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Hassan Z, Hadian MR, Hussain SA, Shadmehr A, Talebian S, Bagheri H, Mir SM, Arslan SA. Comparison of the Conjunct Effects of Electrical Stimulation and Whole-Body Vibration Therapy with Transcranial Direct Current Stimulation and Whole-body Vibration Therapy on Balance and Function in Children With Spastic Cerebral Palsy. Cureus 2024; 16:e61511. [PMID: 38957262 PMCID: PMC11217583 DOI: 10.7759/cureus.61511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral palsy is a neurodevelopmental condition that results in impaired movement and posture, often accompanied by disturbances in balance and functional abilities. Recent advances in neurorehabilitation, including whole-body vibration therapy (WBVT), functional electrical stimulation, and transcranial direct current stimulation, show promise in enhancing traditional interventions and fostering neuroplasticity. However, the efficacy of their conjunct effects remains largely uncharted territory and warrants further exploration. The objective of the study was to compare the conjunct effects of functional electrical stimulation (FES) and WBVT with transcranial direct current stimulation (tDCS) and WBVT on lower extremity range of motion (ROM), dynamic balance, functional mobility, isometric muscle strength and hand grip strength in children with spastic cerebral palsy. METHODS A randomized clinical trial was carried out on 42 children of both genders with spastic cerebral palsy, aged 5-15 years. The children were divided at random into three groups (14 in each group). In Group A, there were three (21.42%) males and 11 (78.57%) females, in Group B, eight (57.14%) were males and six (42.85%) were females, and in Group C, six (42.85%) children were males and eight (57.14%) were females. Group A received WBVT only, Group B received WBVT and FES, and Group C received WBVT and tDCS. The intervention was applied four times a week for four consecutive weeks. The data was collected two times before and immediately after four weeks of intervention. Lower extremity ROM was measured by a goniometer, functional mobility or dynamic balance was measured by a Time Up and Go test, isometric muscle strength was measured by a digital force gauge, and hand grip strength was assessed by a digital hand-held dynamometer. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was utilized for statistical analysis. RESULTS The mean age of the children in groups A, B, and C was 12.21±2.11 years, 11.71±2.01, and 11.07±2.01 years respectively. Intergroup analysis revealed a statistically significant difference (p<0.05) in the lower extremity range of motion, and functional mobility. Hand grip strength and isometric muscle strength between three groups. Post hoc analysis revealed that WBVT with transcranial direct current stimulation combined showed the most improvement. CONCLUSION The study concluded that positive effects were seen in all three groups but tDCS with WBVT was found to be most effective in improving lower extremity ROM, functional mobility or dynamic balance, isometric muscle strength, and hand grip strength in children with spastic CP. The differences between the groups were statistically significant. The effect size was substantial enough to surpass established clinical benchmarks, indicating that the observed improvements are likely to have meaningful and beneficial impacts on patient outcomes.
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Affiliation(s)
- Zainab Hassan
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Mohammad-Reza Hadian
- Brain and Spinal Cord Injury Research Center, Institute of Neuroscience, Tehran, IRN
| | - Syed Ali Hussain
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Azadeh Shadmehr
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Saeed Talebian
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Hossein Bagheri
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - S Mohsen Mir
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
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Han YG, Kim MK. Effectiveness of whole-body vibration in patients with cerebral palsy: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e36441. [PMID: 38050249 PMCID: PMC10695530 DOI: 10.1097/md.0000000000036441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND This study examined the effects of systemic vibration exercises on cerebral palsy patients. METHODS Literature published in Cumulated Index to Nursing and Allied Health Literature (CINAHL), Cochrane library, Embase, Physiotherapy Evidence Database (PEDro), and PubMed was reviewed. A total of 2978 studies were initially retrieved. After further reading of the full texts 17 articles were finally included. A quality assessment of the included studies was conducted using the risk of bias (RoB) 2.0, and the Funnel plot and the Egger test were conducted to confirm the publication bias. Subgroup analysis was carried out according to the dependent variables, the international classification of functioning, disability, and health (ICF), frequency, treatment period and age. RESULTS The overall effect size of homogeneity was 0.474 (CI = 0.148-0.801). The analysis of the dependent variables showed the following order of the effect size: balance, muscle strength, spasticity, bone density, range of motion of the joint, gait function, and motor function. In the ICF classification, the effect size was observed to follow the order of body structure and function, activity, and participation. The effect size in the intervention according to the treatment period showed the following order: 7 to 12 weeks, 1 to 6 weeks, and 14 to 24 weeks. The age-dependent classification showed the following order in the effect size: school age, adolescent and adult, and infant and school age. CONCLUSIONS Systemic vibration is the most effective intervention to improve the balance and gait in patients with cerebral palsy and improve the body structure and function according to the ICF.
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Affiliation(s)
- Yong-Gu Han
- Department of Physical Therapy, Daegu University Medical Clinic, Republic of Korea, Republic of Korea
| | - Myoung-Kwon Kim
- Department of Physical Therapy, College of Rehabilitation Sciences, Daegu University, Jillyang, Gyeongsan, Gyeongbuk, Republic of Korea
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Pulay MÁ, Nagy R, Kói T, Harnos A, Zimonyi N, Garami M, Gasparics Á, Hegyi P, Túri I, Feketéné Szabó É. The Effect of Additional Whole-Body Vibration on Musculoskeletal System in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Med 2023; 12:6759. [PMID: 37959224 PMCID: PMC10648882 DOI: 10.3390/jcm12216759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Nowadays, whole-body vibration (WBV) has become increasingly popular as an additional therapy in the intervention of patients with cerebral palsy (CP). However, the impact of WBV remains a subject of debate. Consequently, a systematic review and meta-analysis were undertaken to evaluate the effects of WBV on the musculoskeletal system in children with CP. Randomized controlled trials (RCTs) were sought in the most frequent databases. The intervention studied was WBV combined with conventional physiotherapy (PT) compared with conventional PT as the control; the main outcomes were changes in the musculoskeletal system. Weighted mean differences with 95%CIs were calculated. A random-effects model was applied, and the publication bias was checked using funnel plots. On the basis of the inclusion and exclusion criteria, 16 articles, including 414 patients, were considered in the final analysis. The improvement in walking performance (speed and step length) was statistically significant (p < 0.05), and although there were no significant differences in the further outcomes, a clear positive tendency was visible in the case of improved muscle strength, decreased spasticity, enhanced gross motor functions, and overall stability. Based on the findings, a clear assessment of the usefulness of this intervention cannot be made; nonetheless, due to the promising results, it would be worthwhile to conduct additional RCTs to enhance the available evidence in this field. Due to the wide range of vibration configurations, including varying durations and intensities, it is suggested to establish guidelines and a strategy for the incorporation of this additional treatment.
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Affiliation(s)
- Márk Ágoston Pulay
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (R.N.); (T.K.); (A.H.); (N.Z.); (P.H.)
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary; (I.T.); (É.F.S.)
- Department of Ergonomics and Psychology, Faculty of Economic and Social Sciences, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (R.N.); (T.K.); (A.H.); (N.Z.); (P.H.)
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7622 Pécs, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (R.N.); (T.K.); (A.H.); (N.Z.); (P.H.)
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Andrea Harnos
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (R.N.); (T.K.); (A.H.); (N.Z.); (P.H.)
- Department of Biostatistics, University of Veterinary Medicine, 1078 Budapest, Hungary
| | - Nóra Zimonyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (R.N.); (T.K.); (A.H.); (N.Z.); (P.H.)
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary; (I.T.); (É.F.S.)
| | - Miklós Garami
- Pediatric Center, Semmelweis University, 1085 Budapest, Hungary;
| | - Ákos Gasparics
- Department of Obstetrics and Gynecology, Semmelweis University, 1088 Budapest, Hungary;
- Division of Neonatology, Department of Pediatrics, Semmelweis University, 1083 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (R.N.); (T.K.); (A.H.); (N.Z.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7622 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, 1085 Budapest, Hungary
| | - Ibolya Túri
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary; (I.T.); (É.F.S.)
| | - Éva Feketéné Szabó
- András Pető Faculty, Semmelweis University, 1125 Budapest, Hungary; (I.T.); (É.F.S.)
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Cai X, Qian G, Cai S, Wang F, Da Y, Ossowski Z. The effect of whole-body vibration on lower extremity function in children with cerebral palsy: A meta-analysis. PLoS One 2023; 18:e0282604. [PMID: 36897858 PMCID: PMC10004558 DOI: 10.1371/journal.pone.0282604] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 02/18/2023] [Indexed: 03/11/2023] Open
Abstract
OBJECTIVE The aim of this meta-analysis was to evaluate the effect of whole-body vibration training on lower limb motor function in children with cerebral palsy in randomized-controlled trials (RCTs). METHODS Two independent reviewers systematically searched the records of nine databases (PubMed, Cochrane, Web of Science, EMBASE, CNKI, etc.) from inception to December 2022. Tools from the Cochrane Collaboration were used to assess risk of bias. Standard meta-analyses were performed using Stata 16.0 and Revman 5.3. For continuous variables, the arms difference was calculated as the weighted mean difference (WMD) between the values before and after the intervention and its 95% confidence interval (95% CI). RESULTS Of the 472 studies identified, 13 (total sample size 451 participants) met the inclusion criteria. Meta-analysis showed that WBV training could effectively improve GMFM88-D [WMD = 2.46, 95% CI (1.26, 3.67), P<0.01] and GMFM88-E [WMD = 3.44, 95% CI (1.21, 5.68), P = 0.003], TUG [WMD = -3.17, 95% CI (-5.11, -1.24), P = 0.001], BBS [WMD = 4.00,95% CI (3.29, 4.71), P<0. 01] and the range of motion of ankle joint and the angle of ankle joint during muscle reaction in children with cerebral palsy. The effect of WBV training on 6MWT walking speed [WMD = 47.64, 95% CI (-25.57, 120.85), p = 0.20] in children with cerebral palsy was not significantly improved. CONCLUSION WBV training is more effective than other types of conventional physical therapy in improving the lower limb motor function of children with cerebral palsy. The results of this meta-analysis strengthen the evidence of previous individual studies, which can be applied to the clinical practice and decision-making of WBV training and rehabilitation in children with cerebral palsy.
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Affiliation(s)
- Xiaoye Cai
- Shanghai Normal University Tianhua College, Shanghai, P. R. China
| | - Guoping Qian
- Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Siyuan Cai
- Victoria university of Wellington, Wellington, New Zealand
| | - Feng Wang
- Shanghai Ocean University, Shanghai, P. R. China
| | - Yingjuan Da
- Shanghai Normal University Tianhua College, Shanghai, P. R. China
| | - Zbigniew Ossowski
- Gdansk University of Physical Education and Sport, Gdańsk, Poland
- * E-mail:
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Swiggum M, Grant L. Monitoring Procedural Pain and Distress in a Child With Rett Syndrome: A Case Report. Pediatr Phys Ther 2019; 31:E1-E5. [PMID: 31469772 DOI: 10.1097/pep.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Whole body vibration training is a viable option for children with Rett syndrome; however, the positioning requirements and intense vibration may be interpreted as pain. CASE A 13-year-old girl with a diagnosis of Rett syndrome, Stage IV, participated. The Individualized Numeric Rating Scale was developed in collaboration with the caregiver and scored by a physical therapist and student physical therapists during 16 sessions of whole body vibration training. OUTCOMES The therapist and students reached 100% agreement on the Individualized Numeric Rating Scale ratings and successfully provided distractions to prevent pain and distress from reaching a level 5 out of 10 for 139 of 144 sessions. CONCLUSION This is the first case in the literature to demonstrate use of the Individualized Numeric Rating Scale with a child who is nonverbal during a potentially painful physical therapy procedure.
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Pin TW, Butler PB, Purves S. Use of whole body vibration therapy in individuals with moderate severity of cerebral palsy- a feasibility study. BMC Neurol 2019; 19:80. [PMID: 31043157 PMCID: PMC6495512 DOI: 10.1186/s12883-019-1307-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background This pilot study was to examine the feasibility and tolerance of whole body vibration therapy (WBVT) for children and adults with moderate severity of cerebral palsy (CP) being graded as levels III or IV on the Gross Motor Function Classification Scale (GMFCS). Methods Study participants received the additional WBVT when standing still on the vibration platform for three 3-min bouts of vibration (20 Hz, 2 mm amplitude), 4 days per week for 4 weeks. In addition to questions relating to feasibility and participants’ opinions, assessment at baseline and completion of the intervention included the Gross Motor Function Measure-66 Item Set (GMFM-66 IS), 2-min walk test (2MWT), Timed Up and Go test (TUG) and Pediatric Evaluation of Disability Inventory (PEDI). Wilcoxon Signed Ranks test was used to compare the results. Results Fourteen participants (mean age = 25.25 years SD 3.71; 9 males, 64%; GMFCS level III n = 13, 92%) were recruited and completed the study. The attendance rate was over 90% with no adverse events. All participants tolerated the protocol which was satisfactorily delivered in a clinical setting. Conclusions The present WBVT protocol was feasible, safe and well-tolerated by the participants with moderate severity of CP, justifying future studies with larger samples and more rigorous study design. Trial registration The present study has been registered under the ClinicalTrials.gov (NCT03375736) and the date of registration commenced on 18 December 2017.
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Affiliation(s)
- Tamis W Pin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | | | - Sheila Purves
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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