Effects of Focal Vibration and Robotic Assistive Therapy on Upper Limb Spasticity in incomplete Spinal Cord Injury

Abstract

Vibration stimulation seems to be an affordable easy-to-use rehabilitation tool. Focal muscle vibration (FV) has potential to reduce spasticity and enhance muscle strength and performance. Combined with robotic assisted movement therapy, the rehabilitation can benefit from improvement of more than one aspect. For example, FV could firstly decrease abnormally increased muscle tone and joint rigidity by tackling volitional control for easier robotic movement exercise. Exactly this approach is evaluated within a clinical trial presented in this paper. FV were applied to relaxed spastic wrist flexor and extensor muscles for 15min. Subsequently, the wrist was engaged in a robotic-assisted game-playing. Results from two cases who completed the trial showed short-term decrease in wrist stiffness as assessed by clinical spasticity measurement Modified Ashworth Scale (MAS). Active range of motion (AROM) and engineering joint stiffness (JS) measurements were estimated using a robotic apparatus and the results complemented previous observations. The AROM increased and JS decreased for both cases when compared at the beginning and at the end of each interventional session. These results are a part of an ongoing clinical trial but show promise for reducing repercussions of spasticity in incomplete spinal cord injury.

An Investigation into the Dissipation of Vibrations Using Electromyography towards the Development of Self-Adapting Robotic Prosthesis

“…Each phase required the participant to contract their muscle for 20 seconds and then to relax the muscle for an additional 20 seconds. This duration was to allow enough window length during post processing for analysis of a steady contracted or relaxed state [16]. This sequence was then repeated three times, beginning in the relaxed state.…”

Effectiveness of Focal Muscle Vibrations in Improving Sensorimotor Performance, Mobility and Strength in Spinal Cord Injury Population: A Systematic Review

“…Nine studies [6-14] addressed the application of FMV on the UL in SCI patients. Six of which focused on understanding the sensory and motor function in patients in response to FMV [6-10, 14] and six studies investigated the role of FMV in improving mobility and muscular strength in the UL [8-13]. Different outcome measures studied are: vibration sensation threshold [6], tonic vibration reflex (TVR) [8], corticomotor excitability [10] and cortical motor maps by transcranial magnetic stimulation (TMS) [14] were studied for assessing the effects on sensory and motor function, while for assessing mobility and strength effects, electromyography effects (EMG) [8], force [7-9], torque [9], range of motion (ROM) [9, 13], grip and release test (GRT) [9], 9 Hole Peg test [10], visuomotor tracking [10], modified Ashworth scale (MAS) [11,13] and questionnaires for mobility [9, 12, 13] were utilised.…”

“…Six of which focused on understanding the sensory and motor function in patients in response to FMV [6-10, 14] and six studies investigated the role of FMV in improving mobility and muscular strength in the UL [8-13]. Different outcome measures studied are: vibration sensation threshold [6], tonic vibration reflex (TVR) [8], corticomotor excitability [10] and cortical motor maps by transcranial magnetic stimulation (TMS) [14] were studied for assessing the effects on sensory and motor function, while for assessing mobility and strength effects, electromyography effects (EMG) [8], force [7-9], torque [9], range of motion (ROM) [9, 13], grip and release test (GRT) [9], 9 Hole Peg test [10], visuomotor tracking [10], modified Ashworth scale (MAS) [11,13] and questionnaires for mobility [9, 12, 13] were utilised. A total of 145 SCI participants were tested in the upper limb, with seven studies focusing on chronic SCIs (76 participants).…”

“…Case studies revealed promise in long-term effects. Six FMV sessions (duration: 15 minutes each) in forearm muscles alongside functional tasks improved the MAS and ROM [13]. Even shorter (duration: 5 minutes each), 10-session FMV interventions in the triceps brachii showed lasting benefits (up to a month) in the MAS [11].…”

“…Nine studies [6][7][8][9][10][11][12][13][14] addressed the application of FMV on the UL in SCI patients. Six of which focused on understanding the sensory and motor function in patients in response to FMV [6][7][8][9][10]14] and six studies investigated the role of FMV in improving mobility and muscular strength in the UL [8][9][10][11][12][13].…”