School of Physical Therapy Effects of Whole Body Vibration on People with Post-Polio Syndrome Carolyn P Da Silva, PT, DSc1,2, NCS, Natasha deSa2, PT, DPT, Lauren Szot1,2, PT, DPT, NCS 1Texas Woman’s University, Houston, TX , 2TIRR Memorial Hermann Rehabilitation and Research, Houston, TX INTRODUCTION METHODS RESULTS Post-Polio Syndrome (PPS) symptoms include increased muscle weakness, reduced functional capacity, pain, fatigue, & sleep disturbances. Quiben 2006 People with PPS have difficulty exercising in a conventional manner due to the potential for symptom exacerbation or overexertion of fatigued muscles.Quiben 2006 Whole Body Vibration (WBV) is a mode of exercise that elicits muscle stimulation through activation of muscle spindles & vibratory tonic reflex. del Pozo-Cruz 2011 WBV shown to improve lower extremity (LE) strength, balance, neuromuscular performance, health-related quality of life, & bone mineral density in healthy, untrained, & elderly populations. del Pozo-Cruz 2011, von Stengel 2011, Marin 2010 Weak-moderate evidence that WBV has a positive effect on people with other neurological conditions. del Pozo-Cruz 2012 Procedures: Participants were randomly assigned to 1 of 2 treatment groups using crossover experimental design. Group A: 8 sessions during 4 weeks of high intensity, low amplitude protocol (Power Plate: 8.82mm; 2.76g) 2-week washout period 8 sessions during 4 weeks of low intensity protocol (Soloflex: 4.53mm; 2.21g) Group B: Same program as Group A, in reverse order, starting with low intensity protocol, followed by high intensity protocol. Testing by PT assessor blinded to group assignment & intervention Baseline Post-intervention 1 After 2-week washout period Post-intervention 2 2-week follow-up Study Flow p=0.049 p=0.093 p=0.055 p=0.678 p=0.686 PURPOSE & HYPOTHESIS p=0.087 p=0.017 Purpose: To determine the feasibility of WBV as a weight-bearing exercise in people with PPS by assessing its effects on the following outcome measures: 10 Meter Walk Test (10mWT) 2 Minute Walk Test (2MWT) Brief Pain Inventory (BPI) Pain Severity Subscale Pain Interference Subscale Pittsburgh Sleep Quality Index Fatigue Severity Scale LE Strength Manual muscle testing (MMT) Hand held dynamometry (HHD) Muscle cramping: patient written logs throughout course of study Hypothesis: There will be a significant improvement in the above outcome measures following WBV intervention in participants with PPS. There were no study-related adverse events. Group B had significantly higher total pain scores at baseline than Group A. No significant changes following lower intensity intervention for either group. No significant changes in any other outcome measure for either group. CONCLUSIONS Study strengths: Blinding of testers Randomized treatment order Study limitations: Small sample size 2x/wk intervention apparent barrier for recruitment/retention Higher intensity protocol yielded significant increase in gait speed only for Group A & decrease in pain severity for both groups regardless of treatment intervention order. No significant results were maintained through follow-up, suggesting: Duration of intervention might not be long enough to yield long-term results WBV may need to be part of regular regimen to maintain function & quality of life in people with PPS. Intervention: Participants stood on WBV platform with UE support as needed, or sat in wheelchair & placed feet on platform, leaning forward to put as much body weight through lower extremities as possible. Intervention began with 10, 1-min WBV bouts. Bouts increased by 15 sec each session until participant was able to tolerate 10, 2-min bouts for maximum of 20 total minutes of treatment time per session. BP, HR, and rating of perceived exertion measured pre/post sessions. PARTICIPANTS 21 participants were recruited from TIRR Memorial Hermann post-polio clinic & local polio support groups. 15 completed the study Inclusion Criteria: History of polio with/without diagnosis of PPS Ages 40 to 85 Body weight less than 500 lbs Ability to bear weight through LEs for 20 minutes Ability to speak/read English Medical approval from personal physician Exclusion criteria: Acute medical conditions Implanted metal devices, joints or fixators Lower limb amputation Most frequent reasons for choosing not to participate when asked: Time/effort/cost involved with coming to Texas Medical Center 2x/week Metal implants (joint replacements, internal fixators) CLINICAL RELEVANCE WBV appears to be a safe, tolerable, & feasible form of weight-bearing exercise for people with PPS. Short term changes in pain & gait speed for some individuals are encouraging for polio survivors who have limited methods to exercise. Further research with greater sample sizes needs to be done to examine long-term use of WBV in people with PPS & other neurological conditions, addressing reduction of barriers to exercise participation. Data Analysis: Descriptive statistics, cross-tabulations, & Mann-Whitney U tests performed to examine significant differences between intervention groups for demographic variables. Wilcoxon signed rank tests used to examine changes over time by intervention group. ACKNOWLEDGEMENTS Participant Demographics This study was funded by Post-Polio Health International. Statistical support provided by Rene Paulson, PhD & Zoheb Allum, MS, Texas Woman’s University, Denton, TX Contributions from Arianne Stoker, PT, DPT, Kelly Hodges, PT, DPT, Mariana Sanjuan, SPT, Maggie Strange, SPT Manuscript submitted 1-2016 to Journal of Neurologic Physical Therapy Average Age (years) 63.80 + 9.40 Average Age Onset of Polio (years) 3.70 + 4.80 Gender 6 Male, 9 Female Walking Status 11 Full-time, 3 Part-time, 1 Nonambulatory TWU School of Physical Therapy TWU School of Physical Therapy TWU School of Physical Therapy