The effects of whole body vibration therapy on neuromotor performance and bone metabolism in individuals with chronic stroke : a randomized controlled trial

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The effects of whole body vibration therapy on neuromotor performance and bone metabolism in individuals with chronic stroke : a randomized controlled trial


Author: Lau, Wai-kin
Title: The effects of whole body vibration therapy on neuromotor performance and bone metabolism in individuals with chronic stroke : a randomized controlled trial
Degree: Ph.D.
Year: 2011
Subject: Cerebrovascular disease -- Patients -- Rehabilitation.
Vibration -- Therapeutic use.
Chronic diseases -- Exercise therapy.
Bone densitometry.
Neuromuscular diseases -- Treatment.
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Rehabilitation Sciences
Pages: xx, 274 leaves : ill. ; 30 cm.
Language: English
Abstract: Background: Whole body vibration (WBV) exercise training has been gaining popularity in rehabilitation for different patient populations in the past decade. A good number of studies have documented the benefits of WBV on enhancing physical functioning and bone health in postmenopausal women and older adults. Few studies, however, have examined the effects of WBV in individuals with stroke. It remains unclear whether incorporating the vibration stimulation in the exercise training regime has any additional benefit in modifying various aspects of physical functioning and bone metabolism. Aims and objectives: The overall aim of this randomized controlled trial was to investigate the effects of a 24-session WBV exercise program on neuromotor performance and bone turnover in community-dwelling individuals with chronic stroke. The specific objectives of this study were to determine whether (1) the WBV program was safe and feasible when used in chronic stroke patients, (2) incorporating WBV in the functional exercise program induced any additional beneficial effects in improving leg muscle strength, balance ability, balance confidence, walking function and bone turnover in community-dwelling individuals with chronic stroke immediately after the training period and also at 1 month follow-up. Method: Eighty-two subjects with chronic stroke were recruited and randomly assigned to either the WBV group (n=41) or the control group (n=41). The subjects in the WBV group received dynamic lower extremity weight bearing exercise together with WBV stimulation while the subjects in the control group received dynamic lower extremity weight bearing exercises only. Both groups underwent their 40-min training sessions 3 times per week for eight weeks. The outcome evaluations were conducted before treatment, after treatment and 1 month after the termination of the treatment. The primary outcome was knee muscle strength (isokinetic dynamometry), whereas the secondary outcomes included Berg Balance Scale (BBS), Mini-BEST Test (Mini-BESTest), Limits of Stability Test (LOS), Chinese version of Activities-specific Balance Confidence scale (ABC), Six-minute Walk Test (6MWT), Ten-meter Walk Test, and biochemical markers for bone turnover (serum bone-specific alkaline phosphatase (BAP) and serum C-telepeptide of type I collagen cross-links (CTx)). Multivariate analysis of variance (MANOVA) was used to determine whether there was a significant time × group interaction, followed by univariate ANOVA and contrast analysis.
Results: In the primary analysis, multivariate ANOVAs revealed no time × group interaction in all the primary and secondary outcomes, but there were statistically significant main effect of time in paretic and non-paretic knee muscle strength, BBS, Mini-BESTtest, LOS, ABC, 6MWT and Ten-meter Walk Test. The contrast analysis showed that regardless of group assignment, the improvements in these outcomes were apparent immediately after the 24-sessions of training and were maintained at 1-month follow-up. In contrast, the serum level of bone turnover markers showed no significant changes over time. In the secondary analysis, baseline characteristics of the subjects (i.e. younger age, lower body mass index, more severe lower extremity motor impairment), better compliance (i.e. better adherence to the treatment frequency of 3 sessions per week) and poorer baseline scores were correlated with more improvement in outcomes. No severe adverse effects were reported from the subjects. Conclusions: WBV exercise training is a safe and feasible treatment option for patients with chronic stroke. However, both the WBV and control groups showed statistically significant but similar improvements in the neuromotor performance after the training, indicating that superimposing WBV on dynamic lower limb exercises had no additional benefits on neurmotor performance when compared with dynamic low extremity weight bearing exercises alone. The result of the present study may only be generalized to the chronic stroke patients with relatively high functional mobility level and mild to moderate leg extremity motor impairment. Further studies are warranted to study the effects of WBV in stroke patients with lower mobility status and poorer neuromotor performance.

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