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Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease.

Ebersbach G, Edler D, Kaufhold O, Wissel J.

Movement Disorders Clinic, Beelitz-Heilstätten, Germany. [email protected]

OBJECTIVE: To compare the effects of whole body vibration (WBV) and conventional physiotherapy (PT) on levodopa-resistant disturbances of balance and gait in idiopathic Parkinson's disease (PD). DESIGN: Randomized controlled rater-blinded trial comparing 2 active interventions, final follow-up assessment 4 weeks after termination of active intervention. SETTING: Specialized referral center, hospitalized care. PARTICIPANTS: Patients with PD and dopa-resistant imbalance on stable dopamine replacement medication (N=27) were randomized (intent-to-treat population) to receive WBV (n=13) or conventional PT (controls, n=14). Twenty-one patients (per protocol population) completed follow-up (14 men, 7 women; mean age, 73.8 y; age range, 62-84 y; mean disease duration, 7.2 y; mean dopa-equivalent dose, 768 mg/d). INTERVENTION: Subjects were randomized to receive 30 sessions (two 15-min sessions a day, 5 days a week) of either WBV on an oscillating platform or conventional balance training including exercises on a tilt board. Twenty-one subjects (10 with WBV, 11 controls) were available for follow-up 4 weeks after treatment termination. MAIN OUTCOME MEASURES: The primary measure was Tinetti Balance Scale score. Secondary clinical ratings included stand-walk-sit test, walking velocity, Unified Parkinson's Disease Rating Scale (section III motor examination) score, performance in the pull test, and dynamic posturography. RESULTS: The Tinetti score improved from 9.3 to 12.8 points in the WBV group and from 8.3 to 11.7 in the controls. All secondary measures, except posturography, likewise improved at follow-up compared with baseline in both groups. Quantitative dynamic posturography only improved in patients with WBV (1937-1467 mm) whereas there was no significant change in controls (1832-2030 mm). CONCLUSIONS: Equilibrium and gait improved in patients with PD receiving conventional WBV or conventional PT in the setting of a comprehensive rehabilitation program. There was no conclusive evidence for superior efficacy of WBV compared with conventional balance training.

Ebersbach G., Edler D., Kaufhold O. & Wissel J. (2008). Whole body vibration versus conventional physiotherapy to improve balance and gait in parkinson's disease. Archives of Physical Medicine and Rehabilitation. 89(3). 399-403.

Effects of whole-body vibration in patients with multiple sclerosis: a pilot study.

Schufried O., Mittermaier C., Jovanovic T., Pieber K., Paternostro-Sluga T.

Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Austria. [email protected]

OBJECTIVE: To examine whether a whole-body vibration (mechanical oscillations) in comparison to a placebo administration leads to better postural control, mobility and balance in patients with multiple sclerosis. DESIGN: Double-blind, randomized controlled trial. SETTING: Outpatient clinic of a university department of physical medicine and rehabilitation. SUBJECTS: Twelve multiple sclerosis patients with moderate disability (Kurtzke's Expanded Disability Status Scale 2.5-5) were allocated either to the intervention group or to the placebo group. INTERVENTIONS: In the intervention group a whole-body vibration at low frequency (2.0-4.4 Hz oscillations at 3-mm amplitude) in five series of 1 min each with a 1-min break between the series was applied. In the placebo group a Burst-transcutaneous electrical nerve stimulation (TENS) application on the nondominant forearm in five series of 1 min each with a 1-min break between the series was applied as well. MAIN OUTCOME MEASURES: Posturographic assessment using the Sensory Organization Test, the Timed Get Up and Go Test and the Functional Reach Test immediately preceding the application, 15 min, one week and two weeks after the application. The statistical analysis was applied to the change score from preapplication values to values 15 min, one week and two weeks post intervention. RESULTS: Compared with the placebo group the intervention group showed advantages in terms of the Sensory Organization Test and the Timed Get Up and Go Test at each time point of measurement after the application. The effects were strongest one week after the intervention, where significant differences for the change score (p = 0.041) were found for the Timed Get Up and Go Test with the mean score reducing from 9.2 s (preapplication) to 8.2 s one week after whole-body vibration and increasing from 9.5 s (preapplication) to 10.2 s one week after placebo application. The mean values of the posturographic assessment increased from 70.5 points (preapplication) to 77.5 points one week after whole body vibration and increased only from 67.2 points (preapplication) to 67.5 points one week after the placebo application. No differences were found for the Functional Reach Test. CONCLUSION: The results of this pilot study indicated that whole-body vibration may positively influence the postural control and mobility in multiple sclerosis patients.

Schuhfried O., Mittermaier C., Jovanovic T., Pieber K. & Paternostro-Sluga T. (2005). Effects of whole-body vibration in patients with multiple sclerosis:a pilot study. Clinical Rehabilitation. 19(8). 834-842.

Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta.

Semler O, Fricke O, Vezyroglou K, Stark C, Stabrey A, Schoenau E.                          

Children's Hospital, University of Cologne, Cologne, Germany.

OBJECTIVE: To evaluate the effect of whole body vibration on the mobility of long-term immobilized children and adolescents with a severe form of osteogenesis imperfecta. Osteogenesis imperfecta is a hereditary primary bone disorder with a prevalence from 1 in 10000 to 1 in 20000 births. Most of these children are suffering from long-term immobilization after recurrent fractures. Due to the immobilization they are affected by loss of muscle (sarcopenia) and secondary loss of bone mass. SUBJECTS: Whole body vibration was applied to eight children and adolescents (osteogenesis imperfecta type 3, N=5; osteogenesis imperfecta type 4, N=3) over a period of six months. INTERVENTIONS AND RESULTS: Whole body vibration was applied by a vibrating platform (Galileo Systems) constructed on a tilting-table. Success of treatment was assessed by measuring alterations of the tilting-angle and evaluating the mobility (Brief Assessment of Motor Function). All individuals were characterized by improved muscle force documented by an increased tilting-angle (median = 35 degrees) or by an increase in ground reaction force (median at start=30.0 [N/kg] (14.48-134.21); median after six months = 146.0 [N/kg] (42.46-245.25). CONCLUSIONS: Whole body vibration may be a promising approach to improve mobility in children and adolescents severely affected with osteogenesis imperfecta.

Semmler O., Fricke O., Vezyroglou K., Stark C., Stabrey A. & Schoenau E. (2008). Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta. Clinical Rehabilitation. 22(5). 387-394.

One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke.

Tihanyi TK, Horvath M, Fazekas G, Hortobagyi T, Tihanyi J.

Semmelweis University, and Department of Rehabilitation Medicine, Saint John Hospital Budapest, Hungary.

OBJECTIVE: To determine the effect of whole body vibration on isometric and eccentric torque and electromyography (EMG) variables of knee extensors on the affected side of stroke patients. DESIGN: A randomized controlled study. SETTING: A rehabilitation centre. SUBJECTS: Sixteen patients (age 58.2+/-9.4 years) were enrolled in an inpatient rehabilitation programme 27.2+/-10.4 days after a stroke. INTERVENTIONS: Eight patients were randomly assigned to the vibration group and received 20 Hz vibration (5 mm amplitude) while standing on a vibration platform for 1 minute six times in one session. Patients in the control group also stood on the platform but did not receive vibration. MAIN MEASURES: Maximum isometric and eccentric torque, rate of torque development, root-mean-squared EMG, median frequency of vastus lateralis, and co-activation of knee flexors. RESULTS: Isometric and eccentric knee extension torque increased 36.6% and 22.2%, respectively, after vibration (P<0.05) and 8.4% and 5.3% in the control group. Vibration increased EMG amplitude 44.9% and the median frequency in the vastus lateralis by 13.1% (all P<0.05) without changes in the control group (10.6% and 3.9%). Vibration improved the ability to generate mechanical work during eccentric contraction (17.5%). Vibration reduced biceps femoris co-activation during isometric (8.4%, ns) and eccentric (22.5%, P<0.05) contraction. CONCLUSION: These results suggest that one bout of whole body vibration can transiently increase voluntary force and muscle activation of the quadriceps muscle affected by a stroke.

Tihanyi T.K., Horvath M., Fazekas G., Hortobagyi T. & Tihanyi J. (2007). One session of whole body vibration increases voluntary muscle strength transiently in patients with stroke. Clinical Rehabilitation. 21(9). 782-793.

Submaximal aerobic exercise with mechanical vibrations improves the functional status of patients with chronic fatigue syndrome.

Saggini R, Vecchiet J, Iezzi S, Racciatti D, Affaitati G, Bellomo RG, Pizzigallo E.

Physical Therapy Institute, Department of Medicine and Aging, G. D'Annunzio University, Chieti, Italy.

AIM: Chronic fatigue syndrome (CFS) is an illness characterised by disabling fatigue of uncertain aetiology and other nonspecific symptoms. Typically CFS patients complain of a severe fatigue made worse by exercise, with a consistent reduction of working activity. A physical deconditioning could explain CFS features as well as a neuromuscular dysfunction, of central or peripheric origin. METHODS: Ten CFS patients were enrolled in a protocol of a rehabilitative treatment over a six-month period: they underwent a submaximal and predominantly aerobic exercise with a reduced O2 consumption using a Galileo 2000 system that provides mechanical vibrations characterised by sinusoid vertical sollecitations. Before and after such treatment, all patients underwent a pressure pain thresholds profile, an evaluation of physical and psychosocial parameters using the visual analogue scale (VAS) of Scott-Huskisson, and a muscle performance analysis by the CIBEX 6000 dynamometer. RESULTS: After the six-month period of study there was an overall improvement of the above described parameters as compared to the basal determinations. CONCLUSION: We conclude that the rehabilitative exertion provides an useful treatment for CFS patients particularly to realize an effective training of the explosive strength.

Saggini R., Vecchiet J., Iezzi S., Racciatti D., Affaitati G., Bellomo R.G. & Pizzigallo E. (2006). Submaximal aerobic exercise with mechanical vibrations improves the functional status of patients with chronic fatigue syndrome. Europa Medocophysica. 42(2). 97-102.

Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy.

Ahlborg L, Andersson C, Julin P.

Department of Rehabilitation Medicine Stockholm, Danderyd University Hospital, Stockholm, Sweden. [email protected]

OBJECTIVE: The aim of this study was to evaluate the effect on spasticity, muscle strength and motor performance after 8 weeks of whole-body vibration training compared with resistance training in adults with cerebral palsy. METHODS: Fourteen persons with spastic diplegia (21-41 years) were randomized to intervention with either whole-body vibration training (n=7) or resistance training (n=7). Pre- and post-training measures of spasticity using the modified Ashworth scale, muscle strength using isokinetic dynamometry, walking ability using Six-Minute Walk Test, balance using Timed Up and Go test and gross motor performance using Gross Motor Function Measure were performed. RESULTS: Spasticity decreased in knee extensors in the whole-body vibration group. Muscle strength increased in the resistance training group at the velocity 30 degrees /s and in both groups at 90 degrees /s. Six-Minute Walk Test and Timed Up and Go test did not change significantly. Gross Motor Function Measure increased in the whole-body vibration group. CONCLUSION: These data suggest that an 8-week intervention of whole-body vibration training or resistance training can increase muscle strength, without negative effect on spasticity, in adults with cerebral palsy.

Ahlborg L., Andersson C., Julin P. (2006). Whole-body vibration training compared with resistance training: effect on spasticity, muscle strength and motor performance in adults with cerebral palsy. Journal of Rehabilitation Medicine. 38(5). 302-308.

The effects of random whole-body-vibration on motor symptoms in Parkinson's disease.

Haas CT, Turbanski S. Kessler K, Schmidtbleicher D.

Institute of Sport Sciences, Johann Wolfgang Goethe-University, Frankfurt, Germany. [email protected]

It is well known that applying vibrations to men influences multiple physiological functions. The authors analysed post effects of whole-body-vibration (WBV) on motor symptoms in Parkinson's disease (PD). Sixty-eight persons with PD were randomly subdivided into one experimental and one control group. Motor symptoms were assessed by the UPDRS (Unified Parkinson's Disease Rating Scale) motor score. A cross-over design was used to control treatment effects. The treatment consisted of 5 series of whole-body-vibration taking 60 seconds each. On average a highly significant (p<0.01) improvement of 16.8% in the UPDRS motor score was found in the treatment group. Only marginal changes (p>0.05) were found in the control group. The cross-over procedure showed comparable treatment effects (14.7% improvement after treatment). With respect to different symptom clusters only small changes were found in limb akinesia and cranial symptoms. By contrast, tremor and rigidity scores were improved by 25% and 24%, respectively. According to the structure of symptom changes it is unlikely that these effects are explainable on peripheral sensory level, exclusively. With respect to the findings of other studies one can speculate about changes in activation of the supplementary motor area and in neurotransmitter functions.

Haas C.T., Turbanski S., Kessler K. & Schmidtbleicher D. (2006). The effects of random whole-body-vibration on motor symptoms in parkinson's disease. Neurorehabilitation. 21(1). 29-36.

Effects of random whole-body vibration on postural control in Parkinson's disease

Turbanski S, Haas CT, Schmidtbleicher D, Friedrich A, Duisberg P.

Institute of Sport Sciences, Johann Wolfgang Goetge-University, Frankfurt/Main, Germany

Parkinson's Disease Hospital, Bad Nauheim, Germany

We investigated spontaneous effects of random whole-body vibration (rWBV) on postural control in Parkinsonian subjects. Effects were examined in biomechanical tests from a total of 52 patients divided equally into one experimental and one control group. Postural control was tested pre- and post-treatment in two standardized conditions (narrow standing and tandem standing). The intervention was based on rWBV (y: 3 mm, f: 6 Hz 1 Hz/sec) consisting of 5 series lasting 60 seconds each. The main findings from this study were that (1) rWBV can improve postural stability in Parkinson's disease (PD) spontaneously (2) these effects depend on the test condition. Based on the results of this study, rWBV can be regarded as an additional device in physical therapy in PD.

Turbanski S., Haas C.T., Schmidtbleicher D., Friedrich A. & Duisberg P. (2005). Effects of random whole-body vibration on postural control in parkinson's disease. Research in Sports Medicine. 13(3). 243-256.

Long-term effects of 6-week whole-body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial.

Van Nes IJ, Latour H, Schils F, Meijer R, van Kuijk A, Geurts AC.

Sint Maartenskliniek Research, Development & Education, P.O. Box 9011, 6500 GM, Nijmegen, The Netherlands. [email protected]

BACKGROUND AND PURPOSE: The long-term effects of 6-weeks whole-body vibration, as a novel method of somatosensory stimulation, on postural control and activities of daily living were compared with those of 6 weeks of exercise therapy on music of the same intensity in the postacute phase of stroke. METHODS: Fifty-three patients with moderate to severe functional disabilities were randomized within 6 weeks poststroke and within 3 days after admission to a rehabilitation center to either whole-body vibration or exercise therapy on music in addition to a regular inpatient rehabilitation program. The whole-body vibration group received 4x45-second stimulation on the Galileo 900 (30-Hz frontal plane oscillations of 3-mm amplitude) for 5 days per week during 6 weeks. The exercise therapy on music group received the same amount of exercise therapy on music. Outcome variables included the Berg Balance Scale, Trunk Control Test, Rivermead Mobility Index, Barthel Index, Functional Ambulation Categories, Motricity Index, and somatosensory threshold at 0, 6, and 12 weeks follow up. RESULTS: At baseline, both groups were comparable in terms of prognostic factors and outcome measures. Both at 6 and 12 weeks follow up, no clinically relevant or statistical differences in outcome were observed between the groups. No side effects were reported. CONCLUSIONS: Daily sessions of whole-body vibration during 6 weeks are not more effective in terms of recovery of balance and activities of daily living than the same amount of exercise therapy on music in the postacute phase of stroke.

Van Nes I.J., Latour H., Schils F., Meijer R., van Kujik A. & Geurts A.C. (2006). Long-term effects of 6 week whole body vibration on balance recovery and activities of daily living in the postacute phase of stroke: a randomized, controlled trial. Stroke. 37(9). 2331-2335.

Contraindications for whole body vibration training: a case of nephrolitiasis.

Monteleone G, De Lorenzo A, Sgroi M, De Angelis S, Di Renzo L.

Department of Surgery, Faculty of Medicine and Surgery, Tor Vergata University, Rome, Italy. [email protected]

The use of whole body vibration (WBV) training is becoming more widespread both among athletes and the general public for improving muscle performance. The biological and mechanical effects of WBV are not completely understood and numerous contraindications, that can be identified while obtaining the patient's clinical history, must be taken into consideration. Nephrolithiasis, which often remains asymptomatic for an indefinite time, is not reported in the medical literature as a contraindication to WBV. This paper reports a case of significant morbidity following one session of WBV training in a patient with asymptomatic nephroli-thiasis.

Monteleone G., De Lorenzo A., Sgroi M., De Angelis S. & Di Renzo L. (2007). Contraindications for whole body vibration training: a case of nephrolitiasis. The Journal of Sports Medicine and Physical Fitness. 47(4). 443-445.

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