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Zeng D, Zhao K, Lei W, Yu Y, Li W, Kong Y, Lai J, Ma F, Ye X, Zhang X. 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. Front Physiol 2024; 15:1295776. [PMID: 38322612 PMCID: PMC10844406 DOI: 10.3389/fphys.2024.1295776] [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] [Received: 09/17/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
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).
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Affiliation(s)
- Duchun Zeng
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Kun Zhao
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Wei Lei
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
- Graduate School, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanmei Yu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Weili Li
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Yurou Kong
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Junmei Lai
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Fenghao Ma
- Department of Physiotherapy, Shanghai Sunshine Rehabilitation Center, Tongji University School of Medicine, Shanghai, China
| | - Xiangming Ye
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
| | - Xiaofeng Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, China
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Mortada H, Ali Zahreldin A, Shafiek Saleh M, Shahien M, Elfeky A, Ibrahim Abdelhamed A, Elaraby A, Elzalabany A, Samir Hammad Y, Elshennawy S. The Efficacy of Whole-Body Vibration in Managing Postburn Victims' Complications: A Systematic Review. J Burn Care Res 2024; 45:48-54. [PMID: 37791999 DOI: 10.1093/jbcr/irad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 10/05/2023]
Abstract
Burn injury is a complicated traumatic event with both systemic and local consequences. These complications include long periods of bed rest, pain, muscle weakness, vitamin D deficiency, and bone mineral density loss. Whole-body vibration demonstrated effectiveness in improving muscle power and bone mineral density in various musculoskeletal populations. This systematic review of randomized controlled trials aims to assess evidence for the effectiveness of using whole-body vibration on postburn survivors with at least 1% total body surface area on sensory and motor outcomes. A systematic search was conducted across six databases, which are, PubMed, Cochrane, PEDro, Scopus, Web of Science, and Google Scholar, from inception till March 2022. Retrieved studies were screened by title and abstract and full-text in two stages using Rayyan web-based. Included studies were assessed for risk of bias using the Cochrane risk of bias tool ROB 2.0. Six randomized controlled trials with 203 participants were included. Five of the included studies demonstrated an overall high risk of bias. Compared to conventional physiotherapy programs, whole-body vibration demonstrated improvement in functional mobility and balance using timed up and go and Biodex balance assessment, respectively. However, there were no differences between whole-body vibration and conventional physiotherapy program alone in bone mineral density and muscle power. Although the current evidence of whole-body vibration is limited, whole-body vibration combined with traditional physical therapy programs may improve functional mobility and balance in postburn survivors compared to physical therapy programs alone.
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Affiliation(s)
- Hossam Mortada
- Biomechanics Unit, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | | | - Marwa Shafiek Saleh
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Al-Zaytoonah University of Jordan, Amman, Jordan
| | | | - Amr Elfeky
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | | | - Ahmed Elzalabany
- Faculty of Physical Therapy, Egyptian Chinese University, Cairo, Egypt
| | - Yara Samir Hammad
- College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Shorouk Elshennawy
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
- College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
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Yoon H, Park C. Effectiveness of Proprioceptive Body Vibration Rehabilitation on Motor Function and Activities of Daily Living in Stroke Patients with Impaired Sensory Function. Healthcare (Basel) 2023; 12:35. [PMID: 38200941 PMCID: PMC10779045 DOI: 10.3390/healthcare12010035] [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: 11/18/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Stroke patients experience impaired sensory and motor functions, which impact their activities of daily living (ADL). The current study was designed to determine the best neurorehabilitation method to improve clinical outcomes, including the trunk-impairment scale (TIS), Berg balance scale (BBS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI), in stroke patients with impaired sensory function. Forty-four stroke survivors consistently underwent proprioceptive body vibration rehabilitation training (PBVT) or conventional physical therapy (CPT) for 30 min/session, 5 days a week for 8 weeks. Four clinical outcome variables-the FMA, TIS, BBS, and MBI-were examined pre- and post-intervention. We observed significant differences in the FMA, BBS, and MBI scores between the PBVT and CPT groups. PBVT and CPT showed significant improvements in FMA, BBS, TIS, and MBI scores. However, PVBT elicited more favorable results than CPT in patients with stroke and impaired sensory function. Collectively, this study provides the first clinical evidence of optimal neurorehabilitation in stroke patients with impaired sensory function.
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Affiliation(s)
- Hyunsik Yoon
- Chungnam National University Hospital, Daejeon 35015, Republic of Korea;
- Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea
| | - Chanhee Park
- Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea
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4
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Wei N, Cai M. Optimal frequency of whole body vibration training for improving balance and physical performance in the older people with chronic stroke: A randomized controlled trial. Clin Rehabil 2021; 36:342-349. [PMID: 34796725 DOI: 10.1177/02692155211050564] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the optimal frequency of whole-body vibration training for improving the balance and physical performance in older people with chronic stroke. DESIGN a single-blind randomized controlled trial. SETTING Two rehabilitation units in the Wuhan Brain Hospital in China. PARTICIPANTS A total of 78 seniors with chronic stroke. INTERVENTIONS Low-frequency group (13 Hz), high-frequency group (26 Hz), and zero-frequency group (Standing on the vibration platform with 0 Hz) for 10 sessions of side-alternating WBV training. MAIN MEASURES The timed-up-and-go test, five-repetition sit-to-stand test, 10-metre walking test, and Berg balance scale were assessed pre- and post-intervention. RESULTS Significant time × group interaction effects in five-repetition sit-to-stand test (p = 0.014) and timed-up-and-go test at self-preferred speed (p = 0.028) were observed. The high-frequency group outperformed the zero-frequency group in both five-repetition sit-to-stand test (p = 0.039) and timed-up-and-go test at self-preferred speed (p = 0.024) after 10-sessions training. The low-frequency group displayed only a significant improvement in five-repetition sit-to-stand test after training (p = 0.028). No significant within- or between-group changes were observed in the Berg balance scale and walking speed (p > 0.05). No significant group-difference were found between low-frequency and high-frequency groups. No adverse events were reported during study. CONCLUSIONS Compared with 13 Hz, 26 Hz had no more benefits on balance and physical performance in older people with chronic stroke.
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Affiliation(s)
- Ning Wei
- Department of Rehabilitation Sciences, 74615Wuhan Polytechnic University, Hubei, China
| | - Mengying Cai
- Department of Rehabilitation Sciences, 74615Wuhan Polytechnic University, Hubei, China
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Maeda N, Urabe Y, Kotoshiba S, Komiya M, Morikawa M, Nishikawa Y, Sasadai J. Acute effects of local vibration stretching on ankle range of motion, vertical jump performance and dynamic balance after landing. ISOKINET EXERC SCI 2021. [DOI: 10.3233/ies-204155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Local vibration (LV) used as part of the warm-up can stimulate a specific body part and muscle group, potentially increasing muscle flexibility and performance. However, the effect of its combination with static stretching (SS) has not been thoroughly examined. OBJECTIVE: To elucidate the acute effectiveness of combining LV and SS (V+S) on the ROM of ankle dorsiflexion, squat jump, counter-movement jump (CMJ) and the dynamic postural stability index (DPSI). METHODS: Fifteen healthy men who were regularly involved in recreational sports participated in this study. Static Stretching, V+S, and non-stretching condition (control) were assigned randomly and the intervention period for each condition was five minutes. RESULTS: The dorsiflexion improved significantly in SS and V+S compared to the control. The CMJ height decreased significantly following SS compared to V+S and control. CONCLUSIONS: This study suggests that V+S improves ankle dorsiflexion ROM without compromising jump performance. Local vibration device could be an effective element in warming up but further research is warranted.
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Affiliation(s)
- Noriaki Maeda
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Urabe
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Somu Kotoshiba
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Komiya
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masanori Morikawa
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuichi Nishikawa
- Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Junpei Sasadai
- Sports Medical Center, Japan Institute of Sports Sciences, Japan
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Yang F, Butler AJ. Efficacy of Controlled Whole-Body Vibration Training on Improving Fall Risk Factors in Stroke Survivors: A Meta-analysis. Neurorehabil Neural Repair 2020; 34:275-288. [PMID: 32106762 DOI: 10.1177/1545968320907073] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background. Controlled whole-body vibration (CWBV) training has been applied to people with stroke. However, it remains inconclusive if CWBV reduces fall risk in this population. Objective. To (1) assess the immediate and retention effects of CWBV training on fall risk factors in people at postacute and chronic stages of stroke and (2) examine if CWBV dosage is correlated with the effect size (ES) for 3 fall risk factors: body balance, functional mobility, and knee strength. Methods. Twelve randomized controlled trials were included. ES was calculated as the standardized mean difference, and meta-analyses were completed using a random-effects model. Results. CWBV training may lead to improved balance and mobility immediately after training (ES = 0.27, P = .03 for balance; ES = 0.34, P = .02 for mobility) but not at the 3-month follow-up test (ES = 0.02, P = .89 for balance; ES = 0.70, P = .11 for mobility). CWBV affects knee strength capacity with mild ES (ES = 0.08 and 0.11, respectively, for immediate and retention effect; P ≥ .68 for both). Metaregression indicated that the immediate ES is strongly correlated with training dosage for balance (r = 0.649; P = .029) and mobility (r = 0.785; P = .036). Conclusions. CWBV training may benefit balance and mobility immediately, but the training effect may not persist among people with stroke. Additionally, the CWBV dosage correlates with the ES for body balance and mobility. More high-quality studies are needed to determine the retention effects of CWBV training.
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Affiliation(s)
- Feng Yang
- Georgia State University, Atlanta, GA, USA
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Ferrer Pastor M, Iñigo Huarte V, Juste Díaz J, Goiri Noguera D, Sogues Colom A, Cerezo Durá M. [Systematic review of the treatment of spasticity in acquired adult brain damage]. Rehabilitacion (Madr) 2020; 54:51-62. [PMID: 32007183 DOI: 10.1016/j.rh.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/12/2019] [Accepted: 06/25/2019] [Indexed: 10/25/2022]
Abstract
Spasticity is a motor disorder characterised by an increase in muscle tone that appears as a consequence of a central nervous system disorder, leading to deficit and disability and impairing quality of life. In acquired adult brain damage, spasticity is a severe and frequent problem, appearing in 20-30% of patients with stroke and in 13-20% of patients with moderate-severe traumatic brain injury. The main objective of this study was to perform a systematic review of the treatments used in spasticity in adult patients with acquired brain damage secondary to stroke and head trauma. A systematic search of randomised controlled trials, published between January 1, 2013 and June 30, 2017 in English and Spanish, was carried out in the PubMed, Cochrane plus Library and Ovid databases. We finally selected 17 studies, with methodological quality that was at least acceptable according to the Jadad scale. The most frequently investigated treatments are botulinum toxin, especially serotype A, together with rehabilitative measures. Clinical scales are the most frequently used to assess spasticity.
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Affiliation(s)
- M Ferrer Pastor
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - V Iñigo Huarte
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - J Juste Díaz
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - D Goiri Noguera
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - A Sogues Colom
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - M Cerezo Durá
- Servicio de Medicina Física y Rehabilitación, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Sade I, Çekmece Ç, İnanir M, SelÇuk B, Dursun N, Dursun E. The Effect of Whole Body Vibration Treatment on Balance and Gait in Patients with Stroke. ACTA ACUST UNITED AC 2019; 57:308-311. [PMID: 33354124 DOI: 10.29399/npa.23380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/07/2018] [Indexed: 11/07/2022]
Abstract
Introduction In patients with neurological disorders Whole Body Vibration (WBV) has been reported to improve motor function. Our aim was to assess the effects of WBV on both balance and walking performance in adult stroke patients. Methods Forty three post-stroke patients were randomly divided into two groups. One would receive WBV therapy (WBV group) while the control group would not. All patients participated in a conventional rehabilitation program for three weeks while the vibration group also received WBV over the same period. Patients balance and walking performance were evaluated using the Berg Balance Scale (BBS), Timed Up and Go Test (TUG) and computerized gait analysis. All evaluations were performed before and after therapy. Results The median (range) age of all patients was 51.00 (18-66) years. The groups numbered 26 and 17 patients for the WBV and control groups respectively. After intervention, significant improvements were found in the WBV group for BBS score (p=0.004), TUG score (p=0.035), step length (p=0.004) and walking speed (p=0.031) when compared to the controls. Conclusion WBV is effective for the improvement of balance and gait performance in stroke patients.
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Affiliation(s)
- Ilgın Sade
- Department of Physical Medicine and Rehabilitation, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Çiğdem Çekmece
- Yahya Kaptan Occupational Therapy School, Kocaeli University, Kocaeli, Turkey
| | - Murat İnanir
- Department of Physical Medicine and Rehabilitation, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Barın SelÇuk
- Department of Physical Medicine and Rehabilitation, Okan University Faculty of Medicine, İstanbul, Turkey
| | - Nigar Dursun
- Department of Physical Medicine and Rehabilitation, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
| | - Erbil Dursun
- Department of Physical Medicine and Rehabilitation, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Edwards LL, King EM, Buetefisch CM, Borich MR. Putting the "Sensory" Into Sensorimotor Control: The Role of Sensorimotor Integration in Goal-Directed Hand Movements After Stroke. Front Integr Neurosci 2019; 13:16. [PMID: 31191265 PMCID: PMC6539545 DOI: 10.3389/fnint.2019.00016] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/03/2019] [Indexed: 12/31/2022] Open
Abstract
Integration of sensory and motor information is one-step, among others, that underlies the successful production of goal-directed hand movements necessary for interacting with our environment. Disruption of sensorimotor integration is prevalent in many neurologic disorders, including stroke. In most stroke survivors, persistent paresis of the hand reduces function and overall quality of life. Current rehabilitative methods are based on neuroplastic principles to promote motor learning that focuses on regaining motor function lost due to paresis, but the sensory contributions to motor control and learning are often overlooked and currently understudied. There is a need to evaluate and understand the contribution of both sensory and motor function in the rehabilitation of skilled hand movements after stroke. Here, we will highlight the importance of integration of sensory and motor information to produce skilled hand movements in healthy individuals and individuals after stroke. We will then discuss how compromised sensorimotor integration influences relearning of skilled hand movements after stroke. Finally, we will propose an approach to target sensorimotor integration through manipulation of sensory input and motor output that may have therapeutic implications.
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Affiliation(s)
- Lauren L Edwards
- Neuroscience Graduate Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, United States
| | - Erin M King
- Neuroscience Graduate Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, United States
| | - Cathrin M Buetefisch
- Department of Rehabilitation Medicine, Laney Graduate School, Emory University, Atlanta, GA, United States.,Department of Neurology, Emory University, Atlanta, GA, United States.,Department of Radiology and Imaging Sciences, School of Medicine, Emory University, Atlanta, GA, United States
| | - Michael R Borich
- Department of Rehabilitation Medicine, Laney Graduate School, Emory University, Atlanta, GA, United States
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Effects of Stochastic Resonance Whole-Body Vibration in Individuals with Unilateral Brain Lesion: A Single-Blind Randomized Controlled Trial: Whole-Body Vibration and Neuromuscular Function. Rehabil Res Pract 2018; 2018:9319258. [PMID: 30155308 PMCID: PMC6093017 DOI: 10.1155/2018/9319258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 07/18/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Stochastic resonance whole-body vibration (SR-WBV) devices are promising sensorimotor interventions to address muscle weakness and to improve balance and mobility particularly in the elderly. However, it remains inconclusive whether individuals with stroke or traumatic brain injury (TBI) can profit from this method. The aim of this prospective single-blind randomized controlled trial was to investigate the effects of SR-WBV on muscle strength as well as gait and balance performance in this population. Methods Forty-eight individuals with stroke or TBI were randomly allocated to an experimental and a sham group. Participants were exposed daily to 5 consecutives 1-minute SR-WBV sessions, whereas the experimental group trained in a standing position with 5 Hz and the sham group in a seated position with 1 Hz. Isometric muscle strength properties of the paretic knee extensor muscles as well as balance and gait performance were measured at baseline, after the first session and after two weeks of SR-WBV. Results Both groups showed short- and long-term effects in gait performance. However, no between-group effects could be found at the three measurement points. Discussion Complementary SR-WBV showed no beneficial effects immediately after the intervention and after two weeks of conventional rehabilitation therapy. Future research is needed to identify the potential efficacy of SR-WBV in individuals with stroke and TBI using shorter and less exhausting test procedures and a generally prolonged intervention time.
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Alp A, Efe B, Adalı M, Bilgiç A, Demir Türe S, Coşkun Ş, Karabulut M, Ertem U, Günay SM. The Impact of Whole Body Vibration Therapy on Spasticity and Disability of the Patients with Poststroke Hemiplegia. Rehabil Res Pract 2018; 2018:8637573. [PMID: 30225145 PMCID: PMC6129331 DOI: 10.1155/2018/8637573] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/11/2018] [Accepted: 03/12/2018] [Indexed: 12/27/2022] Open
Abstract
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.
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Affiliation(s)
- Alev Alp
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Bilge Efe
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Mihriban Adalı
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Adnan Bilgiç
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Sevda Demir Türe
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Şeyma Coşkun
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Merve Karabulut
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Uğur Ertem
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
| | - Selim Mahmut Günay
- Faculty of Medicine, Physical Therapy and Rehabilitation Department, Uludag University, Bursa, Turkey
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Comparison of the Effectiveness of Whole Body Vibration in Stroke Patients: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:5083634. [PMID: 29487869 PMCID: PMC5816889 DOI: 10.1155/2018/5083634] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/21/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022]
Abstract
Objectives The goals of this study were to assess the effectiveness of WBV (whole body vibration) training through an analysis of effect sizes, identify advantages of WBV training, and suggest other effective treatment methods. Methods Four databases, namely, EMBASE, PubMed, EBSCO, and Web of Science, were used to collect articles on vibration. Keywords such as "vibration" and "stroke" were used in the search for published articles. Consequently, eleven studies were selected in the second screening using meta-analyses. Results The total effect size of patients with dementia in the studies was 0.25, which was small. The effect size of spasticity was the greatest at 1.24 (high), followed by metabolism at 0.99 (high), balance, muscle strength, gait, and circulation in the decreasing order of effect size. Conclusions The effect sizes for muscle strength and balance and gait function, all of which play an important role in performance of daily activities, were small. In contrast, effect sizes for bone metabolism and spasticity were moderate. This suggests that WBV training may provide a safe, alternative treatment method for improving the symptoms of stroke in patients.
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Liao LR, Ng GYF, Jones AYM, Huang MZ, Pang MYC. Whole-Body Vibration Intensities in Chronic Stroke: A Randomized Controlled Trial. Med Sci Sports Exerc 2017; 48:1227-38. [PMID: 26918558 DOI: 10.1249/mss.0000000000000909] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE A single-blinded randomized controlled study was conducted to investigate the effects of different whole-body vibration (WBV) intensities on body functions/structures, activity, and participation in individuals with stroke. METHODS Eighty-four individuals with chronic stroke (mean age = 61.2 yr, SD = 9.2) with mild to moderate motor impairment (Chedoke-McMaster Stroke Assessment lower limb motor score: median = 9 out of 14, interquartile range = 7-11.8) were randomly assigned to a low-intensity WBV, high-intensity WBV, or control group. The former two groups performed various leg exercises while receiving low-intensity and high-intensity WBV, respectively. Controls performed the same exercises without WBV. All individuals received 30 training sessions over an average period of 75.5 d (SD = 5.2). Outcome measurements included knee muscle strength (isokinetic dynamometry), knee and ankle joint spasticity (Modified Ashworth Scale), balance (Mini Balance Evaluation Systems Test), mobility (Timed-Up-and-Go test), walking endurance (6-Minute Walk Test), balance self-efficacy (Activities-specific Balance Confidence scale), participation in daily activities (Frenchay Activity Index), perceived environmental barriers to societal participation (Craig Hospital Inventory of Environmental Factors), and quality of life (Short-Form 12 Health Survey). Assessments were performed at baseline and postintervention. RESULTS Intention-to-treat analysis revealed a significant time effect for muscle strength, Timed-Up-and-Go distance, and oxygen consumption rate achieved during the 6-Minute Walk Test, the Mini Balance Evaluation Systems Test, the Activities-specific Balance Confidence scale, and the Short-Form 12 Health Survey physical composite score domain (P < 0.05). However, the time-group interaction was not significant for any of the outcome measures (P > 0.05). CONCLUSION The addition of the 30-session WBV paradigm to the leg exercise protocol was no more effective in enhancing body functions/structures, activity, and participation than leg exercises alone in chronic stroke patients with mild to moderate motor impairments.
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Affiliation(s)
- Lin-Rong Liao
- 1Department of Physiotherapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, CHINA; 2Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, CHINA; and 3School of Allied Health Sciences, Griffith University, Gold Coast, AUSTRALIA
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Kim DY, Kim YH, Lee J, Chang WH, Kim MW, Pyun SB, Yoo WK, Ohn SH, Park KD, Oh BM, Lim SH, Jung KJ, Ryu BJ, Im S, Jee SJ, Seo HG, Rah UW, Park JH, Sohn MK, Chun MH, Shin HS, Lee SJ, Lee YS, Park SW, Park YG, Paik NJ, Lee SG, Lee JK, Koh SE, Kim DK, Park GY, Shin YI, Ko MH, Kim YW, Yoo SD, Kim EJ, Oh MK, Chang JH, Jung SH, Kim TW, Kim WS, Kim DH, Park TH, Lee KS, Hwang BY, Song YJ. Clinical Practice Guideline for Stroke Rehabilitation in Korea 2016. BRAIN & NEUROREHABILITATION 2017. [DOI: 10.12786/bn.2017.10.e11] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Deog Young Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Korea
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Suk Hoon Ohn
- Department of Physical Medicine and Rehabilitation, Hallym University College of Medicine, Korea
| | - Ki Deok Park
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Kang Jae Jung
- Department of Physical Medicine and Rehabilitation, Eulji University Hospital & Eulji University School of Medicine, Korea
| | - Byung-Ju Ryu
- Department of Physical Medicine and Rehabilitation, Sahmyook Medical Center, Korea
| | - Sun Im
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Sung Ju Jee
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Ueon Woo Rah
- Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Min Kyun Sohn
- Department of Rehabilitation Medicine, Chungnam National University College of Medicine, Korea
| | - Min Ho Chun
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Korea
| | - Hee Suk Shin
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Seong Jae Lee
- Department of Rehabilitation Medicine, College of Medicine Dankook University, Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Korea
| | - Si-Woon Park
- Department of Rehabilitation Medicine, Catholic Kwandong University International St Mary's Hospital, Korea
| | - Yoon Ghil Park
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Nam Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Korea
| | - Ju Kang Lee
- Department of Rehabilitation Medicine, Gachon University College of Medicine, Korea
| | - Seong-Eun Koh
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Korea
| | - Don-Kyu Kim
- Department of Physical Medicine and Rehabilitation, College of Medicine, Chung-Ang University, Korea
| | - Geun-Young Park
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Yong Il Shin
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Myoung-Hwan Ko
- Department of Physical Medicine and Rehabilitation, Chonbuk National University Medical School, Korea
| | - Yong Wook Kim
- Department of Rehabilitation Medicine, Yonsei University College of Medicine, Korea
| | - Seung Don Yoo
- Department of Physical Medicine and Rehabilitation, Kyung Hee University College of Medicine, Korea
| | - Eun Joo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Hospital, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine and Institute of Health Sciences, Gyeongsang National University College of Medicine, Korea
| | - Jae Hyeok Chang
- Department of Rehabilitation Medicine, Pusan National University Hospital, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Tae-Woo Kim
- TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Korea
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Korea
| | - Kwan-Sung Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Korea
| | - Byong-Yong Hwang
- Department of Physical Therapy, Yong-In University College of Health & Welfare, Korea
| | - Young Jin Song
- Department of Rehabilitation Medicine, Asan Medical Center, Korea
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Liao LR, Pang MYC. Effect of Whole-Body Vibration on Neuromuscular Activation of Leg Muscles During Dynamic Exercises in Individuals With Stroke. J Strength Cond Res 2016; 31:1954-1962. [PMID: 28002180 DOI: 10.1519/jsc.0000000000001761] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Liao, L-R, and Pang, MYC. Effect of whole-body vibration on neuromuscular activation of leg muscles during dynamic exercises in individuals with stroke. J Strength Cond Res 31(7): 1954-1962, 2017-This study examined the leg muscle activity during exposure to different whole-body vibration (WBV) intensities while performing various dynamic exercises in patients with chronic stroke. Thirty patients with chronic stroke performed a series of dynamic exercises under 3 conditions: (a) low-intensity WBV (peak acceleration: 0.96 units of gravity of Earth [g]), (b) high-intensity WBV (1.61 g), and (c) no WBV. Neuromuscular activation was recorded with surface electromyography (EMG) on bilateral biceps femoris (BF), vastus lateralis, tibialis anterior (TA), and gastrocnemius (GS) in both legs and was reported as EMGrms (root mean square) normalized to % maximal voluntary contraction. The EMG amplitude of all tested muscles was significantly increased by adding WBV during dynamic exercise (p ≤ 0.05). The EMG amplitude of BF, TA, and GS during exposure to high-intensity WBV was significantly greater than low-intensity WBV (p ≤ 0.05). The increase in EMG amplitude caused by WBV was exercise dependent in GS and TA (p ≤ 0.05). The EMG response to WBV in GS and BF in the affected leg was significantly greater than the corresponding muscles in the unaffected leg (p ≤ 0.05). The extent of WBV-induced muscle activity was dependent on the dynamic exercise, WBV intensity, and muscle trained among patients with chronic stroke.
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Affiliation(s)
- Lin-Rong Liao
- 1Department of Rehabilitation, Jiangsu Provincial Yixing Jiuru Rehabilitation Hospital, Yixing, China; and 2Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Huang M, Liao LR, Pang MYC. Effects of whole body vibration on muscle spasticity for people with central nervous system disorders: a systematic review. Clin Rehabil 2016; 31:23-33. [DOI: 10.1177/0269215515621117] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To examine the effects of whole-body vibration on spasticity among people with central nervous system disorders. Methods: Electronic searches were conducted using CINAHL, Cochrane Library, MEDLINE, Physiotherapy Evidence Database, PubMed, PsycINFO, SPORTDiscus and Scopus to identify randomized controlled trials that investigated the effect of whole-body vibration on spasticity among people with central nervous system disorders (last search in August 2015). The methodological quality and level of evidence were rated using the PEDro scale and guidelines set by the Oxford Centre for Evidence-Based Medicine. Results: Nine trials with totally 266 subjects (three in cerebral palsy, one in multiple sclerosis, one in spinocerebellar ataxia, and four in stroke) fulfilled all selection criteria. One study was level 1b (PEDro⩾6 and sample size>50) and eight were level 2b (PEDro<6 or sample size ⩽50). All three cerebral palsy trials (level 2b) reported some beneficial effects of whole-body vibration on reducing leg muscle spasticity. Otherwise, the results revealed no consistent benefits on spasticity in other neurological conditions studied. There is little evidence that change in spasticity was related to change in functional performance. The optimal protocol could not be identified. Many reviewed studies were limited by weak methodological and reporting quality. Adverse events were minor and rare. Conclusion: Whole-body vibration may be useful in reducing leg muscle spasticity in cerebral palsy but this needs to be verified by future high quality trials. There is insufficient evidence to support or refute the notion that whole-body vibration can reduce spasticity in stroke, spinocerebellar ataxia or multiple sclerosis.
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Affiliation(s)
- Meizhen Huang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
| | - Lin-Rong Liao
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
- Department of Physiotherapy, Guangdong Provincial Work Injury Rehabilitation Hospital, Guangzhou, China
| | - Marco YC Pang
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong, China
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Effects of Vibration Intensity, Exercise, and Motor Impairment on Leg Muscle Activity Induced by Whole-Body Vibration in People With Stroke. Phys Ther 2015; 95:1617-27. [PMID: 26023219 DOI: 10.2522/ptj.20140507] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 05/20/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Whole-body vibration (WBV) has increasingly been used as an adjunct treatment in neurological rehabilitation. However, how muscle activation level changes during exposure to different WBV protocols in individuals after stroke remains understudied. OBJECTIVE The purpose of this study was to examine the influence of WBV intensity on the magnitude of biceps femoris (BF) and tibialis anterior (TA) muscle activity and its interaction with exercise and with severity of motor impairment and spasticity among individuals with chronic stroke. METHODS Each of the 36 individuals with chronic stroke (mean age=57.3 years, SD=10.7) performed 8 different static exercises under 3 WBV conditions: (1) no WBV, (2) low-intensity WBV (frequency=20 Hz, amplitude=0.60 mm, peak acceleration=0.96g), and (3) high-intensity WBV (30 Hz, 0.44 mm, 1.61g). The levels of bilateral TA and BF muscle activity were recorded using surface electromyography (EMG). RESULTS The main effect of intensity was significant. Exposure to the low-intensity and high-intensity protocols led to a significantly greater increase in normalized BF and TA muscle electromyographic magnitude in both legs compared with no WBV. The intensity × exercise interaction also was significant, suggesting that the WBV-induced increase in EMG activity was exercise dependent. The EMG responses to WBV were similar between the paretic and nonparetic legs and were not associated with level of lower extremity motor impairment and spasticity. LIMITATIONS Leg muscle activity was measured during static exercises only. CONCLUSIONS Adding WBV during exercise significantly increased EMG activity in the TA and BF muscles. The EMG responses to WBV in the paretic and nonparetic legs were similar and were not related to degree of motor impairment and spasticity. The findings are useful for guiding the design of WBV training protocols for people with stroke.
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Goebel RT, Kleinöder H, Yue Z, Gosh R, Mester J. Effect of Segment-Body Vibration on Strength Parameters. SPORTS MEDICINE-OPEN 2015; 1:14. [PMID: 26258006 PMCID: PMC4526247 DOI: 10.1186/s40798-015-0022-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/21/2015] [Indexed: 12/19/2022]
Abstract
Background In this study, we examine the biomechanical advantage of combining localized vibrations to hamstring muscles involved in a traditional resistance training routine. Methods Thirty-six male and female participants with at least 2 years of experience in resistance training were recruited from the German Sport University Cologne. The participants were randomized into two training groups: vibration training group (VG) and traditional training group (TTG). Both groups underwent a 4-week training phase, where each participant worked out at 70 % of the individual 1 repeat maximum (RM—maximum load capacity of a muscle for one lift to fatigue) (4 sets with 12 repetitions each). For participants in the VG group, local vibration was additionally applied directly to hamstring muscles during exercise. A 2-week examination phase preceded the pretests. After the pretests, the subjects underwent a prescribed training for 4 weeks. At the conclusion of the training, a 2-week detraining was imposed and then the study concluded with posttests and retest. Results The measured parameters were maximum isometric force of the hamstrings and maximum range of motion and muscle tension at maximum knee angle. The study revealed a significant increase in maximum isometric force in both training groups (VG = 21 %, TTG = 14 %). However, VG groups showed an increase in their range of motion by approximately 2 %. Moreover, the muscle tension at maximum knee angle increased less in VG (approximately 35 %) compared to TG (approximately 46 %). Conclusions We conclude that segment-body vibrations applied in resistance training can offer an effective tool to increase maximum isometric force, compared to traditional training. The cause for these findings can be attributed to the additional local vibration stimulus.
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Affiliation(s)
| | - Heinz Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Zengyuan Yue
- The German Research Center, Center of Elite Sport, German Sport University Cologne, Cologne, Germany
| | - Ranajay Gosh
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA USA
| | - Joachim Mester
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
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Pang MYC. The use of whole-body vibration in the neurological population: What is the evidence? PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x14y.0000000162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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