was effective and secure in treating upper and lower limb spasticity in patients with acute and subacute stroke under the age of 60 years.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022293951.

Perspectives of Motor Functional Upper Extremity Recovery with the Use of Immersive Virtual Reality in Stroke Patients

Stroke is one of the leading causes of disability, including loss of hand manipulative skills. It constitutes a major limitation in independence and the ability to perform everyday tasks. Among the numerous accessible physiotherapeutic methods, it is becoming more common to apply Virtual Reality "VR”. The aim of this study was to establish whether immersive VR was worth considering as a form of physical therapy and the advisability of applying it in restoring post-stroke hand function impairment. A proprietary application Virtual Mirror Hand 1.0 was used in the research and its effectiveness in therapy was compared to classical mirror therapy. A total of 20 survivors after ischaemic stroke with comparable functional status were divided into a study group (n = 10) and control group (n = 10). Diagnostic tools included 36-Item Short Form Survey “SF-36” and the Fugl-Meyer Assessment Upper Extremity “FMA-UE”. Collected metrics showed a normal distribution and the differences in mean values were tested by the student’s t-test. In both, the study and control groups’ changes were recorded. A statistically significant outcome for FMA-UE and SF-36 measured by the student’s t-test for dependent or independent samples (p > 0.05) were obtained in both groups. Importantly, proven by conducted studies, an advantage of VR proprietary application was subjective sensations amelioration in pain and sensory impressions. Applying Virtual Mirror Hand 1.0 treatment to patients after a stroke appears to be a good solution and definitely provides the opportunity to consider VR applications as an integral part of the neurorehabilitation process. These results give a basis to plan further larger-scale observation attempts. Moreover, the development of the Virtual Mirror Hand 1.0 as an innovative application in physiotherapy may become equivalent to classical mirror therapy in improving the quality and effectiveness of the treatment used for post-stroke patients.

Analysis of Vibration Frequency and Direction for Facilitating Upper-Limb Muscle Activity

We aimed to determine the effect of vibration frequency and direction on upper-limb muscle activation using a handheld vibrator. We recruited 19 healthy participants who were instructed to hold a handheld vibrator in their dominant hand and maintain the elbow at 90° flexion, while vertical and horizontal vibrations were applied with frequencies of 15, 30, 45, and 60 Hz for 60 s each. Surface electromyography (EMG) measured the activities of the flexor digitorum superficialis (FDS), flexor carpi radialis (FCR), extensor carpi ulnaris (ECU), extensor carpi radialis (ECR), biceps, triceps, and deltoid anterior muscles. EMG changes were evaluated as the difference in muscle activity between vibration and no-vibration (0 Hz) conditions. Muscle activity was induced under vibration conditions in both vertical and horizontal (p < 0.05) directions. At 45 Hz, FDS and FCR activities increased during horizontal vibrations, compared with those during vertical vibrations. ECU activity significantly increased under 15-Hz vertical vibrations compared with that during horizontal vibrations. Vibrations from the handheld vibrator significantly induced upper-limb muscle activity. The maximum muscle activations for FDS, ECR, ECU, biceps, and triceps were induced by 45-Hz horizontal vibration. The 60-Hz vertical and 30-Hz horizontal vibrations facilitated maximum muscle activations for the FCR and deltoid anterior, respectively.

Validation of Vibration Exercises on Enhancing Muscle Strength and Upper Limb Functionality among Pre-Frail Community-Dwelling Older Adults

Pre-frail older adults require appropriate exercise to enhance muscle strength as well as upper limb functionality. We developed a handheld vibrator and evaluated its effectiveness in enhancing muscle strength compared to conventional exercises among pre-frail community-dwelling older adults. Thirty-one pre-frail older adults (aged 75.5 ± 5.1 years) were recruited and randomly allocated to a vibration group (VG) and control group (CG). The VG underwent 20 minutes of vibration (frequency: 30 Hz, amplitude: 5 mm, horizontal vibration) using a handheld vibrator as well as 40 minutes of conventional exercise. The CG received 60 minutes of conventional exercise only. The primary outcome was muscle strength assessment (kg), and the secondary outcome included activities of daily living and instrumental activities of daily living scores. The comparisons between the outcome measures revealed no significant differences at the baseline level. Muscle strength of the dominant (ß = 2.49, p = 0.002) and non-dominant (ß = 1.89, p = 0.02) wrist flexion, brachioradialis (ß = 3.8, p = 0.01), and biceps brachii (ß = 3.02, p = 0.02) in the dominant upper limbs was significantly increased among the VG. The vibration intervention can enhance muscle strength in the upper limbs among pre-frail older adults.

Acceptability and impact on spasticity of a single session of upper extremity vibration in individuals with tetraplegia

STUDY DESIGN

Pre-post design; before and after vibration intervention.

OBJECTIVES

To explore effect of a focal, self-applied upper extremity (UE) vibration intervention on UE spasticity for individuals with tetraplegia. The secondary objectives were to explore the acceptability and ease of use of this intervention.

SETTING

Specialty rehabilitation center in Georgia, USA.

METHODS

Eleven participants each completed one session of focal, self-applied vibration to the UEs. UE spasticity was measured using the Modified Ashworth Scale (MAS). UE function was measured using the Box & Block (B&B) test which measures the effectiveness of grasp, transport, and release. These measurements were taken pre-intervention, immediately post-intervention, and 20 min post-intervention. Participants also self-reported the acceptability and usability of the intervention, their perception of change in their spasticity and completed the Qualities of Spasticity Questionnaire.

RESULTS

In the full group analysis of the spasticity measures, no significant effects were found. Subgroup analysis, however, indicated participants with higher spasticity demonstrated significantly more change on the MAS than the lower spasticity group. Analysis did not reveal any impact of the intervention on UE function as measured by the B&B. Ten out of eleven participants indicated that they agreed or strongly agreed that the intervention would be valuable to have at home.

CONCLUSIONS

Participants with higher spasticity demonstrated decreased spasticity after focal UE vibration, although there was no clear effect on grasp, transport and release function. Participants were satisfied with the intervention; most were able to use it independently and indicated it would be a valuable home intervention.

Effects of Task-Specific Training after Cognitive Sensorimotor Exercise on Proprioception, Spasticity, and Gait Speed in Stroke Patients: A Randomized Controlled Study

Background and objectives: Common problems in stroke patients include loss of proprioception, spasticity, and impaired gait. The purpose of this study was to examine the effects of task-specific training (TST) combined with cognitive sensorimotor exercise (CSE) on proprioception, spasticity and gait speed in stroke patients. Materials andMethods: Thirty-seven subjects were randomly divided into three groups; (1) the TST after CSE group (Experimental I, n = 13); (2) the TST group (Experimental II, n = 12), and (3) a conventional physical therapy training group (control group, n = 12). Evaluations were performed before the commencement of training and again eight weeks after training was initiated. An electrogoniometer was used to evaluate proprioception variation. The composite spasticity score (CSS) and MyotonePRO were used to evaluate spasticity. In addition, 10 m walk test was used to assess gait speed. Results: After training, the Experimental I group showed significant improvement in proprioception compared to the Experimental II and control group (p < 0.05). In CSS, gastrocnemius muscle tone (GMT) and gait speed among three groups, Experimental I group differed significantly after eight weeks of training compared to the control group (p < 0.05). Conclusions: These findings suggest that the TST combined with CSE provided significant improvements in proprioception, spasticity, and gait speed.

Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review

Sensory priming is a technique to facilitate neuroplasticity and improve motor skills after injury. Common sensory priming modalities include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration. The aim of this study was to determine whether sensory priming with a motor intervention results in improved upper limb motor impairment or function after stroke. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and EMBASE were the databases used to search the literature in July 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and recommendations for the Cochrane collaboration. In total, 30 studies were included in the analysis: three studies examined TFD, 16 examined PNS/SES, 10 studied vibration, and one combined the three stimulation techniques. Most studies reported significant improvements for participants receiving sensory priming. Given the low risk, it may be advantageous to use sensory-based priming prior to or concurrent with upper limb training after stroke.

Exploration of barriers and enablers for evidence-based interventions for upper limb rehabilitation following a stroke: Use of Constraint Induced Movement Therapy and Robot Assisted Therapy in NHS Scotland

Introduction

The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. Two such interventions are Constraint Induced Movement Therapy and Robot Assisted Therapy. Despite evidence to support both interventions, their use within the National Health Service appears, anecdotally, to be low. We sought to understand user perceptions in order to explain low uptake in clinical practice.

Methods

A combination of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients was used to explore uptake and user opinions on the benefits, enablers and barriers to each intervention.

Findings

The therapists surveyed reported low use of Constraint Induced Movement Therapy and Robot Assisted Therapy in clinical practice within the Scottish National Health Service. Barriers identified by therapists were inadequate staffing, and a lack of training and resources. Interviews with stroke patients identified themes that may help us to understand the acceptability of each intervention, such as the impact of motivation.

Conclusion

Barriers to the uptake of Constraint Induced Movement Therapy and Robot Assisted Therapy within the clinical setting were found to be similar. Further qualitative research should be completed in order to help us understand the role patient motivation plays in uptake.

Effects of Whole-Body Vibration on Upper Extremity Function and Grip Strength in Patients with Subacute Stroke: A Randomised Single-Blind Controlled Trial

Background

Whole-body vibration has been used to improve motor function in chronic stroke patients, but its effect on patients with subacute strokes remains unclear.

Objectives

We explored the effect of whole-body vibration on patients with subacute strokes.

Methods

Participants were randomly allocated to a whole-body vibration (WBV) group (n = 30) or an upper- and lower-cycle (ULC) group (n = 30). Both groups received occupational therapy after these interventions. All participants received treatment for 30 min/day, 5 days/week, for 4 weeks. Both groups received the same conventional physical therapy.

Results

The manual function test (MFT) score and grip strength improved after both WBV (p = 0.001 and p = 0.001, respectively) and ULC (p = 0.002 and p = 0.001, respectively), but the improvement was more pronounced (MFT p = 0.016; GS p = 0.023) after WBV.

Conclusions

These findings suggest that the use of WBV and ULC was effective as remedial treatments for improving upper extremity motor function and increasing grip strength for patients with subacute strokes. The improvement was more pronounced for the WBV treatment. This trial is registered with KCT0003246.

The Impact of Whole Body Vibration Therapy on Spasticity and Disability of the Patients with Poststroke Hemiplegia

OBJECTIVE

To determine if whole body vibration therapy (WBV) effectively improves functional outcome in patients with poststroke hemiplegia.

MATERIALS AND METHODS

In this single-blind RCT, WBV group (n = 10) had 40 hz frequency/4 mm amplitude vibration during 5 minutes/session, 3 days a week, for a duration of 4 weeks. The control group (n = 11) had no vibration therapy for the same duration while standing on the same platform. Patients in both of the groups did 15 minutes of stretching and active range of motion exercises before the intervention. Outcome measures were Modified Ashworth Scale (MAS), Functional Independence Measurement (FIM), and Timed 10-Meter Walk Test (10 mWT).

RESULTS

Only 10 mWT improved at the 1st week (p = 0.002), 1st month (p < 0.001), and 3rd month (p < 0.001) in favor of the intervention group. There was positive correlation also between 10 mWT and ankle spasticity (p < 0.001, r = 0.931).

CONCLUSION

This study suggests that WBV therapy may be a complementary therapy in gait rehabilitation and functional outcome of the patients with calf muscle spasticity.

Whole-Body Vibration Improves Early Rate of Torque Development in Individuals With Anterior Cruciate Ligament Reconstruction

Pamukoff, DN, Pietrosimone, B, Ryan, ED, Lee, DR, Brown, LE, and Blackburn, JT. Whole body vibration improves early rate of torque development in individuals with anterior cruciate ligament reconstruction. J Strength Cond Res 31(11): 2992-3000, 2017-The purpose of this study was to compare the effect of whole-body vibration (WBV) and local muscle vibration (LMV) on early and late quadriceps rate of torque development (RTD), and electromechanical delay (EMD) in individuals with anterior cruciate ligament reconstruction (ACLR). Twenty individuals with ACLR were recruited for this study. Participants performed isometric squats while being exposed to WBV, LMV, or no vibration (control) in a randomized order during separate visits. Early and late quadriceps RTD and EMD were assessed during a maximal voluntary isometric knee extension before and immediately after WBV, LMV, or control. There was a significant condition by time interaction for early RTD (p = 0.045) but not for late RTD (p = 0.11) or EMD of the vastus medialis (p = 0.15), vastus lateralis (p = 0.17), or rectus femoris (p = 0.39). Post hoc analyses indicated a significant increase in early RTD after WBV (+5.59 N·m·s·kg; 95% confidence interval, 1.47-12.72; p = 0.007). No differences were observed in the LMV or control conditions, and no difference was observed between conditions at posttest. The ability to rapidly produce knee extension torque is essential to physical function, and WBV may be appropriate to aid in the restoration of RTD after ACLR.