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Focal Muscle Vibration For Post-Stroke Rehabilitation: A Systematic Review Of Protocols And Outcomes

Sarah Bulloch, OTS-21, Hongwu Wang, PhD.1,  Cyndy Robinson, OTD1

 Department of Rehabilitation Sciences1 College of Allied Health, University of Oklahoma Health Sciences Center

Background

Stroke is currently the leading cause of disability in the United States. After a stroke, 16% of individuals will live in a long-term care facility, 20% will require an assistive walking device, and 71% will be vocationally impaired. This happens because of the complexity of a stroke leading to complexity in the rehabilitation process. There is very little standardization of rehabilitation, and therefore clinicians and researchers are always working to better understand interventions that will best serve their patients and help them reach the greatest level of independence.

One intervention that has become increasingly studied in the last 10 years, is focal muscle vibration (FMV). The use of vibration as a therapeutic intervention dates back to the 1800s when vibration was used to relieve pain of patients with Parkinson’s. Since then, it has been used as an intervention for a variety of neurological diagnoses, but it’s mechanisms and protocol are not highly understood. Understanding the experimental protocols and establishing which outcome measures are commonly used in FMV studies in stroke rehabilitation may help improve consensus among researchers and clinicians.

Purpose

The purpose of this study is to examine the experimental protocols and identify the commonly used outcome measures in FMV based intervention studies after stroke.

methods

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Table 1: Search Strategy
PubMed, Ovid Medline, CINHAL, Science Citation Index, and Cochrane databases were searched for FMV based intervention studies in stroke according to PRISMA guidelines. Key words for the search included stroke, post-stroke, stroke rehabilitation, focal muscle vibration, local muscle vibration, localized vibration, and local mechanical vibration (see table 1). Studies were included from the last ten years, were written in English, treated patients who have had a stroke, and used focal muscle vibration as an intervention. Studies were excluded if they did not use focal vibration as the main intervention, treated multiple diagnoses, did not have at least one motor outcome, or did not report parameters for the application of vibration. Two review authors independently selected trials for inclusion, assessed trial quality and extracted data. Disagreement was resolved by discussion or, if necessary, referred to a third review author.

RESULTS

Overview

26 studies met all inclusion criteria, 11 were excluded. Of the 15 included, 3 studies looked at the effects of focal vibration on the lower extremity, and 12 looked at the effects of focal vibration on the upper extremity. Table 2 gives a brief overview of the search results (page 4).

Protocol

Protocol for application of focal vibration varied widely (see table 3). Frequency ranged from 60-300Hz. Amplitude was reported as “low amplitude” in 5 studies. 9 studies reported the amplitude numerically, with a range of .4mm-2mm. 1 study reported the amplitude as 10m, which cannot be converted for comparison. Duration of application varied from 5 minutes to 60 minutes.

Table 3: Study Parameters
Study # Freq. (hz) Amp (mm) Duration (minutes)  # of sessions
1 60 low* 5  1
2   70 low* 30 1
3  100 0.2-0.5 10 9
4 100 low* 10 9
5 91 1.0 5 1
6 100 2.0 30 10
7 120 0.01 30 10
8 91 1.0 30 12
9  80 low* 60 40
10  100 low* 10 12
11 300 2.0 30 12
12 70 10m* 30 6
13 120 low* 30 48
14 90 .015 30 30
15 90 0.4 0.58 nr 
*= did not report amplitude in mm  

Outcomes

For outcome measures, there were 21 different outcome measures used across the 15 studies. The most commonly used outcome measure is the Modified Ashworth Scale, which was used in 7 studies. Table 4 (at right) shows all outcome measures and how commonly they were used across studies.

CONCLUSION

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Table 4: Outcome Measures
In conclusion, evidence does not currently support the use of focal muscle vibration as a post-stroke intervention because of the inconsistency in congruency amongst protocol, outcome measures, and results. Protocol for amplitude, frequency and duration were highly varied with no correlation to outcomes. The use of outcome measures was also highly varied, with there being over 20 outcome measures used across the 15 studies analyzed. These findings illustrated the need for more research to understand the mechanisms of FMV, and impact of different parameters on outcome measures.  

KEY FOR CHARTS

BBT=box and block test; BW%= body weight shift percent; CCI=co-contraction index; EG= experimental group; EG1=experimental group 1; EG2=experimental group 2; EG3= experimental group 3; EMG= electromyography; FIM= Functional Independence Measure; FMA=Fugl-Meyer Assessment; FMA-UE=Fugl-Meyer Assessment Upper Extremity; FMV=focal muscle vibration; GS=grip strength; HGST=hand grip strength test; HMR=Hmax/Mmax ratio; JTT=Jebsen Taylor Hand function Test; MAS=Modified Ashworth Scale; MI=motricity index; MR=modulation ration; MVC=maximal voluntary isometric contraction; NR= not reported; RMP= progressive modular rebalancing; SICI= short-interval intracortical inhibition; SCI= Science Citation Index; TMS=transcranial magnetic stimulation; VAS= visual analog scale; VNRS=verbal number rating scale; WMFT=Wolf Motor Function Test

Table 2: Overview of Studies
Study   Participants (n)  Ages (years)     Onset (months) Outcome Measures Intervention  Strategy
1 n=10 57±13  89±117 BBTa EG1: FMV  

EG2: TMS
2 n=10  EG:45-63 EG:>12 FMAa, EMGa EG: FMV
3 n=30 EG:63.6±7.6 EG:39.9±28.8 MASa, WMFTa, SICIa, MIa EG: FMV+PT 

CG: PT only    
4 n=49 EG:57.42±12.79 EG:100.71±82.79 WMFT, VAS, MAS   EG: FMV

CG: placebo
5 n=36 RG:27-83 EG1: 2-35 

EG2:2-73

EG3: 2-39 

 MASc  EG1: Rest

EG2: Stretch

EG3: FMV 
6       n=30 EG: 64.7±5.4 

CG: 65.1±5.8

 no reported MASa, task,

time,a, traject

 EG: FMV+PT

CG: shamFMV+PT
7 n=22 EG:60.3±15.3

CG:60.7±13.2  

 EG:15.5±14.9

CG:13.0±5.0 

 CCIa,b, 

MRa, MVCa

 EG: exercises+FMV

CG: Exercise
8  n=10

EG:62.0±9.0

CG:59±10.1

 EG:11.0±4.3

CG: 9.2±1.9

 BBTa,b, GS,

Sensory 

 EG: FMV only

CG: PT only 
9 n=20  EG: 66±5 

CG: 67±4

 EG:5±2

CG:6±2

 MASa, HMRa

SICIa

 EG: Armeo-Power +FMV

CG: Armeo-Power
10 n=nr EG1: 31-69 

EG2: 30-57 

EG3: 2-7 

 EG1: 2-33 

EG2: 2-4 

EG3: 2-7  

 WMFTa,b

MASa,b,c

MIa,b, VASa,b

 EG1: FMV+RMP

EG2: FMV+physiotherapy

EG3: physiotherapy
11 n=32 EG:62.59±15.50

CG:60.47±16.09

 EGL 2-33  HGSTa, MAS

FIMa, VNRSa

quickDASHa

FMA-UEa, JTTa 

 EG: FMV

CG: sham FMV
12 n=10 EG:62.6±8.6 EG:21.6±18 BBTa, GSa

Sensory 

 EG:FMV
13 n=44 EG:60.3±15.3

CG:60.7±13.2 

 EG:15.5±14.9 

CG:13.0±5.0

 Toe-off(%)a

Cadence 

Step Length

Stride Lengtha

Step Width

Swing Velocity

Gait Speeda 

 EG: FMV+PT

CG: PT only
14 n=32 EG:53.31±8.37

CG:55.73±8.27

 EG:56.94±25.73

CG:49.93±29.97

 Postural sway

Cadencea 

Gait Speeda

P-step lengtha

P single limb

supporta 

 EG: FMV + exercise

CG: exercise
15 n=80 EG: 54.7±10.6

CG:54.7±10.5

 EG:2.0±1.3

CG: nr 

 BW%a EG: FMV (stroke)

CG: FMV (healthy)

astatistically significant change first group listed

bstatistically significant change in second group listed

cstatistically significant change in third group listed 

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