Effects of Single or Multiple Sessions of Whole Body Vibration in Stroke: Is There Any Evidence to Support the Clinical Use in Rehabilitation?

Once again more studies and followup needed. No problems with that, stroke patients can wait forever while the stroke medical world twiddles their thumbs.  In the meantime another 10 million yearly stroke survivors  will have no useful therapy.

Effects of Single or Multiple Sessions of Whole Body Vibration in Stroke: Is There Any Evidence to Support the Clinical Use in Rehabilitation?

Cosimo Costantino
,1 Federica Petraglia,2 Laura Luigia Sabetta,3 and Riccardo Giumelli2

1Department of Medicine and Surgery, University of Parma, Italy
2Physical Medicine and Rehabilitation Residency Program, University of Parma, Italy
3Pre-Med Student, University of Parma, Italy

Correspondence should be addressed to Cosimo Costantino; cosimo.costantino@unipr.it

Received 30 January 2018; Revised 23 April 2018; Accepted 25 May 2018; Published 30 July 2018

Academic Editor: Mario Bernardo-Filho

Copyright © 2018 Cosimo Costantino et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract

Background and Purpose. Recently new technologies and new techniques, such as Whole Body Vibration (WBV), have been introduced by the health and fitness industry to pursue therapeutic or physical performance goals. The aim of this systematic review is to investigate the effectiveness of single or multiple WBV sessions alone or in association with traditional rehabilitation, compared to traditional rehabilitation therapy or with sham therapy in poststroke patients. Methods. Randomized Control Trials and controlled clinical trials written in English between January 1st, 2003, and December 31st, 2017, were selected from PubMed, Cochrane-Central-Register-of-Controlled-Trials, and Physiotherapy-Evidence-Database (PEDro). The single WBV session and multiple sessions’ effects were assessed. Study characteristics, study population, intervention protocols, effects of WBV sessions, and adverse events were investigated with a descriptive analysis. Results. The search reported 365 articles and after screening and removal of duplicates, 11 manuscripts with PEDro score≥6/10 were selected (391 poststroke patients). Study characteristics, study population, intervention protocols (frequencies, amplitude of vibration, and peak acceleration), effects of a single or multiple WBV sessions, and adverse events were analyzed. They have been investigated with particular attention to bone turnover, structure and muscle functions, spasticity, postural control and risk of falls, functional mobility, somatosensory threshold, and activity and participation. Comparing WBV group with control group no significant benefits emerged. Discussion. This systematic review included studies involving participants with non homogeneous characteristics, just considering the incorporation of studies on individuals with chronic and postacute stroke. Despite these limits, WBV treatment has no significant risks for patients and shows interesting effects of WBV treatment in Structure and muscle functions, Spasticity and Postural control. Conclusions. Even though treatment with WBV appears safe and feasible, there is insufficient evidence to support its clinical use in poststroke rehabilitation at this point. More studies assessing other functional tests and with more specific treatment protocols are needed.
1. Introduction

Recently new technologies and new techniques, such as Whole Body Vibration (WBV), have been introduced by the health and fitness industry to pursue therapeutic or physical performance goals. Basic neurophysiological studies have shown that vibration can alter sensory and motor function by mostly activating the primary spindle endings, although secondary spindle endings, such as Golgi tendon organs, Pacinian, and Meissner corpuscles can also be activated [1]. Several types of Whole Body Vibration platforms can be found in literature [2–4].

Currently, there are three commercial typologies of vibration platforms. The first one, Galileo®, has a teeterboard that produces asynchronous sinusoidal side-alternating vertical vibrations.

The second type of commercial machines (Bodypulse®, Power Plate®, Soloflex®, Nemes®, Vibra Pro®, Vibra Fit®, Fitvibe®, PneuVibe®, and VibroGym®) produces vertical synchronous vibrations. The third type, called Extream 1000 AMH International Inc., Korea, is a slipping platform that produces horizontal vibrations [5].

Key descriptors of vibration devices include the frequency (number of complete movement cycles per second, measured in hertz), the amplitude (displacement of oscillatory motion, measured in mm), the acceleration (measured in m/s2 or g), and the duration (exposure time) of the vibration exposure [6]. The intensity of vibration is determined by varying both frequency and amplitude; accordingly it may be possible to get a training program tailored to the needs of the person, or to adapt it to different goals.

The vibration devices can differ with frequency ranges from 0 to 60 Hz, amplitudes from 0 to 12 millimeters, and peak acceleration from 0 to 20,1 g. In a typical session, the user stands on the device doing static or dynamic exercises while the platform produces sinusoidal oscillations. In most cases, the vibration session consists of several bouts of vibration exposure (each lasting from less than a minute to several minutes) separated by rest periods.

The growing interest in vibrations started from animal research in the 1990s and early 2000s when a correlation between vibration and bone deposition was reported [7, 8].

Other studies demonstrated that WBV training causes a continuous proprioceptive stimulation which increases neuromuscular receptivity [9]. Many studies have highlighted the possibility of WBV training to improve sport performance, increasing range of motion, and to be a beneficial supplementary training technique in strength programs for athletes [10–16].

Others studies have explored WBV applications in different clinical frameworks such as Osteoarthritis [17], Cognitive Function [18, 19], Postmenopausal Women [20, 21], Spinal Cord Injury [22], Rheumatoid arthritis [23], Multiple Sclerosis [24], Parkinson’s disease [25], Down Syndrome [26], Metabolic Syndrome [27], Osteoporosis [28], Chronic Obstructive Pulmonary Disease [29], and other medical conditions [30].

The aim of this systematic review is to investigate the effectiveness of single or multiple WBV sessions, alone or in association with traditional rehabilitation, compared to traditional rehabilitation therapy or with sham therapy in patients with a stroke.

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