Quick Thoughts: Whole Body Vibration and Cerebral Palsy

My first experience with whole body vibration (WBV) came when I was browsing through a large fitness equipment store. Towards the front of it there was a large platform that said it vibrated. I asked the salesman bro if I could try it out and promptly started doing my squats while I was jittered up and down. He continued to give a sales pitch which was drowned out by my thoughts about how on earth this contraption could help somebody. My mind was telling me no…..BUT MY BODY. Just kidding. While it does feel pleasant when you hop off, the evidence for a meaningful improvement in strength performance vs regular strength training in the general population is tenuous at best. (1)

Then at Combined Sections Meeting in 2016, WBV was reintroduced to my mind again. The talk was given by Candy Tefertiller, PT, DPT, who is the director of physical therapy for the Craig Hospital. WBV was not the focus of her lecture, but it did pop up with regards to helping manage a stroke patient’s spasticity.

Who else has severe issues with spasticity and tone? People with cerebral palsy. Since we are covering peds right now in school I figured I’d do a quick literature scan on it. First off, CP is the most common motor disability in childhood with prevalence ranging from 1.5-4/1000 live births. Fortunately about 60% can walk independently with the other 40% able to walk with an AD or have severely limited walking ability. (2)

Enough rambling. These are supposed to be quick thoughts.

 

Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy (3)

First let’s look at a study with rather extensive testing. This study was intended to be a RCT, but the potential participants rejected not getting the therapy so there was no control group.  The researchers took 40 subjects with mild to moderate CP and had them build up to 20 weeks of WBV for 9 min/day, 4 times/week at 20 Hz and 1 mm amplitude. Nine minutes were accumulated by three sets of three minutes and the vibration was in a see-saw pattern. Subjects stayed in a quarter squat during the vibration and used a metal frame for support as needed. Compliance seems a little low with only 32 of the 40 completing at least 50% of the sessions.

Lean mass improved in the trunk and lower limbs. Bone mineral content and BMD increased in lumbar spine and lower limbs.

Mildly involved subjects walked 44 meters further during the 6 minute walk test, an 11% improvement. What is very impressive is that the effects were even greater for the more severe group, who walked an extra 40 meters with an average improvement of 35%.

No improvement in jump and balance tests. Compliance was very poor on health-related quality of life. Available info showed subjects did not indicate improvements, but caregivers observed strong improvements, in particular in perceived pain and impact of disability. (3)

Note: Appears to have taken place in New Zealand. Can you trust a Kiwi who Hakas? Time will tell.

 

Effect of whole body vibration training on mobility in children with cerebral palsy: a randomized controlled experimenter-blinded study (4)

This study largely focused on gait kinematics and muscle thickness. Two groups of 15 were split into an experimental group (EG) and control group (CG). The CG received conventional therapy which was defined as gentle massage, muscle stretching and balance training. The EG received conventional therapy plus WBV. There parameters were extensive and it makes my heart happy. The subjects had to be barefoot, foot width was standardized and then increasingly displaced from center and squat positioned was controlled for ranges of 30-100° of knee flexion. Vibration therapy occurred in three minute bouts with standardized ranges varying from 5-25 hz and 1-9 mm. A ten minute warm up and cool down of passive stretching was also included. Both groups met three times per week for eight weeks.

Gait analysis showed significant improvements vs CG in gait speed, stride length and cycle time. Impressively, ankle angle improved by 86% to 13.58°. My assumption is that is dorsiflexion, although I could not find anything stating that specifically.

Thickness of tibialis anterior and soleus significantly increased, but curiously the gastrocs did not.

Notes: Hips don’t lie and there were no significant changes in the participants’.

The EG got three more hours of therapy per week, however it was not specific to gait training.

 

Bottom line:

All of the studies have small sample sizes. When looked at as a whole, several systematic reviews support that WBV may be a helpful adjunct for improving strength, gait, standing, and bone health and decreasing spasticity. WBV therapy tends to consist of bouts of 3-5 minutes in a squat position with a frequency of at least 10 Hz and amplitude of 1-5 mm. The varied presentation of CP makes it inherently challenging to study and develop a protocol. Every study calls for further research into WBV for the CP population. (5,6) I’d like to see there be more control of weight bearing on the platform and, more importantly, have longer follow-up periods to be a viable alternative to current treatments.

 

Ramble on,

Sam

  1. Nordlund, M. M., & Thorstensson, A. (2006). Strength training effects of whole-body vibration?Scand J Med Sci Sports Scandinavian Journal of Medicine and Science in Sports, 0(0). doi:10.1111/j.1600-0838.2006.00586.x
  2. Data & Statistics for Cerebral Palsy. (2016). Retrieved September 02, 2016, from http://www.cdc.gov/ncbddd/cp/data.html
  3. Gusso, S., Munns, C. F., Colle, P., Derraik, J. G., Biggs, J. B., Cutfield, W. S., & Hofman, P. L. (2016). Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy. Sci. Rep. Scientific Reports, 6, 22518. doi:10.1038/srep22518
  4. Lee, B., & Chon, S. (2013). Effect of whole body vibration training on mobility in children with cerebral palsy: A randomized controlled experimenter-blinded study. Clinical Rehabilitation,27(7), 599-607. doi:10.1177/0269215512470673
  5. Duquette, S. A., Guiliano, A. M., & Starmer, D. J. (2015, Sep). Whole body vibration and cerebral palsy: A systematic review. The Journal of the Canadian Chiropractic Association, 59(3), 245-252.
  6. Sasquetto, M., Carvalho, V., Silva, C., Conceicao, C., & Gomes-Neto, M. (2015, April 16). The effects of whole body vibration on mobility and balance in children with cerebral palsy: A systematic review with meta-analysis. Journal of Musculoskeletal and Neuronal Interactions,15(2), 137-144.

Leave a Reply