Segmental Muscle Vibration Improves Walking in Chronic Stroke Patients With Foot Drop: A Randomized Controlled Trial

Paoloni, Marco; Mangone, Massimiliano; Scettri, Paola; Procaccianti, Rita; Cometa, Antonella; Santilli, Valter

doi:10.1177/1545968309349940

Cited by 78 publications

(102 citation statements)

References 44 publications

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“…Nonetheless, other studies have assessed maximum dorsiflexion 20 and ankle dorsiflexion at heel (or foot) contact. 21 These possibilities should be further explored. …”

Section: Foot-drop Measurementsmentioning

confidence: 99%

Functional implications of corticospinal tract impairment on gait after spinal cord injury

et al. 2013

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Objective: Maximum toe elevation during walking is an objective measure of foot drop and reflects the impairment of the corticospinal tract (CST) in persons with spinal cord injury (SCI). To determine if this measurement is functionally relevant to ambulatory abilities, we correlated maximum toe elevation with clinical physiotherapy tests. Setting: Cross-sectional study, laboratory and clinical settings. Methods: A total of 24 individuals with SCI (American Spinal Injury Association (ASIA) Impairment Scale D) were recruited. Maximum toe elevation during the swing phase of treadmill gait was measured with a kinematic system. CST function was assessed in a sitting position by measuring the motor-evoked potentials (MEPs) induced in tibialis anterior muscle with transcranial magnetic stimulation over the motor cortex. Clinical tests performed were 10-m and 6-min walk test (6MWT), Timed-Up and Go (TUG), Walking Index for Spinal Cord Injury, Berg Balance Scale, Lower Extremity Motor Score (LEMS) and sensory score of the L4, L5 and S1 dermatomes. Results: Participants with lower toe elevation during gait walked at a slower speed, took more time to perform the TUG test, and covered a shorter distance in the 6MWT. They also scored lower on the LEMS and showed impaired superficial sensitivity of the dermatomes around the ankles. Few correlations were observed between CST function and clinical tests, but the presence of MEP at rest was indicative of faster speed and longer distance in the 6MWT. Conclusion: These results indicate that maximum toe elevation, which is directly correlated with CST impairment, is functionally relevant as it also correlates with timed clinical tests, LEMS and sensory scores. induced by TMS reflects impaired transmission in CST. Although CST transmission is increased following specific interventions, 1,2 correlation between MEP characteristics and overall gait function is not all that clear. While motor function can remarkably improve during recovery, MEP latency remains pathologically prolonged. 3 Also, a recent study demonstrated lack of correlation between measures of MEPs and gait. 4 One reason might be that CST involvement is more prominent in discrete subtasks of the function rather than in the overall task, which requires concurrent input from many different systems. Identifying the precise role of CST within gait will enable a more specific assessment of incapacities following CST lesion. Previous studies and clinical assessment of stroke patients indicate that the CST is involved in foot elevation during swing and that its impairment induces foot drop. [5][6][7] We have recently shown that measurement of maximum toe elevation during swing can be used as a simple and objective measurement of foot drop and reflects CST impairment in persons

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“…Nonetheless, other studies have assessed maximum dorsiflexion 20 and ankle dorsiflexion at heel (or foot) contact. 21 These possibilities should be further explored. …”

Section: Foot-drop Measurementsmentioning

confidence: 99%

Functional implications of corticospinal tract impairment on gait after spinal cord injury

et al. 2013

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“…The effects of whole body vibration on the recovery of motor function have been studied in stroke survivors with PSS, but the results were not satisfactory [8,9]. Alternatively, significant improvements in neurophysiological status, motor function, and reductions in spasticity have been reported on using segmental or focal vibration [10,11,12,13,14]. In previous studies, the parameters and location of vibratory stimuli varied (frequency, 50-120 Hz; amplitude, 10 µm-2.0 mm; location, muscle belly or tendon).…”

Section: Introductionmentioning

confidence: 99%

Evaluating the Differential Electrophysiological Effects of the Focal Vibrator on the Tendon and Muscle Belly in Healthy People

et al. 2014

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ObjectiveTo investigate the electrophysiological effects of focal vibration on the tendon and muscle belly in healthy people.MethodsThe miniaturized focal vibrator consisted of an unbalanced mass rotating offset and wireless controller. The parameters of vibratory stimulation were adjusted on a flat rigid surface as 65 µm at 70 Hz. Two consecutive tests on the different vibration sites were conducted in 10 healthy volunteers (test 1, the Achilles tendon; test 2, the muscle belly on the medial head of the gastrocnemius). The Hoffman (H)-reflex was measured 7 times during each test. The minimal H-reflex latency, maximal amplitude of H-reflex (Hmax), and maximal amplitude of the M-response (Mmax) were acquired. The ratio of Hmax and Mmax (HMR) and the vibratory inhibition index (VII: the ratio of the Hmax after vibration and Hmax before vibration) were calculated. The changes in parameters according to the time and site of stimulation were analyzed using the generalized estimating equation methods.ResultsAll subjects completed the two tests without serious adverse effects. The minimal H-reflex latency did not show significant changes over time (Wald test: χ2=11.62, p=0.07), and between the two sites (χ2=0.42, p=0.52). The changes in Hmax (χ2=53.74, p<0.01), HMR (χ2=20.49, p<0.01), and VII (χ2=13.16, p=0.02) were significant over time with the adjustment of sites. These parameters were reduced at all time points compared to the baseline, but the decrements reverted instantly after the cessation of stimulation. When adjusted over time, a 1.99-mV decrease in the Hmax (χ2=4.02, p=0.04) and a 9.02% decrease in the VII (χ2=4.54, p=0.03) were observed when the muscle belly was vibrated compared to the tendon.ConclusionThe differential electrophysiological effects of focal vibration were verified. The muscle belly may be the more effective site for reducing the H-reflex compared to the tendon. This study provides the neurophysiological basis for a selective and safe rehabilitation program for spasticity management with focal vibration.

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“…Moreover, segmental vibration has been shown to increase the activation of the tibialis anterior muscle on the paretic side [12]. However, vibration effects are complex.…”

Section: Effects Of Vibration On Forcementioning

confidence: 99%

“…Increased amplitude and a decreased latency of the MEP generated by TMS have been observed during vibration [8,9]. Moreover, there are reports of changes in voluntary force production during and after vibration in healthy [10] and stroke [11] subjects and in motor function in patients with neurological diseases [12,13]. Thus, in the present study, 80 Hz muscle vibration was applied to explore the use of a strong sensory input to improve motor output in hemiparetic subjects.…”

Section: Introductionmentioning

confidence: 99%

Effects of Hand Vibration on Motor Output in Chronic Hemiparesis

Melo

Iancu

Dyer

et al. 2015

International Journal of Brain Science

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Background. Muscle vibration has been shown to increase the corticospinal excitability assessed by transcranial magnetic stimulation (TMS) and to change voluntary force production in healthy subjects. Objectives. To evaluate the effect of vibration on corticospinal excitability using TMS and on maximal motor output using maximal voluntary contraction (MVC) in individuals with chronic hemiparesis. Methodology. Nineteen hemiparetic and 17 healthy control subjects participated in this study. Motor evoked potentials (MEPs) and MVC during lateral pinch grip were recorded at first dorsal interosseous muscle in a single session before, during, and after one-minute trials of 80 Hz vibration of the thenar eminence. Results. In hemiparetic subjects, vibration increased MEP amplitudes to a level comparable to that of control subjects and triggered a MEP response in 4 of 7 patients who did not have a MEP at rest. Also, vibration increased the maximal rate of force production (d /d max ) in both control and hemiparetic subjects but it did not increase MVC. Conclusion. Motor response generated with a descending cortical drive in chronic hemiparetic subjects can be increased during vibration. Vibration could be used when additional input is needed to reveal motor responses and to increase rate of force generation.

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Segmental Muscle Vibration Improves Walking in Chronic Stroke Patients With Foot Drop: A Randomized Controlled Trial

Abstract: SMV added to general physical therapy may improve gait performance in patients with foot drop secondary to chronic stroke. The authors hypothesize that this may be due to the mechanical vibration stimulation, probably as a consequence of effective brain reorganization.

Cited by 78 publications

References 44 publications

Functional implications of corticospinal tract impairment on gait after spinal cord injury

Functional implications of corticospinal tract impairment on gait after spinal cord injury

Evaluating the Differential Electrophysiological Effects of the Focal Vibrator on the Tendon and Muscle Belly in Healthy People

Effects of Hand Vibration on Motor Output in Chronic Hemiparesis

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