Short-Term Effects of Focal Muscle Vibration on Motor Recovery After Acute Stroke: A Pilot Randomized Sham-Controlled Study

Abstract

Repetitive focal muscle vibration (rMV) is known to promote neural plasticity and long-lasting motor recovery in chronic stroke patients. Those structural and functional changes within the motor network underlying motor recovery occur in the very first hours after stroke. Nonetheless, to our knowledge, no rMV-based studies have been carried out in acute stroke patients so far, and the clinical benefit of rMV in this phase of stroke is yet to be determined. The aim of this randomized double-blind sham-controlled study is to investigate the short-term effect of rMV on motor recovery in acute stroke patients. Out of 22 acute stroke patients, 10 were treated with the rMV (vibration group–VG), while 12 underwent the sham treatment (control group–CG). Both treatments were carried out for 3 consecutive days, starting within 72 h of stroke onset; each daily session consisted of three 10-min treatments (for each treated limb), interspersed with a 1-min interval. rMV was delivered using a specific device (Cro®System, NEMOCO srl, Italy). The transducer was applied perpendicular to the target muscle's belly, near its distal tendon insertion, generating a 0.2–0.5 mm peak-to-peak sinusoidal displacement at a frequency of 100 Hz. All participants also underwent a daily standard rehabilitation program. The study protocol underwent local ethics committee approval (ClinicalTrial.gov NCT03697525) and written informed consent was obtained from all of the participants. With regard to the different pre-treatment clinical statuses, VG patients showed significant clinical improvement with respect to CG-treated patients among the NIHSS ( p < 0.001), Fugl-Meyer ( p = 0.001), and Motricity Index ( p < 0.001) scores. In addition, when the upper and lower limb scales scores were compared between the two groups, VG patients were found to have a better clinical improvement at all the clinical end points. This study provides the first evidence that rMV is able to improve the motor outcome in a cohort of acute stroke patients, regardless of the pretreatment clinical status. Being a safe and well-tolerated intervention, which is easy to perform at the bedside, rMV may represent a valid complementary non-pharmacological therapy to promote motor recovery in acute stroke patients.

Differential Effect of Visual and Proprioceptive Stimulation on Corticospinal Output for Reciprocal Muscles

“…To clarify the spinal and cortical mechanisms related to visual and proprioceptive information, future studies should consider performing a detailed examination using TMS, peripheral nerve stimulation, and brain imaging methods. In addition, previous studies have suggested that therapy using motor imagery (Tabernig et al, 2018; Geiger et al, 2019) or vibration (Ahn et al, 2019; Toscano et al, 2019) could be beneficial in the neurorehabilitation of patients with stroke. Although we investigated whether the corticospinal excitabilities for reciprocal muscles were differentially affected by visuo-proprioceptive tasks, further studies should investigate whether engaging in combined observation and vibration can facilitate motor recovery of reciprocal muscles in patients.…”

Motor Recovery After Stroke: From a Vespa Scooter Ride Over the Roman Sampietrini to Focal Muscle Vibration (fMV) Treatment. A 99mTc-HMPAO SPECT and Neurophysiological Case Study

“…A total of 12 fMV sessions (3 sessions per week for 4 consecutive weeks) were carried out by a trained physiatrist. Each daily session consisted of three 10-min treatment, interspersed with a 1-min break ( 11 ).…”

“…Focal repetitive muscle vibration (fMV) is a safe and welltolerated intervention, easy to perform at the bedside, and able to promote motor recovery both in acute (11) and chronic stroke patients (12)(13)(14)(15).…”

Wearable Focal Muscle Vibration on Pain, Balance, Mobility, and Sensation in Individuals with Diabetic Peripheral Neuropathy: A Pilot Study

“…FMV promotes neural plasticity and long-lasting motor recovery [ 17 ]. When applied repeatedly, FMV produces a repeated sensory input that reaches the primary motor cortex (M1) directly via Ia fiber afferent input, thereby leading to an improvement in motor function by means of an intrinsic plasticity-related mechanism [ 17 , 18 , 19 , 20 ]. Recent literature has established evidence supporting the benefits of FMV in activating the primary somatosensory cortex and intensifying the connection strength of the central region [ 17 , 19 , 21 ], increasing nitric oxide production [ 22 ], improving blood flow [ 23 ], and increasing angiogenesis [ 24 ].…”