Biosound Therapy as a treatment for long COVID patients: A pre-post pilot study

BACKGROUND

43 % of people who are diagnosed with COVID-19 will experience persistent symptoms, also known as "long COVID," which lasts past the recovery of the acute infection. Long COVID symptoms overlap with symptoms that the Biosound Therapy System (BTS) has been shown to improve. The BTS is a multimodal treatment that includes biofeedback, vibroacoustic therapy synchronized with music that plays binaural beats, and video content. This study aimed to determine feasibility for a future full-scale Randomized Controlled Trial (RCT) and explore the impact of the BTS on long COVID symptoms.

METHODS

This pre-post pilot study was conducted in an outpatient mental health clinic. Adults aged 20-65 years old with persistent COVID-19 symptoms were screened and randomly assigned to the intervention or control group. The intervention group was given 8 Biosound Therapy sessions during a period of 4 weeks. All participants were assessed at baseline and at post-intervention using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7-item scale (GAD-7), Cambridge Brain Sciences (CBS) tasks, and the COVID-19 Persistent Symptom Questionnaire. The feasibility outcomes were recruitment rates, retention rates, and open-ended questions about participants' experiences.

RESULTS

15 participants enrolled in the study and 13 completed the study (9 intervention, 4 control). Trial recruitment ended prematurely due to the emergence of the Omicron variant of COVID-19. Participants responded to open-ended questions with only positive remarks and made no comments on the study not being feasible. A Wilcoxon signed-rank test indicated that compared to baseline, participants in the intervention group had significant improvement in their GAD-7 score, PHQ9 score, 2 Cambridge Brain Science tasks ("Odd" and "Double Trouble"), fatigue, and difficulties in concentrating or remembering (p < 0.05; 95 % CI).

CONCLUSION

The intervention group showed promising improvement without reported side effects. A full-scale RCT is feasible as long as the recruitment setting is changed to a location that allows access to more patients with long COVID. Results were limited due to the small sample size; therefore, a full-scale trial is needed.

Selected Acoustic Frequencies Have a Positive Impact on Behavioural and Physiological Welfare Indicators in Thoroughbred Racehorses

(1) Background: Since antiquity, it is considered that sounds influence human emotional states and health. Acoustic enrichment has also been proposed for domestic animals. However, in both humans and animals, effects vary according to the type of sound. Human studies suggest that frequencies, more than melodies, play a key role. Low and high frequencies, music tuning frequency and even EEG slow waves used for 'neurofeedback' produce effects. (2) Methods: We tested the possible impact of such pure frequencies on racehorses' behavior and physiology. A commercial non-audible acoustic stimulus, composed of an array of the above-mentioned frequencies, was broadcasted twice daily and for three weeks to 12 thoroughbred horses in their home stall. (3) Results: The results show a decrease in stereotypic behaviors and other indicators such as yawning or vacuum chewing, an increase in the time spent in recumbent resting and foraging, and better hematological measures during and after the playback phase for 4 of the 10 physiological parameters measured. (4) Conclusions: These results open new lines of research on possible ways of alleviating the stress related to housing and training conditions in racehorses and of improving physical recovery.

Influence of Isometric Exercise Combined With Electromyostimulation on Inflammatory Cytokine Levels, Muscle Strength, and Knee Joint Function in Elderly Women With Early Knee Osteoarthritis

Background and Objectives: Muscle strengthening exercise is suggested to beneficial for patients with knee osteoarthritis (OA) and electrical muscular stimulation is reported to be effective in improvement of muscle strength. This study examined whether isometric exercise combined with whole body-electromyostimulation (WB-EMS) can improve serum cytokine levels, muscle strength, and knee function in elderly women with early knee OA.

Materials and Methods: This randomized controlled study included 75 participants assigned into three groups: the control group (CON), isometric exercise group (ISOM), and isometric exercise and electromyostimulation group (ISOM + EMS). The two exercise groups performed their respective programs for 8 weeks, 3 days a week, 30 min a day. The main exercises for both groups were performed continuously during the 20 min in an alternation of a 6-s contraction with a 4-s break. At pre- and post-intervention, anthropometric variables, muscle strength, Knee Injury and Osteoarthritis Outcome Score (KOOS), and blood sampling for biomarkers including interleukin-6, tumor necrosis factor-α, C-reactive protein, and resistin were performed.

Results: All variables at pre-intervention showed no significant differences among the three groups. However, there were significant differences between groups for body composition, muscle strength, KOOS subscale scores, and biomarkers. ISOM + EMS group resulted in a significant reduction in body weight, fat mass, fat percentage, inflammatory cytokine levels, and increased muscle strength. An ISOM + EMS group had the best KOOS score among all groups.

Conclusion: Isometric exercise combined with WB-EMS resulted in the best overall improvements in knee function and alleviating the pain and symptoms of patients with early knee OA. Further, reduced levels of inflammatory cytokines were observed. These non-pharmacologic, non-invasive interventions should be considered by healthcare specialists for elderly patients with early knee OA.

Resistance Exercise, Electrical Muscle Stimulation, and Whole-Body Vibration in Older Adults: Systematic Review and Meta-Analysis of Randomized Controlled Trials

It has been shown that resistance exercise (RT) is one of the most effective approaches to counteract the physical and functional changes associated with aging. This systematic review with meta-analysis compared the effects of RT, whole-body vibration (WBV), and electrical muscle stimulation (EMS) on muscle strength, body composition, and functional performance in older adults. A thorough literature review was conducted, and the analyses were limited to randomized controlled trials. In total, 63 studies were included in the meta-analysis (48 RT, 11 WBV, and 4 EMS). The results showed that RT and WBV are comparably effective for improving muscle strength, while the effects of EMS remains debated. RT interventions also improved some outcome measures related to functional performance, as well as the cross-sectional area of the quadriceps. Muscle mass was not significantly affected by RT. A limitation of the review is the smaller number of WBV and particularly EMS studies. For this reason, the effects of WBV and EMS could not be comprehensively compared to the effect of RT for all outcome measures. For the moment, RT or combinations of RT and WBV or EMS, is probably the most reliable way to improve muscle strength and functional performance, while the best approach to increase muscle mass in older adults remains open to further studies.

Effect of complementary therapies on functional capacity and quality of life among prefrail and frail older adults: A systematic review of randomized controlled trials

OBJECTIVE

Investigate the effects of complementary therapies on functional capacity and quality of life among prefrail and frail older adults.

MATERIALS AND METHOD

An electronic search was performed in the PubMed, EMBASE, Web of Science, Cochrane Library, LILACS and PEDro databases for relevant articles published up to September 2019. Only randomized controlled trials with interventions involving complementary therapies for prefrail and frail older adults were included. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane recommendations. The methodological quality of the selected studies was appraised using the PEDro scale and the evidence was synthesized using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) scale.

RESULTS

Fifteen studies met the inclusion criteria and were selected for the present review. Six different complementary therapies were identified and the main findings were related to Tai Chi. A very low to moderate level of evidence was found regarding the effectiveness of Tai Chi in terms a functional capacity (balance, mobility, gait speed, functional reach and lower limb muscle strength) and a low level of evidence was found regarding its effect on quality of life. To the other complementary therapies it was not possible to synthetize evidence level.

CONCLUSION

Tai chi may be used as an important resource to improve functional capacity and quality of life among prefrail and frail older adults.

An Overview of Acoustic-Based Interventions to Improve Motor Symptoms in Parkinson's Disease

Parkinson’s disease (PD) is characterized by motor and cognitive deficits that negatively impact on activities of daily living. While dopaminergic medications are used to attenuate motor symptoms, adjuvant therapies such as acoustic-based non-pharmacological interventions are used as a complement to standard drug treatments. At present, preliminary studies of acoustic-based interventions such as rhythmic-auditory stimulation (RAS) and vibroacoustic therapy (VAT) suggest two competing hypotheses: (1) RAS may recruit alternative motor networks that may bypass faulty spatiotemporal motor networks of movement in PD; or (2) the use of RAS enhances BG function through entrainment of beta oscillatory activities. In this mini review article, we discuss the mechanisms underlying the role of acoustic-based interventions and how it may serve to improve motor deficits such as gait impairments and tremors. We further provide suggestions for future work that may use a combination of RAS, VAT, and physical therapy to improve motor function in PD.

EMS-effect of Exercises with Music on Fatness and Biomarkers of Obese Elderly Women

Background and objectives: Electromyostimulation (EMS) has been shown to improve body composition, but what biomarkers it affects has not been investigated. The purpose of this study was to compare the EMS-effect of exercises with music on fatness and biomarker levels in obese elderly. Materials and Methods: Twenty-five women were randomly classified into a control group (CON) and EMS group (EMSG). EMS suits used in this study enabled the simultaneous activation of eight pairs with selectable intensities. Program sessions of EMS were combined with exercises of listening to music three times a week for eight weeks. Although both groups received the same program, CON did not receive electrical stimuli. Results: Compared with CON, a significant effect of the EMS intervention concerning decreased fatness, as well as an increased skeletal muscle mass and basal metabolic rate, were evident. Tumor necrosis factor-a, C-reactive protein, resistin, and carcinoembryonic antigen of biomarkers were significantly different in the groups by time interaction. Similarly, the positive changes caused by EMS were represented in lipoprotein-cholesterols. Conclusions: The results indicate that a significant effect due to the EMS intervention was found concerning body composition and biomarkers in obese elderly women.

Rehabilitation Program Combined with Local Vibroacoustics Improves Psychophysiological Conditions in Patients with ACL Reconstruction

Background and objective: This study investigated the therapeutic effect of applying local body vibration (LBV) with built-in vibroacoustic sound on patients who had an anterior cruciate ligament (ACL) reconstruction. Materials and Methods: Twenty-four participants were randomly classified into a LBV group (LBVG; n = 11) or a non-LBV group (nLBVG; n = 13). Both groups received the same program; however, the LBVG received LBV. Psychological measures included pain, anxiety, and symptoms; physiological measures included systolic blood pressure (SBP), diastolic blood pressure, heart rate (HR), breathing rate (BR), sympathetic activation (SA), parasympathetic activation (PSA), range of motion (ROM), and isokinetic muscle strength at Weeks 0, 4, and 8. Results: Among the psychophysiological variables, pain, anxiety, symptoms, SBP, BR, and SA were significantly reduced in both groups, whereas HR, PSA, isokinetic peak torque (PT) of the knee joint, and ROM were significantly improved only in the LBVG. Comparing both groups, a significant difference appeared in pain, symptom, SA, PSA, isokinetic PT, and ROM at Weeks 4 and 8. Conclusions: The results indicate that the LBV intervention mitigated the participants' pain and symptoms and improved their leg strength and ROM, thus highlighting its effectiveness.

Treatment of chronic back pain using indirect vibroacoustic therapy: A pilot study

BACKGROUND

Low frequency sound wave stimulation therapy has become increasingly popular in the rehabilitation fields, due to its ease, less fatiguing and time efficient application.

OBJECTIVE

This 12-week pilot study examines the efficacy of applying low frequency sound wave stimulation (between 16-160 Hz) through both hands and feet on relieving pain and improving functional ability in patients with chronic back pain.

METHODS

Twenty-three participants with chronic shoulder (eleven participants) or low back pain (twelve participants) underwent a 12-week vibration therapy program of three sessions per week. A low frequency sound wave device comprising four piezoelectric vibration-type tactile tranducers enclosed in separate 5-cm diameter circular plates, which generate sinusoidal vibratory stimuli at a frequency of 16-160 Hz, was used in this study. Primary outcome measure was pain sensation measured using the Visual Analogue Scale (P-VAS). The secondary outcome measures were pain-related disability measured using the pain disability index (PDI) and quality of life measured using the SF-12.

RESULTS

At week 12, significant reductions in pain sensation and pain-related disability were observed, with mean reductions of 3.5 points in P-VAS and 13.5 points in the PDI scores. Sixty-five percent of the participants had a reduction of at least 3 points on the P-VAS score, while 52% participants showed a decrease of at least 10 points in the PDI score. Significant improvement was observed in the SF-12 physical composite score but not the mental composite score.

CONCLUSIONS

The preliminary findings showed that passive application of low frequency sound wave stimulation therapy through both hands and feet was effective in alleviating pain and improving functional ability in patients with chronic back pain.

Are We Doing More Than We Know? Possible Mechanisms of Response to Music Therapy

Due to advances in medical knowledge the population of older adults struggling with issues of aging like Alzheimer's disease (AD), Parkinson's disease (PD), and stroke is growing. There is a need for therapeutic interventions to provide adaptive strategies to sustain quality of life, decrease neurologic impairment, and maintain or slow cognitive decline and function due to degenerative neurologic diseases. Musical interventions with adults with cognitive impairments have received increased attention over the past few years, such as the value of personalized music listening in the iPod project for AD (1); music as a tool to decrease agitation and anxiety in dementia (2); and music to aid in episodic memory (3); Rhythmic Auditory Stimulation as rehabilitation for PD (4); and recently the potential of 40 Hz sensory brain stimulation with AD and PD (5, 6). These approaches indicate the expanding scope and efficacy of music therapy and the potential mechanisms involved. This paper explicates a four-level model of mechanisms of music response (7, 8) that may help understand current music therapy approaches and treatments and help focus future research. Each level will be illustrated with research and suggestions for research directions.

Short-Term Effects of Binaural Beats on EEG Power, Functional Connectivity, Cognition, Gait and Anxiety in Parkinson’s Disease

We applied rhythmic binaural sound to Parkinson’s Disease (PD) patients to investigate its influence on several symptoms of this disease and on Electrophysiology (Electrocardiography and Electroencephalography (EEG)). We conducted a double-blind, randomized controlled study in which rhythmic binaural beats and control were administered over two randomized and counterbalanced sessions (within-subjects repeated-measures design). Patients ([Formula: see text], age [Formula: see text], stage I–III Hoehn & Yahr scale) participated in two sessions of sound stimulation for 10[Formula: see text]min separated by a minimum of 7 days. Data were collected immediately before and after both stimulations with the following results: (1) a decrease in theta activity, (2) a general decrease in Functional Connectivity (FC), and (3) an improvement in working memory performance. However, no significant changes were identified in the gait performance, heart rate or anxiety level of the patients. With regard to the control stimulation, we did not identify significant changes in the variables analyzed. The use of binaural-rhythm stimulation for PD, as designed in this study, seems to be an effective, portable, inexpensive and noninvasive method to modulate brain activity. This influence on brain activity did not induce changes in anxiety or gait parameters; however, it resulted in a normalization of EEG power (altered in PD), normalization of brain FC (also altered in PD) and working memory improvement (a normalizing effect). In summary, we consider that sound, particularly binaural-rhythmic sound, may be a co-assistant tool in the treatment of PD, however more research is needed to consider the use of this type of stimulation as an effective therapy.

The effect of low-frequency sound stimulation on patients with fibromyalgia: a clinical study

BACKGROUND

The search for effective treatments for fibromyalgia (FM) has continued for years. The present study premises that thalamocortical dysrhythmia is implicated in fibromyalgia and that low-frequency sound stimulation (LFSS) can play a regulatory function by driving neural rhythmic oscillatory activity.

OBJECTIVE

To assess the effect of LFSS on FM.

METHOD

The present open-label study with no control group used a repeated-measures design with no noncompleters. Nineteen female volunteers (median age 51 years; median duration of FM 5.76 years) were administered 10 treatments (twice per week for five weeks). Treatments involved 23 min of LFSS at 40 Hz, delivered using transducers in a supine position. Measures (repeated before and after treatment) included the Fibromyalgia Impact Questionnaire, Jenkins Sleep Scale, Pain Disability Index, sitting and standing without pain (in minutes), cervical muscle range of motion and muscle tone. Mean percentages were calculated on end of treatment self-reports of improvement on pain, mood, insomnia and activities of daily living.

RESULTS

Significant improvements were observed with median scores: Fibromyalgia Impact Questionnaire, 81% (P<0.0001); Jenkins Sleep Scale, 90% (P<0.0001); and Pain Disability Index, 49.1% (P<0.0001). Medication dose was reduced in 73.68% of patients and completely discontinued in 26.32%. Time sitting and standing without pain increased significantly (P<0.0001). Cervical muscle range of motion increased from 25% to 75% (P=0.001), while muscle tone changed from hypertonic to normal (P=0.0002).

CONCLUSION

In the present study, the LFSS treatment showed no adverse effects and patients receiving the LFSS treatment showed statistically and clinically relevant improvement. Further phase 2 and 3 trials are warranted.

Effectiveness of Physio Acoustic Sound (PAS) therapy in demented nursing home residents with nocturnal restlessness: study protocol for a randomized controlled trial

Background

Many older people with neuropsychiatric disorders such as Alzheimer's disease and frontotemporal dementia suffer from sleeping problems and often show nocturnal restlessness. Professionals and informal carers face considerable problems in solving these problems. Attempts to diminish these problems with medication in a safe and responsible manner have proven hardly effective or not effective at all. Therefore, nowadays the focus lies more on non-pharmacological solutions, for example by influencing environmental factors. There are indications that treatment with low-frequency acoustic vibrations, that is Physio Acoustic Sound (PAS) therapy, has a positive effect on sleeping problems. Therefore we study the effectiveness of PAS therapy in demented patients with nocturnal restlessness.

Methods

In a randomized clinical trial, 66 nursing home patients will be divided into two groups: an intervention group and a control group. For both groups nocturnal restlessness will be measured with actiwatches during a period of six weeks. In addition, a sleep diary will be filled in.

For the intervention group the baseline will be assessed, in the first two weeks, reflecting the existing situation regarding nocturnal restlessness. In the next two weeks, this group will sleep on a bed identical to their own, but with a mattress containing an in-built PAS device. As soon as the patient is lying in bed, the computer programme inducing the vibrations will be switched on for the duration of 30 min. In the last two weeks, the wash-out period, the measurements of the intervention group are continued, without the PAS intervention.

During the total study period, other relevant data of all the implied patients will be recorded systematically and continuously, for example patient characteristics (data from patient files), the type and seriousness of the dementia, occurrence of neuropsychiatric symptoms during the research period, and the occurrence of intermittent co-morbidity.

Discussion

If PAS therapy turns out to be effective, it can be of added value to the treatment of nocturnal restlessness in demented patients. Non-pharmacological PAS therapy is not only safe and patient-friendly, but it can also be widely used in a simple and relatively inexpensive way, both in institutions such as nursing homes and residential homes for the elderly, and at home. Ultimately, this may lead to a decrease in the frequent and still common use of psychotropic drugs. In addition, care needs of demented patients also may decrease as well as the number of preventable admissions to care institutions.

Trial registration

Netherlands Trial Register (NTR): NTR3242

The effects of whole body vibration therapy on bone mineral density and leg muscle strength in older adults: a systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis of randomized controlled trials was undertaken to determine whether whole body vibration improves bone mineral density and leg muscle strength in older adults.

DATA SOURCES

Sources included MEDLINE, CINAHL, EMBASE, PEDro, PubMed, Science Citation Index and the reference list of each eligible article.

REVIEW METHODS

Article search and selection was performed independently by two researchers. The methodological quality of each selected article was rated by the PEDro scale.

RESULTS

Thirteen randomized trials (18 articles) totalling 896 subjects fulfilled the selection criteria. Four were considered to have good or excellent methodological quality and the rest were rated as fair. Meta-analyses revealed that whole body vibration has no significant effect on hip or lumbar spine bone mineral density in older women when compared with no intervention or active exercise (P > 0.05). Whole body vibration, however, had a significant treatment effect on knee extension dynamic strength (standardized mean difference = 0.63, P = 0.006), leg extension isometric strength (standardized mean difference = 0.57, P = 0.003), and functional measures of leg muscle strength such as jumping height (standardized mean difference = 0.51, P = 0.010) and performance in sit-to-stand (standardized mean difference = 0.72, P < 0.001) among older adults compared with no intervention.

CONCLUSION

Whole body vibration is beneficial for enhancing leg muscle strength among older adults. However, the review suggests that whole body vibration has no overall treatment effect on bone mineral density in older women. No randomized trial has examined the effects of whole body vibration on bone mineral density in older men.

Effects of whole-body vibration on sensorimotor performance in people with Parkinson disease: a systematic review

BACKGROUND

Earlier studies show that whole-body vibration (WBV) has beneficial effects on neuromuscular performance in older adults and may be a viable treatment option for people with Parkinson disease (PD).

PURPOSE

This systematic review was aimed at determining whether WBV improves sensorimotor performance in people with PD.

DATA SOURCES

The sources used in this review were MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Excerpta Medica database (EMBASE), the Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database (PEDro) (last searched in April 2010).

STUDY SELECTION

Randomized and nonrandomized controlled studies examining the effects of WBV in people with PD were selected. Six studies fulfilled the selection criteria and were included in this review.

DATA EXTRACTION

The PEDro score was used to evaluate methodological quality. The effects of WBV on various sensorimotor outcomes were noted.

DATA SYNTHESIS

Methodological quality was rated as good for 1 study (PEDro score of 6), fair for 4 studies (PEDro score of 4 or 5), and poor for 1 study (PEDro score of 2). Two studies showed that, compared with no intervention, WBV treatment led to significant reductions in tremor and rigidity, as measured with the Unified Parkinson Disease Rating Scale (UPDRS). The findings for other UPDRS cluster scores were conflicting, however. Two studies showed that longer-term WBV (3-5 weeks) did not result in better sensorimotor outcomes than conventional exercise training.

LIMITATIONS

The studies reviewed here are limited by their methodological weaknesses and small, heterogeneous samples.

CONCLUSIONS

There is insufficient evidence to prove or refute the effectiveness of WBV in enhancing sensorimotor performance in people with PD (ie, grade D recommendations). More good-quality trials are needed to establish the clinical efficacy of WBV in improving sensorimotor function in people with PD.