Alleviation of Motor Impairments in Patients with Cerebral Palsy: Acute Effects of Whole-body Vibration on Stretch Reflex Response, Voluntary Muscle Activation and Mobility

Abstract

IntroductionIndividuals suffering from cerebral palsy (CP) often have involuntary, reflex-evoked muscle activity resulting in spastic hyperreflexia. Whole-body vibration (WBV) has been demonstrated to reduce reflex activity in healthy subjects, but evidence in CP patients is still limited. Therefore, this study aimed to establish the acute neuromuscular and kinematic effects of WBV in subjects with spastic CP.Methods44 children with spastic CP were tested on neuromuscular activation and kinematics before and immediately after a 1-min bout of WBV (16–25 Hz, 1.5–3 mm). Assessment included (1) recordings of stretch reflex (SR) activity of the triceps surae, (2) electromyography (EMG) measurements of maximal voluntary muscle activation of lower limb muscles, and (3) neuromuscular activation during active range of motion (aROM). We recorded EMG of m. soleus (SOL), m. gastrocnemius medialis (GM), m. tibialis anterior, m. vastus medialis, m. rectus femoris, and m. biceps femoris. Angular excursion was recorded by goniometry of the ankle and knee joint.ResultsAfter WBV, (1) SOL SRs were decreased (p < 0.01) while (2) maximal voluntary activation (p < 0.05) and (3) angular excursion in the knee joint (p < 0.01) were significantly increased. No changes could be observed for GM SR amplitudes or ankle joint excursion. Neuromuscular coordination expressed by greater agonist–antagonist ratios during aROM was significantly enhanced (p < 0.05).DiscussionThe findings point toward acute neuromuscular and kinematic effects following one bout of WBV. Protocols demonstrate that pathological reflex responses are reduced (spinal level), while the execution of voluntary movement (supraspinal level) is improved in regards to kinematic and neuromuscular control. This facilitation of muscle and joint control is probably due to a reduction of spasticity-associated spinal excitability in favor of giving access for greater supraspinal input during voluntary motor control.

Evaluation of Whole-Body Vibration Exercise on Neuromuscular Activation Through Electromyographic Pattern of Vastus Lateralis Muscle and on Range of Motion of Knees in Metabolic Syndrome: A Quasi-Randomized Cross-Over Controlled Trial

“…In the present study, significant changes in the electromyographic signal of the VL muscle on both legs were observed in the acute effect of the last session of the 5-week WBVE intervention (Table 6). This is in agreement with other authors that have shown improvement in muscle activity due to WBVE intervention in different muscles in individuals with various diseases [27], such as acute and chronic stroke [30,56], spinal cord injury [24], Friedreich's ataxia [57], and cerebral palsy [29]. Liao et al detected changes in muscle activity even in individuals with paresis [30].…”

“…Yang et al concluded that WBVE increased the flexibility of the ankle joint, reduced the fear of falling, and strengthened the bones [38]. Although Krause et al observed no changes in the ankle joint excursion immediately after a 1-min bout of WBVE, they found an increase in the knee joint active angular excursion during flexion and extension (p < 0.01) in individuals with cerebral palsy [29]. In another study performed in children with cerebral palsy, a significant increase in ROM was detected immediately after treatment with WBVE [44].…”

“…It is well described that WBVE can improve joint mobility [29,37,38]. Moreover, Wang et al found that WBVE in combination with quadriceps resistance exercise compared with quadriceps resistance exercise alone showed significantly greater improvement in knee flexion and extension in individuals with knee osteoarthritis [39].…”

“…Authors evaluated the effects of WBVE on MetS individuals, and important responses were observed, such as improvement of quality of life and flexibility [25,26]. Moreover, WBVE is safe and effective to treat muscle complications in populations with different disorders [27][28][29][30][31] as well as healthy individuals [32,33].…”

Clinical Approaches of Whole-Body Vibration Exercises in Individuals with Stroke: A Narrative Revision

“…Moreover, as a mode of physical activity, WBVE has been identified as a feasible intervention with little to no adverse events [ 19 , 20 ]. WBVE has progressively been applied with beneficial outcomes to various clinical populations including stroke [ 7 , 21 ], obesity [ 22 ], rheumatoid arthritis [ 23 ], diabetes [ 24 ], spinal cord injury [ 25 ], chronic kidney disease [ 26 ], fibromyalgia [ 27 , 28 ], multiple sclerosis [ 29 ], cerebral palsy [ 30 , 31 ], Duchenne muscular dystrophy [ 32 ], osteogenesis imperfecta [ 33 ], osteoarthritis [ 34 ], and chronic obstructive pulmonary disease [ 35 ]. The effects of the WBVE may be due to neuromuscular responses to the interaction of the mechanical vibrations with the body and the tonic vibration response [ 36 – 39 ].…”