Comparison of Single-Session Dose Response Effects of Whole Body Vibration on Spasticity and Walking Speed in Persons with Spinal Cord Injury

Estes, Stephen P.; Iddings, Jennifer A.; Ray, Somu; Kirk-Sanchez, Neva; Field-Fote, Edelle C.

doi:10.1007/s13311-018-0644-1

Cited by 19 publications

(21 citation statements)

References 37 publications

(53 reference statements)

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“…A limitation of the current study, and a general challenge for clinical studies using tSCS, is the lack of a sham intervention with confirmed ineffectiveness [33,34,83]. Yet, in the assessment of rhythmic ankle movements, effects were only observed in the more affected lower limb with significantly lower LEMS, indicating that placebo effects likely played a minor role.…”

Section: Discussionmentioning

confidence: 85%

Immediate Effects of Transcutaneous Spinal Cord Stimulation on Motor Function in Chronic, Sensorimotor Incomplete Spinal Cord Injury

Meyer

Hofstoetter

Hubli

et al. 2020

JCM

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Deficient ankle control after incomplete spinal cord injury (iSCI) often accentuates walking impairments. Transcutaneous electrical spinal cord stimulation (tSCS) has been shown to augment locomotor activity after iSCI, presumably due to modulation of spinal excitability. However, the effects of possible excitability modulations induced by tSCS on ankle control have not yet been assessed. This study investigated the immediate (i.e., without training) effects during single-sessions of tonic tSCS on ankle control, spinal excitability, and locomotion in ten individuals with chronic, sensorimotor iSCI (American Spinal Injury Association Impairment Scale D). Participants performed rhythmic ankle movements (dorsi- and plantar flexion) at a given rate, and irregular ankle movements following a predetermined trajectory with and without tonic tSCS at 15 Hz, 30 Hz, and 50 Hz. In a subgroup of eight participants, the effects of tSCS on assisted over-ground walking were studied. Furthermore, the activity of a polysynaptic spinal reflex, associated with spinal locomotor networks, was investigated to study the effect of the stimulation on the dedicated spinal circuitry associated with locomotor function. Tonic tSCS at 30 Hz immediately improved maximum dorsiflexion by +4.6° ± 0.9° in the more affected lower limb during the rhythmic ankle movement task, resulting in an increase of +2.9° ± 0.9° in active range of motion. Coordination of ankle movements, assessed by the ability to perform rhythmic ankle movements at a given target rate and to perform irregular movements according to a trajectory, was unchanged during stimulation. tSCS at 30 Hz modulated spinal reflex activity, reflected by a significant suppression of pathological activity specific to SCI in the assessed polysynaptic spinal reflex. During walking, there was no statistical group effect of tSCS. In the subgroup of eight assessed participants, the three with the lowest as well as the one with the highest walking function scores showed positive stimulation effects, including increased maximum walking speed, or more continuous and faster stepping at a self-selected speed. Future studies need to investigate if multiple applications and individual optimization of the stimulation parameters can increase the effects of tSCS, and if the technique can improve the outcome of locomotor rehabilitation after iSCI.

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Section: Discussionmentioning

confidence: 85%

Immediate Effects of Transcutaneous Spinal Cord Stimulation on Motor Function in Chronic, Sensorimotor Incomplete Spinal Cord Injury

Meyer

Hofstoetter

Hubli

et al. 2020

JCM

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“…Higher use of prescription drugs for spasticity-related problems have also been associated with a greater risk of mortality (Krause et al 2009), highlighting the need for effective non-pharmacological treatments. Although some studies have suggested that whole body vibration (Ness & Field-Fote, 2009;Estes et al 2018) and focal vibration (Laessoe et al 2004;Murillo et al 2011) can decrease symptoms of spasticity, there is currently no conclusive evidence for their use as an anti-spasmodic approach in people with SCI (Sadeghi & Sawatzky, 2014). Their effect is also short-lasting and it seems to be present only in participants with severe spasticity (Estes et al 2018).…”

Section: Functional Considerationsmentioning

confidence: 99%

“…Although some studies have suggested that whole body vibration (Ness & Field-Fote, 2009;Estes et al 2018) and focal vibration (Laessoe et al 2004;Murillo et al 2011) can decrease symptoms of spasticity, there is currently no conclusive evidence for their use as an anti-spasmodic approach in people with SCI (Sadeghi & Sawatzky, 2014). Their effect is also short-lasting and it seems to be present only in participants with severe spasticity (Estes et al 2018). Because movement-related receptive fields of motoneurons are widened after SCI (Hyngstrom et al 2008;Johnson et al 2013) a better control of afferent transmission could result in better management of whole-limb spasms after the injury.…”

Section: Functional Considerationsmentioning

confidence: 99%

“…In humans with SCI, repeated activation of sensory afferents projecting to motoneurons might be useful to modulate symptoms of hyperexcitability. For example, whole body vibration has been shown to decrease, at times, stretch reflex excitability in individuals with SCI (Estes et al 2018). Note that in control (Ritzmann et al 2018) and SCI (Perez et al 2004) participants, vibration increases reciprocal Ia inhibition in an antagonistic muscle.…”

Section: Introductionmentioning

confidence: 98%

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Vibration attenuates spasm‐like activity in humans with spinal cord injury

DeForest

Bohórquez

Perez

2020

The Journal of Physiology

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Cutaneous reflexes were tested to examine the neuronal mechanisms contributing to muscle spasms in humans with chronic spinal cord injury (SCI). Specifically, we tested the effect of Achilles and tibialis anterior tendon vibration on the early and late components of the cutaneous reflex and reciprocal Ia inhibition in the soleus and tibialis anterior muscles in humans with chronic SCI.r We found that tendon vibration reduced the amplitude of later but not earlier cutaneous reflex in the antagonist but not in the agonist muscle relative to the location of the vibration. In addition, reciprocal Ia inhibition between antagonist ankle muscles increased with tendon vibration and participants with a larger suppression of the later component of the cutaneous reflex had stronger reciprocal Ia inhibition from the antagonistic muscle.r Our study is the first to provide evidence that tendon vibration attenuates late cutaneous spasm-like reflex activity, likely via reciprocal inhibitory mechanisms, and may represent a method, when properly targeted, for controlling spasms in humans with SCI.

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“…More recently, electrophysiological techniques are being used increasingly in combination with behavioral protocols with the goal to investigate the role of controlled motor activity, promote spinal cord plasticity and understand its relationship with motor recovery in individuals with SCI. In light of this, Efekhtar et al [15] review reflex training as a novel approach to improve motor function, and Iddings et al [16] discuss the use of vibration to improve spasticity and gait speed. Donovan et al [17] conclude with a thorough review of the current state of affairs in SCI clinical trials, giving an overview of where we are currently.…”

mentioning

confidence: 99%